Category Archives: Aging at Home

Living at Home Forever

by Tom Wells

My dad was diagnosed with Alzheimer’s about 10 years before he died in 2007 at age 93. It was a slowly progressing disease at first. Fortunately my parents could maintain their regular retirement activities up until the last couple of years, when Dad’s flexibility and ability to care for himself really diminished. My parents chose to live at home, not really having the money or inclination to move to any type of retirement setting.

My parent’s scenario is typical of a lot of families these days and will become even more prevalent over the next 40 years. The Baby Boom cohort (of which I am a member) and our elderly parents, by choice or circumstance, will be living in their homes until they die. Unfortunately most of our homes are not really set up to enable graceful living as our ability to function in a “normal” way diminishes. Each of us will feel frustrated, bordering on angry, just like my Dad did, when we can not really care for ourselves in a dignified way. For Dad, changing a few simple things in his house would have gone a
long way to mitigating that frustration.

The nice thing about the changed that were needed for my parent’s house is that they actually increased the value of it, if even slightly. Number one on the list was installing a first floor powder room. For obvious reasons everyone liked this concept. Next was things to hold onto. Things like these can be a really sturdy chair or couch, an additional railing for a tricky spot getting in the house or at the top of the stairs, a decorative and sturdy towel bar in the kitchen or bath, stylish grab bars in the shower or by the toilet, some hooks for hanging coats and hats installed 6 inches lower or a non skid mat by the
front door.

A couple of years ago I pulled a leg muscle while working. It required a month of physical therapy up at St. Mary’s. What an eye opener – first of all there were people of all ages getting worked on and almost every part of the body was involved. For three weeks I could not bend over to tie my shoes unless I lay on the floor contorted something awful. My wish list then (and for the future) was a first floor bedroom ‘cause getting up and down the stairs was a time consuming ordeal. Also slightly wider doors to the bathroom, a few more foot stools to rest on, a side table or two, lever style door knobs,
and non-slip floors. I also noticed that having windows that opened easily made a difference, as I could tell that my diminished leg strength was affecting my ability to lift things. My kids, who for some reason love dumb waiters, thought there must be a location in the house for one of those – maybe to get their text books or I-pod upstairs!

Not to belabor the point, but going forward, whether we now own a home or will be moving into a different one in the future, most of us will be requiring our homes to help us live full functioning lives as our bodies begin to say otherwise. Making changes to the layout, structure and amenities long before the changes are needed is prudent. Lastly, if we are going to be living in our home indefinitely then the home should be as energy
wise as possible. Get an Energy Audit. Years of energy savings will mean a lot of money in your pocket.

Tom Wells is a Member of Fallsington Meeting in Bucks County PA, Sustainable Building Advisor, Certified Green Advantage Residential Practitioner and Certified Aging in Place Specialist.

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Find a Certified Aging in Place Specialist in your area

Conversations About Driving

Q: Am I ready to offer assistance as part of my religious community? Am I equally willing to accept graciously the help of others? Am I open to counsel and advice?
PYM Faith and Practice, 2002

Discerning when it is time to relinquish responsibilities may be more difficult when faced with our need to accept help, and the issue over whether one is able to drive safely is among the most difficult conversations to initiate with aging loved ones. In a 2008 survey, 36% of family members surveyed said they had trouble talking to an older family member about giving up driving—more people than had trouble asking about preferences for funeral plans.

Age itself does not determine one’s ability to drive safely. Older drivers are more likely to self– regulate than other age groups, for example limiting their own driving to daytime or local streets, and are statistically more cautious . However, older adults are also at higher risk for physical conditions that impede one’s ability to drive safely, and are more likely to be taking prescription drugs that can have a negative effect on driving skills. Giving up driving may be necessary, but it is often understandably difficult for people to take this step.

Even if you have a lifestyle that does not make you dependent on driving, imagine not being able to take the bus, walk or bicycle to the store, the park, a loved one’s home, or Meeting. Imagine that you need to call someone every time you need to get to a doctor appointment or pick up a few groceries. Giving up one’s mode of transportation means becoming more dependent upon others for help. This may well be why some people resist giving up driving, even when it has become uncomfortable or risky.

What can we do to help ourselves or others make this difficult transition?

“Every stage of our lives offers fresh opportunities. Responding to divine guidance, try to discern the right time to undertake or relinquish responsibilities without due pride or guilt.”
Quaker Faith & Practice 1.28 (Fourth edition), Britain Yearly Meeting, 2009

Don’t wait until driving is a problem. Think and talk about what one would do if driving were no longer a possibility.
If concerned about a loved one, consider a professional evaluation by a social worker or doctor to help determine whether it is same for him/her to drive.
Be honest about your concern while also offering alternatives– be ready with information about county transportation, individual help, or volunteer services available.
Embrace public transportation and shared rides, it’s better for the environment anyway. If you live in a place where this is difficult, consider whether this will be a good environment for you “down the road”.
Advocate for better public transportation systems.
Establish car pools or bus companions for getting to Meeting—why not do it for everyone, not just those who no longer drive?
Consider partnering with other local faith groups to provide ready teams for transporting people who can no longer drive to medical appointments, for groceries, and other services. See www.faithinaction.org for an example of this program.

LINKS TO MORE INFORMATION: Click on the blue text below to be directed to outside websites that offer additional information on this topic. Articles from this site will open in the same browser window/tab. Articles from other websites will open in a new window; when you are done, simply click out of that window and you will be back on this site.

Download this article in pamphlet form

More articles on this website:

Allowing Yourself to be Cared For: Autonomy, Interdependence and Interrelationship

Other Articles/Links:

AARP resources on driving safety
Association for Driving Rehab Specialists

Hoarding

“I saw that a humble man with the blessing of the Lord might live on a little…”
John Woolman, 1743, Quoted in PYM Faith and Practice, 2002

Hoarding is a phenomenon that leads to social isolation, depression, anxiety, and reluctance to move in retirement. This reluctance often brings hoarding to the awareness of family and Meeting. By hoarding I do not mean simple clutter; a cluttered home may have piles of stuff here and there that are worked at and diminished from time to time.

Hoarding is a psychological issue that results in stuff everywhere, a home that can’t be walked through, a bathtub full of clothes, all correspondence for the past 20 years in boxes, a dining room table piled so high that no one has ever eaten there, appliances that don’t work and can’t be gotten rid of, half the bed covered with junk mail.

A way to distinguish between clutter and hoarding is the emotional distress or barriers thrown up at the thought of getting rid of anything. For hoarders their stuff is an extension, definition, or protection, of Self and cannot be eliminated. There are YouTube sites with videos of the homes of hoarders, and of the negative results of making a surprise intervention and cleaning the place while Mom is not home.

While hoarding may be treated successfully as an addiction, it is an anxiety based disorder and sometimes requires professional help. There is a network of social workers who specialize in this phenomenon. There are also a few workbooks that can walk the hoarder through making changes in small steps, a process best done with on-site assistance of someone with great patience, which usually means not a family member.

Due to the emotional need for their stuff, hoarders can be extremely reluctant to move. Trudy had severe arthritis but lived in a house with five levels; she needed to be some place that was all on one floor, or with elevators. Her children had shown her attractive places to move to, but she continued to refuse in spite of her constant pain. An Aging Services Specialist worked with Trudy weekly for 6 months, gaining her trust, helping her to decide what she truly wanted to save and what could be gotten rid of, and they worked together on one small area at a time. Once the most important things were boxed, Trudy agreed to move and leave behind the bulk of stuff to be cleaned out after moving. This order of moving first and then getting rid of stuff is more effective and easier on the hoarder than thinking that everything extraneous must go before a move can be contemplated.

The other learning for families or Meetings of anyone reluctant to move is taking the time to listen to the reasons, and then taking those reasons seriously. For Will it was that the house held all his memories of his wife who had died many years before. Offering Will a large box in which he could put the things most central to his memories would allow him a sense of control and respect.

Marta’s need was to know that everything she was leaving behind would go to a home somewhere. First Marta invited family and friends to take what they wanted, and then Marta identified the charity that would receive the proceeds of the estate sale held after the move. Marta’s needs were met and she could move.

However, neither Will nor Marta was a hoarder; both were merely savers. Hoarders need time and expertise to make moving thinkable.

Download this article in pamphlet form

More articles on this website:

Anxiety and Change
Honoring the Individual Through Validation

Other Articles/Links:

Find Help With Hoarding
National Association of Senior Move Managers

Sources/Further Reading:

David F. Tolin, Randy O. Frost, Gail Steketee, Buried in Treasures, 2007, Oxford University Press, New York, NY.

Housing Options

Q: “What will this newfound present of old age and its unknown future demand of us?”
Mary Morrison, Without Nightfall Upon the Spirit, Pendle Hill Pamphlet 311

Retire according to your values: You will consult a pension specialist, call Social Security, and choose a Medicare supplement before you retire. Plans are made, goals set; you have been looking forward to this part of life for a long time.

Have you considered what you would like your spiritual life to be like in an intentional way? How do you intend to go deeper, discover meaning, be a gift to others? Thinking about this foundational part of your life will help other goals to fall into place, and will give you strength in challenging times.

Moving after retirement: Much as we would like to stay in our own homes, changes may make that impossible: you cannot climb stairs or drive, you feel too isolated where you are, your spouse dies and you do not feel safe alone. As you retire, imagine that you might move two or three times; first to a dream home or a smaller place, then to a place with more assistance, or closer to children. It may be unrealistic to say, “Don’t ever put me in one of those places.”

At some point in time, your physical and emotional needs may not be adequately met without additional support. Instead, consider educating yourself about available options, and let your loved ones know what you would prefer if you needed to live in a more supported environment. Maybe you will never need it, but it helps to prepare yourself emotionally if you do. Some options include:

Life Care and Continuing Care Retirement Communities (CCRC) provide a continuum of housing and services, such as independent and assisted living, and skilled nursing care. This usually involves a “buy in” fee.
Senior Co-Housing is a form of intentional community where people pool resources for care of one another and with attention to values.
Aging in Place entails staying in one’s own home with supports if needed.
Skilled Nursing Facility provides round the clock nursing care.
Assisted Living usually provides personal care such as help with bathing and medicines, sometimes with some nursing care.
Independent Living usually has separate units with shared meals and services such as transportation. Some support for other needs may be available.

Moving to another state: Some surveys have found that 50% of those who move to another state in retirement move back within three years. To learn more about a place you are considering, get the local paper, notice prices and political issues; evaluate medical care; plan how you would replace present activities and contacts, and how long that might take. If you have visited for vacation, have you considered what the community is like in the off-season? Would moving closer to children mean that you’d see them more often?

Aging in Place: It is increasingly possible to stay in your own home as you age. More in-home services are becoming available, such as aides to help with bathing, or chore services that will rake leaves or wash windows. Most places have at least one grocery store that will deliver. Senior Centers and Adult Day Health Programs offer opportunities for socialization and support.

If you decide to spend your retirement in your current home, look around the outside as if you were 10 years older. Could you still put up the storm windows? Paint the second story? What needs to be changed or improved now so that you might be able to stay in the same house? Now do the same on the inside. Do you need safety improvements like grab bars in the bath, banisters on both sides of the stairs, better lighting? Ask your local Office for the Aging for information on safety in the home and support services that are available in your community. Consider consulting a Certified Aging in Place specialist who can make recommendations for making your home more accessible.

In addition, some locales are experimenting with “nursing homes without walls” designed to keep seniors in their own homes with a myriad of support services, including day programs and transportation. Again, your Office for the Aging will know if such programs exist in your area. Please see the links below for more information about options.

“Make provisions for the settlement of all outward affairs while in health, so that others may not be burdened and so that one may be freed to live more fully in the Truth that shall stand against all the entanglements, distractions and confusions of our times.”
Advices, PYM Faith and Practice 2002

Download this article in pamphlet form

More articles on this website:

Downsizing and Spiritual Practice
Senior Co Housing and Intentional Communities

Other Articles/Links:

Friends Rehabilitation Program
Friends Life Care at Home
Naturally Occuring Retirement Communities
Friends Services for the Aging
Financing Long Term Care
Communities Without Walls

Adaptive Advices

Q: Is my home a place where all members of the family receive affection and understanding, and where visitors are welcome?
PYM Faith and Practice, 2002

Assistive Devices can help people maintain self care skills and participate in their favorite activities. Communities benefit from diversity when adaptations are made to include people with physical or other disabilities. What are assistive devices and how can they help?

Grandpa’s knees hurt and he is having trouble getting out of his favorite chair. Marge has painted watercolors for years, but at 73 holding the brush has gotten painful. Irene’s bridge group has noticed she is having trouble distinguishing between the cards. All of these limitations can be resolved with assistive devices and home remedies.

First, if the limitation might be remedied with a wheelchair, a shower seat, a cane, walker or other equipment, get in touch with the medical provider and ask for a referral to an Occupational Therapist (OT) for an evaluation. Medicare covers the O.T.’s visit and several items she might recommend are also covered by Medicare with a doctor’s prescription. Consulting with a professional may help save money and effort—too many have bought a shower seat only to find it’s not the best model and they have to pay out of pocket.

Sometimes the solution becomes clear from observation. I watched Grandpa struggle to get out of his chair and noticed that his hips were lower than his knees. I suggested he get a recliner with a lift that would slowly rise until he was standing. However, this was a favorite chair, so instead, two cushions were put under his seat and now, with his hips higher than his knees, standing is less of a struggle. Marge’s arthritis meant that holding a paintbrush for long was painful. However, when a sponge was wrapped around the brush handle and secured with two rubber bands, she could paint much longer and pain free.

Irene’s macular degeneration meant that she no longer had any central vision. Her daughter called the Association for the Blind for a free in-home evaluation. They recommended several small changes in her home, such as a bright dot put on the thermostat at Irene’s favorite temperature, and a similar dot on the oven dial at a common temperature for baking. Then they showed Irene a catalogue of assistive devices so she could order large playing cards. They also suggested Irene would enjoy Talking Books and explained that the books she chose would be mailed to her for free, along with the machine to play them on.

Irene’s level of vision loss meant that she qualified for other free adaptations. The phone company would give her a phone with very large numbers, and she could receive free 411 information services since she could not read the tiny print of the phone book. Some services, such as tailored radio stations and Talking Books are available to the vision impaired, not just the blind, plus those who cannot read because of some other cause. The phone company also has special equipment for the hearing impaired that is available on a one time sliding scale payment.

This article has just touched the tip of the assistive equipment and devices available. You can find catalogues on line or through medical equipment stores, and see our list of links and other resources.

Considerations for Faith Communities:

Is your Meeting a safe, loving place?
When we become aware of someone’s need, do we offer assistance?
Are the meetinghouse and the Meeting property accessible to all?
— Queries from Philadelphia Yearly Meeting Faith and Practice, 2002

Know what resources and services are available in your area, such as your county Agency on Aging and the local chapter of the Association for the Blind, so that you can be prepared to share this information with Friends in need. Your regional organization, such as the Archdiocese or Quaker Yearly Meeting, may also provide information, and see our list of links and other resources.
Assess your place of worship for accessibility- physical, communication, and attitude.
Ask people using wheelchairs, walkers, and canes, or with vision impairment- can they safely access the building, including bathrooms and other areas? Do you have the proper variety of chairs, including some sturdy ones with arms? Consider consulting with a Certified Aging in Place Specialist to help determine what you may need to change.
Is information communicated in a way that is accessible and inclusive? Ask people with hearing or vision differences what will help them stay in touch with the rest of the community.Are there adaptations or devices that can be used, such as seating arrangements, audio systems in the Meeting room, availability of books on tape for your library?
Is there an attitude of inclusion? Is your community consciously inclusive of people with age related or other challenges in planning and facilitation of events and activities? Do you ask people what will help them participate?
As individuals are we open to receiving help and support, and if not, how can we help one another to be so?

“In joyful dependence, we can grow to be as fully human as possible, as thoroughly in the image of God as we are intended to be.”
Howard R. Macy, 1988, PYM Faith and Practice

Download this article in pamphlet form

More articles on this website:

Including Everyone: Faith Community Care for People with Challenges
Living at Home Forever

Other Articles/Links:

Certified Aging in Place Specialist
Adapting the Home After a Stroke
Interfaith Disability Network
Interfaith Disability Advocacy blog

Sources/Further Reading:

National Organization on Disability, That All May Worship, 2005, Washington, DC.

Erik W. Carter, Including People with Disabilities in Faith Communities, 2007 Paul H. Brookes Publishing, Baltimore, Maryland.