Colorado Real Estate Journal - October 21, 2015
In August 2014, my mom left Denver to travel back to our hometown in northwest Illinois. My grandfather had suffered from several mini strokes and falls over the last couple of years, and that spring he had been diagnosed with pancreatic cancer. I had already visited him in June, when hospice had been brought in so he could stay in his home. Just before Labor Day weekend, he died in the early morning hours with my grandmother asleep in the lounge chair next to his bed. He was 86, and she was 82. They had been married for over 50 years. My grandfather died in the living room of the rural one-room school he and my grandmother had added onto and made a home in the early 1960s. Although his health had deteriorated, hers was quite good. She didn’t have problems with falls, her vitals and vision were good, she could walk well and her balance was strong. Despite her positive state of health, I expected our family would have an easy time discussing options to move her into one of the two assisted-living communities in town. Why wouldn’t she move? Without my grandfather, I knew she would become isolated. Caring for him had been her sense of purpose, and now he was gone. She didn’t feel comfortable driving anymore, so she was reliant on others for transportation to the grocery store, doctor and church. If she would move to a community, she would have others around her for companionship. She wouldn’t have to clean or cook for herself, and there were transportation options – beyond the fact that she would be more connected by being in town. Our family’s concern about timing of emergency responders including paramedics and the fire department would disappear. It seemed very simple to me. It also was very simple to her: She wasn’t leaving. Aging in place is a hot button discussion today. It’s commonly recognized that by the year 2030, 20 percent of the American population will be over age 65. AARP estimates that “87 percent of adults age 65-plus want to stay in their current home or community as they age, and among people age 50 to 64, 71 percent of people want to age in place.” The idea of aging in place is not going away, but what is the best place for aging? The Centers for Disease Control and Prevention defines aging in place as “the ability to live in one's own home and community safely, independently and comfortably, regardless of age, income or ability level.” This concept is commonly related to a person aging in their single-family home. It can however, apply to a congregate community. A resident living in independent living or an age-restricted community may reach a point where more care is warranted, but the resident doesn’t want to leave. Both options have benefits and challenges. For my family, aging in place meant my grandmother wanted to stay in her single-family home. The problem with her home is that it’s isolated in a rural area and she doesn’t drive. There are providers who offer in-home services for seniors aging in place. Amanda Cavaleri, thought leader with Carnegie Mellon University's Quality of Life Technology Center and CEO of Connect the Ages, has found that the biggest concerns with elders aging in place is combatting isolation and boredom. “Fostering a sense of purpose and connection to the outside world are key.” Calvaleri previously operated a home concierge service, enabling clients to thrive in their homes. Home services can allow seniors to stay in their homes by providing them with social interaction, care management and coordination of care and out-ofhome services like transportation to medical appointments or visiting friends. The clients are often taken out to perform their weekly errands such as grocery shopping and picking up medications, instead of having it done for them. Living independently can become a sense of purpose of its own. Challenges do come with aging in a single -family home. Although the goal is independence, the downside to in-home services is that they typically do not occur every day and cannot be lengthy enough to provide enough social interaction on their own. The cost of the services can be impacted by the “windshield time” service providers spend getting from one client to the next. Another challenge of aging in a single-family home comes from spaces that are costly or not easily adapted to barrier free design. Many bathrooms were not designed with clear floor space or room for grab bars. Retrofits are possible using accessories like swing-down grab bars, but often feel forced. The necessary use of stairs in some homes becomes a hazard by increasing the possibility for falls. These all become challenges when one decides to age in place in their single-family home. Daily services and other residents are examples of how congregate communities have an advantage. Living in a community can easily facilitate socialization on a daily basis. Even the most cost-effective, age-restricted, noncongregate communities can be thoughtfully designed to integrate spaces throughout that allow for interaction. Congregate communities typically offer programming to provide activities and learning opportunities for their residents to foster a sense of purpose and connection. Communities typically provide transportation that allows residents to handle their own shopping and medical appointments. It is easier and more cost-effective for outside service providers to serve a community because of the density of residents. Communities can provide a strong ability to foster socialization, but not all communities allow one to age in the same place. The intent of a CCRC is to move residents through the continuum of care as their needs increase, but the moving is not always well received. Often when residents move from their single-family home to a community, it is a significant transition in their lives, and many only want to make that one last move. If the resident moves into independent living, it may feel traumatic when they reach the point where they need to move into assisted living or a higher level of acuity. Another challenge occurs when couples age at different rates and one of them begins to require a higher level of care. The spouse likely will take on this extra care, but that is usually a temporary solution. The couple may be required to move together, or the more rapidly aging spouse may be required to move alone. In our project work, we find that when designing a place for long-term aging, many factors should be considered. In a single-family residence, easy access without stairs is much safer to prevent falls. Stairs should be eliminated within the home. Bathrooms and kitchens should be provided with extra space so movement by a person in a wheelchair – and with assistance if necessary – is possible. Ease of exterior maintenance, or covering that through a homeowners’ association, should be considered. Flooring materials should be easily cleanable. Internal lighting should be appropriate for the color of aging skin and sensitivity of aging eyes. In a community, spaces should be created and placed throughout for gathering and socialization. Facilities can consider licensing to a more stringent certification so it’s possible to keep residents in their units longer, and a spouse if that need arises. Noncongregate communities also can seek medical and other out-of-home services that can serve the community as a whole. Transportation and connection to other neighborhood amenities must be readily accessible. Attention to the subtle details of aging can create an environment that sustains aging in place. Even though my grandmother manages in her home today, it is uncertain how long that can continue or how long it should continue. The reality is that aging in place becomes challenging as aging changes the human body. Many single-family homes do not easily adapt to reduced mobility and can potentially create isolation as they grant independence. Communities can help to combat many of these challenges, but must continue to evolve to support the changing desires of different generations. The communities that served the silent generation will not likely suffice for boomers. It will be necessary for designers, developers and operators to challenge themselves to push innovation to meet the changing demands of new generations while allowing residents to remain in place as long as possible. Housing that safely accommodates the needs of the aging body, that allows for connection to others and the outside world and that offers the ability for one to maintain a sense of purpose and independence. That is the best place for aging.