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What’s old has become new again – the halo of aging in place

Henry Cisneros discovers aging in place.  In August, 2012, Kaiser Health News published an interview with former HUD Secretary, Henry Cisneros, who talked about his mother who is aging in place, following some well-considered home modifications. Cisneros also edited a book, Independent for Life – and just published an op-ed in the Miami Herald discussing this new frontier in housing, using his own mother as an example. Home modifications enabled her to remain in her home -- she insisted and he was apparently too cowardly to argue. She is described as widowed, 87 years old, requiring an alarm system, her home in a "neighborhood somewhat in decline." Her neighbors on three sides had passed away, and he admits that even though he visits her frequently (every other day, come on, now really???): "Aging in place in that neighborhood means older women living on their own." Looking ahead: he could have noted that one-third of the 90+ live alone – and while aging in place sounds pretty good, one must pause and remember life expectancy and personal expectation – half of the 65+ today expect to live to 90. And they're right. If a woman lives to 65, she is likely to live to 85. But by age 90, there is an equal likelihood of each of these scenarios: she will live alone, or with her relatives, or in some type of institution.  

So people believe that remaining forever in their own home is wise? Did anyone notice this change in AARP survey results about the 45+ population? AARP has often asked the question about a 'desire to age in place' – sampling different groups over the years. Throughout their own reports, they often quote their 2005 survey when they indicate that 89% of the 50+ prefer to 'age in place', that is, they want to live in their own home for as long as possible. Recently that dropped to 75%.  But in 2003, the survey respondents aged 45+ were asked a different question: "How likely do you think it is that you be able to stay in your current home for the rest of your life?" Their realistic response: 54% said that it was 'very likely’ but another 21% thought it was 'somewhat likely.' The rest were unenthusiastic. Why? I bet that after the post-war boom in building two-story colonials and one-story ranch homes, when on the phone with AARP's survey firm, responders must have glanced around their houses, many of them now multi-story and expanded with steep stairs to the basement and/or attic -- they thought about their own parents and grandparents -- and shuddered.

Aging in place is a nightmare for the 90+. Our real ages may be on the downswing. Sixty is the new 40. And working past 65 is the new normal, while the population aged 90+ is the new 85+.  But away from the hype, what if the neighbors and friends die, as in the case of Henry's mother, or the house is cavernous or rickety, or it's a safety nightmare for those with declining vision, hearing, or mobility issues? The house is in a cold climate or it's out in the country; the sidewalk is icy, the suburban neighbors are an acre away or they're at work all day. Exactly what’s the upside of aging in that place? What sounds like the good life for the 65-75 year old may not work at age ninety. At the least it requires the cash of the Cisneros family and I bet he travels more than he admits. Or it demands devoted relatives with a large yard for a granny pod or an attached apartment. It mandates the willingness to spend quite a bit of time overseeing health issues, having someone to provide needed care, or moving to assisted living or a nursing home, where the care is now distributed and isolation risk is (somewhat) mitigated. So you might have been a lucky kid and your grandpa is cooler than you – or he may have been be one of the of the 85+ with dementia. Those folks – Cisneros’ vision and mother not withstanding -- are going to age miserably in place. They will make their families miserable -- or they’re going to move to a better place. Everything else is marketing.

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Good article. However, if you are out of money you have few options. House underwater (check), savings exhausted (check), no pension (check), living on Social Security (check). I think you get the picture on why a whole lot of folks are now aging in the community.

Anonymous is right; s/he speaks for many in tough financial times. I have supported people in their own homes, in care communities, and those who have had to move in with family members to simply get by. We need to look closer at how to redesign homes to work as best they can for aging folks because of these financial reasons, and because it's realistic that many will need to be at home. Also, I see the need for revitalizing public spaces with concerts, art demonstrations, and interactive public art, providing more opportunities to raise the energy of caregivers and the ones they care for. I have learned that the right promise to make to an aging relative or friend is, "We'll walk this path together, and I'll make sure you have what you need," which allows for adding support people to the team, whether in one's own home or in a care community.

My parents saw the hell my wife and I went through taking care of my wife's mother about 25 years ago.

16 years ago they moved into a retirement community that has become like home for them and since my father passed 3 years ago it is home for my mother.

Everything she needs is there and the town helps with services for the residents there. They chose an apartment but the cottage community is great! It's reasonably priced too. My mother is doing fine on my father's social security, his modest pension and some limited savings. She is very comfortable. She is 91!

Twice she has had to use the nursing unit and we were pleased with the support.

The trick was moving in when they were healthy, becoming part of the community and finding out how it works! She is still independent!!!

Oregon Public Broadcasting has a morning show called “Think Out Loud,” and a recent topic was down-sizing a senior. A guest from AARP told a personal story of having to move her mother out of the family home she promised to keep her in. It was heart-wrenching to listen and the anguish was still palpable in her voice.

Her story reminds that for most aging-in-place is preferred—but for some, it becomes untenable...Read it below:

Sensitivity to Telling Mom She Can’t Stay Home Alone Anymore

A common cry for help from an adult daughter living in Brazoria, Texas, reaches out for advice:

Mom is 82 and slipping in memory…she has recently been recommended to benefit from “assisted living”. I DON’T need ideas on how to keep her in her own home. We have exhausted ourselves providing company of ourselves which include her children, grandchildren, and great-grandchildren, life-support lines, meals, cleaning and shopping, medical appointments, writing her bills, etc. In-home-health or assisted living is the next best thing…but it won’t come without breaking my heart and her’s. Please don’t suggest she come live with one of us…she did when the hurricane displaced her and she was miserable. I need suggestions how to be kind, but firm that she needs help…more than we can provide with her medical needs at this time of her life. She has CHF and COPD and is down to 70 + lbs. She has a nurse coming weekly and physical therapists, and occupational therapists, too. What do you say?? thank you for listening…

The HELL the adult children are put through is also of concern and I appreciate it wasn't over-looked by Laurie in this post.

Aging-in-place does not always mean aging in the home you have lived in for 40 years. It can also mean aging in a more suitable home in the same neighborhood and maintaining the connections to the community you love.

Obviously the choice of where to live "to the end" is complicated and based on many factors. As someone who has orchestrated the "stay-home" option for two sisters who lived together until 106 and 107 years old, I can tell you that it is not trivial to organize, but it isn't rocket science either.

I think it is important to differentiate between bias and choice. Bias is what people want, choices are limited to the viable options. Clearly, the majority of older adults are biased against the idea of assisted living. Indeed, I have spoken to many who speak about CCRCs that are like living at the Four Seasons as if they are dungeons. And the fact is, if you can afford a high-end CCRC you can probably afford to age in place at home with caregivers. Especially if you have two people, the costs are not that wildly different. The problem is that only a small fraction of the population has the financial wherewithal to have that choice as a "problem."

The Aging in Place "movement" (which skews toward the high-end of the net worth scale) has created a mythology around the bias but has not created realistic new choices for the vast majority of older adults. After all, if you are rich, you do have to CHOOSE whether to sell your house and move to an equally swish CCRC. If you are not, the options are not as appealing. So you stay and hope for the best with the other 80%. The aging in place movement has an average age in the mid-seventies. These folks are just hitting the first bumps, and with a little help can get patched up and sent back in the game. Villages and the like are great for that. And who knows, over the next 10 years, they may come up with new solutions but what is for sure is, when the 90s and 100s come...the idea that you will be that amazing centenarian who lives a wonderful life until she dies during her afternoon nap is not a great bet from a planning perspective. Even when that actually happens, it's a lot harder (and more expensive) than it looks.

We have been building smaller eco-homes that are affordable, super efficient and just right for everyone. You really do not need a McMansion. That said, for years we have been annoyed by the local planning process that typically prevents cottage developments from occurring. What's the point? All too often we see truly tremendous suburban towns with all the amenities of a perfect community except for that fact that there is no planning for the old or the young. Whether you are 28 or 68 you might have spent the last 20+ years in a town you love but when you graduate college or finally admit that you cannot maintain the back forty there is no nice place in town where you can relocate. Sure there might be a seedy old apartment house down the road you never traveled but for decades nobody has provided nice, new, small, independent housing (let alone affordable) so that the young professional with a new job or the old bat that everyone loves can continue to be a part of the community. Rather sad. This year our firm AmeriSus will be venturing out with somewhat of a first a neighborhood of cottage eco-homes all detached, all upscale and available for purchase or lease within the budget constraints of an individual earning minimum wage. We think it might be the new trend in housing. Graduate college, get a halfway decent job, move into a new eco-home for $500 per month and sock the rest of your paycheck away so that when it happens (whatever it may be) you are prepared for it. At the other end of the spectrum, you've been on a fixed income for longer than most people stay married and it is time to start living like you deserve a better life. Cut your housing costs by two-thirds and start enjoying life as as a proud deserving senior citizen.

Dear Laurie, knowing you and Henry, and in meetings and discussions with you both we all know it is tough to age in place under current infrastructure limitations and stubborn service silos. But we also know that aging in place 2.0 can be different. It requires commitment from smart leaders like Henry and you, as well as individual commitment of families and older citizens, and business and agencies. This is not easy. The task is huge. Ignoring the need is perilous.

And just as the numbers and health of older citizens has no precedent the path we must take will also be previously untraveled. So I view Henry's involvement as a first and critical salvo in bringing the complex issues of aging housing and care to the level of attention needed. Having sat through meetings with the secretary I find his capabilities substantial. He has the gravitas we need to raise the issue's profile. But we all need to look beyond what we know to a future we must approach with earnest and open minds. And dedicate ourselves to respect and dignity for older Americans with the care they deserve from none other than the best and richest country on earth.

I would suggest that aging in place doesn't have to seem so bleak. Between advances in mobility and accessibility technology and cultural shifts that are making it less taboo for families to live in multi-generational homes (http://www.aging2.com/2013/04/multigenerational/), aging in place can actually benefit everyone in the family. Yes, home modifications do cost money, but they are far less expensive than moving to an institution or care facility. In addition, studies have also shown that aging in place helps combat depression, which is prevalent among seniors and has even been linked to dementia. Aging in place can allow anyone to live a longer, better quality life.


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