Engaging with Aging, Part 2

Planning Reflection

With age comes change, and change means facing the unfamiliar. After decades of comfortable routines and relationships, our days shift to include new concerns. Some are physical, such as maintaining muscle strength to walk independently which in turn maintains our cardiovascular system. Beyond the physical, we also need to step up our day-to-day planning for meals, and activities, facing a need for increased decision-making as we manage life’s details and integrate doctor’s visits or physical therapy sessions with the continuing social activities on our calendar. 

We face a need for increased decision-making, yet the normal cognitive decline of aging makes that harder. How do we restructure our lives to effectively supplement our own (now perhaps declining) abilities? In Engaging with Aging, Part 1 we emphasized adaptability and the fact that our lives can become more dynamic as we deal with changing needs. In today’s article, we will look at getting outside assistance to help us sustain a comfortable and enjoyable later phase of life. Specifically, we’ll discuss what it takes to “age in place” in your home, as well as what needs to be considered when choosing a move to a care community. 

Staying in your current home or moving to a care community is a complex decision. A jumbled Venn diagram of overlapping concerns demand consideration – geographic location, accessibility of your current home, size of the care communities you are considering, level of care available, the cost of home care versus community care, the size and feel of the available apartments. The blend of issues alone can be overwhelming enough to cause most people to stick to the status quo – staying in their house – until some physical or medical problem forces the issue. 

Now may be the moment when you roll out your ability to delegate, and invite a family member to help you with the “executive function” of managing decision-making. If you have no one else available, there is a growing number of care managers with health expertise and experience managing safety and accessibility that can step in and support decision-making. With this sort of assistance, you become the executive – and they carry out the functions. They can coordinate medical care for you, and also bring you curated choices for your living situation that reflect your preferences and address your needs. Once you decide what you want, they can make it happen. 

Let’s look next at two areas of preparation that care managers will focus on that can make aging at home workable: handling clutter, and creating accessibility. 

Most of us want to stay in our home as we age, yet most homes as built are not accessible as we lose mobility. Beginning early is always a positive, especially if you remodel – consider incorporating features you will appreciate as you age. This could include a level entry, wide doorways for walkers or wheelchairs, a ground floor bedroom, and a walk-in shower with grab bars. Beyond remodeling, a care manager can also coach you on changes to furnishings to avoid falls and create a safe and functional environment.   

Clearing things out is an essential part of creating accessibility. Whatever the size of our home, quiet corners and closets can be chock full of treasured but unused items. We all infuse material objects with emotional meaning as a way of bonding with our family and community, and may keep those things for decades as important touchstones. Late in life, though, the time comes when we should retain the memories, but let go of the clutter.   

Marie Kondo has famously advised a burst of gratitude when handling an object with emotional meaning – gratitude for the person who gifted it or for your connection with them – and then a burst of generosity to pass on that item. This allows us to gift meaningful items to family members now rather than later. It also makes downsizing to a smaller home, condo, or to a care community much easier if that is a current choice or becomes necessary later. Whether you hire an organizer, or you invite family over to help, you’ll end up with a new sense of space and a clearer head to decide on next steps.

We are social creatures, energized by contact with others, and healed by connection. Studies of extraordinary longevity and health in Sardinia, Italy have shown that contact with family – or in the absence of family, daily visits from neighbors and friends – play a significant role. In the US, our ability to socialize easily as we age is hampered when family lives at a distance. Informal caregiving by adult children is often preferred, but without family near, it is key to create a social support structure not only if you are aging at home, but especially if you are moving to a care community. 

Every care community has a different feel, a different layout, and different levels of care that they offer. Be sure to visit different locations and identify the place you feel most comfortable and that you think will bet provide you with the social interaction you think will work for you. Beyond that, confirm that the level of care is appropriate for you and what you think may be your future needs. 

Care communities typically offer some combination of four levels of care:  independent living, assisted living, memory care, and skilled nursing. Some offer all of those, and some are more limited. Independent living is similar to living in an apartment building – but include additional amenities that may remind you of a residential hotel, such as restaurant-style meals and weekly laundry of linens. Assisted living goes beyond that and gives you the options of having personal care provided in your apartment. Commonly, new residents initially choose one of these two options, and may only later make a transition into apartments in which memory care and skilled nursing are provided. 

Regardless of level, every community will want to assess your physical and cognitive health to ensure a good fit between your needs and their services. The first step is having your primary care physician sign a form attesting to your ability to live independently or areas where you need care. With that in hand, each community will have their own nursing staff interview you before officially offering for you to move in.  

Many communities charge for their services on a month-to-month basis, with an up-front facilities fee that commonly ranges from one to three months’ rent. The monthly rent covers virtually all services, including the cost of housing, three meals a day in the dining room or delivered to your room, laundry services, activities coordination and more. The specific cost will range broadly depending on the cost of living in the area you are considering. 

There are many paths forward – including some we haven’t discussed in detail such as moving closer to family, or downsizing. Whatever your path, once a decision is made the resulting clarity should bring some energy to carry out the needed change. You will be better prepared to sort through the appealing elements you look forward to – meals prepared by someone else! – and the regretful losses you dread, such as downsizing a hallway full of family portraits or giving up a treasured yard view. 

Whatever timeframe you are facing, beginning your exploration of choices earlier is always better. Include family or friends in the process, so you aren’t alone as you assess what works and what doesn’t. Interview a care manager for in-home needs, clean out a closet you rarely go into, make a visit to a care community. With each step you’ll learn something, and can then move on to the next step you need to take to be safe and settled.