Category Archives: Aging in Place

Sorry about last week, my friends.  I wasn’t able to get a blog post done.  I had to do my taxes.

This week’s blog continues the discussion of an aging adult who wants to stay in his or her home.  The introductory installment (on February 11, 2016) discussed the emotional turmoil that can face the adult children in deciding whether to accede to the aging parent’s wishes to stay home.  The February 18, 2016 installment discussed home modifications that may make it easier for an aging adult to stay home.  The February 25, 2016 installment discussed medication management.  The March 3, 2016 installment discussed hiring someone to help with activities of daily living.  The March 10, 2016 installment discussed whether aging in place is an appropriate choice for someone suffering cognitive issues.  The March 17, 2016 installment discussed services that can make it easier for an aging adult to stay home.  The March 24, 2016 installment discussed the aging parent moving into an adult child’s home.  The March 31, 2016 installment discussed an adult child moving into the home with his or her aging parent.  The April 7, 2016 installment discussed whether aging in place is an appropriate choice for someone suffering cognitive issues.  Today’s installment will discuss signs that it is time to move out of the home into a care community.

An older adult who is trying to stay home does not want to come to the realization that staying home is no longer appropriate.  Unfortunately, for some older adults, the time comes to stop trying to stay home and to move into a care community that can provide more services.  There are, though, very few hard and fast rules on how to identify when it is time to move a loved one out of the home and into a more structured residence, like a senior apartment, assisted living, or a nursing home.  The lack of a bright line test might be fortunate, and it might be unfortunate, and it might be both.  Nonetheless, just as everything else in life that you don’t buy at a store, there is no “owner’s manual” for aging adults.

Now, if we’re looking at a rehabilitation stay (rather than long term care,) there pretty much is a bright line test.   It starts with the need for some medical service (like a fall) that causes a trip to the hospital.  Then, the doctor orders rehab after the hospital visit.  (Who pays for the rehab is a different question that we’re not discussing here.)  When deciding that it’s time for rehab, that’s a pretty bright line.

Long term care is different than rehab, at least when deciding between home and a care community.  If a doctor says that it is time, then it’s probably time.  If a social worker or a geriatric care manager says that it is time, then it’s probably time.  If the family does not receive input (or doesn’t want to heed input) from these professionals, the family should at least consider some signs that might indicate that it is time.

IS THE FAMILY CAREGIVER’S HEALTH FAILING?  There is almost always one family member who carries most of the caregiving burden.  If that family caregiver is starting to suffer medically, then it’s probably time to consider moving the older adult into a residential care community.  If the family delay’s much longer, there might be two people who need care.

IS THE TV THE ONLY SOCIALIZATION?  If the aging family member does little other than watch TV, it is time to consider a senior living community of some kind.  Senior apartments, assisted living communities, and nursing homes have a variety of activities in addition to the TV.  (Even TV watching is a communal activity rather than a solitary activity in a nursing home.)  There are other activities as well, such as Bingo (a staple,) Wii Bowling (a favorite that grew quickly as well as other Wii activities, singing, religious services, card games, field trips, and many other, varied activities.  Loneliness and isolation are huge issues among older adults,  Staying home and watching TV adds to loneliness and isolation.

HAS THE OLDER ADULT’S HEALTH DECLINED?  A significant health decline signals that it might be time to move out of the house.  The decline doesn’t need to be sudden, and it doesn’t need to be “caused” by the home environment.  A significant decline (no matter the speed or the cause) indicates that the home care may not be enough anymore.

DOES THE OLDER ADULT HAVE BED SORES?  Bed sores (aka pressure wounds) indicate that the person is not moving around or being moved around enough.  A professional care setting may avoid pressure wounds better than a home environment.

IS THE HOME FALLING INTO DISREPAIR?  A home that isn’t being maintained indicates that the residents are overwhelmed by other concerns.  There simply is too much to do.  While the condition of the house is certainly less important than the health of the residents, an inability of the residents to keep themselves and the house in order shows that perhaps it is time to allow someone else to pick up some of the burden.

IS THE PRIMARY CAREGIVER EMOTIONALLY OVERWHELMED?  Many family caregivers feel as though they are “at the end of their rope.”  That is probably an indication that it’s time to consider moving out of the house.  If the caregiver loses hold of the end of the rope, then two people will need care.

DOES THE OLDER ADULT SOMETIMES FAIL TO RECOGNIZE THAT HE OR SHE IS HOME?  Older adults with cognitive issues sometimes decline to the point that they do not recognize their own homes.  When that happens, the older adult can become increasingly agitated because of a constant feeling of being lost.  (Do you know that anxious feeling you get when you have lost your way?  Imagine feeling that way all the time.)  I feel as though the older adult should move into a senior living community before he or she declines to the point of not recognizing his or her own home.  If he or she moves into a new place before losing all connection with the old place, I feel as though there is at least some chance at developing a recognition of the new place so that the anxious feeling of being lost may not be constant at the new place.  (Please note:  I have no data to back up this conclusion.  It’s just something that seems logical to me and passes my “gut feeling” test.)

This list of indicators that it is time to consider moving into a senior living community is certainly not exhaustive.  Yet, it might help give some families a place to start when facing this difficult decision.

This week’s blog continues the discussion of an aging adult who wants to stay in his or her home.  The introductory installment (on February 11, 2016) discussed the emotional turmoil that can face the adult children in deciding whether to accede to the aging parent’s wishes to stay home.  The February 18, 2016 installment discussed home modifications that may make it easier for an aging adult to stay home.  The February 25, 2016 installment discussed medication management.  The March 3, 2016 installment discussed hiring someone to help with activities of daily living.  The March 10, 2016 installment discussed whether aging in place is an appropriate choice for someone suffering cognitive issues.  The March 17, 2016 installment discussed services that can make it easier for an aging adult to stay home.  The March 24, 2016 installment discussed the aging parent moving into an adult child’s home.  The March 31, 2016 installment discussed an adult child moving into the home with his or her aging parent.  Today’s installment will discuss whether aging in place is an appropriate choice for someone suffering cognitive issues.

Someone with a physical ailment can make changes to his or her physical environment to make aging in place workable.  As we’ve discussed over the last several installments, physical limitations can be overcome.  Cognitive issues are a different story, however.  Home adaptations and in-home care may not be enough to allow someone with memory loss or cognitive decline to stay at home.

First, the safety issues are different.  Someone with cognitive difficulties probably cannot stay live alone.  He or she may not be able to stay home alone even for short periods of time.

Wandering is a huge risk.  Someone with cognitive difficulties might leave the home and get lost in just a few minutes.  Unless the family wishes to keep the home’s doors locked, like the exit from a secured memory care community, the loved one suffering cognitive decline can easily walk out.

Even without wandering, homes have many risks for someone with cognitive impairment.  Someone with dementia might not recognize the risk of lighting a cigarette from the flame of a gas stove right after using hair spray.  Someone with dementia and an unsteady gait might not remember to use his or her walker, creating a risk of falling.  Someone with dementia might not remember how hot the hot water is as it comes out of the tap.

There are safety risks to the home caregivers as well.  Someone with dementia might not recognize a family member or professional home caregiver and react violently, for example.  As the dementia sufferer becomes less connected to his or her surroundings, a constant anxiety or even a paranoia might set in.  (Do you know that anxious feeling you get when you get lost in the car?  Imagine feeling that way all the time.)

None of this is meant to imply that aging in place is impossible for someone in cognitive decline. While the cognitive decline is mild, aging in place is likely very possible.  The issues surrounding the attempt to age in place are very different, however, when the aging senior has cognitive issues rather than physical issues.

This week’s blog continues the discussion of an aging adult who wants to stay in his or her home.  The introductory installment (on February 11, 2016) discussed the emotional turmoil that can face the adult children in deciding whether to accede to the aging parent’s wishes to stay home.  The February 18, 2016 installment discussed home modifications that may make it easier for an aging adult to stay home.  The February 25, 2016 installment discussed medication management.  The March 3, 2016 installment discussed hiring someone to help with activities of daily living.  The March 10, 2016 installment discussed whether aging in place is an appropriate choice for someone suffering cognitive issues.  The March 17, 2016 installment discussed services that can make it easier for an aging adult to stay home.  The March 24, 2016 installment discussed the aging parent moving into an adult child’s home.  Today’s installment will discuss an adult child moving into the home with his or her aging parent.

Many of the issues discussed in the last installment about the aging parent moving into the home of the adult child must be considered before an adult child moves into the home of an aging parent.  Moving in with an aging parent requires the cooperation of the child’s spouse (if there is one) and the child’s children (i.e., the aging parent’s grandchildren) if any.  The physical layout of the aging parent’s house might be very important to the parent’s ability to stay home.  Of course, living in the parent’s home (grandparent’s home as far as the children are concerned) needs to fit into the lifestyle of the adult child’s family.

There is one big difference when the adult child moves into the aging parent’s house.  The aging parent might be able to give the house to the child without creating a problem with Medicaid (if the aging parent later needs Medicaid to help pay for long term care.)  There are some specific conditions that must be met, however, for a transfer of the house to be okay with Medicaid.

The short version of this rule is that Medicaid will reward the adult child that helps keep the aging parent out of a nursing home for two years.

So, to qualify for a transfer of the house to the adult child:
(1) the aging parent would need to move into a nursing home if not for the adult child’s help at home,
(2) the aging parent must have a level of care assessment indicating that the parent needs an “intermediate level of care” (usually meaning that the person needs help with two “activities of daily living” such as bathing, toileting, dressing, grooming, getting out of bed or a chair, walking around, or eating,)
(3) the doctor issues a letter stating that the aging parent would need to be in a nursing home if not for the child’s presence in the home,
(4) the child must live in the parent’s house for two years, and
(5) the parent must not move into a nursing home for at least two years.
(Note:  This is only a Medicaid rule.  It does not avoid possible IRS taxation of gifts.  It also does not make the parent’s mortgage go away.)

Sounds easy, right?  Maybe, maybe not!

The aging parent needs to get good care.  The incentive of a home transferred from Mom or Dad should NOT create an incentive for failing to get the care that Mom or Dad actually need.  Failure to take proper care of Mom or Dad should create a great deal of guilt.  If extreme, it should prompt a visit from Adult Protective Services.

An adult child (with our without family in tow) moving into the aging parent’s home can sometimes help the parent age in place.  The home and the child’s involvement need to be appropriate for the aging adult’s care.  If everything falls into place (and that’s often a matter of luck,) the family may be able to protect the house from the parent’s long term care costs.

This week’s blog continues the discussion of an aging adult who wants to stay in his or her home.  The introductory installment (on February 11, 2016) discussed the emotional turmoil that can face the adult children in deciding whether to accede to the aging parent’s wishes to stay home.  The February 18, 2016 installment discussed home modifications that may make it easier for an aging adult to stay home.  The February 25, 2016 installment discussed medication management.  The March 3, 2016 installment discussed hiring someone to help with activities of daily living.  The March 10, 2016 installment discussed whether aging in place is an appropriate choice for someone suffering cognitive issues.  The March 17, 2016 installment discussed services that can make it easier for an aging adult to stay home.  Today’s installment will discuss the aging parent moving into an adult child’s home.

When an adult child sees Mom or Dad start to have trouble functioning with everyday activities, the adult child might consider moving Mom or Dad into the adult child’s house.  Frequently, the parent and adult child have talked about this possibility in the past, usually at a time when the parent didn’t show any signs of ever needing help with routine activities.  Even more frequently it seems, the parent has always assumed that he or she would move into the adult child’s house but has not discussed that assumption with the child.

Of course, the adult child must get agreement from his or her spouse (if married) before bringing an aging parent into the household.  In addition, if the adult child has any children at home, their buy-in is certainly preferable if not absolutely necessary.

The adult child must consider the home’s physical layout before bringing an aging parent into the household.  For example, if the aging parent cannot go up and down stairs, the house must have a place to sleep and a full bathroom on the main floor and may also need a ramp at one of the outer doors.  As another example, if the aging adult needs a wheelchair or walker, an older home with narrow doorways and hallways may not be acceptable.

In addition, the adult child must consider his or her nuclear family’s lifestyle before bringing an aging parent into the household.  If the adult child and his or her spouse work, will the aging parent be able to receive the supervision necessary to stay in the home?  If the adult child and spouse are not “homebodies,” will either of them be willing to spend significant amounts of time at home with the aging parent (or in-law?)  The care needs of the aging parent will put a strain on family relationships.  How will the family deal with the strain?

Moving an aging parent into the adult child’s home sounds like it would solve most the the care issues for the aging adult.  The devil is in the details, however.  It is a much tougher situation than most people realize.

This week’s blog continues the discussion of an aging adult who wants to stay in his or her home.  The introductory installment (on February 11, 2016) discussed the emotional turmoil that can face the adult children in deciding whether to accede to the aging parent’s wishes to stay home.  The February 18, 2016 installment discussed home modifications that may make it easier for an aging adult to stay home.  The February 25, 2016 installment discussed medication management.  The March 3, 2016 installment discussed hiring someone to help with activities of daily living.  Today’s installment will discuss technologies that can make it easier for an aging adult to stay home.

Perhaps, the most well known device that helps aging adults stay in their homes is the pendant monitor.  (If you’re old enough, you remember “I’ve fallen, and I can’t get up.)  The older adult wears the pendant.  If he or she falls, the pendant has a button to push that allows the person to talk to a base receiver in the home.  (Push the button, and talk is much like a walkie-talkie.)  As the older adult talks into the pendant (well, actually, talks into the air and the pendant picks it up,) the pendant sends the message to the base.  The base is connected to the phone line (or to a cell number, if the house doesn’t have a land line.)  When the senior pushes the button on the pendant, the base places a phone call to a designated monitoring service.  The monitor will hear what the senior says “into” the pendant and can initiate a response, like calling an ambulance, for instance.  The monitor can also speak to the older adult through the pendant, keeping him or her up to date on what is happening.  (It’s kind of like GM’s On Star system that way.)

Of course, if the older adult suffers from some form of cognitive impairment, he or she may not remember to use the pendant to summon help.  (I worked with a family in the past in which the mother’s ability to remember her pendant was a big issue among the adult children.)  A pendant isn’t much good when the wearer doesn’t remember to use it.  Likewise, a pendant isn’t much help if a fall knocks the person unconscious and incapable of pressing the button.  To avoid these problems, there are pendants now available that detect when the wearer has fallen.  The pendant will call the base itself if it detects a fall.  (Unfortunately, these systems sometimes detect a fall when the person has not, in fact, fallen.)

With the availability of security cameras and video feeds over the internet, adult children can keep an eye on aging parents from their computers.  With one or two cameras, children can check whether their parent is moving around the house.   With a number of cameras, children can keep an eye on their parent anywhere in or around the house.

In addition, if the parent has a cell phone or something else that he or she keeps close all the time, the children can attach a gps locator, allowing the children to check the parent’s location at all times.  While gps locators may not be sensitive enough to follow movements in the house, they are useful to find the aging adult if he or she has wandered away from the house.  (If the parent has a medical monitoring pendant, a gps locator may be attached to it.)

If the aging adult lives in a “smart house” (or in a house that can be updated with smart technology, the house’s technology may be used to keep the adult safe.  Smart houses can often monitor for a stove left on too long.  The can monitor the temperature inside the home (to make sure the aging adult isn’t living in an overly cold or overly hot house.)  Motion detectors can check whether the parent is moving around.  Contact switches can monitor doors to see if they’ve been opened.

New technology can be used to help keep an aging parent home.  To be fair, the technology is more reactive than proactive.  The technology allows a monitoring company or the family to respond more quickly to a problem or to an usual behavior pattern.  The technology won’t get the aging adult up and out of bed.  It can, however, let family know when the parent is staying in bed overly long (possibly indicating a problem.)  Technology allows the aging parent to stay in his or her home longer by making the family less scared of emergencies.