Plan to THRIVE in Place - By Mariel C. Kraus, OTR/L, CAPS - CGA
As seen in Gig Harbor Living Local, January 2018 edition.
Gig Harbor is a wonderful inter-generational community with a thriving population of young families who have children of all ages, and sandwiched generation families who are caring for aging parents while still raising active kids. We worry about the safety of our children AND our parents whenever we are not present to supervise. We are emotionally invested in our homes for all the memories that fill each room.
In a study by AARP (Source: AARP PPI, "What is Livable? Community Preferences of Older Adults," April 2014), “87% of adults age 65+ want to stay in their current home and community as they age. Among people age 50 to 64, 71% of people want to age in place.” Too often, people start worrying about where and how they will spend the 4th quarter of their life but by then, the options can be limited after a fall with serious injury or a progressive illness.
In Gig Harbor, many older homes are multi-level with steep stairways to basements for laundry facilities and garage access. Several have steep driveways and steps to enter. Some bathrooms do not accommodate wheelchairs or allow the use of safety equipment such as a tub transfer bench or toilet rails. Sadly, many of the newer 55+ housing tracts do not meet the standards of an Aging in Place home.
Occupational Therapists (OTs) are educated and have training in home safety assessments (mostly for urgent needs discharge planning at hospitals or nursing facilities) to make sure their patient is safe to return home after a surgery or illness, and not become home-bound or injured trying to bathe or use the toilet. OTs will make a home visit with the patient to see if they can enter and exit their home safely, access the bathroom and recommend safety equipment that will facilitate independence and safety. Sometimes a home health OT performs this assessment when the patient is discharged home with known accessibility concerns.
OTs who are Certified Aging in Place Specialists (CAPS) have additional education, training, and are (ideally) experienced working in the Home (and Commercial) Building Industry to recommend the best modification to allow a person to remain in their home until the very end. CAPS OTs work well with contractors in problem-solving accessibility challenges and being clinicians, recommend features that may become necessary as a disease or illness progresses.
CAPS OT assessments are affordable and can save thousands of dollars in home modification revisions because of missed details. They offer the best solutions for families with disabled family members of any age and help their clients to THRIVE not just Age in Place.
If you are considering REMAINING IN YOUR HOME AS YOU AGE, read on to the expanded article only found in this blog:
As the saying goes, "If you fail to PLAN, you are planning to FAIL" and this is a devastating reality for most seniors who end up in a nursing home when they could have remained home longer or transitioned to a healthy retirement community of their choice (given their financial options). It's never too soon to start planning for retirement or for aging in place. This all starts with your vision of how you see yourself aging, whether you are active and healthy or dealing with a progressive illness. Misconceptions of what your options are will lead you down a path of disappointment and a drain on your finances when you are no longer generating an income.
Lets start with the misconception that retirement communities will meet your needs when you are a senior. Most 55+ communities are not optimally designed to keep folks in their homes and it all starts beyond the home itself. Important things to consider are having local conveniences within walking distance for when driving is no longer an option but a short walk can be a part of a home exercise program. As a former home health therapist, many of my patients were actually living in retirement communities but were "Home-Bound" because of poor accessibility of the home and lack of para-transit services in their area. A one story home with no step entry is truly the best foundation to build on if you need further modifications. This is why ramblers are on short supply - everyone wants one!
When choosing to transition into a 55+ community, visit several of them and take notes. The best communities will be WALK-ABLE, meaning, that you can safely walk around the neighborhood - especially important if you have a dog that needs the exercise and daily "constitutional" service. Sidewalks need to be in good repair, not lifted by tree roots or uneven and level driveways and path to your door to prevent a fall injury. Look to see if there are conveniences in walking or short-drive distance such as grocery stores, pharmacy, and medical center - these are ESSENTIAL; But if you also have hair and nail salons, dining and entertainment nearby, this is OPTIMAL. Make sure that para-transit services are available in your community for when you are no longer able to drive and have no reliable source of transportation (i.e. family or friends).
Another misconception is that Independent and Assisted Living Facilities (ILFs and ALFs) are all inclusive. While you may start out living in the ILF side of a combined facility, you MAY have to pay for a meal plan and each facility has an la carte menu of services you can choose at an additional monthly cost. One of the quickest ways that ILFs develop a higher level of care for residents is built into the bathroom design: Step-in shower stalls that do not accommodate a removable and height adjustable shower bench, having a stall or shower-tub door that is a barrier for independent and safe entry, are common reasons for having to pay for an aide to supervise or provide physical help in bathing.
Some facilities are divided into two floors or sections to keep the aides more efficient so if you start out Independent but then need help with bathing, dressing, and getting your medications on a schedule, because of an illness or injury, you will have to move to a unit in the Assisted side - IF one is available. You may not have the same amenities you first signed up for because the Assisted apartments usually do not have a kitchen, only a small refrigerator, a sink, a microwave, and a small counter with limited cabinet space, which will limit meal preparation drastically.
In ANY home or apartment that you plan on aging in place, take a good look at the bathroom and imagine yourself in a wheelchair and a caregiver helping you on and off the toilet, in and out of the shower or bathtub, and sitting in front of the sink to brush your teeth. By doing this, you will know if that bathroom is going to meet your long-term needs or if it will be the reason you have to find another home when you are in pain, have depleted finances, or may have impaired mental functioning. Many times, CAPS OTs will have simple solutions that will not require remodeling such as a sliding tub transfer bench, installing grab bars, toilet rails, and removing the sink cabinet or tub shower doors. Ask your landlord to write a permission for these simple solutions into your lease in case you need them in the future.
If you are seriously determined to stay home until the end, you will need to look at the cost of having home care services and equipment. Caregiver costs vary by state: (http://longtermcareinsurancepartner.com/resources-page/2017-cost-of-long-term-care-by-state)
In MOST cases, staying home is the least costly because you have likely already paid your home off and can pay for home care aids as you need them. There are many home care agencies to interview - and you should look look at their client reviews, consult your physician, or ask your friends for recommendations. By looking at a side-by-side cost analysis, you can decide if it makes sense to invest in your current home to make it accessible and consult with a CAPS OT to begin drafting your Aging in Place plan. Be aware, not all CAPS OTs have this skill set or experience.
At Integrative Therapeutic Solutions, we are not only experienced in helping our clients design a comprehensive Aging in Place plan and Life Care Plan, we have worked in the building industry for over 17 years and have made homes universally accessible without the use of unsightly ramps, which can make seniors vulnerable to predators. In some cases, HOAs do not approve of ramps but an Integrative Therapeutic Solutions home is appealing because modifications are discrete and add resale value.
Don't wait for a fall or injury to start worrying about your home accessibility, CALL Integrative Therapeutic Solutions, LLC in Gig Harbor TODAY for more information on how to get started on your THRIVING in Place Plan because Living Life on YOUR terms is OUR PRIORITY!
Mariel C. Kraus, OTR/L is a Nationally Board Certified and Registered Occupational Therapist, and Washington state Licensed Healthcare Practitioner. She is credentialed by the National Association of Home Builders (NAHB) as a Certified Aging in Place Specialist (CAPS) with additional education as a Certified Graduate Associate (CGA) in the building industry. She is a specialized in neurologic and physical dsyfunctions which gives her a keen perspective into home accessibility needs of clients with progressive disorders. You will find her full bio on IntegrativeBody.net under Home menu.