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Know Your Options: The Pros and Cons of Living at Home as You Age

Aging in place, as defined by the U.S. Centers for Disease Control and Prevention, is “the ability to live in one’s home and community safely, independently, and comfortably, regardless of age, income or ability level.” Ninety percent of individuals 65 years of age and older report that they would prefer to continue living in their current residence as they age.

There are times, however, when the desire to age in place doesn’t match reality. If and when an individual’s home can no longer support independence, safety, and comfort, or when a health change makes it difficult to thrive within that environment, it might be time to consider options.

Where do you start?

We usually look at three key areas—physical and cognitive health, physical environment, and finances.

Physical and cognitive health are essential to living independently. If someone is having trouble with activities of daily living (ADLs) like eating, dressing, transferring between a bed and chair, toileting, or controlling bladder and bowel functions and/or with other essential activities they need to live independently, like housework, meal preparation, medication management, managing finances, or using a telephone, we need to take a closer look at what the barriers might be.

The physical environment can be an obstacle for many. Many homes in King County are built in hilly areas, given our geography. There are steep steps leading to our front doors. Once inside our homes, there are often more stairs to navigate. Also, traditional bathtub-shower units require you to lift your legs over 12 inches to enter.

Our neighborhoods don’t always have sidewalks or good lighting and might not be safe or walkable. Home and yard maintenance are equally important. Lack of regular maintenance can cause hazards. Doorways aren’t always wide enough to accommodate the use of a walker or a wheelchair. And then there are considerations such as access to health care, food, activities, and transportation.

Finances guide many decisions and options. If someone wants to stay at home, but requires 24/7 care, this is often the most expensive option and not always feasible financially.

When does someone need 24/7 care or supervision?

Following are some examples of situations that may indicate the need for closer supervision:

  • Help with medication management is required, especially when under- or overdosing has occurred.
  • Meal planning, shopping, and preparation can no longer be managed.
  • Physical health is declining and an individual needs help with activities of daily living.
  • Night-time care is required because of cognitive and/or physical changes.
  • Supervision is needed due to sundowning or wandering.

When is it time to consider a move to a long-term care setting?

A move can happen at any time. It is best to thoughtfully research options and to make decisions and make the move before physical or cognitive changes make moving more complex and difficult. Waiting too long before making a move can often limit options.

Patience is your best friend in these situations. Often, loved ones who need extra support are resistant to receiving help in their home, and they can’t imagine changing living environments. When a move is inevitable, time, patience, and planning are required. Family members may benefit from the support of a professional move manager, care consultant, or care manager who can guide, coach, and assist in the process.

Levels of care vary. It’s important to find the appropriate support that works best with your budget. You may find Navigating the Overwhelming Options of Long-Term Care (AgeWise King County, May 2019) by my colleague Nicole Amico Kane of help in understanding home- and community-based options, different types of housing, and their associated costs.

Who can help?

  • Community Living Connections (Seattle & King County) can connect you with the right kind of help, when and where you need it. Adults of any age, adults with disabilities, caregivers, family members, and professionals can call (toll-free) 1-844-348-5464 to get objective, confidential information about community resources and service options, free of charge. Many services are also free of charge.
  • Aging Life Care Association offers a directory of geriatric care managers who can help streamline your process by assisting in navigating transitions and changes, serving as a local advocate on behalf of an older adult. Care managers can help with care planning and know the local resources best.
  • National Association of Senior Move Managers provides a directory of moving professionals that can assist with every step of your transition. Members specialize in helping older adults and their families with the daunting process of downsizing and moving to a new residence.

Contributor Harisa Paco, MSW, LSWAIC, CMC is a Certified Care Manager with Aging Wisdom. She holds a Bachelor’s degree in Social Welfare and a Master’s Degree in Social Work with a focus on Multigenerational practice from the University of Washington. Harisa is a co-chair of the Aging Life Care Association’s Seattle Unit Group and serves on the board of the Western Region Chapter.