Thursday, December 27, 2012
Living and Aging Differently
After realizing that shit happens regardless of age and that aging is not a one size fits all concept in our society, I began to realize the need to find homes for all ages of all needs. And from that I wanted to figure out how people who have lived "independently" to suddenly realize that living alone is no longer an option and that is not about health or age but often about economics or other extraneous factors. And how do we find the ability to commune together and that became my inspiration for what I call the new "commun-ty" be that family members that share a common DNA or those who choose to call one another family.
A family is multi-generational and in turn multi need. So how does one find the right fit for those needs in the current economic climate and do so in either suburban or urban homes? The standard solution was the MIL flat or add on to an existing home that is basically separate but equal. But that is not equal as one living adjacent, independently but adjacent to the family home is outside looking in. I am not sure that is an effective way to living collaboratively, effectively and affordably. Two homes are not better than one.
I also think we have to learn that we can live together independently, successfully if in fact the physical property is remodeled to meet the varying needs but in ways that are not exclusively for one individual versus another. Private en suites, excellent soundproofing, quality finishes, and communal spaces that are open and yet not part of food preparation or other work spaces.
There is also a design movement away from the great rooms of the past and a move to enclose kitchens and have rooms that are similar to ones of a generation ago. Frankly just on energy use alone, the ability to appropriately ventilate as need and effectively control humidity in a kitchen versus an entire space is an HVAC dream come true.
Plus its very easy to clean and maintain and if the finishes are well chosen the long term maintenance and upkeep are seriously reduced and that also is cost effective. Home design and interior decor is more an act of both science and in turn analysis. Understanding what your needs are - both economic and physical - is a psych-social enterprise that few Contractors and even Interior Designers understand. So finding those whom you can communicate with are essential or in fact finding a consultant who will do the research for you to save time and energy and provide a comprehensive list that gives both pros and cons to make the decision making process easier. This can then be used to determine budget and costs overall and in turn reduce costs from change orders or worse later frustration when you find out that what was in trend is not working for you.
Homes are like those that live in them - individual. And they have a life and purpose that serve that individual not the other way around. All residents in home can live together under one roof in ways that we have yet to fully learn but in other countries and cultures its a given. This is where the idea of community serves a much more intimate but still relevant purpose. And community is sustainability.
Staying Independent in Old Age, With a Little Help
By: Jane E Brody
My 92-year-old aunt, who is cognitively impaired and requires a walker or wheelchair to get around, still lives in her own apartment, where round-the-clock home health aides help her get to and from the bathroom, bathe, dress and undress, and go outside each day for some fresh air. The aides shop, prepare and serve meals, do light housekeeping and make sure she takes her medications on time.
But last month, my aunt’s long-term care insurance ran out, and her meager savings will soon do the same. Then what?
Her daughters, both of whom work to support their families, cannot afford the $150 a day for 24-hour care by a certified home health aide, and my aunt has nothing to sell that could bring in the needed cash. Nor does she yet qualify for Medicaid or have a terminal illness that would justify hospice care, which would be covered by Medicare.
Complicating matters, her daughters long ago promised that they would not put her in a nursing home.
Such dilemmas are increasingly common as people live longer. The number of Americans 65 and older is expected to double to 80 million in the next three decades. People 85 and older are the fastest-growing age group; by 2020, there will be 6.6 million people in that age bracket, when rates of debilitating ailments soar.
Most Americans over 65 will eventually need help with the so-called tasks of daily living — eating, dressing, bathing, shopping and the like. But with family members spread all over the map or unable to be full-time caregivers for other reasons, the need for new and better options will only increase.
When asked, 80 to 90 percent of older people say they want to remain in their own homes as long as possible. Yet remaining in one’s home indefinitely is not always the best choice, even if it is financially feasible. As life draws near a close, many older adults need more care than can be provided safely at home. Simply finding reputable home health aides can be a nightmare, and family members often are forced to fill gaps in even the best caregiving plans.
The challenge is all the more difficult when no one has thought through the options before a serious illness or injury makes it impossible for elders to return home without full-time help.
Many elders living independently need outside help long before they require round-the-clock care. A range of assistance and housing alternatives has rapidly sprung up to meet this demand. Many focus on improving accessibility in the home and access to neighborhood conveniences.
An older person living in the suburbs who can no longer drive may become isolated, lonely and at risk of malnutrition if there is no person or community service to shop for her and take her places. Even stairs are a major obstacle.
Elinor Ginzler, director of the Cahnmann Center for Supportive Services at the Jewish Council for the Aging in Rockville, Md., writes that “the ability to age in place is greatly determined by the physical design and accessibility of a home, as well as community features like the availability of nearby services and amenities, affordable housing and transportation options.”
Organizations like Staying in Place, a nonprofit group of volunteers, helps people age 50 and older in Woodstock, N.Y., and surrounding communities “maintain active, independent, fulfilling lives in their own homes.” For $125 a year (plus $50 for each additional household member over 50), the organization assists with paperwork and technology; free or low-cost transportation; referrals to discounted service workers; information about, and transport to, local classes and cultural and social activities; and recommendations for home health care agencies and personnel.
Other services that are free or low-cost include Meals on Wheels; friendly visiting; shopping services accessed by phone or computer; activities at senior centers; and adult day care centers.
There are also more costly commercial organizations like Home Instead Senior Care, an international network of more than 900 independently owned franchises that provide in-home nonmedical care for elders and support for their caregivers.
The organization sponsored a yearlong online study of 1,631 caregivers, 697 of whom were assisted by paid in-home nonmedical care. The study found that people receiving the additional paid care required 25 percent fewer doctor visits and were more likely to participate in adult day care.
Sadly, many aides are seriously underpaid. Home Instead, for instance, has lobbied to keep home health care aides exempt from minimum wage standards.
Henry Cisneros, former secretary of the United States Department of Housing and Urban Development and editor of the book “Independent for Life: Homes and Neighborhoods for an Aging America,” points out that “Americans are aging in traditional homes, neighborhoods and communities that were designed for yesterday’s demographic realities, not those of today or the future.”
Mr. Cisneros advocates changing our communities so that the elderly can remain in them. “Homes can be retrofitted, new age-appropriate homes built, existing neighborhoods reconnected, and new communities planned,” he wrote. For example, to accommodate declining eyesight, homes can be fitted with brighter bulbs, better lighting locations, easily accessed controls and nighttime guide lights.
Mr. Cisneros sees a pressing need for affordable packages of home modifications and maintenance to make residences more suitable for older people.
“A certified renovation package for aging in place could include roll-under kitchen and bathroom sinks, grab bars, curbless showers, lever faucets and door handles, a zero-step entrance, and wider doors and hallways,” he wrote.
While such changes have a price tag, they may cost a lot less than current care alternatives for the elderly.
Needed changes at the community level include affordable small-scale housing and cluster housing situated in walkable communities with nearby amenities, businesses, health facilities and public transportation.
Borrowing from the design of assisted living facilities, individual dwelling units might be located around a common space that includes dining areas and social rooms.
For elders who want to be near family members yet maintain their independence, so-called accessory dwelling units with their own kitchens and bathrooms are being built near or attached to family homes.