Category Archives: Aging in Place

Impact of Deportations on America’s Seniors: The Great Unknown

We don’t yet know what the full impact of President Trump’s immigration enforcement policy changes will be, but the outlook is stark. According to the New York Times, “President Trump has directed his administration to enforce the nation’s immigration laws more aggressively, unleashing the full force of the federal government to find, arrest and deport those in the country illegally, regardless of whether they have committed serious crimes.” Millions of immigrants are potentially affected.

Little attention is being paid at the moment to what the consequences of sweeping deportations might be for America’s seniors. There is a crying need for data on how many seniors are being cared for by undocumented immigrants. Seniors in assisted living facilities and nursing homes could suffer due to staff shortages. How many seniors trying to age in place are being helped by companions who are undocumented? What will these seniors do when their companions are suddenly gone?  Supermarkets, restaurants, bus services, and taxi companies used by seniors may have difficulty operating.

Americans of all ages in several cities discovered the vital role immigrants play in the service sector on February 16, the “Day Without Immigrants.” That day could soon become the new reality nationwide.

When immigrants are no longer available to care for seniors or provide critical services, where will the burden fall? Most likely on the children — the sandwich generation already stretched to the limit.

The country, and seniors in particular — along with their children — would have benefited from a deeper discussion of the impact increased deportations will have, long before the Trump deportation policy changes were suddenly announced.

High Tech Help for Aging in Place

If you are caring for a senior senior, or worried about how you’ll manage when you become one, you’ll be interested in this story from Marketplace.  It’s about a company based in Baltimore, Sentinel Care, that works nationwide with alarm companies, such as ADT, to put sensors around the home that can alert up to ten caregivers to problems. It all works through a cell phone app.

Has the loved one gotten out of bed this morning? Has the medicine cabinet been opened? How many times was the bathroom used last night? (Frequent visits could indicate a health issue.)  Is the kitchen being used at mealtimes? More basically, is there motion within the apartment, indicating that the loved one is at home and moving around?

Sounds intrusive, but many of us know of instances in which a senior has fallen and lain for hours unattended. Even if they have a panic button, they may have left it somewhere or not wanted to push it for fear of causing a fuss. We also know of folks who have wandered off outside due to dementia.

Here’s the website of Sentinel Care, also known as Concordia Systems. (Be careful when browsing. There seem to be a number of companies called Sentinel Care.)

This sort of high tech system may well make it possible for seniors, even those living alone, to remain at home into advanced age.

CCRC’s: Don’t Feel Pressured By The Life Care Contract

In a recent post, Common Sense for Seniors discussed continuing care retirement communities. They seem like nice places to live, with lots of amenities and conveniences, but is it really necessary to move to one?

Imagine that you are living in a home that is already equipped for senior living. You can live on one floor if you need to, and you don’t have to go up or down steps — or not very many — to get into the place. You have grab bars in the bathrooms. You don’t have any loose rugs or cords around that are going to trip you. Perhaps you’re in a condo, so you don’t have to worry about maintenance, or perhaps you’re able to hire someone to help whenever a chore is beyond your capability. If you’re in a city or suburb, you can arrange to have your groceries delivered, and you might be able to take advantage of volunteer or concierge programs that offer rides and other sorts of help. One of the children might live nearby and can keep an eye on your health and capabilities.

It seems to me that a senior could live comfortably in such a situation for a very long time — without forking over hundreds of thousands of dollars to a CCRC.

Of course, CCRC’s come with a lifetime care contract so that, if necessary, you can move up to a higher level of care (assisted living or skilled nursing) at no additional monthly charge.  But Medicare (best backed up by a Medigap policy) provides a broad range of medical services to seniors living outside CCRC’s. These include some home health services and 100 days in nursing home rehab after a hospital stay.

If you are aging in place and your health starts to deteriorate, you or your children could consider hiring a geriatric care manager to come up with a care plan and arrange services. Advice on care options in such a situation may also be available from a local agency, such as the Yates County Office on Aging or Fairfax County Services for Older Adults.

Should you have to go into assisted living, so be it. Assisted living facilities are not hard to find. You’ll pay $3,500 per month on average, according to Genworth Financial, which is less than the typical monthly fee at a CCRC. It’s an amount that many seniors can manage based on Social Security, a pension, savings, and the sale of a house.

A nursing home, should you need one beyond 100 days is more expensive — $6,690 for a semi-private room per month on average. If you’re lucky, you bought long-term care insurance years ago. If not, you’ll have to pay the full amount, covering the fee with your income and savings. It would take a long time to pay what you would have paid a CCRC as an entrance fee and subsequent monthly fees.  The harsh facts of old age are likely to limit the length of any stay in a nursing home. According to a study published by the National Institutes of Heath, a few of us seniors have long nursing home stays, but the typical stay is just five months. Over 53 percent die within six months of admission.

So I don’t think anyone should feel pressured to move to a CCRC because of the lifetime care guarantee. Life care can be arranged by other means. The decision to move to a CCRC should be made for positive reasons, not fear. If you like the life style, the amenities, and the general ease of living that you’ll find at a CCRC — and you can afford it — by all means, make the move. But if you decide against it, that’s OK too.

Should We Move Near An Adult Child — Or Another Caring, Younger Relative?

Time to leave the old place?

Time to leave the old place?

Should we move near one of the children? That’s a question seniors often ask themselves. Those who don’t have children may be thinking about moving closer to some other caring adult – a niece or nephew, perhaps, or a younger sibling.

For younger seniors, it may be the pull of a new grandchild that makes them think of relocating. More senior seniors are starting to wonder if it might be a good idea to have a younger relative nearby should their health start to fail – someone to be sure the bills are paid and appointments kept, or, down the road, to help with a transition to assisted living or a nursing home.

Some of us are perfectly happy where we are, but we’re being nagged by children to move close-by, so they can keep an eye on us. It’s annoying, but they only want to help. Anyway, they have jobs and families – lives of their own – and they can’t be flying in or driving for hours whenever we have a problem.

It’s a tough decision. We have friends, interests, places of worship, and health care providers where we’ve been living for years – lifetimes in some cases. Why would we go somewhere else and have to establish all those ties again? Maybe we’ll fail to reconnect in a new place and fall into depression. Maybe we’ll depend too much on our younger relative for human contact and come to be regarded as a burden.

On the other hand, perhaps a change of scene is just what we need. Making a move will force us to deal with all the clutter that’s built up over the years. If our younger relative lives in a more urban location, it’s just possible that the medical system, transportation, shopping, and overall support for aging in place will be better and more convenient than where we’re currently living. We can always find new friends and places of worship if we give ourselves a little kick you know where and get out and about.

Common Sense for Seniors staff will be looking at these issues over the next couple of weeks. We’re probably years from making a decision to move or not, but we’ll be with the kids and their families over Thanksgiving. It will be a good time to have a conversation about the future and to look around at some of the living options closer to where they live.

We’ll keep you posted!

In-Home Care: Pros and Cons

Many seniors find themselves responsible for the care of aged parents or other family members who are determined to remain in their homes. These senior seniors won’t hear of assisted living and refuse to consider alternative solutions, such as moving closer to one of their children. In such situations, hiring an in-home care giver, though expensive, might seem the best approach.

But finding the right in-home care giver is fraught with difficulties. It’s a problem every senior should give some thought to, because one day any of us could be the one needing in-home care.

Just finding an honest home health aide is something to worry about. We have a friend whose father was bilked out of hundreds of thousands of dollars by a care-giver. This isn’t an isolated problem – AARP recently highlighted the issue. Reports of physical abuse of seniors by health aides are common.

If you’re thinking of hiring a home health aide directly, you should be certain to require references from people you trust. Of course, direct hire means you will be responsible for paying Social Security taxes and unemployment insurance; and you could be left liable in case of an accident.

That’s why it’s more common to use a home health care agency. According to the New York Times, there are 12,000 such agencies serving five million Americans.

Experts advise, naturally, that you inquire whether an agency you are considering conducts background checks on its employees and provides training, but this too can be problematic since industry regulation can be quite loose. AARP points out that

“Only about half of all states require home-care agencies to conduct any sort of training for their employees. Just 15 states require agencies to conduct periodic in-home reviews to make sure workers are doing their jobs. Most states require criminal background checks of home-care workers but do not require agencies to check records in other states.”

Be prepared to pay upwards of $20 per hour for in-home care, and between $250 and $500 per day for round the clock services. An assisted living facility could make more sense from a financial perspective. However, Medicare may pay for some in-home services, and help may be available from Medicaid or the VA.  Some long-term care insurance policies will also cover in-home care.

Despite the problems, in-home care is bringing peace of mind to families and their aged parents across the country. Another of our friends is exasperated with his mother because she has just fired the caregiver the family had found for her. Mom didn’t like having a stranger in her house, tending to her needs, or driving her around. She’s back to depending on her stressed out daughter for care.

There’s a lesson for seniors here. When and if the time comes for us to receive in-home care, let’s try to be good sports about it. Of course, we can’t tolerate abuse or neglect and should speak up if either occurs. But otherwise, let’s give it a shot. Those who love us will be relieved.

England and Wales: Some Lessons for Seniors

Danger! A warning sign in Wales. These are also common in England.

Danger! A warning sign in Wales. These are also common in England.

Common Sense for Seniors staff have returned from their trip to England. We spent a week each in and around two ancient towns, Hereford and Worcester, and a few days in two modern cities, Liverpool and Manchester. We also took a day-trip into Wales.

We found that England and Wales have much to offer their retirees. For one thing, the public transportation system is terrific. Frequent train service links towns of any size and even many smaller places. Locals complain that the trains cost more than they used to, but off-peak tickets seemed reasonable to us, and discount cards are available to seniors.

At the Ledbury bus stop. Not a bad idea!

At the Ledbury bus stop. Not a bad idea! Dial 999 to get the code.

The inter-city National Express bus costs less than the trains, but we were particularly impressed by the local buses, which take you to the smaller towns and villages. There were hourly buses to every little place we wanted to go, and the drivers were all very friendly. They cheerfully explained the fares and made sure we got off at the right stops.

Seniors would be hard pressed to find comparable services in the United States, although public transport survives in the northeast corridor and some metropolitan areas. It’s certainly something to look for when choosing a place to live.

Hereford shopping

 

We were also impressed by the walkability of English towns. Hereford and Worcester have pedistrianized their core areas, making it safe and enjoyable to stroll, sightsee, and shop, or to find a place for a bite to eat. Liverpool and Manchester also have vast, pedestrian-friendly downtown shopping areas.

In town and city, these areas are thronged at lunchtime, late afternoon, and on weekends. On Saturday and other “market days,” vendors set up tents and sell everything from pork pies, bratwurst, and olives to garden ornaments. Pedestrian zones and fun shopping can be found in some American towns as well – again, something to keep an eye out for.

In Hereford and Worcester, we stayed in Airbnb homes that were smaller than typical American houses, but comfortable and within walking distance of downtown. Not all housing is so close to town, but we saw many pleasant outer neighborhoods, with local shops and pubs and, of course, good bus service.

Malvern Priory, countryside in background

Malvern Priory, countryside in background

The English seem to have done a good job of avoiding sprawl. Town and country are more clearly separated than here, and this means that most people tend to be close to hospitals and other essential services. Right now, we’re loving our life out in the country – it was a joy to return to fall colors in the Finger Lakes. But someday, we’ll need to start thinking of moving into a town ourselves.

England isn’t entirely retirement-friendly, however. Houses tend to have steps in odd and unexpected places. Even in hotels, for unknown reasons, tubs and showers can be elevated, so that getting in or out requires a balancing act. And who can figure out English shower controls? They should at least have hot and cold water indicators. In restaurants, you might find that the rest rooms are located up or down a flight of stairs or two.

Worcester Cathedral

Worcester Cathedral

But on the whole, we thought that an English town might be a very pleasant place to be a senior. The cities, though fascinating, were too crowded and fast-paced for easy retirement living, But an English town, with pedestrian shopping on the High Street, and perhaps an ancient cathedral, a river dotted with swans, and some fine old buildings could be just right for aging in place.

Whippersnapper Comment

This comment came in from a whippersnapper we know in response to our post on Five Flights Up. It might be painful for some seniors to read, but the fact is, we need to be aware of the problems we can create for others.

“Ray, you forgot only one thing — how unfair it is for parents to remain in an unsustainable living arrangement that forces them into dependence on their kids for everything from shopping to cleaning house.

My mother had a million reasons for not moving into a retirement community when she was 75 or 80 — she was fine on her own, she couldn’t take her dog, etc., etc. She also had a million reasons for not buying a house on my sister’s block — she liked her home, she didn’t want to live on a hill, etc., etc.

The upshot: Mom at 89 is living in a huge two-story house, is unable to drive, relies on my sister for everything, and is completely unable to appreciate how dependent she has become. She wouldn’t dream of moving out unless the cops physically carried her out. It was quite selfish of her not to plan ahead.”

Aging in Place: Help is Available

Ashley Tillman and Becky Bennett-Tears at the Penn Yan Public Library

Ashley Tillman and Becky Bennett-Tears at the Penn Yan Public Library

In a recent post, we took a look at the unrealistic approach to aging in place celebrated in the film Five Flights Up. If you’re prepared to take a common sense approach to aging in place, help is available from a variety of agencies and organizations.

That’s what we learned last week at a meeting at the Penn Yan Public Library. The speakers were Becky Bennett-Tears and Ashley Tillman from ProAction Yates Office for the Aging. ProAction aims to help seniors 60 and above remain independent in their homes, while maintaining their dignity and quality of life.

The agency will arrange transportation for trips to medical appointments as well as trips for shopping, errands, and special events. It provides information on health insurance issues, including Medicare and long-term care insurance. It sponsors a Bone Builders exercise class and instruction in Tai Chi. When income tax time rolls around, ProAction is there to help seniors prepare their tax forms. Home delivered meals and regular check-in phone calls are available, as are nutrition counseling and support for caregivers. The Senior Employment Program helps seniors who need to keep working find jobs, and those who want to volunteer are put in touch with opportunities that suit their interests. And these are just some of the services available.

I’ve checked around online and found that similar programs are widely available – in Sarasota County, Fairfax County (VA), Baltimore County, and Los Angeles County, for example.

I worry, though, that many seniors may be shy about asking for help or reluctant for other reasons. We’ve mentioned Sally down in Florida in other posts, and I doubt that she would have asked a public agency for a ride to the doctor’s office. Instead, she depended on friends. It made her feel more independent, but in fact, she was causing her friends – all seniors too – a good bit of stress.

Help is available. Don’t be afraid to ask for it. That’s just common sense.

Five Flights Up: Glamorizing a Bad Decision

Five flights upWe watched Five Flights Up (Diane Keaton and Morgan Freeman) last week, expecting great acting. We weren’t disappointed in that.

We also thought we might gain some insights into the dilemmas of aging in place. After all, the film’s premise is that the couple inhabit a Brooklyn apartment that is indeed five flights up, and they are aging. Unfortunately, Insight, reason, and common sense are entirely lacking in this film.

It’s always amusing to renew our acquaintance with New York City tropes, as in a Woody Allen film – the sort of people who believe that downsizing means buying an apartment in Manhattan or that $10,000 for surgery on an old dog (too old to make it up the stairs) is well spent.

The problem is that the film glamorizes really bad decision-making with respect to aging in place. After rejecting the wholly inappropriate apartment they look at in Manhattan, the couple decides to remain in their five floor walkup. The film portrays this decision as brave, heroic, and romantic – a kind of thinking that is all too common. We are far too prone to think that people who decide to stay where they are and age in place, even though their home is ill-suited for the purpose, are to be admired.

I would like to see the sequel to this film, when Diane or Morgan has to make it upstairs following  knee surgery or hip replacement. I would love to see the expression on the face of the Meals on Wheels volunteer when she first looks up the stairwell.

And may God help the Diane and Morgan characters should they ever face debilitating COPD or be confined to a wheel chair. The New York Times reported in June:

“Almost two million people over age 65, or nearly 6 percent of those Americans (excluding nursing home residents), rarely or never leave their homes, researchers recently reported in JAMA Internal Medicine. The homebound far outnumber the 1.4 million residents of nursing homes.”

Some of these homebound seniors regard themselves as “independent,” but in the words of the Times, they are in fact “imprisoned.” People in assisted living get out more than they do. Not surprisingly, imprisoned seniors are sicker and more depressed than others.

Our “Common Sense” seniors will enjoy watching Diane Keaton and Morgan Freeman play off one another, but they won’t be taken in by the lesson Five Flights Up purports to offer.

Seniors Caring for Senior Seniors

Old houseWe know so many seniors who are caring for someone even more senior, usually a parent and most often a mother in her late 80s or 90s. Sometimes these senior seniors are really good sports, willing to get with the program and do what needs to be done for their own health and well being. I hope I’m that way, should I live so long.

All too often, I hear of elderly people who insist on living by themselves and refuse to consider making a change to safer living quarters, where they can receive the care they need. Sometimes old folks are admired for living independently, and that’s well and good as long as they are truly able to fend for themselves. But even if that’s the case, senior seniors should be preparing themselves for change, both mentally and in terms of their living arrangements, because their health situation could turn in an instant, with one misstep or a heart attack or stroke.

Anyone approaching 80, it seems to me, should be putting themselves into a situation that will allow them to transition to advanced old age without imposing an undue financial or psychological burden on those who will have to care for them. If that means clearing out the old place and moving to a senior living facility, co-housing, or a continuing care community, then so be it. Or maybe a little house or apartment close to shopping and health care might do the trick, as long as it’s in a place where in-home care is available should it become necessary. Something nearer the kids might well be a good idea.

Yet many refuse to budge, and so I hear younger seniors lamenting that “I’m so worried about Mom. She can’t take care of herself or that big old house, but she won’t move.” Or “What if I die before mother does? What will become of her then?” Or even “I’m half afraid I’ll walk in there one day and find her dead on the floor, but there’s nothing I can do.”

I once found myself responsible for a senior relative in Florida, 1,300 miles from where I live. She was in a rehab facility after a fall at home, followed by hospitalization. Sally insisted that she was going to return to her house, where she had lived alone since the death of her husband the year before. Hadn’t she been caring for a house all her life?

Sally told the staff at rehab that I was coming to Florida to take her home, and they were scrambling to bring her to a point where she could at least prepare a simple meal on her own to keep herself alive. When I arrived, I spoke with Sally’s neighbors and learned that she had hardly ventured out for weeks. Obviously very weak, she had been backing her car down her short driveway just to pick up her mail. Sally’s nurses confirmed that she really wasn’t in a position to care for herself, at least for now, so going home was just not in the cards. But Sally would hear of nothing else.

Fortunately, the rehab facility had a stern and effective social worker, who seemed to carry more weight with Sally than I did. She persuaded her to check into assisted living for thirty days of “respite care” and go from there.

Once Sally got into assisted living, she saw that it was what she had been needing for months. Trained professionals took care of her medications and her oxygen. If she didn’t feel like going to the dining room, an aide would cheerfully bring a meal to her room. If she did go to the dining room, she could socialize, which she had been avoiding, and even laugh a little.

I hear stories all the time of older seniors who are happier in assisted living than they ever thought they would be. Certainly their younger senior caregivers are relieved to have them there.

What experiences have you had in dealing with senior seniors? Maybe your stories, like the one we heard from Ron a while back, would help others.