Older adults who need more help with activities of daily living for safety have options in the community
By Deborah Jeanne Sergeant
When an older adult needs more help with activities of daily living (ADLs) for safety, health and comfort, several options are available before considering full-time skilled care in a nursing home: aging in place with support, independent living and assisted living.
Reserving nursing home care only for those who need it is important for reasons beyond the individual’s preference and the organization’s admission requirements. The shortage of nursing home slots is largely fueled by the lack of funds to adequately pay caregivers, spurred by low reimbursement rates. Nursing home reimbursement can be lower than $200 a day to cover each person’s 24-hour care, nutrition, housekeeping and recreation.
Many people prefer to age at home or the home of a loved one. For many people, this would require home modifications such as grab bars, building an addition to add a bedroom and full, first-floor bathroom and other changes.
Denise Pallotta, certified aging-in-place specialist with Frank Webb Homes in Syracuse, can help people make home modifications that may lengthen the timeline of how long they can age in place at home.
“We take the environment and adapt it to you,” Pallotta said. “By changing the environment of the house, you can stay home.”
For many people, an acute event like a stroke can make activities of daily living challenging, such as stepping in and out of the tub or toileting. But installing grab bars, a low-entry shower and raised toilet can make these ADLs easier.
Although making adaptations to older homes is more challenging, many adaptations are usually possible.
As the need for assistance increases, older adults may need help at home. Home care services are not covered by Medicare typical health insurance plans and most people do not have long-term care insurance.
Intergenerational living can provide considerable support, as merging households can prove mutually beneficial in many ways. Homes with in-law suites and first-floor bedrooms can help make it possible for older adults to stay at home longer. Some families choose to move to a new home to provide space for themselves and their seniors.
Using technology such as cameras, fall alert pendants and smartwatches can help the family better protect their older loved ones. It’s also helpful to have Meals on Wheels stop by for older adults living by themselves or who are home alone while their family members are at work.
Loretto and the county’s office for the aging may recommend local resources.
Some older adults don’t want help, which is where caregiving family members may need to get creative. Instead of arranging for a family friend to stop by and check on your loved one, arranging for someone to drop by to play a few card games two days a week can really be a gentle way to check in with a senior’s wellbeing. Scheduling a visit per week from a handful of friends can provide socialization and safety.
Some older adults do not want to have the responsibility of yard work and household maintenance and feel unsettled in their large, now-empty home since their children moved out and their spouse passed away. Others may not need to downsize right now but want to do so before it becomes an emergency. Independent living may be a good next step.
“With independent living, you don’t need someone checking in with you,” Pallotta said. “It’s generally downsizing, like from a five-bedroom house and you’re now just you and you maybe need two. You want to move somewhere you don’t have to mow the lawn or shovel the snow. There are maintenance people to call. But you’re living independently and no one checks in.”
Residents manage their own cooking, medication and personal care and it offers the benefits of a safe neighborhood, similarly aged neighbors and secure shared spaces such as sometimes a community center or green space.
“Independent living is designed for 55-plus community most of the time,” said Kate Conan, registered nurse and senior outreach coordinator at Loretto in Syracuse. “Usually it’s 55- to 60-ish folks whose kids are now gone. Their home maintenance is becoming difficult. These communities are designed for active seniors who want a maintenance-free lifestyle with recreational facilities.”
Many times assisted living residences include services a la carte. Since residents are already in the system, transitioning to a higher level of care is seamless once people need assisted living, which can include assistance with ADLs, housekeeping, laundry, meals and medication management.
“Sometimes people are hesitant, thinking that they can’t do things outside the community, but they can come and go as long as they sign in and out, unless they’re in memory care,” Conan said. “Seniors get a supported environment with 24-hour staffing.”
The security and social opportunities are also big draws for assisted living communities, as emergency services are readily available and resources like hair salons, libraries and more are nearby.
“Families feel a sense of relief,” Conan said. “It’s got to be what works best for the individual and family dynamic.”
She encourages beginning conversations about care early, checking out communities and reviewing the care continuum available. This leads to better outcomes than making rushed decisions. Older adults should be part of the conversation with their input respected and considered.
Conan said to look at the patient—staff ratio, activity calendar, engagement of residents and overall ambiance of the community.
“Before you go into a community, if Medicaid will be in the future, ensure the facility can accommodate that payor source,” Conan said. “Otherwise, you will need to uproot your loved one when the funds dwindle.”
Making the move sooner can better ensure placement as care needs escalate. Otherwise, older adults may have to wait many months for a spot while their families scramble to provide support.