As your clients age, they may reach the point when they can’t live independently anymore and need to consider community living options.
This decision can be a difficult one to make, and your client, or her adult children, may ask for your help. Or, if the client has no family or close friends, the impetus might be thrust on you. To assist your clients with this tough decision, it helps to know what elderly clients may experience as well as what options are available to them.
While there’s been much written regarding aging successfully, most authors have focused on the individual. However, placing the individual within the environment is an important element. Individuals with similar demographics and similar physical limitations can experience a significantly different quality of life, depending on where they live.
Two paradigms have emerged when looking at the physical environment of older individuals. The first is the objective environment, the one that we, on the outside, observe. We might notice that the neighborhood has declined, the house is in disrepair, transportation is a challenge or the structure of the house is difficult to navigate successfully. The second is the emotional view of the environment, which can be considerably more powerful for the older individual than the objective perspective. The elderly may not notice, or care, that the neighborhood has declined; it’s familiar to them. They learn to cope with the lack of transportation by relying on neighbors, or they avoid the parts of the house that are challenging. While objective elements are easy to evaluate, the subjective, emotional perspective is unique and only understood by the individual. Ideally, an individual can find a place to live that’s both emotionally comfortable and objectively adequate.
Costs of Moving vs. Staying
Before promoting one alternative—moving—over another—staying, it’s key for you to understand the costs and benefits of each. Some of the costs are financial: It can be expensive to pay for repairs and maintenance. In addition, as physical limitations grow, the need to rely on others to fix or fetch, increases. While family might be willing at first, they might grow very tired of helping out over the years. As a consequence, a secondary outcome emerges in that the house faces disrepair and the individual confronts isolation. The older individual quits asking and, not only does the fence remain broken, but also the social contact dissolves.
Remaining at Home
Remaining in the home isn’t all bad. As mentioned earlier, don’t totally discount familiarity and mastery. The sense of identity, the need for privacy, the feeling of normalcy and the joy of the status quo are important benefits of remaining at home.
Today, many programs make living in place practical. Social service agencies, senior centers and private companies provide transportation and meals, either at a center or delivered to the home. Volunteer organizations, such as the “Senior Village” concept, offer help with tasks such as reading, light housekeeping, pet care or transportation. Senior caregiver companies provide more significant help with activities of daily living. Also, easy fixes can make an individual’s home more livable with additions such as grab bars and ramps.
New technologies are also being developed that will allow seniors to live at home. These innovations can do all kinds of tasks from turning off the lights to monitoring medications, protecting the individual from falls to calling an ambulance in case of a fall. The Internet allows the family to be present in the elderly individual’s home even when the family lives across town or across the country.
Throughout the country, the concept of livable communities is becoming much more common. Communities are supporting their aging populations through providing a healthy environment, easy transportation, affordable nutrition and opportunities for engagement.
All that being said, problems can emerge with living alone. The biggest question is: When is it too late? With all these resources in place, an elderly individual can still fall or be abused by a caretaker. Her loneliness can take a toll, or a decline may go unnoticed. At that time, the move may feel like—or actually be—a crisis.
Community Living Options
Scientists tracked more than 2,000 people age 50 and over and found that the loneliest were nearly twice as likely to die during the 6-year study than the least lonely. Loneliness can be the most severe outcome from remaining in place, and community living is one of the quickest and easiest solutions to fix the problem.
Several options exist for community living, ranging from the generic age 55+ community to the buy-in continuing care community. While each has its costs and benefits, the fit with the individual client, in terms of cost, competency and environment, is key. I’ll outline a few of the basics.
Co-housing. In this model, older individuals live together in groups ranging in size from a few individuals to a whole (mini) village. The idea is that they can take care of each other, as they focus on wellness and support. In our culture of individualism, with the additional challenges of creating an organization and architecture that can work for a variety of people, this model has been slow to evolve.
Active age-qualifying communities. Communities have developed across the country that restrict residents to a minimum age, generally 55 and over. These communities vary greatly, from mobile home parks to gated communities, apartment buildings to suburban sprawl. While they also range in terms of the variety of activities offered, one commonality is that individuals tend to join for the activities and companionship.
The age segregation is both a positive and a negative—depending on whom you ask. Some may feel safer and more comfortable, while others may feel isolated. An individual may view the organized activities as fun, engaging and meaningful or as vapid and self-indulgent. The bottom line is that this option isn’t for everyone and will depend on an individual’s personality and lifestyle.
An additional issue with age-qualifying communities concerns managing the next phase of life. Some criticize the communities for not supporting the “fourth age group” (after 80), while other, younger members complain that they don’t want their active lifestyle to be compromised by the changes required to meet the needs of this elderly group. Whether these communities support the older seniors or not, the likelihood is that they’ll have to move out of the community at some time in the future as their health declines, and they’re in need of further assistance.
Independent living communities. These communities allow for individuals to move in with their own furnishings, yet have features, such as grab bars, and amenities like housekeeping and central dining, to make living much easier for aging individuals. The communities program for activities and offer some support, but don’t help with activities of daily living (ADL).
Assisted living. These facilities typically don’t allow for the integration of the individual’s own furnishings, but they do offer the necessary help with ADL. When an individual has lost the ability to manage two or more ADL, assisted living or home health care are the only two options.
Continuing care. This living concept is designed for the senior to join while healthy and remain in the community all the way through the whole range of changing needs, including skilled nursing care. Generally, a significant deposit is required in return for the long-term guarantee of care.
Worth the Risk
Often, advisors feel that they’re interfering in a negative way when pursuing the issue of moving out of independent living into some sort of community living situation. Studies indicate a high level of loneliness among the elderly and a strong connection between loneliness and health issues. Instead of hurting your client, more often than not, your conversation will be a welcome relief.
Gratitude will be your reward for taking the risk.
This is an adapted version of the author’s original article in the July 2017 issue of Trusts & Estates.