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Best "Elder-Housing Decisions" Not Made During a Crisis

The ideal home is one that you like, one that fits you and your needs, makes you feel comfortable and safe. The ideal elder home includes all of these attributes but it is also a home that allows the elderly resident to age in place.

Age in Place?
When you age in place, you live in the same community until you die. This does not necessarily mean you live in the same residence until you die, although it can mean that.

Moving is always stressful, but leaving the family home after more than half a century as a result of a life-changing illness that will never go away and will always have to be managed is a trauma and a disaster waiting to happen.

I wrote Making the Right Move: Housing Options for Seniors to help the elderly and their loved ones make the "move-or-not-move decision" after informed inquiry – and before any decision have to be made.

If people who consult the book feel they are doing the right thing for themselves or a loved one once all the decision that must be made are made and are making those decisions in a timely manner, my fondest hopes will have been fulfilled.

Today’s elders are the parents of the leading-edge boomers who are now in their late 50s. The boomers have changed the way we live throughout their lives; they will change how elders are treated.

I doubt, for example, they will tolerate shared rooms in nursing homes or a nursing-home regimen that limits baths to one a week. Both are currently typical.

Maintaining Independence
Elders are very vital contributors to our society. Therefore having healthy elders becomes a priority and their housing, because housing is a determinant of health, becomes a priority. To be healthy you need to feel safe, secure and needed within your home and your neighbourhood. Having a sense of independence is part of that.

Nursing homes for intermediate care and especially nursing homes for chronic or extended care are not usually very good at promoting resident independence. (It is faster and easier for the health care aid to do things for you than with you.)

One statistic is that 40 percent of US nursing-home residents could have been better cared for in a less intense setting. This means that making the right move for an elderly person may be to another place other than a nursing home.

Complicated Choices
Choosing the right home is a complicated process. Unfortunately, most people who have to make the decision to move make it only when there is a crisis. They get sick and cannot cope any longer in their present setting.

A nursing home seems the only choice because they have not heard of, or seen, any suggested by professionals.

When choosing a nursing home, the most commonly asked questions are: where is the home located? Is a private room available? And how much does it cost?

There are so Many More Things to Consider
Does this dwelling have a garden, for example, and offer places for you to walk safely within your complex? It is easy to get a wheelchair out to the garden? Do the doors automatically open and have no sills to manoeuvre over? Is there a covered entrance so you do not get wet from the rain or slip on the ice when you get out of the car?

Is this dwelling near to amenities that have been important all you life – a library, a bank, a hospital?

These are just a few of the questions you should be considering about the physical environment. You also have to frame questions about the mental or spiritual environment.

Is this nursing home resident-centered? Are the programs and amenities right for you? Can you be alone or conduct a private conversation other than in your room? If soaking in a hot tub relaxes you, is one provided? If you like to play bridge, is there a group you can join? Are there activities besides mindless games like bingo? One home I know of takes residents and care-givers yearly to Hawaii for a holiday.

R.E.S.P.E.C.T
It is important that residents are respected by staff. Do staff kindly and gently touch residents and squat down to talk to them at eye level if they are in a wheelchair? Again this is just a sample of the questions that will help you evaluate mental and spiritual aspects of a home.

Cost Factors
Cost is another of the common questions asked. Assisted-living nursing homes are expensive they can range from $1,500 to $12,000 (cdn) per month. Each province has different expenses they cover for long-term care because elder’s home care is not part of the Canada Health Act.

British Columbia residents are better of than other Canadians because limited home care and extended/chronic care are covered and the upper levels of intermediate care are also subsidized.The cost of a subsidized bed is not for the health care provided, but for accommodation only. The problem is that there are few low-cost alternatives. The government subsidizes some nursing home beds and very few alternatives.

One low-cost alternative is granny flats. In Australia, mobile-home-type unit attached to an adult child’s home permit granny to live independently and the family to help out as needed. In Canada, we have in-law suites that serve the same purpose.

Another low-cost alternative is Abbeyfield, developed in England, in which 12 to 15 residents live independently in a home and meals are provided by a housekeeper/cook. There are more than 20 of these homes in BC.

Home care is the alternative the government provides but it is so rationed that without supplementing the care offered people are generally unsafe and end up back in emergency with another crisis.

For the wealthy, home care is how they are able to age in place. They gradually add caregiver hours until someone is looking after them 24 hours a day. The cost for a companion/care aide is about $6,000 to $10,000 per month.

There are stories in my book about how my mother negotiated with the health-care system and was able to die at home. The stories in Making the Right Move are grounded in reality. Only the names have been changed.

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Need advice? Ask us.

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Bowen Island resident Gillian Eades Telford is a gerontologist consultant and former nursing-home and home-care director, with a working lifetime in the care field complemented by masters’ degrees in environmental studies and long-term care administration. Making the Right Move: Housing Options for Seniors can be purchased for $15 at many bookstores or from the Self-Counsel Press website: www.self-counsel.com