Aging in Place: When Is It the Right Choice?

Are you caring for a loved one with dementia? You don't have to figure this out all on your own. Welcome to Truth, Lies Alzheimer's, the show that helps you reimagine a new relationship with your loved one, a relationship a little more free of stress and anxiety. Join host Lisa Skinner and her 30+ years of experience as she guides you on a new path to a better relationship with those you care for. Here's Lisa.

Hi everybody, welcome to another new episode of The Truth, Lies Alzheimer's Show, and I'm Lisa Skinner, your host. There is a fairly new term that has surfaced in the last 5 to 10 years. It's called aging in place. Place, and it's become extremely popular, especially since COVID And I've noticed that a lot of people Google that term, so I thought it would be great to do an episode dedicated to what is aging in place, what does it mean, and then how can we choose between aging in place assisted living, and memory care. So I'm going to share all that information with you. So let's start with what is aging in place. Aging in place means that a person lives in their own home, which would be their house, their condo, their apartment, or a similar residence, safely and comfortably. For as long as possible and as their needs change. It is not a single event like staying put forever. Instead, it's an approach that typically involves ongoing planning, home safety adjustments, having support services in place like in-home help and community resources, Making sure regular assessments as health and abilities will definitely be changing. So what aging in place means in practice, it means a person will keep their familiar environment, their familiar routines, their familiar neighbors and community, and that they maintain their own personal preferences in daily life. Meaning their meals, their activities, their sleep schedule, and their privacy. But it also means proactively reducing living risks. And to do this, maybe there will be a need to implement preventive fall measures, put those in place, need to implement improved medication safety measures, need to address transportation challenges, and need to ensure the home remains accessible as a person's mobility changes through building a reliable and readily available support system, through family involvement, etc. You need to have a plan for somebody that checks in with them, that coordinates their daily life or provides hands-on help. That could be with paid caregivers available to help with bathing, dressing, meals, housekeeping, companionship. It also means having or having identified healthcare and therapy support resources that would include primary care, Home health, PT and OT, physical therapy or occupational therapy, as needed. Now, some of the core components of successful aging in place is, of course, having a plan, having a home readiness plan in place. So make sure that trip hazards have been removed. Like loose rugs, clutter, poor lighting, that measures have been taken to enhance bathroom safety, like installing grab bars, safer shower access, that you've improved mobility routes that they walk around their home environment, and to do this, you need to make sure that pathways are cleared. Consider ramps or stair solutions. You have a care coordination plan in place. For example, decide ahead of time who is going to help, how often they can help, and with which tasks. Coordinate medical care with home support services. You have a plan for emergencies already in place, such as what is, what is going to happen if there's a fall, that you notice worsening confusion, or a sudden illness. You have a plan to maintain their autonomy while ensuring daily tasks remain feasible. You also need to have reassessment plans in place over time, which includes a plan to review their existing care plan after health changes, after a hospitalization, perhaps after medication changes, and after functional decline, which it will inevitably happen as they progress through the stages of dementia. Now we also need to devise a plan to revisit both physical safety and cognitive safety, especially if dementia is present or suspected. So here are some comparisons between aging in place versus assisted living versus memory care, and these are things that we need to take into consideration. Now, in the aging-in-place model, where the person lives is in their own home. The support model will lean heavily on in-home services and family or community coordination. It's a best fit when needs can be safely met with modifications and of course reliable help. Those people are going to show up when they're supposed to be there. Now comparing to the assisted living model where the person lives is in a residential community in the private apartment or a room with shared amenities. The support model is that staff is on site and they help with activities of, of activities of daily living, in other words, the ADLs, and with medication coordination. Best fit for that environment is when a person needs consistent help and possibly supervision, but do not require specialized dementia programming. They're not far enough along in the stage of dementia. They're still in the early stage, if they do have it, to fit well into assisted living. Now, when we compare that to actual memory care environment, the person will live in a specialized dementia-focused community, a room within that specialized community. The support model here is higher supervision and dementia-informed programming. When it comes to that choice for your loved one, make sure the staff has gone through extensive dementia care training. It's going to make all the difference in the world to their quality of life. The best fit in this case is when dementia-related behaviors or cognitive impairment make home or standard assisted living unsafe or ineffective. Now, what does assisted living typically provide? Some of the more common services are assistance with their activities of daily living, which are bathing, dressing, grooming, toileting, and mobility. They manage medication and do medication reminders, and depending on the facility and their level of need, they provide meals and basic housekeeping. They provide activities and social programming. They provide scheduled care staff availability. And what varies widely in assisted living? Level of dementia specialization. Some communities have limited dementia programming. The staff-to-resident ratios and response capabilities vary from assisted living to assisted living. You want to make sure that you know how they handle worsening medical or behavioral needs. And then in terms of memory care and actual dedicated memory care neighborhood, what actually makes it different from assisted living? Well, it is exclusively designed for dementia-related needs. It provides structured routines to reduce confusion. The dementia staff is hopefully very well trained. The environmental design that supports safety and orientation exists within the environment, and they also have very well-planned features for safety and supervision. It typically provides a secure environment, especially if wandering is a risk. They provide greater monitoring than in standard assisted living, but of course that also varies facility to facility. They have plans in place and skilled training for approaches to address agitation, resistance to care, and with communication challenges. They're focused on behavioral and cognitive expressions They have care plans that address behavioral triggers like noise, lighting, and unmet needs, how to recognize that they're trying to communicate something, and then of course the caregivers will immediately know how to determine what triggered whatever the behavior is that has just shown up. They offer activities that are tailored to each individual person's cognitive abilities. It's not a one-size-fits-all program. They are very proficient in redirection and communication strategies. So here are some things that people need to know and things to consider. Before choosing aging in place. These are what I call decision essentials. What is the person's mobility and fall risk currently? Do they have gait instability? Are they balance challenged? Do they have difficulty navigating stairs or bathroom access? In terms of their activities of daily living, we need to consider the approach to bathing, dressing, toileting, eating, transferring, and mobility. Instrumental activities of daily living, those include cooking, cleaning, shopping, transportation, managing medications and finance. All of these things. Need to be considered for aging in place. The home environment is extremely important. You need to consider lighting, the bathroom setup, the entry or exit, nighttime pathways. If they get up in the middle of the night and need to go to the bathroom, make sure they know exactly how to get from their bed to the closest bathroom. And of course, kitchen safety needs to be considered. Medical complexity and medication management. Complexity, it refers to having multiple prescriptions, insulin, anticoagulants, um, whatever it is they have. The ability to track the refills, the dosing, and side effects. Have a log. And then, of course, access to healthcare. The ability to attend appointments, to get them to their appointments. A plan for home health services or therapy if and when needed. Their cognitive health and dementia risk. Mild cognitive impairment versus dementia. What are some of the things that we need to consider here? Well, forgetting can progress into safety-relevant errors over time. Did that cross your mind? There are dementia risk factors that can change the plan, like wandering tendencies. Nighttime confusion that maybe just showed up out of nowhere, medication mistakes, unsafe stove use, or leaving doors unlocked. And here is a key question: Can you maintain consistent supervision and safe structure at home as the cognition changes. Gotta have a plan for everything in place. You need to consider caregiver and household capacity. Who'd have thought of that? Care is not just emotional, it's also operational. You have to think about scheduling, training, Physical assistance, documentation, caregiver burnout risk. Even devoted family caregivers can reach limits. So practical realism here includes who covers mornings, evenings, etc. Aging in place is usually about capacity. Not willpower. Even with love and good intentions, anybody may reach a point where consistent supervision and hands-on help are no longer realistic. Safety isn't only physical. There are medication errors to be mindful of, leaving appliances on, scams that target the elderly, Financial mistakes and getting lost can be just as dangerous as falls. As we know, dementia can shift risk quickly, sometimes much faster than we expected. Care needs rise or can rise in spikes and not a straight line. A fall, an infection, A medication change or a hospitalization can cause a sudden decline in your loved one. So we must have a plan for what happens after these setbacks, not only day-to-day function, but ongoing long-term. Caregiving coverage must include nights and emergencies. And I'll tell you, many families underestimate nighttime supervision. They think, oh well, my loved one's going to be sleeping throughout the night. That is not necessarily the case, especially with mid to late stage dementia. We see sleep reversal patterns with dementia, wandering, repeated bathroom trips, and extreme confusion. So who Who's going to be available at night? What are you going to do if a caregiver calls out? What's your backup plan for this? Transitions can take time, even if you're trying to be fast moving to assisted living or memory care, because it often involves wait lists. Do your homework, find out what availability looks like on average. What paperwork do you need to have taken care of? You're going to probably need a full exam at your doctor's office, at your loved one's doctor, before they will admit you. Sometimes that takes a while. Waiting for a crisis can inevitably reduce your options and also increase your stress. And not all assisted living communities handle dementia well. Some can support early symptoms, others struggle as behaviors change, and they will and do change. Now, memory care is not automatically equivalent across providers, staff training, and security. Practices matter here. They'll make all the difference in in the world to quality of life, and we all want to make sure that we are providing our loved ones with the best and highest quality of life possible under these circumstances. Now, in terms of aging in place, home modifications are much easier to do, the earlier the better, like installing grab bars. Improving bathroom access and improving lighting are much easier before a crisis or an injury occurs. Delaying upgrades often increases a person's fall risk and caregiver strain. Budget and affordability planning is a necessary consideration. In-home care hours, home modifications, transportation, and supplies can all add up quickly. They can become expensive. Ask about total monthly costs, not just base rates. Care hours, medication management fees, levels of care changes—these are all part of the admission process, the assessment process in assisted living, and Memory Care. Now, written care rules prevent confusion during stressful moments. So create simple instructions for your care partners, like the medication routine, meal preferences, who to call, what behaviors mean, preferred calming strategies. For dementia, consistency in approach is very important to make sure that we reduce agitation and not exacerbate it. And I want you to know, caregiver burnout is a real medical issue. If the care partner is exhausted, the person's safety and quality of care will also drop. So build a respite plan into the whole experience. Even short breaks can help. You need to consider legal and financial planning, and this should happen earlier than you think before they progress too far into the dementia and no longer have a sound mind. Mind. You want to consider advanced directives, a power of attorney, a healthcare proxy, and how decisions will be made if the— your loved one's cognition declines. This is going to reduce conflict and delays later on. Make a threshold conversation with the family now. Decide together what triggers Help escalation or a move, wandering, medication errors, repeated unsafe nighttime incidents, frequent falls. The goal is to remove blame during crisis decisions. So here is what I created for you, an Aging in Place Readiness Family Checklist. So, safety basics in the home. Bathroom safety ready, grab bars, safer shower or tub setup, non-slip surfaces, toilet height is supportive if needed, their fall risks are reduced, clear the walkways, no clutter or loose rugs, good lighting in the hallways and nighttime routes. Steps or stairs are addressed. Ramp/stair solutions are in place if needed. For kitchen and stove safety, stoves can be used safely or, um, have a plan to reduce the risk. Make sure there's a plan for easy-to-reach food areas. Have an emergency plan in place, like phone accessibility or medical alert system if a appropriate, who is going to be called, and how quickly help can arrive. Then we need to think about having a plan for daily needs, which cover bathing and personal care, and this is a realistic checklist that needs to be in place. Who's gonna help? How often? And what tasks are going to be covered? If toileting support is planned, does it include nighttime needs if relevant? We need a meals and hydration plan, regular meals, plan for reduced appetite or forgetting meals. We need a transportation plan, how appointments and errands will be handled consistently. We need a medication plan. This is critical. Medication management, We have to feel confident that it's reliable, that someone will track doses, not just remembering them. This system in place prevents missed doses and double dosing. How are you going to handle refills? A clear responsibility and a timeline for refills. And for new prescriptions, you need to update their care plan and include new prescriptions. And have clear instructions for any changes, especially after a hospitalization. And that pretty much covers everything I feel is really critical and essential for everybody to know. If you really prefer or your loved one prefers aging in place for as long as they possibly can, and I know Right now, statistically, more people want to stay in their own homes than, um, they have pre-COVID. So it's perfectly okay as long as you take under consideration everything that I have shared with you today. So thanks again for being here. I hope this has been extremely helpful. And that, you know, you start taking these things into consideration now and not wait until there's a crisis on your hands. So I will be back next week with another new episode of The Truth, Lies Alzheimer's Show. Again, I'm Lisa Skinner, your host. So glad you could all be here with me today. And as I always say, Have a great rest of your week. Always try to stay happy and as healthy as you possibly can. And I will be back next week with another new episode for you. So take care for now, and I'll be back next week. Thanks again.

Bye-bye. Thank you for listening to Truth, Lies Alzheimer's. We hope you found something in today's episode that helps. We understand that caring for a loved one with dementia can be the challenge of a lifetime, but you don't have to do it alone. If you're ready for exclusive access to even more great content and resources, head on over to Facebook and join Lisa Skinner's Minding Dementia support group. We're a community of like-minded caregivers, and we're here Good to help.