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Changing Long-term Care
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Options and Recommendations
for Elders to Remain in their Homes

By Sarah W. Morgan

Predicted Changes in the Population
Predictions about future population demographics indicate significant changes of relevance to the elderly and their family members as well as middle-aged and older adults. One future forecast indicates that there will be a significant difference in the numbers of persons over the age of 65 and those under the age of 65. This means that those over the age of sixty five will outnumber those who will be available to care for them. In addition, it is expected that between now and the year 2030 the number of people in the United States age 65 and older is expected to double from 35.6 million to 71.5 million. Another category of individuals — the oldest old or those ages 85 and older — is expected to increase from the 2003 figure of 4.6 million individuals to a staggering number of 9.8 million individuals by the year 2030.

The Changes of Aging
It appears that older adults are aging better than in decades past but aging stills brings with it a number of physical, mental, and emotional changes, all of which can have an impact on the daily lives of older adults. In the year 2000 the most frequently occurring chronic conditions affecting older adults were high blood pressure, arthritis, heart disease, cancer, sinus infections, and diabetes. Other major conditions that have an effect on the lives and health of older adults include bladder and bowel control problems, hearing loss, visual impairment and memory loss. A way to determine how health conditions impact the daily lives of older adults is to measure their ability to perform Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). Activities of daily living include, but are not limited to, bathing, eating, toileting, dressing, and transferring. Instrumental activities of daily living include such tasks as shopping, managing money, using the telephone, and traveling to appointments.

The ability to perform ADL and IADL decreases as people age. In examination of adults between the ages of 65-74, an estimated 19.9 percent reported one or more difficulty, while this number increased to 52.2 percent of those adults over the age of 85. Recent estimates show that at least 6.7 million older adults need assistance with at least one ADL. Improving or assisting elders in performing both ADLs and IADLs can have a positive effect on his or her ability to remain living at own home.

Older adults are prone to develop cognitive impairments as they age. “Cognitive impairment” serves as an umbrella term for anything from severe chronic depression to dementia, but generally implies a reduction in brain performance in terms of memory, abstraction, language, visuospatial ability and attention. Cognitive impairments, like physical impairments, are a detriment to an older adult’s performance of ADLs and IADLs.

Elders and Long-Term Care
When thinking about interventions to help elderly people avoid leaving home for a long-term care facility there are several factors that must be taken into account. These include:

  1. What kind of plans are people making about long-term care as they age?
  2. As the elderly experience physical and cognitive decline what types of informal services are they accessing and taking advantage and what are the barriers to care?
  3. What leads elders and/or their caregivers to decide that nursing home care is needed? and,
  4. What are the predictors of nursing home admissions?

As people age, many fail to make plans for a later date when physical and cognitive deficits may arise and care needs change. Several factors have been found to have a negative impact on planning for future care needs including, difficulty in predicting what one’s future care needs may be, fear that future planning would have a negative impact on one’s current sense of well-being, a low perceived need for future care, have few resources to plan for the future, and relying on others such as doctors and children to make the plans. Factors that promoted future planning included, feeling more secure about future needs, the positive effect of planning for potential caregivers, and the positive effect of planning on coping with current health problems.

Interventions to Help Elders Remain at Home
Remaining at home versus moving to a long-term care facility for an elder involves maintaining a precarious balance between physical care needs, managing health conditions, acute and chronic, and activities of daily living and the resources, financial and human, that address those needs. There are a variety of interventions that have the potential for helping elders remain at home but not all are available and affordable for all elders. The concept of “aging in place” involves an interdisciplinary approach of housing design and modification and coordination of health care and social services to keep elders living in the community even as his or her health needs increase. It has been found that, if implemented effectively; “aging in place” design will reduce the need for personal care and, eventually, alleviate the costs and caregiver burden associated with providing long-term care for older adults.

Another intervention that has shown success is to assess the home environment for hazards as well as modifications that can be made to reduce the risk of falls and make completing ADLs easier. Bathrooms have been found to be the most hazardous room. Common hazards found in all rooms include the lack of grab bars, loose throw rugs, obstructed pathways, poor lighting, stairs, unsafe outside steps, arising from chairs, getting out of bed, getting on and off the toilet, and getting in and out of bed. Also, some research findings suggested that the home environment contributes to one-third to one-half of all falls among the elderly. Difficulties which can be lessened with appropriate home modifications have been found in bathrooms, kitchens, and bed rooms, the primary locations in homes in which self-care activities such as bathing, meal preparation, and dressing are performed. Difficulties resulted from the inaccessibility of rooms or objects important to self-care tasks, unsafe conditions such as clutter or the lack of needed grab bars, or a lack of home repairs which compromised safety or interfered with daily functioning such as plumbing problems, or difficult to open windows. Modifications that can be helpful in the bathroom include such things as using a long-handled sponge, bath rails, a hand-held showerhead, a raised toilet, a non-slip bath mat, and a tub chair.

Another concept currently being incorporated into some new construction is the concept of universal design which designs spaces that can be used by or easily adapted to the needs of people of all ages and physical abilities. One last newly emerging concept is called smart home technology which is currently being tested within and outside of the United States. Smart home technology incorporates “smart” features into homes that can assist elders in ADLs and IADLs as well help reduce environmental hazards. These technologies include systems that, monitor homes for break-ins, detect long periods of inactivity, maintain safety lighting, turn off appliances that are not needed or potentially dangerous, prevent tub water overflow, maintain a safe water temperature, and can find mislaid items.

Being able to age at home is the goal of most people. Achieving this goal as one ages requires maintaining a balance between needs and resources as well as having made some preparations for the future when needs may increase. This summary introduces some of the possible resources that may be helpful to elders hoping to remain at home if as physical and mental abilities decline. This summary is taken from a larger review of professional literature and those wanting more information about any of the resources outlined please refer to the list of resources on the Almost Home main page or contact someone at Almost Home using the contact information also listed on our home page.

Sarah W. Morgan, PhD, RN, Clinical Assistant Professor, College of Nursing - Center for, Nursing Research and Evaluation; Coordinator, LBGT Studies Certificate Program, University of Wisconsin - Milwaukee

leave home?

Lynn Hoffman reflects on her choice to leave home.

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»Essay by Sara W. Morgan

Interview with Ralph Nelson


Additional resources

Home Away from Home: Relocating Your Parents

What is "Aging in Place"?

Information on older adult relocating and housing options

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