Growing older at home
3/21/2024 by Natalie Mohammad, APRN, C.N.P.
There are 65 million older households in the United States, and someone 50 years or older lives in over half of them. A majority of older adults still live in single-family homes. Many older adults live in another person's home; 3.4 million live in homes with their children and 1.1 million live in homes with other relatives. In 2018, 2.4 million older adults lived in group quarters such as skilled nursing facilities (Joint Center for Housing Studies, 2018).
Many older adults desire to stay in their homes for as long as possible. Many want to die in their home. Whether or not that is safe and reasonable depends on several factors.
When is it time to move?
For many, moving from independent living to a resident home needs to occur when:
- They're no longer able to care for themselves.
- Their caregiver — whether a loved one (spouse, child, etc.) or paid formal caregiver — can no longer safely care for them at home.
- Their caregiver becomes ill or unable to handle their role.
- They are having frequent falls or medical needs (for example, repeat hospital stays).
What housing options are there?
Many! Based on the level of care needed, these are some options:
- Assisted living. Rochester has 13 assisted-living facilities (ALF). All offer similar resources, such as nurses on site, medication management and help with bathing, dressing and meals. These facilities are great options if you enjoy communal dining and activities.
- Adult foster home. These are homes that typically house four to five residents. They provide meals and medications and take care of daily needs, much like assisted-living facilities. These homes are ideal if you want more of a "home" feel.
- Nursing homes/long-term care. These facilities have more resources than assisted living and are for people who need increased help taking care of themselves. If your loved one is no longer able to walk or needs a lift to move from the bed to a chair, they have the staff and equipment to help.
- Memory care. These are special units designed for dementia patients, including those with Alzheimer's, Lewy Body dementia, etc. They have locked units in case your loved one is prone to wandering and has left the house unexpectedly.
But I want to stay at home!
Many people want to stay in their own homes, to maintain independence for as long as possible, and to not be a burden to their loved ones. Staying in your home is often called "aging in place." Most of the services to help you remain at home are informal and offered by children, family members or close friends. These activities usually include medication setup, household chores, grocery shopping, money management and sometimes personal care (bathing, dressing).
If you want to remain in your home and you have not experienced frequent falls or hospital stays, then consider the following:
- Make your home safe and accessible: Remove rugs, limit going up and down stairs (keep everything you need on the main living floor if possible).
- Connect with family and friends who may be able to help with grocery shopping and informal needs.
- Contact home health agencies if you need medication set up.
- Be sure to talk to your doctor or healthcare clinician to get their thoughts.
Where do I start? How do I choose?
Deciding what type of housing is needed can be a difficult decision and is based on the care needs of your loved one. Many times both parents can live together in an assisted-living apartment if their needs can be safely met.
A good place to start is by talking to your primary care clinician. They may be able to offer insights so you can prevent numerous moves in a short time, such as moving your loved one to a townhouse, but then finding they need memory care a year later.
At Mayo Clinic, social workers at the hospital and in Primary Care are a great resource. Mayo Clinic has a booklet called "Senior Services: Keep Living at Home" that has a list of most community resources including meal delivery service, home health, and assisted living versus long-term care facilities. Try touring several facilities early, long before you or your loved one may need to move.
Other great resources
- Elder Network is available statewide to meet with you and discuss all senior living options as well.
- Senior LinkAge Line is another statewide resource, with information available by phone or online.
- Family Services Rochester offers several resources for maintaining senior independence at home such as safety checks and Meals on Wheels.
How can I help my loved one adjust to the move?
Making the move from one's home to a nursing home or assisted living is difficult. Many clinicians have personal experience managing this transition with loved ones and know it's challenging for both you and them.
- Allow your loved one to maintain as much independence as possible. This approach may be as simple as allowing them to decide the time of day they want a bath by facility staff, to the time they attend meals. Speak with staff about allowing your loved one as much independence and control as possible.
- For patients with dementia, expect about a month of "transition time" for them to adjust to their new living situation. Dementia patients do best with routines and consistency. If loved ones visit at the same time every day, it can help ease this transition
- For caregivers, remember to take care of yourself. We want you to remain their child, friend or neighbor without being burdened by caregiving. Do not feel like you need to be there every day. Allow time for yourself and your own home and family needs.
It's challenging and never easy to move your loved ones out of their home. It may be the safest thing, but that doesn't mean it's the easiest thing to do.
Natalie Mohammad, APRN, C.N.P., is a nurse practitioner in the Division of Community Internal Medicine, Geriatrics and Palliative Care in Rochester, Minnesota. She practices in the Care Transitions and Palliative Care Homebound Programs as well as the Nursing Home practice. She has a special interest in geriatric care, palliative care and having difficult goals of care conversations with loved ones. She spends her non-clinical time gardening or baking gluten-free goodies.