I have a Stone Soup comic (https://www.stonesoupcartoons.com/) posted by my desk. In this two block strip, two older men are sitting on a park bench. One of the men states “They sat me down and said, ‘Pops, we need to talk about aging in place.’ ” In the next frame, he continues “I said, ‘Aging in place of what?’ “
The cartoon may be referencing alternatives to aging (and I’ve been told by a number of older adults during my career, “Honey, don’t get old”), but “aging in place” has become a loosely defined catch phrase among older adult service providers for individuals who remain at home and don’t move to a congregate living facility.
Over the years, our firm’s interactions with older adults indicate that the majority would prefer to remain in their own home, even though they may not fully understand the implications of “aging in place.” This concept appeals to older adults for a variety of reasons.
Aging at home implies freedom and independence to many older adults. They see home as the place where personal control is absolute. At home they can make their own choices and do things their own way (in reality, sometimes this works and other times it doesn’t). Even if loved ones are providing assistance to the older adult with one or more tasks of daily living, if they are not paying for any type of service, they may continue to consider themselves to be “independent.”
Aging at home also allows older adults the comfort of remaining in a familiar environment. They are surrounded by a lifetime of personal belongings and may have lived in the same house or apartment for many years. Additional reassurance may come from understanding the community which surrounds them, whether it be a rural area, town, or city; even if an individual was not particularly active in the community. Community accessibility and services such as transportation, shopping, medical care, and recreational opportunities can influence the ease of “aging in place.”
Finally, a belief that family members/loved ones will provide the best care if the need arises promotes feelings of acceptance and security. It is natural to seek assistance from others who care about us before considering other alternatives. Although loved ones may lack knowledge and/or experience related to caregiving, good intentions may be more important than skill to the individual who is facing the possibility of a major change to his/her lifestyle because of care needs.
While aging in place may bring to mind staying in a home where someone has been for an extended period of time, some older adults choose to move to a different location with the goal of “aging in place” in their new surroundings. Intentional planning for potential changes in one’s physical abilities and/or financial situation may lead an individual to consider a retirement community, a smaller or more accessible home, a home or apartment close to other family members, or sharing a home with other family members or friends (remember The Golden Girls?). As with any other life event, planning ahead for “aging in place” allows more time to explore options, to handle details, and to prepare emotionally, psychologically, and physically for change. Without planning, “aging in place” can look very different when a crisis occurs and forces the implementation of immediate strategies to meet care needs and maintain safety.
For the best outcomes, “aging in place” requires a focus not only on physical location but also on an individual’s willingness and ability to adapt to and accept change. The ultimate goal may be to “die in my sleep in my own bed,” but a high likelihood exists that routines, people, and the immediate environment may require adjustments along the road to that goal. Meal preparation, social activities, and personal care habits are examples of routines which may become challenging and need some tweaking. People other than family members or friends may spend time in the home as companions or caregivers. Changes to the environment may become necessary for safety, for example moving to a bedroom on the first floor and/or the installation of a ramp to enter and exit if stairs become challenging, or the removal of throw rugs and “clutter” or the reorganization of furniture to reduce falls (https://keystoneelderlaw.com/sentinel-articles/a-user-friendly-home-keystone-elder-law-mechanicsburg-pa/).
Factors outside of an individual’s control may also influence an ability to “age in place.” Neighbors, friends, and family who are part of an individual’s support system may move away. Natural disasters or national/world events may change the look, feel, and function of a community or impact an individual’s financial status and security.
“Aging in place” involves much more than just staying at home. It is a complex approach to daily living which must constantly evolve with an older adult and his/her personality, circumstances, health, and environment. The ability to age in place is influenced by personal, cultural, and societal elements. As our nation’s older population increases, enhanced concepts and systems which promote “aging in place” will be part of our future.
Karen Kaslow, RN, BSN