Independent Living - At Home

The folk(s) may be doing very well in their own in their own home. You have watched them for years doing what they have always done - be Mom and Dad. One day you might notice little things that one could usually attribute to "getting old". It happens to all of us. Here are common symptoms one might see in an older person.

• Hearing loss - A fact becoming alarmingly more common in the "boomer" generation, this is also the most common disability incurred by elders.
• Physical limitations - The usual problem is typically arthritis, a painful malady that can affect use of limbs - hands, legs. The parent should get a medical opinion if they haven't already. Range or ability to reach due to confinement to wheelchair or other problems can also begin to restrict a person's abilities around the house.
• Vision impairment - Such as with every organ in the body, eyes can begin to deteriorate.
• Dizziness/disorientation - Common in older people
• Frailty - As we age we tend to loss muscle and body mass. Women can suffer from osteoporosis. It's not something that you are imaging, Mom/Dad are getting smaller. This will present, over time, a wide variety of problems - from driving to taking out the trash and other household chores.

These signs are not necessarily cause for alarm. They are just signs that things are changing for the folks - and you. Take heed. Getting old is not a disease. It just means the body is being modified. As a result it may be the physical environment, the folk's house, that needs to be modified.

Home Modification
When considering all of the housing options for the folks, Home Modification should be considered before any other. Given that health, medical and family barriers are not major obstacles home modification may provide practical, financial and emotional solutions to housing for the folks.

Following are some things to keep in mind so that in the event of an illness and/or disability they won't be forced to move:

SAFETY has to be an overriding consideration. It is estimated that one third to one half of home accidents can be prevented with home modification and repair. If thoughts or concerns of expense arise in considering home modification consider as well the costs associated with medical and/or subsequent health care costs!

Home modification is the alterations and changes needed to accommodate the folks in their home. These could be minor or major items such as installing grab bars in the bathroom to installing a bathroom on the first floor.

Minor items sometimes called Functional Aids or Assistive Devices are generally those products and services that can be installed to assist in the day to day routines around the house. There are entire catalogs devoted solely to this market genre. Here are just some examples some aids and devices;

• For physical limitations: Handy devices for opening jars, easy grip eating & writing utensils, walking aids, bathtub benches & safety handles are a few examples
• For vision limitations: An enormous variety of devices are available in Braille or large type such as clocks and phone/computer accessories. Besides assistive devices there simple, practical things that can be done for visually impaired persons. Increase wattage of light bulbs and put in new, white lampshades for better light. Place contrasting tape along the edges of steps.
• For hearing limitations: A wide range of products for amplification and alerting for doorbells, clocks, phone/computers, smoke alarms and televisions.

Major Home Modification may entail significant and costly changes to the home. This could be any number of things such as wheelchair ramps, door widening, room alterations and accessible plumbing and electrical fixtures. Significant costs may be a consideration.

The financial aspects of major modifications may be daunting but so are the alternatives. Your unique family situation will have to be weighed with facts particular to your family. Devise a plan that weighs all the factors involved:

• Cost of modifications
• Cost of alternate housing
• Cost of additional care - at home and alternate
• The personal desires of the folks - of family
• Benefits pro and con

Check with the local Area Agency on Aging and other senior assist agencies in the folk's community. There are low-interest loan programs for home modifications. If required or prescribed by a doctor the modifications may be tax deductible. If Mom/Dad have an occupational therapist they can provide valuable guidance in planning.

NOTE: If you or the folks are considering major home modification you will most likely need a contractor. As is the case with any industry the vast majority of business people are honest. As you are no doubt aware there are unscrupulous people in the building trades as well. This consumer information is mentioned here because if home modification is planned then 1). It is probably coming at a very critical time, 2). The folks' house is likely their most valuable asset and 3) Dealing with bad contractors at this time (or any time) is very frustrating.

There are many ways in which a bad contractor can rip you and/or the folks off. A few of the more common ways are, not completing work on time and to satisfaction, using inferior products and materials, overcharging, change-orders, ridiculously low bids, making false claims and adding extra work.

Check with the local Better Business Bureau or contact the National Association of the Remodeling Industry, 4900 Seminary Road, Suite 320, Alexandria, Virginia 22311 or www.nari.org.

If financing the home modifications is an obstacle one possible source of funding may be the house itself. The FINANCES section of this guide discusses among other options, reverse mortgages, a type of Home Equity Conversion.

The Home Itself - A Checklist:
• Is it expensive to maintain?
• What modifications necessary to:
• Insure their safety?
• Improve their mobility?

Check For Obstacles - inside and out which can become difficult to negotiate:
• steps
• hills
• other barriers
• Is there a first floor room suitable as a bedroom?
• Is there a first floor bathroom that could be wheelchair-accessible?

Availability of Community Services
• What kind of transportation services are available? See Transportation in CAREGIVING Chapter.
• What kind of health care providers are there in the community?
• What kind of health care facilities are there?
• What kind of supportive in-home services & community-based services are there?

PERS - PERSONAL EMERGENCY RESPONSE SYSTEMS
PERS are devices used to summon emergency help to the home. PERS are mentioned here as a device to be considered, if necessary, in assisting your folks stay in their home. There may be costs associated with the PERS. Inquire about PERS from the Local Area Agency on Aging. Check the phone book for agencies or contact ELDERCARE 1 800 677-1116 for the agency nearest the folks.

Technology is changing almost daily. Computers with E-mail are getting cheaper and easier to use. Communications can now be accomplished with televisions and pagers. Make attempts to discern what communication devices are currently available and how they might best suit your needs. Start with some questions about the folks, their communicative needs and what might best suit those needs. Expand and/or modify these questions to your situation.

• Would it be useful/practical to have enhanced or adaptive communications for the folks?
  
  
• Who would they contact for emergencies, assistance, or just to talk?
  
  
• What technologies are currently available in your folks area and would they use them?
  
  
• What are costs associated with the communications.

It is difficult to keep up with the evolvement of communication technology. The tried and true way is to network. After assessing family needs talk with local Area Agencies on Aging, support service groups, the phone company, local alarm service companies, friends, etc.

Medicare will pay for some home health services, provided certain criteria are met:

• Services must be provided by a Medicare certified Home Health agency;
  
  
• Your parent must be confined to their residence;
  
  
• The care must be short term or rehabilitative; and
  
  
• The care must be of the type prescribed by the physician, i.e., a therapy such as occupational, speech or physical, or care requiring skilled nursing.

If these conditions are met Medicare Part A will pay the full costs of approved services such as part time nursing or rehabilitation Mom/Dad could be responsible for a 20% coinsurance charge for medical equipment such as a walker or wheelchair.

Home care can be provided by many types of medical professionals such as nurses, therapists, nutritionists, aides and medical social workers.

The folks have had a home for as long as you can remember. Very likely you grew up there. Your folks have their house(s) their home for a long time and whether or not they own their home its likely they enjoy being there. Over time it can be increasingly difficult for them to stay in their home for either financial or physical limitations. At some point they will begin to need some help staying in their home.

This assistance can range from the once a week lawn and yard service to daily nursing care. Sooner or later the folks, even with the given that they stay healthy, will increasingly need a hand around the house.

Being in one's home can lend a sense of independence of which much can be said. But you also want to be sure that if Mom &/or Dad are going to remain in their home, that the home is safe, secure and the community services they may need in time are available. Be sure and review chapters Transportation and Safety.

Most often people prefer to remain in their own homes for as long as possible. It is a familiar place - one with the comforts and memories generally acquired through time with family and friends. It has all the accessories of comfort, solace, peace and reassurance. Home is where the heart is.

1.Housing Intro
2.Independent Living - At Home
3.Independent Living - Other Options
4.Semi-Independent Living
5.Dependent Care