Will You Go to a Nursing Home?

images-1In a recent AARP study, nearly 75% of adults 45 and older said they strongly desire to stay in their current home as long as possible if they have a chronic illness or need long term care. Many baby boomers state that they would never cross the threshold of a traditional nursing home. But what happens if a spouse is not able to take care of you or you can no longer get around your home?

Many assisted living residences have replaced nursing homes to provide care to those who are chronically ill or have lost their mental capacity. But Increasing numbers of baby boomers will seek out new alternatives for independent living where care can be provided.

Intentional communities for philosophical, religious, and lifestyle groups are emerging. Wikipedia describes an intentional community as “a planned residential community designed from the start to have a high degree of social cohesion and teamwork. The members of an intentional community typically hold a common social, political, religious, or spiritual vision and often follow an alternative lifestyle. They typically share responsibilities and resources.”

Alex Mawhinney (jamlll@charter.net) , a developer of retirement communities for over 25 years, reports that “intentional elder neighborhoods are becoming the new paradigm for elder living.” He states that boomers will no longer be interested in “the older generation of elder living options that were available to our parents that follows this model:

  • Age in place — in a home not designed for aging in place, and eventually aging alone
  • Move in with children or other relatives
  • Move to an institution — and pay dearly for care delivered by strangers, under their rules and according to their schedules. The institution might be a nursing home, an assisted living facility, a rest home, a retirement hotel, or a continuing care retirement community with multiple levels of care.

There are SOTELs (service-oriented technically enhanced living—like an upscale Embassy Suites); ecovillages; senior cohousing; and the new lifestyle communities like those being developed by Canyon Ranch.These elder neighborhoods are taking many different forms.

The common traits of these new alternatives are that they are:

  • Human scaled (not large and impersonal)
  • Relationship-based
  • resident managed/centered, with an overlay of lifelong learning, later-life spirituality
  • giving back to the community

Dr. Bill Thomas, came up with an alternative that he describes as “Green Houses”  in the 1990s,  based on “a really radical idea: Let’s abolish the nursing home.”

Thomas, a geriatrician from upstate New York, had patients then who lived in nursing homes, and he realized “that the medicines I was prescribing were not treating the true source of suffering, which was loneliness.”

He also realized that traditional nursing homes were going to have to be replaced soon anyway. “Most of them were built in the 1960s and ’70s, and, you know, their time is done. So I got to asking the question: What comes next?”

What came next were the first Green House homes, which opened in Tupelo, Miss., in 2004. Now, with 148 Green House homes nationwide, there’s enough research to get an idea of how they’re working.

And they’re doing pretty well.

Each resident has their own private room. There are no strict schedules at Green House homes, so while many of the residents gather at the table for lunch, they can have their meals sent to their room. David Farrell, director of the Green House Project nationwide, explains that those private rooms aren’t a luxury — they’re safer than a traditional nursing home, where two or even three people might share a room and also share a bathroom with the two or three people in the room next door.

Research also shows that Green House residents maintain their independence longer than residents of traditional nursing homes, where hallways are long and schedules are tight. “So people really are kind of relegated to a wheelchair in order to efficiently move them around,” Farrell says, “and they quickly lose their ability to walk.”

This program of private rooms and personal service sounds like it could be much more expensive than the traditional nursing home, but Green House home costs have shown to be about the median for nursing homes nationally.

There are now about 150 more Green House homes in development, where residents will be able to enjoy the privacy of their own rooms or the company of the communal table. It’ll be their choice.

Aging In Place

In a recent AARP study, nearly 75% of adults 45 and older said they strongly desire to stay in their current home as long as possible. To make sure that you can “age in place” you may have to make several updates to your home and your financial plan. Do not expect that your children or the government is going to step in and help you out. You need to create a plan to take care of yourself.

In addition to concerns about transportation and the availability and cost of help you need to take a serious look at your home. Don’t wait until there is a crisis to make needed improvements. Are your doorways wide enough to accommodate a wheelchair? A narrow wheelchair or walker needs clearance of at least 32 inches.

Do you have your master bedroom on the first floor? If not, are the steps to the second floor steep and is the stairway narrow? You may have to consider some sort of stairway elevator to get up and down at some point. Do you have a full bathroom on the first floor? If so does it  have a walk in shower? Converting a bathtub to a walk-in shower may cost somewhere between $3000-5000. This is most likely one of your most costly changes.

Look at your faucets and cabinet handles. Are they big enough to access with a closed fist? Check out your lighting. Older eyes need more light to see clearly. Check to see that the lighting is good in areas where tasks are performed. Consider the interior colors in your home. If your home has dark floors, keep the walls light. Change the color at potential tripping points, such as where the carpet on the stairs meets the floor. Are there other step ups or step downs in the home where it is possible to trip and fall?

You need to review access to the home itself. In addition to the entry way being wide enough for a wheelchair or walker, is there room to install a ramp for access if necessary?

Do not wait until someone is coming home from the hospital to consider these steps. Look around now and start planning to make the changes that will help you stay in your home.  Most of the suggestions listed above will not only make your home safe and accessible but they will probably increase its market value as well.