While most older adults want to age in their homes, some of them will find themselves institutionalized. While many are receptive to assisted living as they age, very few consider skilled nursing facility a welcome outcome. If we take a closer look at Nursing home admissions data, most residents are admitted from some sort of healthcare facilities, such as hospitals or rehabilitation centers, with only around 5.3% admitted from home. In comparison, around 30% of Assisted Living residents are admitted from home. Home dwelling persons with dementia showed a significantly higher quality of life (QUALID) than persons with dementia in Nursing Homes. Only 44% of nursing home residents maintained their functional capacity after two years. Of those admitted to a Nursing Home, a large percentage never return to the community.
Dementia and diabetes are among the strongest predictors for Nursing Home admissions. These are chronic conditions that result in functional limitations and require careful management. Falls and resulting injuries are another major predictors of Nursing Home admission. Several studies have been conducted in an attempt to identify individuals at risk for institutionalization in order to avoid Nursing Home admission through care planning an
d resource allocation.
Given the facts that nursing home admission is not a desirable outcome, and that it can be at least partially predicted, future planning and resource management appear to be the winning strategies for those hoping to age in place.
While the cost-effectiveness of aging in place interventions has been proven, most of us, have a vague idea of the specific needs of older adults that contribute to successful aging in place (such as home maintenance, home modifications) and what is available in the community.
Community-based organizations benefit a large population of older adults and their caregivers. Early identification of the need is crucial to help seniors manage their health effectively and prevent functional decline. For planners, family members, and healthcare professionals, it is beneficial to be aware of and discuss the following services before the need is urgent:
1. Meals. Home delivered and congregate (offered in a community setting). Subsidized nutrition programs for older adults are not limited to widely known “Meals on Wheels”. The services are designed to reduce food insecurity, promote health, well-being, and social inclusion. https://acl.gov/programs/health-wellness/nutrition-services
2. Transportation. From county/city senior public transportation services to volunteer organizations such as “Drive a senior”, safe and reliable transportation enables older adults to remain active members of the community, reduces isolation, and helps seniors keep their scheduled medical appointments.
3. Home safety. Home assessment by licensed occupational therapists and modification to ensure accessibility and safety of the home environment, increase a person’s independence within their home, and prevent falls.
4. Case management. Personalized management of one’s healthcare to ensure positive outcomes. Identification of emerging medical and psychosocial needs, and assistance with access to appropriate services and resources.
5. Home maintenance. Delinquency with home repairs, cleaning, and yard work due to health reasons results in increased fall risk, decreased quality of life, decreased ability to perform self-care due to cluttered environment, insufficient lighting, malfunctioning appliances.
6. Information, access, and legal services. Services aimed to identify available resources, determine eligibility, provide consultation and representation for benefits, financial, and housing matters.
7. Caregiver services. Include personal assistance with self-care tasks, respite care, and adult day services (community-based Monday-Friday services).
8. Senior centers. Aimed to improve the physical and mental well-being of older adults, these facilities offer a variety of activities including exercise classes, support groups, hobby-based activities. They also serve as resource centers for available senior services in the area.
9. Technology providers. Research shows that older adults more readily adopt technology that increases their personal safety or offers means to social interaction. The personal safety category is broad and includes medical alert devices, digital smartwatch technology with fall sensors, tracking technologies for persons with dementia, house alarms, and many more. Social interaction frequently includes phone and computer use. Additional technology solutions are available within the home modification realm and include smart home features, automatic door openers, and electronic aids to daily living.
The services listed above vary based on the area. Area Agency on Aging Network can be a good starting point to see what is available, in addition to the national eldercare locator (www.eldercare.gov), and web search of individual services in a specific location. Knowing your options, as well as bringing the needed services on board early on can be critical to keeping older adults successfully aging in the community.