Aging in Place is NOT for Everyone

There. I am on record. Aging in Place is not for everyone. I have never been reluctant to say it, but some readers might think I feel differently. Aging in Place should be one of the viable options. I am an advocate for Aging in Place, It is what I know best. I’ve studied what it will take to make it a viable option. Now what prompted this subject?

I saw the movie Away from Her with Julie Christie. It is a good romantic yarn about a happy and healthy couple in their sixties/seventies. She starts to lose her mind and memory. She pushes her husband to place her in a facility for people with dementia. The movie is a real tearjerker. I recommend it.

I have never been reluctant to say that I am not completely comfortable advising families with dementia and other cognitive problems. I know there are wide degrees of presentation and progressions. I understand that cueing, prompts that help a person remember certain things or ways to behave, can be helpful. That can mean notes on cabinet doors or glass doors to help you remember what is inside. A poster may divert someone from what is behind it. I was once told that a washcloth on the handle of a bedside commode can be a bad cue. The washcloth may suggest someone wash their face there. None of these ideas can be trusted to work every time. None of these are suggestions from expertise, just examples of cueing.

I know that familiarity may slow progress, at least sometimes. From that standpoint it is better to keep folks in surroundings where they have memories. That is one argument for Aging in Place.

The facility depicted in Away from Her allows NO visitors during the first 30 days of residence. They say this helps make a clean, less confusing, break. One staffer suggests it is not necessarily easier on the resident, certainly not easier for the family, but is clearly easier on the staff. Clearly, this clean break from familiarity can hasten memory loss. The resident adapts more easily. Are they giving up the last of their memories and connections to facilitate operations?

I have consulted with families facing some of these issues. I often feel the burden of care is going to be too much. I am particularly attentive to people who want to bring mom or dad home because they are upset about how little of themselves she/he remembers and blames the staff or the place. Guilt and hurt are not good reasons to take over care. The condition will continue to be upsetting, and grow worse. In addition the requirements of care mean other family members are drawn into giving care and get less attention. It is so upsetting to deal with a loved one who does not remember you. There are few opportunities for respite. Caregivers may quickly be worn out and feeling worse with fewer ways to turn.

When is the situation probably not right for Aging in Place and family care?
1. One is when it is not so much about the physical environment as the full range of emotions, energy and reality of what care and presence means.
2. Second, are we hastening the progress too much by moving people when they would progress more slowly if we leave them at home?
3. Third, in this and other types of facility housing when is it okay for management decisions to be made at the expense of the resident in favor of staff convenience?

One of the experts on this subject is a friend of many years, Mark Warner, author of the Complete Guide to Alzheimer’s Proofing You Home. Mark and his wife Ellen run The Alzheimer’s Store. Check their stuff out.