Old age is sometimes associated with deterioration of the body and mind. In these cases living alone may no longer be a safe option. This article will explore alternate living arrangements and supports that seniors and those affected by a loss of independence may need to consider.
Living With Supportive Family
One of the most common living arrangements is to reside with one’s family or relatives. This is a great alternative for several reasons:
- Financial resources can be pooled together
- Family can provide support with everyday living tasks such as bathing, dressing and meal preparation if needed
- Family can help with transportation to medical appointments and stay on top of upcoming medical procedures and tests
- Families can advocate for their loved ones and get the care they need in a timely fashion and help navigate complex medical systems
- Family can remind the elderly to take their medication, organize it into a pill box or help administer it
- Family units can better plan for future care needs and are often better at seeking supports from healthcare providers when required
When compared to other types of living circumstances, a close knit family often contributes to better overall health and happiness. This is not surprising as often it is one’s family that cares the most regarding one’s health and quality of life.
That said, not all families are equal and some may experience burnout. For example, dealing with an aging parents or relatives, but also with work responsibilities and/or child care could take a toll on one’s energy reserves or financial situation. In this situation, there is a high probability of caregiver burnout, and one may require additional supports like home care or a personal support worker to supplement or meet one’s needs. Let’s explore how these different services could help one age safely within their home.
Home Care or Home Supports
Home care supports is a broad term for services that can be arranged in various settings ranging from one’s home to a retirement community and many more places. This service can encompass many different professionals whose purpose is to help support one to safely age in place, and reduce the risk of being admitted into a nursing home. These healthcare workers typically offer their support in various ways:
- Occupational therapy to maximize home safety and independence with things like bathing, dressing, feeding, but also household duties like cleaning and laundry. They train you to do the things that you normally do in a safe manner while taking into consideration declines in physical strength or cognitive abilities.
- Physical therapy to boost one’s strength, endurance and balance with a home exercise program. They try to get you back to a baseline in terms of your physical abilities following acute illness or injury and deconditioning after a hospital stay.
- Personal support worker to assist one with dressing or bathing when one cannot safely do these things on their own. They can be present to physically help you get in or out of the shower, but can also help you with the act of bathing. Typically reserved for people that are unable to manage their own personal care needs.
- Speech language pathology can help with treating communication impairments and address issues with swallowing food or fluids.
- Nursing to help with wound care, intravenous and subcutaneous medication administration when ordered by a doctor. This helps to promote healing of wounds or injuries and to reduce hospital admissions.
- Case manager to coordinate one’s healthcare and address any additional needs as they arise. They also provide system navigation and help one better understand how the healthcare system works to better serve their patients.
- Home visiting pharmacist to review one’s medication regime. They ensure that meds are being taken correctly and that there are no adverse side effects or interactions.
- Home visiting physician to review one’s medical conditions and prescribe treatment to lead to overall better health and quality of life.
- Mental health workers to support one’s mental state in times of crises. They can provide counseling and reassurance as required.
The above list of services are typically offered by many home and community care agencies, however there may be service restrictions or waiting lists in effect. Quite often there is an overwhelming demand for these services, but only so much funding allocated to them. In cases like these, people need to be put onto a wait list unless they are able to afford privately pay for their care. Let’s now talk about personal support workers, a service that is most commonly on wait list.
Personal Support Worker Assistance
This is a healthcare provider that helps people with their personal care such as bathing, dressing and spoon feeding those that cannot feed themselves. Their role is typically limited to these duties when the service is provided free of charge by a government run organization. However, if paid for privately, their role and scope can expand to include light housekeeping, preparing food, doing one’s laundry and other duties.
This service is found in almost every environment ranging from hospitals where they help acutely ill patients to nursing homes where they support the chronically ill and aging population. As well they can be found in one’s home, and may even be employed at retirement homes or in assistive living divisions.
Note that while this service is considered a member of the health team, it is possible that your personal support worker has no formal training or education at all. These workers have no regulating college or body, and thus need no special training or education to call themselves personal support workers. That said, there are many college programs out there where one can obtain a certificate or diploma in this field. Quite often the larger institutions like hospitals or long term care settings require this training and experience before they are hired. In contrast, smaller agencies that provide assistance in the home sometimes have less stringent requirements.
Independent Senior Living Community
Also known as a retirement community, this environment is usually a congregation of seniors that are able to live on their own with very limited assistance. If there is a need for assistance, it usually involves minimal supports like medication reminders and/or supervision with high risk activities such as bathing. Generally the elderly that live in this environment manage their own meal preparation, however help with this can also be obtained for an additional fee. This assistance is usually provided by a third party agency hired to be in the building, government agency or by the person themselves to provide support on an as needed basis. Commonly this living setup is found in apartment buildings or small housing units where there is minimal home or yard maintenance involved. This offers advantages to a senior that can no longer perform these duties on their own, but wish to maintain a respectable quality of life. In some cases, this housing may even be subsidized so seniors can afford to live here at reduced rates.
A retirement home is a building for seniors where services like meals, changing of bed sheets and light vacuuming is provided. This environment essentially allows the elderly to congregate in a common setting so that many of their care needs can be met as a group. As a result, one benefit to retirement homes is the increased socialization experienced in shared dining halls, planned activities like card games or other special events. As well, the individual rooms are often made to be senior friendly with open spacious pathways, safety equipment in the bathroom, and nearby emergency alert systems.
One thing to remember is that living in a retirement home is like a taking a trip on a cruise ship. With your monthly fee, you are only paying for the boarding pass to eat and stay in the retirement residence. Any additional services you want will cost you extra and these fees add up. When exploring different retirement homes, it is important to consider what amenities are included in the base package, and what can be added later when a need arises. For an additional fee, it is not uncommon for homes to have the option to:
- delivery of meals to one’s room when there are difficulties walking to the dining hall
- push a wheelchair to the dining hall and back when the resident has difficulty doing this on their own
- perform regular housekeeping
- do one’s laundry
- help with bathing when one is at risk of falling in the shower or has difficulty with stepping in and out
- manage one’s medication and ensure they are taken at the appropriate time
- regularly check in on a resident to ensure they have not had a fall
In a sense, a retirement home can resemble an assistive living home in many ways when the additional services are purchased. This should not be surprising as assistive living floors are often found in many retirement homes, where these additional needs can be supported easily by the existing staff. That said, it should be noted that this environment cannot provide round the clock 24 hour nursing care that is commonly found in a long term care home.
Assistive living is very similar to a retirement home, however it is typically a place for people with higher care needs. Usually these individuals require assistance with daily activities like medication, eating, bathing, dressing, and toileting and would be unable to cope on their own without these supports. Because of the increased service needs, assistive living is more expensive compared to a retirement home. While these places typically have nurses on staff to perform simple tasks like uncomplicated wound care, these facilities cannot provide 24/7 nursing care for complex patients.
Nursing Home or Long Term Care
A long term care home is typically used when all other community resources have been exhausted and one is incapable of living safely outside of a supervised setting. Typically, people admitted into nursing homes require 24 hour care and supervision from nursing and related healthcare staff.
Let now differentiate between a nursing home and a hospital setting. They both offer similar levels of care and supervision, however there is a big difference between the two. Hospital admissions and visits are generally more costly and reserved for people that are acutely ill. Once someone is declared medically stable, they are discharged to free up beds for other ill patients. However, when determined that one cannot live safely in the community, a crisis placement into a long term care home may be initiated to help minimize hospital use while meeting one’s care needs.
Commonly, people in long term care settings have complex medical needs which affect all aspects of their living. This can range from impairment of one’s thinking, understanding, rationalization, but can also include deficits in one’s physical abilities or endurance. Overall these people are unable to manage their own care needs, and require a high level of support round the clock. Some common diagnoses that are seen in admitted patients include the advanced stage of:
- Multiple sclerosis.
- Dementia and Alzheimer’s disease.
- Parkinson’s disease.
- And generally, any age related diseases that contribute to a decline in physical, cognitive and/or mental abilities.