Aging in Place: When Is It the Right Choice?

Hi everybody! Welcome to another new episode

of the Truth, Lies, and Alzheimer's show, and I'm Lisa

Skinner, your host. There is a fairly new term that has

surfaced in the last five to 10 years. It's called aging in

place, and it's become extremely popular, especially since COVID.

And I've noticed that a lot of people Google that term. So I

thought it would be great to do an episode dedicated to what is

aging in place, what does it mean, and then how can we choose

between aging in place, assisted living, and memory care? So I'm

going to share all that information with you. So let's

start with what is aging in place. Aging in place means that

a person lives in their own home, which would be their

house, their condo, their apartment, or a similar

residence, safely and comfortably for as long as

possible, and as their needs change, it is not a single event

like staying put forever. Instead, it's an approach that

typically involves ongoing planning, home safety

adjustments, having support services in place like in-home

help and community resources, making sure regular assessments

as health and abilities will definitely be changing. So, what

aging in place means in practice? It means a person will

keep their familiar environment, their familiar routines, their

familiar neighbors and community, and that they

maintain their own personal preferences in daily life,

meaning their meals, their activities, their sleep

schedule, and their privacy. But it also means proactively

reducing living risks, and to do this, maybe there will be a need

to implement preventive fall measures. Put those in place.

Need to implement improved medication safety measures. Need

to address Transportation challenges, and need to ensure

the home remains accessible as a person's mobility changes

through building a reliable and readily available support

system, through family involvement, etc. Need to have a

plan for somebody that checks in with them, that coordinates

their daily life, or provides hands-on help. That could be

with paid caregivers available to help with bathing, dressing,

meals, housekeeping, companionship. It also means

having or having identified healthcare and therapy support

resources that would include primary care, home health, PT

and OT, physical therapy or occupational therapy, as needed.

Now, some of the core components of successful aging in place is,

of course, having a plan, having a home readiness plan in place.

So make sure that trip hazards have been removed, like loose

rugs, clutter, poor lighting. That measures have been taken to

enhance bathroom safety, like installing grab bars, safer

shower access. That you've improved the mobility routes

that they walk around their home environment, and to do this, you

need to make sure that pathways are cleared. Consider ramps or

stair solutions. You have a care coordination plan in place. For

example, decide ahead of time who is going to help, how often

they can help, and with which tasks. Coordinate medical care

with home support services. You have a plan for emergencies

already in place, such as what is what is going. Happen if

there's a fall that you notice worsening confusion or a sudden

illness, you have a plan to maintain their autonomy while

ensuring daily tasks remain feasible. You also need to have

reassessment plans in place over time, which includes a plan to

review their existing care plan after health changes, after a

hospitalization perhaps, after medication changes, and after

functional decline, which it will inevitably happen as they

progress through the stages of dementia. Now we also need to

devise a plan to revisit both physical safety and cognitive

safety, especially if dementia is present or suspected. So,

here are some comparisons between aging in place versus

assisted living versus memory care, and these are things that

we need to take into consideration. Now, in the aging

in place model, where the person lives is in their own home. The

support model will lean heavily on in-home services and family

or community coordination. It's a best fit when needs can be

safely met with modifications and, of course, reliable help.

Those people are going to show up when they're supposed to be

there. Now, comparing to the assisted living model, where the

person lives is in a residential community in the private

apartment or a room with shared amenities. The support model is

that staff is on site and they help with activities of of daily

living.

In other words, the ADLs and with medication coordination.

Best fit for that environment is when a person needs consistent

help and possibly supervision, but do not require specialized

dementia programming. They're not far enough along in the

stage of dementia. They're still in the early stage if they do

have it to fit well into assisted living. Now, when we

compare that to actual memory care environment, the person

will live in a specialized dementia-focused community, a

room within that specialized community, the support model

here is higher supervision and dementia-informed programming.

When it comes to that choice for your loved one, make sure the

staff has gone through extensive dementia care training. It's

going to make all the difference in the world to their quality of

life. The best fit in this case is when dementia-related

behaviors or cognitive impairment make home or standard

assisted living unsafe or ineffective. Now, what does

assisted living typically provide? Some of the more common

services are assistance with their activities of daily

living, which are bathing, dressing, grooming, toileting,

and mobility. They manage medication and do medication

reminders. And depending on the facility and their level of

need, they provide meals and basic housekeeping. They provide

activities and social programming. They provide

scheduled care staff availability, and what varies

widely in assisted living. Level of dementia specialization. Some

communities have limited dementia programming. The staff

to resident ratios and response capabilities vary from assisted

living to assisted living. You want to make sure that you know

how they handle worsening medical or behavioral needs, and

then in terms of memory care and actual dedication. Memory care

neighborhood. What actually makes it different from assisted

living? Well, it is exclusively designed for dementia-related

needs. It provides structured routines to reduce confusion,

the dementia staff is hopefully very well trained. The

environmental design that supports safety and orientation

exists within the Environment, and they also have a very

well-planned features for safety and supervision. It typically

provides a secure environment, especially if wandering is a

risk. They provide greater monitoring than in standard

assisted living, but of course that also varies facility to

facility. They have plans in place and skilled training for

approaches to address agitation, resistance to care, and with

communication challenges, they're focused on behavioral

and cognitive expressions. They have care plans that address

behavioral triggers like noise, lighting, and unmet needs. How

to recognize that they're trying to communicate something, and

then of course the caregivers will immediately know how to

determine what triggered whatever the behavior is that

has just shown up. They offer activities that are tailored to

each individual person's cognitive abilities. It's not a

one-size-fits-all program. They are very proficient in

redirection and communication strategies. So here are some

things that people need to know and things to consider before

choosing aging in place. These are what I call decision

essentials. What is the person's mobility and fall risk

currently? Do they have gait instability? Are they balance

challenged? Do they have difficulty navigating stairs or

bathroom access? In terms of their activities of daily

living, we need to consider the approach to bathing, dressing,

toileting, eating, transferring, and mobility. Instrumental

activities of daily living; those include cooking, cleaning,

shopping, transportation, managing medications, and

finance. All of these things need to be considered for aging

in place, the home environment is extremely important. You need

to consider lighting, the bathroom setup, the entry or

exit, nighttime pathways. If they get up in the middle of the

night and need to go to the bathroom, make sure they know

exactly how to get from their bed to the closest bathroom, and

of course, kitchen safety needs to be considered. Medical

complexity and medication management complexity it refers

to having multiple prescriptions, insulin,

anticoagulants, whatever it is they have, the ability to track

the refills, the dosing and side effects, have a log, and then of

course, access to healthcare, the ability to attend

appointments to get them to their appointments, a plan for

home health services or therapy if and when needed, their

cognitive health and dementia risk, mild cognitive impairment

versus dementia. What are some of the things that we need to

consider here? Well, forgetting can progress into

safety-relevant errors over time. Did that cross your mind?

There are dementia risk factors.

That can change the plan, like wandering tendencies, nighttime

confusion that maybe just showed up out of nowhere, medication

mistakes, unsafe stove use, or leaving doors unlocked. And here

is a key question: Can you maintain consistent supervision

and safe structure at home as the cognition changes? Got to

have a plan for everything in place. You need to consider

caregiver and household capacity. Who'd have thought of

that? Care is not just emotional; it's also

operational. You have to think about scheduling, training,

physical assistance, documentation, caregiver burnout

risk. Even devoted family caregivers can reach limits. So

practical realism here includes who covers mornings, evenings,

etc. Aging in place is usually about capacity, not willpower.

Even with love and good intentions, anybody may reach a

point where consistent supervision and hands-on help

are no longer realistic. Safety isn't only physical. There are

medication errors to be mindful of, leaving appliances on, scams

that target the elderly, financial mistakes, and getting

lost can be just as dangerous as falls. As we know, dementia can

shift risk quickly, sometimes much faster than we expected.

Care needs rise, or can rise in spikes and not a straight line.

A fall, an infection, a medication change, or a

hospitalization can cause a sudden decline in your loved

one, so we must have a plan for what happens after these

setbacks. Not only day-to-day function, but ongoing, long-term

caregiving coverage must include nights and emergencies, and I'll

tell you, many families underestimate nighttime

supervision. They think, "Oh well, my loved one's going to be

sleeping throughout the night. That is not necessarily the

case, especially with mid to late stage dementia. We see

sleep reversal patterns with dementia, wandering, repeated

bathroom trips, and extreme confusion. So, who's going to be

available at night? What are you going to do if a caregiver calls

out? What's your backup plan for this? Transitions can take time,

even if you're trying to be fast moving to assisted living or

memory care, because it often involves wait lists. Do your

homework. Find out what availability looks like on

Average, what paperwork do you need to have taken care of?

You're going to probably need a full exam at your doctor's

office at your loved one's doctor before they will admit

you. Sometimes that takes a while. Waiting for a crisis can

inevitably reduce your options and also increase your stress.

And not all assisted living communities handle dementia

well. Some can support early symptoms; others struggle as

behaviors change, and they will and do change. Now, memory care

is not automatically equivalent across providers, staff,

training, and security. Practices matter here; they'll

make all the difference in the world to quality of life, and we

all want to make sure that we are providing our loved ones

with the best and highest quality of life possible under

these circumstances. Now, in terms of aging in place, home

modifications are much easier to do. The earlier, the better.

Like installing grab bars. Improving bathroom access and

improving lighting are much easier before a crisis or an

injury occurs. Delaying upgrades often increases a person's fall

risk and caregiver strain. Budget and affordability

planning is a necessary consideration: in-home care

hours, home modifications, transportation, and supplies can

all add up quickly. They can become expensive. Ask about

total monthly costs, not just base Rates, care hours,

medication management fees, levels of care changes-these are

all part of the admission process, the assessment process

in assisted living and memory care. Now, written care rules

prevent confusion during stressful moments, so create

simple instructions for your care partners, like the

medication routine, meal preferences, who to call, what

behaviors mean, preferred calming Strategies for dementia

consistency in approach is very important to make sure that we

reduce agitation and not exacerbate it. And I want you to

know, caregiver burnout is a real medical issue. If the care

partner is exhausted, the person's safety and quality of

care will also drop. So build a respite plan into the whole

experience, even short breaks can help. You need to consider

legal and financial planning, and this should happen earlier

than you think before they progress too far into the

dementia and no longer have a sound mind. You want to consider

advance directives, a power of attorney, a healthcare proxy,

and how decisions will be made if your loved one's cognition

declines. This is going to reduce conflict and delays later

on.

Make a threshold conversation with the family now. Decide

together what triggers help escalation or a move? Wandering

medication errors, repeated unsafe nighttime incidents,

frequent falls. The goal is to remove blame during crisis

decisions. So here is what I created for you: an aging in

place readiness family checklist. So, safety basics in

the home, bathroom safety ready grab bars, safer shower or tub

setup, non-slip surfaces, toilet height is supportive if needed.

Their fall risks are reduced. Clear the walkways. No clutter

or loose rugs. Good lighting in the hallways and nighttime

routes. Steps or stairs are addressed. Ramp stair solutions

are in place if needed for kitchen and stove safety. Stoves

can be used safely or have a plan to reduce risk. Make sure

there's a plan for easy to reach food areas. Have an emergency

plan in place, like phone accessibility or medical alert

system if appropriate, who is going to be called, and how

quickly help can arrive. Then we need to think about having a

plan for daily needs, which cover bathing and personal care,

and this is a realistic checklist that needs to be in

place, who's going to help? How often? And what tasks are going

to be covered? If toileting support is planned, does it

include nighttime needs if relevant? We need a meals and

hydration plan, regular meals plan for reduced appetite or for

getting meals. We need a transportation plan. How

appointments and errands will be handled consistently. We need a

medication plan. This is critical. Medication management.

We have to feel confident that it's reliable, that someone will

track doses. Not just remembering them. This system in

place prevents missed doses and double dosing. How are you going

to handle refills? A clear responsibility and a timeline

for refills, and for new prescriptions need to update

their care plan and include new prescriptions, and have clear

instructions for any changes, especially after a

hospitalization. And that pretty much covers everything I feel is

really critical and essential for everybody to know if you

really prefer or your loved one prefers aging in place for as

long as they possibly can. And I know right now statistically,

more people want to stay in their own homes than They have

pre-COVID, so it's perfectly okay as long as you take under

consideration everything that I have shared with you today. So

thanks again for being here. I hope this has been extremely

helpful, and that you know you start taking these things into

consideration now, and not wait until there's a crisis on your

hands. So I will be back next week with another new episode of

the Truth, Lies, and Alzheimer show. Again, I'm Lisa Skinner,

your host. So glad you could all be here with me today, and as I

always say, have a great rest of your week. Always try to stay

happy and as healthy as you possibly can, and I will be back

next week with another new episode for you. So take care

for now, and I'll be back next week. Thanks again. Bye bye.