Navigating Health and Aging: What aging in place really means

Last month, and for three days, an "Aging in Place" series ran in the Carroll County Times. I would like to share my experienced and professional differences to many of the facts that are stated in these articles.

I argue that beginning the "Aging in Place" series with an article titled, "Move to a facility can boost quality of life" is misleading. First and foremost, moving to a facility is the alternative to aging in place. Moving to a facility is often a decision arrived upon after very much consideration and agony over the decision on the part of seniors and/or their family members. This happens when the alternative to remain at home is no longer an option due to finances or medical necessities.

Aging in place, the latest catchphrase in the world of aging, expresses the desire to remain in the home; not to move to a facility.

In order to successfully age in place, one must do more than just wish it to happen. A great deal of financial, legal and health planning must take place before it just happens.

In previous columns, I have discussed and emphasized the need to plan ahead and make physical environment changes to remain safe in your home. Financial planning to accommodate for modifications of space, help or services from home care aides if needed, and sustainability of a lifestyle, which can become expensive, is imperative. Relying on services from the state in the form of programs to support the expense of aging in place is never a good plan. The waiting lists for some state-sponsored services are long and the amount of help offered through state-sponsored programs may not be inclusive enough to provide sufficient care.

For those who do remain in their homes when aging with health concerns that may impact their independence, home health aides or companions may provide the support they require in order to remain independent and successful. Residential service agencies or companion care companies must not be confused with "home health agencies." The difference between home health that Medicare pays for after a hospitalization, for example, and a residential service agency - which provides nursing aides or certified nursing assistants - is the level of care and payment sources. Residential services agencies do not provide skilled services such as registered nurses, physical therapy and occupational therapy. They strictly have nursing aides with oversight from registered nurses. Medicare does not pay for them. They are strictly private pay, or in some cases subsidized by state programs if available. The costs can be offset with long-term health insurance.

There is also the problem of not having the proverbial crystal ball. No one knows what the future holds. A health crisis may prohibit the ability to age in place at least for some period of time. Those who wish to be proactive may move into a continuing care retirement community or CCRC. In Carroll County, those would include Fairhaven and Carroll Lutheran Village.

The series compared these communities to "college dormitories." If I were a marketing representative or a potential resident, I would rather think of CCRC's as a place where diverse, proactive seniors live in a supportive community atmosphere to explore common interests, utilize a whole host of services and have peace of mind for a lifetime of care. Often, these communities are comparable to perhaps an all-inclusive resort-like setting, rather than a college dormitory. CCRC's are high-ticket communities with amenities and the opportunity to age in place - or at least age in community.

When aging in your home or community is no longer an option, then assisted living offers the next level of care to promote some independence, while not being the most restrictive environment.

In my world of geriatric care management, my goal is to keep individuals in the least restrictive environment, while preserving the highest level of functionality and maintaining safety and dignity. Assisted living can provide a more home-like and affordable option. When I say more affordable, I mean less per month than the nursing home prices. These facilities are not paid for by Medicare. Helpful hint: Medicare does not pay for anything other than hospitalization and some outpatient care. Not home aides, assisted living or long-term nursing home care. One of the most frequently asked questions I hear: "Will Medicare pay for the assisted living or nursing home?" In a perfect world, yes - but not in our world.

Finally, moving on to a nursing home, while not preferable to many, can be the best or only option for some families. Is it aging in place? No. Should we have another long discussion about benefits of long-term care and payment options? Yes. However, this should not occur in the same discussion as aging in place. I will save that for another day.