World's Oldest Woman Passes away

Yone Minagawa, named the world’s oldest person in January, died of old age (114!) Monday in a nursing home 520 miles southwest of Tokyo. She reportedly had seven grandchildren, 12 great-grandchildren and two great-great-grandchildren.

Joint Commission on Human Rights Report

Here's a report from England with some interesting reading regarding seniors and their rights released August 17. It seems they've enacted a Human Rights Act with a portion dedicated to seniors and have a follow up report which can be found here, but some key points are at the end of this posting. relating to their recommendations on findings of senior abuse and ageism.

Treatment of older people in hospitals and care homes

1. In our view, elder abuse is a serious and severe human rights abuse which is perpetrated on vulnerable older people who often depend on their abusers to provide them with care. Not only is it a betrayal of trust, it would also, in certain circumstances, amount to a criminal offence. (Paragraph 20)

4. What became clear to us from the evidence is that an older person's age is much less likely to be directly taken into account when decisions are taken about his or her healthcare than in the past. However, age discrimination in both hospitals and care homes is now more subtle and indirect. (Paragraph 47)

5. We consider that the power imbalance between service providers and service users and the strong evidence that we have received of historic and embedded ageism within healthcare for older people are important factors in the failure to respect and protect the human rights of older people. These problems require more than simply action at the local level, but an entire culture change in the way that healthcare services for older people are run, as well as strong leadership from the top. The Human Rights Act has an important role to play in moving the culture to one where the needs of the individual older person are at the heart of healthcare services. (Paragraph 59)

The role of staff in protecting human rights

40. In our view, human rights training should have been provided throughout hospitals and care homes and other public service organisations from 2000. We recommend that all staff working in healthcare (both clinical and non-clinical) receive targeted and regular training in human rights principles and positive duties and how they apply to their work. (Paragraph 222)

44. Whilst we do not want to increase the burdens on healthcare staff, we are conscious that they have a vital role to play in ensuring that all patients and residents with whom they come into contact are treated with dignity and respect and are not subjected to abuse. A duty to report suspected abuse is more than merely a moral duty and we consider that such a duty should be a requirement for all staff working in the NHS and in care homes. We therefore recommend that the Government include a requirement in both the Care Standards for Better Health and the National Minimum Standards for Care Homes for Older People (or, as we have already recommended, preferably in one set of integrated care standards) that hospitals and care homes should have a policy requiring all healthcare workers to report abuse or suspected abuse, with protection for whistle-blowing and confidentiality. (Paragraph 232)

Empowering older people

45. We were alarmed and concerned by how little protection care home residents appear to have against eviction, as compared to ordinary tenants in rented accommodation who have the protection of housing legislation, and suggest that rectifying this anomaly be considered as a matter of urgency. (Paragraph 241)

47. We conclude that older people, especially those who are the most vulnerable, would greatly benefit from the assistance of independent advocates in order to secure their human rights on the same basis as the rest of society. We welcome the Minister's support for independent advocates and recommend that he ensures that the Department provides sufficient independent advocacy services to older people, with particular priority being given to older people with mental health problems or who are unable to communicate in English. These advocates should have an understanding of human rights principles and the positive duties of service providers towards older people. (Paragraph 249)

50. It is important that older people and their advocates or carers have sufficient information about their rights, to ensure that they can claim them from service providers if they wish to do so. However, this should be a matter of last resort. Given the power imbalance between older people and service providers, and their resulting reluctance to complain, we do not consider that it is either realistic or appropriate to expect older people to shoulder the burden for ensuring that service providers treat them with respect for their human rights. The primary responsibility for the protection of human rights, as we have repeatedly said in this Report, falls on providers of public services. We have already recommended in Chapters 4, 5 and 6 what the Department of Health, providers of healthcare services, inspectorates and other healthcare agencies should be doing to ensure that older people's human rights are protected in hospitals and care homes. (Paragraph 272)

51. We consider that a dual approach is required: firstly, older people need information about their human rights; and secondly, institutions need to mainstream human rights within their work. We recommend that the Department of Health, the inspectorates, healthcare policy-makers and every provider of healthcare services make a public commitment to: (a) embed a human rights approach in hospitals and care homes across the country and (b) make sure that accessible information on human rights and how to use them are provided to patients, care home residents, relatives, carers and advocates, and the public as a whole. (Paragraph 276)

Seniors and Prescription Drugs

Does your parent need to take prescription medication on a daily basis? If so, there is a genuine need for seniors to understand what drugs they are taking and how to take them. You know, more often than not, seniors rely on their doctors so much; they fail to ask questions when given prescription drugs. They trust the doctors implicitly, but in some cases, it can do them more harm than good. Seniors and prescription drugs have become synonymous as more and more seniors live longer and are prone to more diseases.

If you have a parent who has been prescribed drugs, perhaps now is a good time to research the drug to ascertain what side affects, if any, are associated with it. Some doctors offer medications without completely understanding the side affects they may have on one patient as opposed to another patient. While one individual may have no ill affects, another may feel the full brunt of the medication.

For seniors who have dementia, this is especially true. There is a case of a woman who was given medication to help her sleep. This was due to the fact that she stayed up most of the night serving dinner to people she thought were in her house. While she was constantly being monitored by her daughter-in-law, nonetheless she had days of complete clarity, whereas other days she had the aforementioned dinner parties. The doctor prescribed a medication to calm her and provide a restful nights sleep. Unfortunately, it did the opposite. She quickly became agitated and anxiety ridden. The daughter-in-law called the doctor and explained the symptoms. He immediately changed the medication.

It has become apparent today that the pharmaceutical companies push their drugs onto doctors, who in turn prescribe them to patients. While one cannot definitively say that these drugs are given without consideration to the patient, there is a definite relationship between these companies and the health care insurance companies. Case in point: Escripts is used by some union-based organizations as the company to use for all medications. Unfortunately, however, there are conditions for using this company. Escripts allows members to purchase drugs through their pharmacy for 3 months, at which time one needs their approval to continue receiving the same medication. Furthermore, if Escripts determines the drug is inappropriate, they will change the medication without the doctor’s approval and offer it to the patient. Absurd, but true.

The pharmaceutical companies are out to make money as is Escripts, but what about the patients? Who is looking out for them? Certainly not unscrupulous individuals who want to make a quick buck. Seniors and prescriptions drugs are a major conundrum in this society, and unless and until someone comes up with a reasonable and safe plan to help our seniors afford the proper medication, we all lose.

Neither Wind nor Rain…..

With so many senior citizens living alone in New York City, a new plan has been implemented to “identify signs of distress among seniors and people with disabilities and quickly connect them with social services through the City’s Department for the Aging.” This, according to Mayor Michael Bloomberg is the beginning of a new service called the Carrier’s Alert Program. The postal carriers of New York City will be the champions of this new endeavor.

How will this be implemented? According to Mayor Bloomberg, “the letter carriers, who in many cases are the first people to recognize signs of distress, will now be empowered to act at the first signs of trouble.” Letter carriers know their route and the people they service more than most. Consequently, if a letter carrier notices that an elderly person’s mail has not been picked up, he will be able to act quickly and effectively to determine if the person is incapacitated and needs medical assistance.

This is a wonderful program, and one which prefaces the importance of keeping an eye on our elderly. During times when blackouts occur in certain boroughs or neighborhoods, everyone is encouraged to check on their neighbors to ensure they are okay. In fact in some areas, the police department checks each and every home to determine if anyone is alone and needs assistance. Blackouts are especially difficult for those who are on oxygen or who have no air conditioning units in their apartments.

With this new Carriers Alert Program, seniors can now rest easy that at least one person will always be on the lookout to determine if they need help. In addition, this will empower the community to do their part to become more aware of seniors’ concerns and do their utmost to ensure they are well and safe.

If you are a senior or have an elderly parent living in New York City, encourage them to sign up by contacting the Department for the Aging to enroll in this program. An application is available online. Once the application is filled out with the name, date of birth, address, telephone number and emergency telephone number, the letter carrier will place the Carrier Alert sticker in the senior’s mailbox.

Today, more and more seniors are living longer. It is up to each and every community in New York City to do all we can to make their lives happy and free from worry. For years they have worked and given their time to make our communities safe and friendly; now it is time to give a little something back on their behalf – a moment of your time. For more information, you can go to: http://www.nyc.gov/html/dfta/html/senior/carrier_alert.shtml.

The Zimmers

Been a while since I posted - these guys woke me up again. Betty doing well :-)

Formed in early 2007, The Zimmers are not only the oldest gigging band in the world (with an average age of 78), they are also the most celebrated, having recorded their debut album at the famous Abbey Road Studios, under the watchful eye of Acclaimed Producer Mike Hedges.

Oh and by the way, don't tell them you think this is funny, with more aggression than Nirvana and more talent than The Beatles, these OAP's are here to stay. Their first single 'My Generation' is released on May 14th. Expect it to climb faster than a Stenna Stair Lift!

Other songs in THE ZIMMERS repertoire include 'Firestarter' by The Prodigy, 'When I'm (one hundred and)64' by The Beatles and the live favorite (Jermain Stewarts worldwide hit) 'We Don't have to take our clothes off (to have a good time)'.


MEET THE BAND

Winifred Warburton (99)
Winifred lives in a care home in Derbyshire. When she was younger she did a bit of freelance work as a journalist and also wrote a few ladybird books on how to crochet. She’s a bit of a poet and is writing her memoirs. She also likes reading novels and keeping abreast of current affairs through the broadsheets. She used to play the organ and brushed up on her skills in preparation for the recording of “My Generation”. Winifred finds it hard to settle in a care home or find somewhere that really feels like home. She craves more stimulation and interaction with likeminded people. Not one to sit around doing nothing Winifred likes to take matters into her own hands and has moved care home so many times that she’s on first name terms with the removals man.

Eric Whitty (69)
Eric lives in a care home near Liverpool. He’s like a human jukebox – loves karaoke and singing anything from Beatles to Elvis and he does a great rendition of Amarillo. The Abbey Road session was Eric’s first time in London – with “My Generation” set to storm the charts it probably won’t be his last.

Tim O'Donovan (81)
Tim lives in a care home attached to a convent in Clacton. He’s a man of the church and left Ireland to spend many years working as a missionary in Africa. He has mastered computers and writes articles reminiscing about the people and places he’s come across during his life. Tim also enjoys a pint of Guinness in the local pub. Despite being very happy with the home and mindful of how lucky he is, he’s conscious that he’s somewhat outnumbered – sharing a home with 30 women, there’s only so much chit-chat about knitting and manicures that a man can take. Tim craves a bit more male banter and a good joke over a pint now and then.

Joan Bennett (it's rude to ask a ladies age!)
Joan lives on her own in London. Aside from routine visits to the GP Joan hasn’t been out of the flat for 3 years. A carer does all her shopping – her only contact with the outside world is her radio. She used to play the harmonica but it’s been gathering dust in a cupboard for 20 years – who knows, success in the charts just might re-kindle that musical spark.

Alf Carretta (90 years old – Zimmers lead singer) and Bingo friends Ivy Lock, Rose Dickens, Dolores Murray, Rita, Sylvia Beaton, Sally Page. This group of people met at the Mecca bingo hall on Essex Road and have been friends ever since. Some of them were there the day it opened, but sadly, after 30 odd years they’ve played their final game – according to Rank, who own Mecca, the double taxation on bingo gives them no choice but to shut it down. Alf says these are the only friends he has and he’s worried he’ll lose touch. Their efforts to keep the hall open have fallen on deaf ears and they’re hoping a bit of music might be what’s needed to grab people’s attention.

Gillian (Deddie) Davies (69 years old - Actor)
Gillian’s acting career has spanned decades from rep to TV - She played Mrs Perks in the Railway Children and has appeared in comedy classics such as Waiting for God and Little Britain. Gillian is a trustee of Compassion in Care and has been campaigning about quality of life for elderly people ever since her friend was badly treated in a care home. We’re glad to have at least one RADA-trained singer in the band!

Peter Oakley (Coming up for 80)
Otherwise known as “Geriatric 1927” to regular You Tubers, Peter has become the internet Grandad through his video blogs with his reflections on life. People love the fact that he’s just himself – utterly genuine – as well as being someone who challenges many of the stereotypes of elderly people. In the build up to the Abbey Road session Peter was looking forward to meeting others face to face for a change, and he watched videos of The Who performing My Generation live in preparation for our recording.

see Peter in action
http://www.youtube.com/watch?v=zqfFrCUrEbY

Buster Martin (100)
Buster works 3 days a week for Pimlico Plumbers. He was recently in the press because he gave as good as he got when attacked by muggers. Someone like Buster who is still going strong at 100 years old is a great example to us all.

John & Bubbles Tree (big jazz fans – used to listen to Chris Walker's jazz show on Radio Solent), Rob Fulford (Used to enjoy Dennis Skillicorn’s sailing programme on Radio Solent), Dennis Skillicorn (Former presenter on Radio Solent) Though they once tuned in on a daily basis to listen to their favourite shows, these former listeners turned off when Radio Solent decided it was time to let some of their more elderly presenters go. None too impressed with the current trend for music and banter geared towards a younger audience, they’re united in their determination to get older voices back on air. If they can get a record in the top 40 they’ll be all over the airwaves.

Grace Cook (83)
Grace entered the world of showbiz at the age of 7 enrolling in an amateur dancing school where she was trained to sing. She went on to perform mainly in pantos and summer shows and she’s been with the Hoxton Singers for about 10 years, performing occasionally to elderly people in care homes. Grace jumped at the chance to lend solidarity to the other band members and break down a few stereotypes at the Abbey Road session - at 83 she’s definitely still got it.

Personal Blog Item

Betty, my mother, had a fall yesterday at the top of the stairs - fortunately, she landed at the top - she fell on a shoe of all things -they took her to hospital at about 10:00 pm, gave her meds to reduce her Blood pressure which was at 220 given the stress of the situation, conducted an examination and concluded she had no broken bones. She twisted her spine and bruised her side badly. She's in awful pain.

My brother Colm acted quickly and set up a bedroom on the ground floor for her . . . she came back today and is resting there already. We had a plan. There's already a shower on the ground floor. We're pretty much shutting off the upstairs and Mum and Dad will live on the ground floor until we can get a stair lift. Betty will need 3 weeks to recuperate - we're setting up support systems.

A fall has real personal meaning when it happens - people are in pain - you need to think about it before hand so that things are quickly put in place - a little thought and preparation before hand are essential to pulling this off.

Wii and thee

Residents at the Sedgebrook retirement community in Lincolnshire, USA have been playing the Nintendo Wii regularly from Christmas. The average age of the residents at the old age home is 77 and majority of the people living here have not picked up a video game controller in their entire life.

Flora Dierbach, 72, says, “I’ve never been into video games But this is addictive. They come in after dinner and play. Sometimes, on Saturday afternoons, their grandkids come to play with them. Many grandparents are being taught by their grandkids. But, now, some grandparents are instead teaching their grandkids we’ll even have a fan for people to dry their hands before they bowl.”

Nintendo is also enthusiastic about it. Beth Llewelyn, Nintendo’s Director of corporate communications explains, “And that’s the whole idea. We certainly are grateful to our ‘core’ gamers and will continue to supply them with games. However, the question is, how do you build a bigger audience. Therefore, the idea was to make the controller look like a remote control with just a couple of buttons. People have no fear of picking up a remote control, but they’re hesitant to pick up a video game controller”

The residents of the Sedgebrook retirement community prefer bowling and they have loved it so much, that on Sunday afternoon there will be a video game bowling tournament in the lounge. Twenty residents have already signed up for the tourney and are all geared up to win the competition, just like the younger gamers who play in WCG and GameBox. The Wii is a couple of hundred bucks and is freely available in Best Buy and other dens of iniquity.

Numbers tell the story

The Virginia-based National Association of Home Builders estimates the 55-and-older population will reach 85 million by 2014, at which time it will represent 41.7 percent of homeowners. That group is pushing changes in design that crop up everywhere, from apartments to family homes that feature "first-floor masters" or ground-level suites that cut out taking those nasty steps at the end of the day. "The market is definitely there," says Howard Hanna, chairman and chief executive officer of Howard Hanna Real Estate Services.

The demand is resulting in new homes that allow a person to age in place, says Mary Jo Peterson, a member of the home builders' 50+ Housing Council. "The age boom is helping people because it is leveling the playing field for everyone," says Peterson, of Connecticut, who also is an interior designer.

The demand has led the American Society of Interior Design to appoint an Aging in Place Council. It will try to "educate the public and designers" on the best ways to approach this aspect of life, says Michael Berens, director of research for the group.

"What a different set of seniors," says Nanci Case, vice president of marketing at the St. Barnabas Health System, which has a 110-unit home site geared to active, independent adults in Valencia, Butler County. She says this up-and-coming breed, which often includes new retirees, is more active than the same generation from the past. They look for communities that have walking trails, or are built around golf courses or near enticing attractions.

"It is not about age, but functional level," Pieffer says of Presbyterian SeniorCare. "It is a lifestyle choice." Some members of this maturing generation look for services at their home sites, while others simply want to maintain an independent, but easier, lifestyle. Renee Lukehart, for instance, talks about how there is a great feeling of freedom, but togetherness, in Cambridge Manor because the neighbors tend to be around the same age, in their 40s and 50s.

"There's a clubhouse with an exercise room, and people get together for all sorts of things," she says of the site with 180 condos and 10 single-family homes.

Wanted: An easier lifestyle

Home developer Bruce Crum believes the most important part of this lifestyle search is the desire to stay in a single-family home, but one that is simpler to handle. He is one of the owners of Adams Development Group, which has built a carriage-home community near Mars, Butler County. That neighborhood started in 2000 with 60 homes and now is in the construction phase of the latest addition, which will bring the total to 190.

He says he and his partner, Chris Frank, saw the yuppies of the 1980s were getting ready to retire and wanted homes that gave them all the features they were used to, but didn't require a lot of maintenance issues. The result was a community in which nearly all of the carriage homes are in units of four with all maintenance included in a $150-a-month condo fee. The homes start at prices from $265,000 to $325,000 and feature customizable living spaces.

Cathedral-ceilinged great rooms can be made into one-story areas with another room added above. Enclosed sun rooms can become outdoor porches. "These are people who don't want to worry about things," he says of his clientele, which he describes as between their late 40s and late 60s. "They want to be able to travel and not worry about security or whether the grass is cut." Dick Ciripompa agrees, saying that easier lifestyle is exactly why he and Judie are moving from their Franklin Park home.

That search for independent, free living also is the reason the St. Barnabas Health System added its collection of Woodlands homes a little more than a mile away from Adams Crossing. Douglas W. Day, president of St. Barnabas Communities, says the leaders of that retirement community saw the same desire when they began work on their collection of the same type of homes. "The new retiree, the young retiree, is very different from that of the past," he says. "They are active and want activities for them. In fact, they demand it." Because this site is part of St. Barnabas, its clientele is a little older. Day says the age of the residents ranges from 57 to late 80s, with most in their 60s and 70s. There are 110 units in the Woodlands now, and work is continuing toward an eventual total of nearly 300, he says. The community is full and has a waiting list and an average turnover of one or two a year, Day says. These homes are rented, however, at between $1,800 and $2,751 a month, and residents immediately become part of the health system.

Part of a community

That is why Cyril and Gloria Rogers moved to the Woodlands from their two-story home in McCandless. He had his left knee replaced in 2005 and had to deal with multi-level living during his rehabilitation. "The stairs finally defeated us," says Rogers, who is spry and energetic at 88.
Gloria Rogers, who will not offer her age but jokes she is "much younger," says the health-care aspect was the lifestyle offering that made the community attractive. "We knew we would have to do something eventually about health care," she says. "This gave us the chance to do it before we were made to." She says the single-family nature of the homes, along with the social activities offered by St. Barnabas, also made the site attractive.

Somewhere in the middle are the residences offered at Redmont Village in Hempfield, Westmoreland County. The 12 elevator-served apartments and 50 one-floor homes are sold from $120,000 to $275,000, says Presbyterian SeniorCare's Pieffer. It is next to Redstone Highlands, an elderly care facility connected to SeniorCare. The Village is not a direct part the health system, and residents simply are put on preferential status when they need care, he says.

Some communities, such as St. Barnabas and Redmont Village, are age-qualified, meaning residents must be of a specified age to move in, most often 55. Others areas, though, draw a certain generation of people because of their nature. Patricia Burk, director of housing and urban development at the Pittsburgh Downtown Partnership, suggests that Downtown is attractive to adults wanting to pursue a lifestyle geared toward cultural activities.

She points to research done at Carnegie Mellon University that indicates 44 percent of recent migrants to Downtown are between 45 and 64. The largest part of that group comes from the baby boom generation. The U.S. Census Bureau defines that as being made up of people born between 1946 and 1965. "Some people just want to be in the center of things," Burk says. The neighborhoods can become pleasant because of that shared nature -- but that isn't necessarily an entirely positive effect, says a sociologist from Duquesne University, Uptown.

Michael Irwin, an associate professor in the department of sociology, says research done there shows that a variety of people creates a "social capital" that is lost when residents are the same. He also says residents generally feel better about the worth of their neighborhoods when they encounter different people in them. "Suburbs can be homogenous," he says, "but that generally is by class, not age." Nonetheless, homeowners such as the Rogers and Lukeharts speak positively of their move. "It was the best decision we ever made," Renee Lukehart says.

Accessibility features

Mary Jo Peterson says members of the baby boom generation are open to design changes in homes "as long as you're doing it for someone else." "Everyone wants to be nice about making sure a home is usable by the disabled," she says, discussing clients who often don't want to deal with aging. "Just don't mention the 'A' word when you're talking about something for them."

Peterson is an interior designer from Connecticut and a member of the National Association of Home Builders 50+ Housing Council. "Let's face it," she says, "no one wants to get old."

Baby boomers need to deal with matters of attitude as well as housing features when they are looking for a new home, an aging-in-place expert insists. Rebecca Stahr is a member of the National Association of Home Builders 50+ Housing Council. She also is a member of the American Society of Interior Design and a Certified Aging in Place Specialist. She says physical features that make homes easier to use create a sense of "empowerment that allows you to feel in control of things -- and that is the best attitude you can have." That means, she adds, home buyers need to be aware of the aspects of everyday life that are important to them.

"A lot is dependent on personality," says Stahr, the founder of LifeSpring Environs Inc., an Atlanta firm that does housing redesign and assessments. She says, for instance, if cooking is important, a resident should make sure the kitchen has counters that are the proper size, appliances that are appropriately placed and storage spaces that are easy to access. She says there are hundreds of items that can be part of an easily livable home space. Among the most important:

• A full bedroom and bath on the main level
• No-step entries
• 32-inch or wider doors throughout so a wheelchair can pass if necessary
• Drawers that pull out all the way, allowing easier access
• Levers instead of doorknobs
• Lighting that meets individual visual needs
• Appropriate placement of seating
• Low maintenance
• Access to service, cultural activities, medical treatment, friends and family

While most baby boomers in this category are empty-nesters, friends and other members of the family often visit. Therefore, it is important to have room for those stays, Stahr says. The whole matter centers on being aware of features and what they mean, she says.

Naturally Occurring Retirement Communities

Social Scientists are noticing the growth of Naturally Occurring Retirement Communities across the country. These are social communities where the vast majority of the population are seniors who have simply remained in place as their kids live and move to other parts of the country, so that eventually a significant portion of the population is retired and still living in their old homes.

USA Today has an article today on a couple who wish to age at Home in a NORC. Edna and Kenny Geiman moved to Campbell Street, New Hyde Park, NY in 1950 when it was full of starter homes for WWII Veterans. Now the kids and grandkids are mostly grown up and gone, and, in many of the houses, only seniors remain. The Geimans aren't interested in senior housing, assisted living or moving to North Carolina to be near one of their four children. "I would rather stay in the house I stayed in all my life," Edna Geiman says.

A new program called Project Independence, funded by the state, the town and a social service agency, is designed to help the Geimans do just that. It provides care giver support, help with transportation, doctors who make house calls, and referrals for services for seniors like a local Handyman. Project Independence is one of a growing number of programs that make it possible for residents of senior communities to stay in their homes rather than move to senior housing or nursing homes.

Like 5,000 other neighborhoods across the country, according to an AARP estimate, this patch of Long Island is a "naturally occurring retirement community," or NORC, a demographic term used to describe neighborhoods where at least 40% of the residents are older than 60. The first NORC program began in New York City in 1985. Now, funded by grants from government, foundations such as the Denver-based Daniels Fund, and social service agencies, there are such programs in 25 states. Most federal money for the programs — about $23 million since 2001 — has come from "earmarking," funds obtained by a member of Congress for a specific program. Earmarking, however, is a practice the Bush administration and the new Democratic congressional leadership have vowed to end.

In October, Congress included NORC programs in the reauthorization of the Older Americans Act, which gives grants to states for services for the seniors. Money to fund the programs has yet to be appropriated by Congress. If federal money comes, the programs could get a big boost, but money for all programs for the seniors has been increasingly scarce, says Rob Goldberg of United Jewish Communities. "Our focus in this Congress will be to get that program funded," he said. UJC is the umbrella organization for Jewish social service agencies and perhaps the biggest champion of NORC programs: It has funded 41 programs and is very active here in Michigan.

Those who advocate for services for the seniors say expanding the programs is urgent. Not only will many of those seniors want to grow old at home, some of them will have to. "You can't possibly build enough senior housing for every senior," says Julia Pierson, a senior housing consultant in Baltimore, where there is a NORC program. There are some serious benefits to using NORCs to support aging in place. NORCs typically have an economy of scale which allow the sharing of services such as described above affordably across the community.

Younger seniors often are recruited to take care of home repairs. "This notion that 'it takes a village' does not apply just to children," says Fredda Vladeck, who founded the first NORC program and is director of an aging-in-place initiative for the United Hospital Fund, a New York research and grant-making foundation. "We need to go back to transforming our communities into good places to grow old," Vladeck says. "If we don't, we're still going to be doing aging services one hip fracture at a time. And that's not an effective way to do it."

Want to see if you community is a NORC? Check the following scholarly article for some pointers on how to measure the factors that make up a NORC.

Appliance makers show Senior Sensitive products in Orlando

Catering to the Baby Boomer market, appliance-makers are focusing more on ease of use. Last week the had the equivalent of the ultimate home center with 1,900 exhibitors at the International Builders' Show here in orlando displaying cutting-edge products for the home.

Take, for example, the Lift Oven by Gaggenau. With the push of a button, the glass-ceramic base drops down to counter height so cookie sheets and roasting pans can slide from the counter to be easily loaded and then raised back up to the oven. "You do not have to bend or lift. When you reach into the oven, that's when you get burned. This time the oven comes to your worktop," said spokeswoman Vanessa Trost. Already for sale in Europe, the oven will be available in the U.S. in July and will cost about $3,300.

Fumbling with house keys may soon be a thing of the past as both Schlage and Kwikset showed locks that work with the touch of a finger. Kwikset's biometric fingerprint SmartScan deadbolt is activated by the swipe of a fingerprint across an indicator behind the teardrop-shaped lock. The battery-operated lock requires no hardwiring and can be programmed for up to 50 fingerprints. It also can be programmed to allow entry for limited time periods if, say, the housekeeper comes from 8 a.m. to noon on Fridays. And, of course, it could solve the problem if you always lose your keys, like me. The lock will cost about $200 and be available in June.

Interesting Post On Gilbert Guide Blog

Here's an interesting post on Baby Boomer Women sandwiched between children and senior family members. This relates to the topic of Caregiver burnout as a major cause of having to move to assisted living which was discussed earlier here.

Monitoring and Response for Seniors

We have all seen the classic “I’ve fallen and I can’t get up!” commercials. This caricature, although humorous, is representative of an important class of technology that provides monitoring of health and well-being status, communication to interested parties, and in some cases provides automated responses to perform some corrective action. Few people would choose to have a caregiver following their movements twenty-four hours a day, seven days a week to ensure their well being. Studies show that providing this level of monitoring through technology is more acceptable and provides a high level of support for independent seniors. With a professionally developed program the caregiver can better the ongoing day to day maintenance required and also life’s little emergencies.

These monitor and response systems can operate in the short term to sense a crisis situation, such as a fall, and provide a way to make a call for help. Medical alert systems like American Medical Alarms, Inc. all allow a greater degree of freedom for an older person, and peace of mind for adult children, by allowing independence while providing a safety net in case of medical crisis. Some devices might automatically detect a crisis (such as a fall). Others depend on activation by the individual (or someone nearby) to initiate a call for help.

Monitoring systems can be classified along a number of dimensions:

• What information is being recorded or transmitted? It could be medical information (e.g., heart rate, respiration, blood pressure, medication compliance, incontinence), movement data (e.g., restlessness in bed, gait patterns), or simply awareness information (e.g., a video transmission to a relative).
• Over what period of time are data analyzed? The capture of information can be for instantaneous purposes only (e.g., a “GrannyCam” usually transmits images over the Internet to be viewed in real time only) or over a period of time for trend analysis, as you would expect for vital signs in a telemedicine application or in medication monitoring for compliance in a home or assisted living environment.
• How is information reported to relevant individuals? Medical alert systems provide a phone call to a response agency. Telemedicine applications report over a secure channel to an electronic patient record that can be consulted by trusted medical professionals or even by the individual being monitored. Cameras are sued to provide easy monitoring for family (usually over the Internet, serving an important social communication function discussed below) or remote caregivers (at a nursing station, for example).
• What is the role of the older person in using the technology? Does the monitoring require any instrumentation or active cooperation on the part of the individual being monitored? For example, do they have to wear an infrared badge for a positioning system, or is it passive, with the environment instrumented to measure a naturally occurring phenomenon using devices such as a motion detector or face recognition system?

There are many examples of these monitoring systems for an aging population. Some address the safety and security of individuals who may wander. Devices can either prevent undesired wandering (e.g., automatically closing doors or gates to a house or community grounds to protect Alzheimer’s patients) or remind other to take corrective action (e.g., at nighttime when someone inappropriately leaves the bed). Simple load sensors in the beds of residents at Elite Care’s Oatfield Estates Cluster in Milwaukie, Oregon (http://www.elite-care.com), feed a visualization to allow caretakers to detect periods of restlessness in the night.

Some research is focused on monitoring ADL tasks in the home using a variety of sensing technologies and this is the part we’re interested in. Sensors and switches attached to various objects, or optical and audio sensors embedded in the environment, are used to detect which task a person is performing. Research trials with several subjects indicate that this method of tracking a person’s actions is a good way to monitor the state of a person’s health and independence and several commercial products are available for this purpose. Two companies, Quietcare (http://www.quietcare.com/) in partnership with ADT, and Xanboo in partnership with AT&T (http://www.attrm.com/) deliver home monitoring capability. The Quietcare product is best described in the attached first comment and is a significant and thoughtful step in home based senior monitoring. It is critical to have the infrastructure to support installations for effective home monitoring of seniors. People and homes are complex and individual and the configuration requirements for each installation cannot be managed with a canned security approach. The Quietcare product is focused on homebound elderly and other at-risk clients with chronic medical conditions, on monitoring in assisted care facilities and the AT&T product on home monitoring while the senior is in their summer or winter residence.

Friedman (1993) developed a wearable microcomputer with a location-sensing system and additional sensors to determine task-related information. Recently a commercial product is available from Bodymedia which shows some benefit of a wearable unit but primarily to support an exercise regime. Still, this is worth considering if you need to lose weight although I hate the idea of wearing an armband continually personally.

Age at Home - Dallas Morning News Example

Tuesday, February 6, 2007 By BOB MOOS / The Dallas Morning News

Bill and Judy Slease have built a house for the ages. All ages. The sixtysomething couple have constructed for themselves a "universally designed" house that can accommodate every stage of life and every physical ability.

As the nation's older population doubles over the next 25 years, experts predict, the demand for homes such as the Sleases' will grow substantially.

MIKE STONE/Special Contributor

Judy Slease, with husband Bill Slease, pulls out a mixer using a mount in her kitchen, which also includes a retractable bread board.

Empty-nesters looking to buy the home of their dreams will want a
place where they can spend the rest of their lives.

The Sleases say their new house gives them peace of mind. Both now enjoy good health. But if either becomes disabled or frail in old age, they know they'll be able to remain in their home as long as they like.

"We intend for this to be our last house," Mr. Slease said as he relaxed in his living room, which would be an easy wheelchair ride to the rest of the house and even the outdoors, through wide hallways and doorways and no steps.

Universal design has been around since the 1970s, but it has only recently attracted attention as more Americans approach retirement.

The Sleases first heard about the concept at a homebuilders convention. Intrigued by it, they decided to try the idea on themselves.

Their two-story, 3,500-square-foot home looks like any other in their upscale McKinney neighborhood, but it includes 80 elements of universal design.

"The beauty of universal design is that it doesn't call attention to itself; it just makes life more convenient," Mr. Slease said.

The first hints that there's something different about the Sleases' house are the step-free entrance and wide front door.

Inside, there are wider hallways, hard-surface floors, lower light switches, higher electrical outlets and an elevator that resembles an entryway closet.

The master bedroom and a full bath are on the first floor, to the side of the spacious living room.

All make it easier for anyone to move around and use the home.

Kitchens and bathrooms

In building their house, the couple paid particular attention to the kitchen and bathrooms, since those often present barriers to people with disabilities.

In the kitchen, cabinets and appliances such as the oven and microwave are mounted lower on the walls. On the other hand, the dishwasher is elevated, so that someone in a wheelchair doesn't have to bend down to load or unload it.

In the master bath, the shower floor has been sloped for drainage, so it doesn't need the little lip that most shower entrances have. The toilet is higher. And decorative grab bars have been installed throughout the room.

The Sleases have led dozens of tours through their home in recent months.

Prospective clients, other homebuilders, curious real estate agents and advocates for the disabled have visited the house to learn more about universal design.

"It's difficult to describe universal design, but when you see it, it instantly makes sense," Mr. Slease said.

The Sleases hope their house will persuade others in their industry to rethink how they build homes.

"Homebuilders may have heard about universal design, but very few have actually incorporated it into their construction," said Richard Duncan, senior project manager at North Carolina State University's Center for Universal Design.

Though builders are jumping into the remodeling business to make existing residences more accessible for older people who want to "age in place," they've been slower to construct universally designed houses, Mr. Duncan said.

The Sleases' company, Tapestry Custom Homes, is one of only seven builders that belong to EasyLiving Home Texas, a recently formed public-private coalition that promotes the concept of accessibility in home construction.

Tajauna Arnold, the group's project director, said she visits homebuilder shows to introduce the coalition and recruit members.

"We're where energy-efficient homes once were," she said. "Builders don't understand us yet. Once they do, they'll climb aboard."

Universal design still labors under several misconceptions, Mr. Duncan said.

One is that homes built to accommodate all ages and abilities are ugly.

Charles Schwab, an Illinois architect who designed 10 age-friendly houses last year, including one in Texarkana, said many builders are under the mistaken impression that universal design gives a home an institutional look and feel.

"When done well, a universally designed home resembles any another house," he said.

The Slease's kitchen includes a retractable bread board.

Dallas-based Centex Corp. recently built a univerally designed house in one of its Virginia subdivisions to acquaint homebuyers with the concept.

An architect took one of Centex's existing designs – a two-story, 4,000-square-foot house – and adapted it.

"The public's response has been overwhelming. A couple of thousand people have walked through it since December and have raved about it," said Char Kurihara, vice president of sales for Centex Homes in the Virginia area.

Ms. Kurihara said the demonstration house will help Centex develop a corporate strategy on universal design.

Cost myth

A second misconception about universally designed homes is that they're much more expensive, Mr. Duncan said.

"In many cases, universal design is no more expensive," Mr. Slease said. "It doesn't cost any more, for instance, to use door levers instead of knobs."

When all features are included, a universally designed house may cost up to 5 percent more, Mr. Schwab said.

That's because kitchens and baths must be roomier to accommodate wheelchairs, he said. Likewise, wider hallways add square footage.

On the other hand, incorporating universal design in a home under construction is far less expensive than modifying it later, Mr. Schwab said.

"Why not spend a few thousand more to build an age-friendly bath now and save yourself the $20,000 to retrofit it later?" he said.

Experts say the main reason most builders haven't yet adopted universal design is that they think there's only a limited market for it.

"Builders aren't risk-takers. They respond to the market," said Leon Harper, a senior housing specialist who worked with Centex on its Virginia home.

"So far, homebuyers haven't banged on builders' doors asking for universal design," he said.

Most consumers still don't know about it, Mr. Harper said, or don't understand it.

Boomer market

But he and other advocates of universal design are convinced that's about to change.

Mr. Schwab said many of his clients are boomers who have seen elderly parents reluctantly move out of their homes of 30 or 40 years because they can't climb the stairs or step into the shower anymore.

"The average home doesn't work for an older adult, and boomers are beginning to demand something better for themselves when they grow old," he said.

A universally designed house may turn out to be the smartest investment someone makes, Mr. Duncan said.

"An assisted-living community costs $40,000 a year and a nursing home, even more," he said. "If you can avoid or delay moving out of your home, just think of the savings, not to mention the satisfaction of staying put."

This is a great example of the kind of things one can do to their home to set themselves up for the future. Here are some common features of a universally designed home:

•No steps at the entrance

•All doorways at least 36 inches wide

•Lever door handles

•Pull-down shelves in upper cabinets and rollout shelves in lower cabinets (below)

•Elevator or shaft for future installation

•Stepless shower stall (right)

•Low-pile carpet or hard-surface floors

•One bedroom and full bath on main floor

•Front-loading washer and dryer

SOURCE: Center for Universal Design

Shortage of Home Care Aides

In the United States, there is a severe shortage of home care aides, who are essential lifelines for many elderly and disabled Americans struggling to maintain independent lives in their homes. Aides provide personal care such as bathing, feeding, and dressing, as well as, home making activities, such as doing light housework, preparing meals, and shopping. Recipients of these services are more impaired and frail than most of the over 60 population (Ref: Highlights from the Pilot Study: Second National Survey of Older Americans Act Title III Service Recipients). Without these aides’ vital assistance, many elderly and disabled Americans would be unable to remain in their homes. They would be forced into institutional living situations at great expense to the public care system and at the loss of their personal choice and dignity.

Personal care aides are critical components in the home care industry performing physically, mentally, and emotionally demanding jobs with the most vulnerable members of our population. They often are poorly screened, minimally trained or supervised and rarely provided fringe benefits. These critical workers receive some of the lowest wages in the workforce often making less than hotel maids and fast- food workers. Turnover due to difficult working conditions and low wages drives up the cost of elder care while disrupting continuity and eroding the overall quality of care received by older citizens.

What Do They Do and Who Are They?

Direct care workers, usually referred to as personal and home care aides provide the bulk of paid home care. Personal care aides are unlicensed individuals who provide direct care services in the home as an employee of the client or an agency. They assist with personal care activities such as, bathing, dressing, toileting, transferring, and eating, and home-making activities such as preparing meals, doing light housecleaning, and shopping. These aides are truly essential to the ability of many older and disabled individuals to live as independently and productively as possible.

The need for personal care aides will grow faster than the average of all occupations through 2014. The number of personal care aides will grow 47 percent between 2000 and 2010 (Ref: Health Care Employment Projections: An Analysis of Bureau of Labor Statistics Occupational Projections, 2000-2010). But this is as would be expected based simply on the demographic trends previously discussed. Personal and home care aide is expected to be one of the fastest growing occupations, as a result of both growing demand for home services from an aging population and efforts to contain costs by moving patients out of hospitals and nursing care facilities as quickly as possible.

Agencies report vacancy rates as high as 35 percent and difficulties finding qualified personal care providers. Few agencies are accepting new clients for personal care services. This means that thousands of elders and people with disabilities are languishing in costly government funded institutions. In Texas, for example, the average cost of community care is $15,529 per year compared to an average cost for nursing home care of $30,882 per year. This is a shocking waste of both human capital and public dollars.

Who is taking these jobs?

Nine out of ten personal care aides are women approximately 40 years old. These women often are the sole providers for their own households. Many personal care aides earn incomes below the federal poverty level with many workers or their children qualifying for public assistance programs. Individuals work as aides for a variety of reasons but characteristically because they care and know they are making a difference for the clients they serve.

Why Is There a Shortage of Direct Care Workers?

Despite the current need and growing demand for personal care aides, high turnover rates plague the industry, ranging from 25 to 50 percent in home health care. The majority of that turnover occurs in the first three months of employment. High turnover rates lead to poor quality of care, disruption of continuity of care and reduced access to service for these services. High turnover rates also increase the costs for providers. High turnover and vacancies mean that providers must spend relatively large amounts on recruitment and training costs, an estimate of at least $2,500 per lost employee. This reduces funds available for aide compensation, thereby creating a cycle of further high turnover and vacancies.

What Needs to Be Done?

Efforts must be concentrated in areas that will enhance screening, promote retention and reverse high turnover rates for direct care workers. First, enhanced screening methods that provide comprehensive criminal record and applicable registries checks must be employed. Adequate and ongoing training of personal care aides must be provided by care institutions. The content needs to provide practical up-front training with peers and orientation for new hires to prepare individuals to work with increasingly frail, possibly cognitively altered elders. Finally, and most importantly, wages must be raised to a competitive level for these positions. A Wisconsin study found that facilities that paid direct care workers higher wages had lower turnover rates (Ref. Hattan, E. & Dresser, L. (2003).

What’s the big deal? It all comes down to paying a reasonable wage, providing adequate training, treating people with respect and expecting them to be respectful.

Recent Research on Falls and the Value of Exercise

We've seem in a previous blog that seniors can reduce the risk of falls by increasing body strength and improving balance through regular physical activity (Judge 1993; Lord 1993; Campbell 1999). Recent research by Dr. Phillippe Perrin of the Universite Henri Poincare-Nancy, at Villers-les-Nancy investigated 130 men and women who averaged 70 years of age and showed that seniors who are active in their older years, no matter when they start benefit about the same as seniors who exercise all of their life. Also, individuals who are active their whole life but sedentary in their old age are nor better off than individuals who are sedentary for most of their life. Once again we see the value of any form of exercise.

Renovation and Home Maintenance for Seniors and others

One thing about having a business idea is to test it in the marketplace but this will take us a little while as we raise capital for marketing and our final push of product development . . . so it's worth seeing what other people are doing out there to see if our proposal has any traction.

This article from the Catholic Sentinel discusses Senior Home Renovation and Maintenance programs in Oregon is remarkably similar to my own experience. The origins of Age@Home come from a late night discussion with my mother, Betty, 3000 miles away in Ireland. Now, Betty is 74 years of age, in reasonable health and of very sound mind. After way too many whiskies we started discussing the topic of what she wanted as her age and inevitably declining health progressed. I was surprised by the strength of her answer - 'I want my own doorstep' and the emotion in her voice. So I started studying (like any good Irish Boy/Man who has an engineering degree) to see how we could help . . . and hence we are where we are today and sometime later this year or early next year I'm shipping the crew to Ireland for a week to set them up. Anyway, back to the article, the story is about Brian Bartholomew in Oregon who had a similar awakening with his mother as she moved into a care facility. He too was interested in moving away from corporate life, and started a local Renovation and Maintenance company to assist seniors who want to continue living at home.

In late 2003, they launched their business, which they called In Your Home.Now they have eight employees and a growing list of faithful customers. Last year, In Your Home brought in $700,000 in revenue.

Customers are the 50-plus crowd and people who are disabled. Both groups have a fierce desire to remain independent as long as possible. Most get in touch with Bartholomew with a crisis like this — “My husband broke his hip and can’t come home until the bathtub gets revised.” Others are slowly becoming unable to rise from the toilet seat, reach high shelves or read the newspaper with current lighting schemes. For example, lever doorknobs are kinder on arthritic hands. Steps from outside can become gradual cement ramps. The oven door can swing to the side, rather than down. Grab bars can make it easier to use the toilet or get out of the shower. Sliding shelves can make cabinets more usable. Wider doors are better for wheelchairs and walkers. In Your Home can install technology such as automatic door openers, bathtub lifts and devices that allow people to answer a call without going to the phone.

In Your Home can do one job and then be gone, but more often the company becomes an abiding presence. Bartholomew takes photos in houses and keeps meticulous records so that when a customer calls needing a door widened or a ramp added, he knows just what they’re talking about. Some clients keep a list of small fixes needed and get a visit every three months from a worker.

In Your Home is often a comfort for children of seniors, who face the struggle of what to do as parents age. Also, it often turns out to be cheaper to make a senior’s home livable than to move.

Bartholomew says that some Baby Boomers are thinking ahead for themselves, getting their homes ready for the days when they are 80-somethings. He admires those people who have overcome society’s general denial of aging. Everyone, he adds, should consider whether visitors can use their house safely.

So, this is small, but is a good example of the kind of one-time and ongoing support services which can be offered and which clearly have benefit. There are many such organizations springing up around the country, such as one similar to Age@Home in Minnesota and ones where the community is built for boomers to move in and is ready made for Aging in Place in California. On the charitable side there's Rebuilding Together which worked on 8900 homes in 2006 (although it isn't just for seniors) and many government initiatives at federal, state, and local levels.

If you have any other good examples, I'd be interested in hearing - send me a note at steve@age-at-home.com.

Reverse Mortgages - Using your Home to stay at Home

I did some basic research on the reverse mortgage side of things and wanted to share with you for your continued discussions . . .

A National council on the Aging (NCOA) study released in January, 2005 shows that reverse mortgages can be used by over 13 million Americans to pay for long-term care expenses at home, allowing many to remain independent and in their homes longer.

“The study shows that reverse mortgages have significant potential to help many seniors pay for help at home or to make home modifications. It also points to the need for strong consumer safeguards and lower transaction costs if these loans are to appeal to the millions of older Americans who could potentially benefit,” said NCOA president and CEO James Firman.

According to the study, there are some 9.8 million elder households (aged 62 and older) that are dealing with an impairment that can make it hard to live at home. In total, these households could access as much as $695 billion through reverse mortgages. For individuals, the extra cash could go a long way to help with family caregiving and other long-term care expenses. For example, a borrower aged 75 years old with a home worth $100,000 could receive a reverse mortgage loan that could pay them $500 a month for almost 12 years.

“This is an important study that, for the first time, shows that elderly homeowners, many with chronic conditions, can use reverse mortgages to pay for care at home,” said Jim Knickman, vice president for Research at the Robert Wood Johnson Foundation. “We hope that these findings will prompt new thinking into how the nation addresses the challenge of financing long-term care.”

However, there are several obstacles to their growth for this purpose. For example, the NCOA study shows that while two-thirds (67 percent) of older homeowners today have heard of a reverse mortgage, only 9 percent indicate that they are likely to use this financing option to pay for assistance at home. Many worry that they risk impoverishment, or won’t be able to leave a legacy to their children if they tap home equity. The cost of these loans, and current Medicaid policies on how reverse mortgages affect eligibility for long-term care benefits, also appear to be barriers.

Recent studies show that older Americans, including those who have serious health problems and need long-term care, want to live at home rather than in an institution. Most elders (82 percent of those age 62 and older) own their homes and 74 percent of those own them free and clear. With over $2 trillion tied up in home equity, this financial resource has the potential to dramatically increase the ability of seniors to pay for long-term care at home. Reverse mortgages can free up needed cash while enabling seniors to continue to own their home.

Of the nearly 28 million American households age 62 and older, NCOA has found that almost half (48 percent), or about 13.2 million, are good candidates for a reverse mortgage. The amount that these older households could receive from a reverse mortgage is substantial – on average $72,128. These funds can go a long way to pay for help at home and for retrofitting the home to make it safer and more comfortable. For some, they could be used to purchase long-term care insurance if they qualify. In total, an estimated $953 billion could be available from reverse mortgages for immediate long-term care needs and to promote aging in place.

For many older families, home equity is their single, biggest financial asset. Unlocking these substantial resources can help empower “house rich, cash poor” seniors by giving them additional resources to purchase the services they feel best suit their needs. The use of private funds from reverse mortgages can also strengthen community long-term care programs and reduce the burden on state Medicaid budgets.

The Baby Boomer Time Bomb

Fed Chairman Ben Bernanke warned the U.S. Congress on Thursday that failure to take action soon to deal with the budgetary strains posed by an aging U.S. population could lead to serious economic harm. Bernanke cited projections by the Congressional Budget Office that showed spending on entitlement program would reach about 15 percent of U.S. gross domestic product by 2030. read more about it here.

"One of the biggest failures of our government at all levels is we have not responded to a problem that has been staring us in the face for decades. We have waited way too long. Time is short, and the baby boomers are getting older." -U.S. Sen. Russ Feingold (D-WI)

When we look back at the first half of the 21st Century, it will not be global warming, nor rising sea levels, nor the loss of the North Atlantic drift that will be the most significant thing in our minds - it will be that we are living in a new kind of society, one with the oldest citizens that has ever existed in the history of mankind. The population over 65 will have doubled, the population over 85 will have quadrupled, instead of five working people for each retired person there will be two. We will be dealing with the fact that only 1% of the 700,000 physicians in the US are trained to work with the elderly.


As Senator Feingold explains and as we see in the Figure above, there will be great demographic changes in the coming years. Between 1995 and 2000, there were 35,320,000 individuals in the U.S. over 65 years. This figure is projected to more than double to over 77,010,000 between 2030 and 2040. During this time, the percentage of the U.S. population over 65 will grow from 12.8% to 20.7%. Even more dramatic is the growth in the oldest population group, aged 85 years and over. In 1990, there were approximately 3,060,000 individuals in this group; by 2000 the figure grew to 4,260,000. By 2050, it is estimated that this category will jump to 18,220,000 individuals (all facts U.S. Census Bureau 2004). Our target market is the largest growing demographic globally.

People are living longer and healthier lives, a mark of success in both public health and medical care. Reports indicate that Americans wish to age at home as long as possible. Residents who felt their home would meet their physical needs were more likely to remain in their current home as long as possible. In response to the preferences of older people and deficiencies in the current housing market, home modifications have been increasing in the United States. Nevertheless, a large gap exists. National data suggests that over 1 million older persons with functional limitations have an unmet need for such features as grab bars, handrails, and ramps (National Alliance for Caregiving & AARP, 2004).

So what does this mean: I believe we have to change the course of current practice to start focusing on non-medical solutions to the aging populations problems. I'll try and develop this idea a little further in the next posting.

Possible Solutions . . . The Design of Age@Home

"As we age, we face declining abilities from age related diseases and the aging process itself. Our home and network can assist or hinder our ability to complete self-care and household activities."

Dr.Mann, University of S. Florida, 2006

Seniors are living longer and staying healthier than at any point in history, yet most seniors inevitably reach a point when they need some assistance with activities of daily living, like eating, drinking and cleaning. Current evidence suggests that aging adults are receptive to services and technology to support Aging in Place as an alternative to assisted living communities. A recent study by Mann et al (2002) suggest strong consumer acceptance for home care and monitoring among frail elders. We, at my company (www.age-at-home.com) have conducted focus group studies with local seniors which support this idea and lead to the development of a three stage process to allow seniors to remain longer in their homes prior to, or possibly replacing the need for assisted living. The process consists first of modifications to the home to eliminate the most common problems in case of healthy individuals, or specifically target problem areas in the event of a crisis. Simultaneously, support services are engaged depending on the clients’ particular situation to reduce the high stress issues of aging such as resource identification and basic home maintenance. Finally, monitoring is put in place to quickly identify non-medical conditions that may cause a deterioration of the individual’s state and communication paths established to share this information with caregivers, family and friends.

Renovation - By making basic renovations to kitchens and bathrooms renovation services provide non-institutional remodeling which will support Aging-in-Place. Research has shown a low point of entry for a significant increase in safety and efficiency. Decreased difficulty were shown in getting in/out of the house, moving around the house, and bathroom activities for a home modification costing on average $5543/person (Hammel, 2006). This equates to two months cost of assisted living and demonstrates the cost effectiveness of our approach. We will offer services in two major categories: revisions to improve safety and security and a more extensive remodeling which includes complete kitchen refurbishment for approx. $36,000. Since professional modifications are often barely noticeable to visitors, homeowners can enjoy their home safely and without any institutional feel and with a moderate increase in the market value of the home.

Support - One must complement this remodeling service with social and home-aide services to support management of an individual’s personal situation, in particular, addressing areas of risk in ADLs. This program is for individuals, couples and caregivers who need or desire additional home health care services other than medical coverage. We will work with seniors and their families to create a home care program that meets all of the seniors’ daily living needs.

Prevention - To support these services we have developed proprietary expert software and integrate systems into the home for home automation and client monitoring. These systems may be installed during remodeling or purchased as stand-alone systems. Automated home features use commercially available low cost wireless sensor solutions and control home elements such as lighting and temperature. They also monitor and report variations in activities such as eating, drinking and toileting. The smart-home approach is integrated with wired security, fire prevention and guest management systems to support safety. Few people would choose to have a caregiver following their movements twenty-four hours a day, seven days a week to ensure their well being. Studies show, however, that providing this level of monitoring through technology is more acceptable and provides a high level of support for independent seniors.

Hopefully, this model will work and sell, because demographics indicates that we don't have much of an option. More on this later.

Steve

Issues with Activities of Daily Living

The third topic on the list of four critical issues we’ll discuss relates to diminishing capability to perform activities of Daily Living . Activities of daily living (ADLs), is a way to describe the functional status of a person and are typically defined as the ability to: dress, eat, ambulate (walk), do toileting and take care of their own hygiene. These are critical to the ability to live independently. Instrumental ADLs includes activities not necessary for fundamental functioning, but still very useful in a community. Cooking, shopping, housework and transport are in this category. In general, performance of IADLs is necessary for maintenance of one’s household, and thus necessary for independent living in the community. However, many areas of IADLs are generally optional in nature, and can be delegated to others. Generally though, these should be seen as rough guidelines for the assessment of a patient's ability to care for themselves.

Loss of any of these abilities increases the risk of hospitalization, increased nursing home placement and to some extent predicts higher mortality rate Carey (2004). There are multiple assessment tools that are used to measure these important concepts of functional status and independence. Regardless of the measure used, there is a steep increase with age in the proportion of person who reports ADLs and IADLs limitations. In the United States as of 1996, 44 percent of community-dwelling women and 42 percent of men age 75 years and older reported difficulty or inability to perform at least one daily activity (Kramarow et al). Among community-dwelling elders age 85 and older, approximately 55 percent of women and 42 percent of men report ADLs disability. Functional disability results from both physical and cognitive conditions. Osteoarthritis, fractures, stroke, and osteoporosis are some of the specific medical conditions that limit physical functioning. Cognitive losses associated with dementia (e.g., Alzheimer’s disease, multi-infarct dementia, and others) also limit functional ability. Cognitive and physical limitations often occur together in advanced age; thus elders are at increased risk for functional impairments as they age.

Functional disability is a key determinant of moving into an assisted living facility or nursing home. It has been reported that the average older adult living in an assisted living facility requires assistance in three IADLs and that about 50 percent of these resident have some level of cognitive impairment (Mollica, 1998). In contrast, nursing home resident have an average of 4.7 ADL limitations, and between 75 and 86 percent have cognitive impairment (Cohen and Miller, 2000). Thus, ALH resident have functional disabilities, largely in the IADL domain, that require supportive services whereas nursing home residents are substantially more impaired and more dependent in both IADL and basic ADL functioning.

In addition to functional status, there are other factors that influence transitions from independent living to assist living to nursing home. These include acute illness (such as stroke), progression of chronic diseases (both cognitive and physical), and lack of social support. Indeed, it has been stated that the difference between needing and not needing nursing home care depends on the availability of social support (Kane et al., 1999). It has been estimated that for every person over age 65 in a nursing home, there are approximately 1-3 people equally disabled living in the community (Kane et al, 1999). The people in the community, however, typically have more resources, support services, and family caregivers available to assist them. In addition, these elders may have more access to, and ability to use, the various technological means that are available to help them maintain their functioning.

Technology may play an important role in enabling older adults to live in a less-restrictive environment for as long as possible and may delay transitions into assisted living or nursing home facilities. The topic of housing and living environments for older adults has been of some interest to gerontologist over the past several decades. In 1973, Lawton and Nahemow introduced the term “person-environment fit” as an important factor in determining the well being and functioning of older adults. Person-environments fit refers to the match between individuals’ personal needs and capabilities and the available resources and demands of the living environment. Kane and Kane (2001) stressed the need for an integrated approach to meeting the needs of older adults; that is, a merging of the therapeutic (e.g., medical) and social service (e.g., rehabilitative and compensatory) models of care. Thus, technology is likely to play different roles in different living environments. It is on this note that we will proceed to discuss a proposed holistic solution to allow individuals to remain at home longer.

Caregiver Burnout

One of the other main causes of loss of independence is caregiver burnout. Most people are in fact predominantly in the hands of their spouses, daughters or daughters-in-law as caregivers. Research has shown that the most significant factor to stay out of a nursing home is simply to have 3 or more engaged daughters and / or daughters in law (Presidents Council on Bioethics, 2005). But for most of us this isn't an option and caregiver burnout is a big consideration. So what is it? Our friends at WebMD define it as:

" Caregiver burnout is a state of physical, emotional, and mental exhaustion that may be accompanied by a change in attitude -- from positive and caring to negative and unconcerned. Burnout can occur when caregivers don't get the help they need, or if they try to do more than they are able -- either physically or financially. Caregivers who are "burned out" may experience fatigue, stress, anxiety, and depression. Many caregivers also feel guilty if they spend time on themselves rather than on their ill or elderly loved ones."

So what would lead to this situation . . .

• Emergency Conditions - in many cases the role of caregiver is thrust upon an individual without any warning and without any respite - there is no time to grive a change in the state of the relationship, many times one has to shoulder new responsibilities in addition to the caregiving role like finances - it can be overwhelming
• Saturation or Lack of bandwidth - even if the role of caregiver is more gradual there might just not be enough time in the day to abosrb all the new tasks . . . women over the last 25 years have increasingly become financial breadwinners (something to be lauded) which leaves them with less time - but they still are expected, many times, to fulfill the traditional role fo caregiver
• Frustration at diminishing progress - often, the individual being cared for does not make significant progress despite the best efforts of the caregiver

Despite this over 60% of caregivers find it a positive thing in their life and willingly suffer the burden. Many don't realize they're slipping into burnout. And the most important thing in a situation like this is not the patient, but the caregiver who has to hold it all together.

So what can be done . . .

• Recognize your limits - and get some help - if not a friend or family member then ask in your religious institution - most people will willingly help - if you can't figure it out yourself then contact a local social work agency and have someone come over to help you out
  
• Get some time away from the situation every day - make sure you have time for yourself so you're not swallowed up in the situation on a daily basis (later we'll discuss home monitoring systems which can assist with this)
  
• Take advantage of respite care services - many of these services will allow you some time give you a break for a weekend, or a week
• Try and be realistic about your loved one's situation - find a group of people going through the same situation - In fact, severe cognitive, behavioural and emotional changes in the patient is reported to constitute the main risk factor for caregiver burnout - we're social beings and sharing a burden reduces it's significance - a local social work professional can find these for you if you're having difficulty
  
• Try and keep your sense of humor - laughter is after all, the best medicine

My grandmother, Nellie, lived with us for seven years before my mother realized she had burnout. Her family was unwilling to help. the situation reached a crisis and Nellie, who we dearly loved, was sent to her youngest son who really shouldn't have been looking after her as he has his own issue with alcohol.

The situation with my mother took 6 or 8 weeks to resolve her sanity and by that time we'd moved Nellie into a home where she eventually passed on. If, we'd been smart enough to recognize the signs early enough, we could have taken steps to make Nellie's final conditions a little happier for her. From first hand experience, I cannot stress enough the need to take care of the primary caregiver first.

So to some sources:

www.caregiver.org is an excellent source of information on this topic
www.alz.org is an excellent source which deals specifically with Alzheimer's
An electronic forum for caregivers of people with neurological disorders to find support from other caregivers can be found here

Keep smilin'
Steve

Falls and Fractures and how to reduce the risk

My Father, Gerry, who we will see is a bit of a character, is 75 now and had a bad fall a couple of years ago from a step ladder. Gerry is a short but heavy man - he loves his food - so he's a little unbalanced and his ankles are not as strong as they used to be. I received a phone call from my mother describing the details and the subsequent hospitalization overnight and how he was in terrible pain. I asked to talk to Dad and the first words out of his mouth were "Humpty Dumpty had a great fall". God bless him!

Our previous posting referred to one of the biggest causes of losing independence as falls in the home. Let's look at some of the details.

• More than one-third of adults ages 65 years and older fall each year (Hornbrook 1994; Hausdorff 2001).
• In 2003 more than 1.8 million seniors age 65 and older were treated in emergency departments for fall-related injuries and more than 421,000 were hospitalized (CDC 2005).
• Among people ages 75 years and older, those who fall are four to five times more likely to be admitted to a long-term care facility for a year or longer (Donald 1999).
• Among older adults, the majority of fractures are caused by falls (Bell 2000).
• In 2000, direct medical costs totaled $179 million dollars for fatal and $19.3 billion dollars for nonfatal fall injuries (Stevens 2005, in press).
• Women sustain about 80% of all hip fractures (Stevens 2000).

How can seniors reduce their risk of falling?

Through careful scientific studies, researchers have identified a number of modifiable risk factors:

• Lower body weakness (Graafmans 1996)
• Problems with walking and balance (Graafmans 1996; AGS 2001)
• Taking four or more medications or any psychoactive medications (Tinetti 1989; Ray 1990; Lord 1993; Cumming 1998).

Seniors can modify these risk factors by:

• Increasing lower body strength and improving balance through regular physical activity (Judge 1993; Lord 1993; Campbell 1999). Tai Chi is one type of exercise program that has been shown to be very effective (Wolf 1996; Li 2005).
• Asking their doctor or pharmacist to review all their medicines (both prescription and over-the-counter) to reduce side effects and interactions. It may be possible to reduce the number of medications used, particularly tranquilizers, sleeping pills, and anti-anxiety drugs (Ray 1990).

Strong studies have shown that some other important fall risk factors are visual impairments (Dolinis 1997; Ivers 1998; Lord 2001). To reduce these risks, seniors should see a health care provider regularly for chronic conditions and have an eye doctor check their vision at least once a year.

What other things may help reduce fall risk?

Because seniors spend most of their time at home, one-half to two-thirds of all falls occur in or around the home (Nevitt 1989; Wilkins 1999). Most fall injuries are caused by falls on the same level (not from falling down stairs) and from a standing height (for example, by tripping while walking) (Ellis 2001). Therefore, it makes sense to reduce home hazards and make living areas safer.

Common environmental fall hazards include tripping hazards, lack of stair railings or grab bars, slippery surfaces, unstable furniture, and poor lighting (Northridge 1995; Connell 1996; Gill 1999).

To make living areas safer, seniors should:

• Consider eliminating some elevations in the home (in some cases this may mean moving to one level)
• Consider any potential furniture or passageway issues – doors should be 36” wide if possible, hallways should be 42”
• All stairs, if used, should have easily reachable handrails which will hold your weight, possibly on both sides of stairways
• Remove tripping hazards such as throw rugs and clutter in walkways
• Use non-slip mats in the bathtub and on shower floors
• Have grab bars put in next to the toilet and in the tub or shower
• Consider replacing your tub with the high step in with a walk in shower
• Have handrails put into any area where elevations change (especially externally)
• Improve lighting throughout the home.

These preventive actions can be complemented with some assistive technologies such as:

• Personal Emergency Pendants
• Home Fall Monitoring Systems
• Consider automating lighting so that you will always have light when you move around
  

Any good contractor can provide the hardware solutions described above and we are willing to share our expertise at Age@Home. These preventive actions should form one of the critical components in any home renovation you consider. However, contact any supplier of grab bars and they'll be able to recommend an installation source locally – make sure they know you don’t want it to look like an institution. If it’s a fairly significant renovation – consider asking them to hire a trained Occupational Therapist to help in the design.