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.