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Putting Together the Pieces for "Aging in Place"

October 1, 2001
by Bonnie Solomon
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  One of the most common trends facing providers of senior housing is that many of our existing residents have become physically frail. Their mobility might be limited, and they generally do not have much strength and endurance. Some might have impaired cognitive function. They might be somewhat forgetful, react to situations much more slowly than they used to and might not be thinking on a concrete level. These seniors might not require ongoing oversight, but they do have chronic physical and/or mental problems. Age itself has not produced disability, but rather a combination of disease process, poor health and a natural slowing down of bodily functions. "Aging in place"-the process of becoming increasingly frail while still living in an independent living environment-is beginning to pose a challenge for many operators.
For the older adult resident, those promised "Golden Years" are just a bit tarnished. Their progressive frailty impacts their ability to perform at least one of the "activities of daily living" (ADLs) or "independent activities of daily living" (IADLs):
  • ADLs include dressing, bathing, grooming, toileting, eating and ambulating.
  • IADLs include meal preparation, shopping, housecleaning, using the telephone, managing money and taking medication.

Ultimately, the decline impairs their ability to sustain self- and home or apartment care. They might have increased difficulty shopping for groceries and preparing meals. They might have reduced social contacts and a limited ability to participate in the social milieu of the housing community, thus feeling isolated, lonely and often depressed. Their disturbed sleeping habits might keep them and other residents awake later at night because the television is on just a bit too loud. They might have reduced ability to care for their beloved pets. They might be experiencing frequent falls. They might spend time in your public areas and lobbies, just sitting or sleeping. They are increasingly dependent on other residents and staff to help them.

Certainly the challenge to the seniors housing management staff can be evident in increased maintenance and housekeeping problems because of odors, pest infestations and incontinence, for example. Some residents might report persistent knocking on their doors by neighbors requesting assistance or orientation reassurance. Reports might increase regarding "stolen" possessions that later are found misplaced in another location in the apartment, as well as lost keys, accidental lockouts and complaints from other residents. Management might even notice that some appliances require additional maintenance because of misuse or abuse.

The impact of the resident's "aging in place" must also be seen in the context of their families' reactions, e.g., families feeling:

Guilty. After all, they have busy lives. Consider that Mom might be 90 years old and the daughter could be 72 and retired in Florida with her 78-year-old husband. Their own daughter is 44, a single mother raising two teenage children of her own. Sometimes the guilt can be laid upon the family by the resident herself: "How come one mother can take care of five children, but five children can't take care of one mother?"

Angry. "Why should I be spending my time helping Mom? I do all that I can and she doesn't appreciate it or remember that I've been here." Often unresolved conflicts from childhood surface at this stage of life.

Frustrated. "I've tried everything. She won't let in the homemaker I hired," or, "He won't give up his car keys and insists on driving without a license or insurance."

Afraid...of their own aging or death. Watching close relatives functionally de-cline can be scary to family members. So many are afraid that dementia or Alz-heimer's disease will be their fate, as well.

A sense of grief and loss. A serious change in a close relative can produce the same reaction as his or her death-grieving for the person who is no longer there. So often we hear, "I wish you had known my mother before, or when...." Unlike death, a loss of this kind has no set rules or rituals to follow to ease the pain.

In denial or out of touch. "I just took her to the doctor and she's fine." And how often do we hear, "That's why we pay you. You take care of Mom!"

And that really is management's problem. What do we do with residents who have functionally aged beyond the ability of the housing community's service capacity? How do we deliver the additional level of services our residents require and at the same time continue to attract active, independent residents?
Before answering that question, there are several points to consider:

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In all your nice online posts, Delmar Gardens talks the talk alright. I actually do think you're a great nursing home environment but the facts are horribly clear to me, that Gabe shouldn't refuse communication with Jimbo. If I'm seeing something wrong he needs to meet with my hubsand and myself to see if there is a resolution. A total public apology and huge photographs of my husband in Chef Attire in every nursing home would do for starters! Geesh what's it take to get the rich to see that we poor people have rights too? Did you know he used to play poker in the basement of Jimmies home years ago, he and the guys. They were all best friends, or at least he assumed to be. Please Bonnie, just tell Gabe to do the right thing. No matter what he feels about me, I am not going to go away until he talks to my husband, and then even after that I would wonder if he would trick me, trying to accuse me of some kind of blackmail, I don't want this man flicken money, I want my husbands self respect returned to him NOW!!!!!!!!!!!!!!!!!!!!!!!! Ask Gage what he think about Jimbo sitting around at age 86 in near tears because he didn't get a full retirement? Ask him Bonnie please?

Sorry for the typos I'm just so darn upset. Gabe makes me feel like I did something wrong to ruin my husbands chances of retirement when he clearly refused him in his office the last time we were in, years ago. If my husband passes from this earth without a retirement I will continue to spend my lifes on-going mission to get Gabe (sorry for the type earlier) to get GABE to do something in my husbands honor, this is disgusting to me, a downright sin, if not illegal, it's a sin to treat another human being with such diregard. Of course these are only my opinions. Just read the blog at http://www.thestlousiattorneys.com and reply. That's all I care about.

Please have Gabe Grossberg read my blogs about Delmar Gardens on http://www.thestlouisattorneys.com site. I'm sure he'll want to respond to the already high ranking consumer complaint blog that I have designed. It's a nice blog, but it does feature him center stage of a question beign posed, "Why is he earning a massive living off the retirements of St. Louis's wealthiest and yet refuses to pay Jimbo Sias a retirment?" I hope he answers quickly cause my fingers are getting tired of writing about it, trying to figure out how he could ignore my questions.

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