Aging in place, at its core, means adapting to changes that are happening physically, psychologically, emotionally, and cognitively. It also means finding an environment that can accommodate those changes. You can create a quality of life that will see you through the changes you will experience as you leave your work world, transition into “retirement”, and then negotiate your needs until you die.
Typically, Americans make four housing transitions between retirement and death. The first is to leave the place where you raised a family or spent the majority of your working life and downsize. Some of you will stay in that geographic vicinity; others will move to a better climate. Some will leave for economic reasons like lower taxes; some will leave to be closer to children and/or grandchildren.
The second move happens after a decline in health and/or functioning. For many, this move is psychologically difficult because of having to come to terms with physical limitations. This move is frequently to assisted living, where meals are provided, transportation is included, caregivers are available to help, and there are opportunities for social interaction. It is a benchmark of functional decline that marks an irrevocable turning point.
The third move is to a skilled nursing facility (SNF) . The route to the nursing home typically includes a stop in the hospital first. After discharge, you might stay in the SNF for a short while (weeks or at most three months), in order to receive 24-hour nursing care and rehabilitation. If the rehab doesn’t work or there is further decline, the short-term stay turns into a need for long-term care. If you have sufficient funds, you can be cared for at home. If you don’t have family or funds, you may end up staying in that SNF.
The final “move” is often from a care facility to a hospital either for acute treatment or palliative care. Statistics suggest that the last stop for most of us is the hospital or nursing home. According to a study by Stanford University, only 20% of older Americans die at home; this in spite of a near universal wish to “die at home in my own bed.”
Considerations for Aging in Place
There are any number of variables to consider when initially brainstorming how you will age in place. Most of us do research on costs of living, including taxes and fees. These are the financial drivers, which need to be taken into consideration, but there are other areas that have an equal if not greater impact on quality of life. And it pays to think about them before you make your move!
Here are areas to consider: 1) availability and adaptability of housing, 2) access to healthcare, 3) types of transportation and frequency, 4) food sourcing, 5) intellectual/social stimulation, 6) opportunities to earn money or add value to your community, 7) recreation accessibility, 8) spiritual communities, and 9) creative expression (in terms of enjoying and creating).
Each of these intersects with others, and contributes to the overall quality of life not just for aging adults, but for all who live and work in that community. A guiding question unique to elders, therefore, is how does the community you are wanting to move to value elders and what role(s) are available for elders to assume? Needless to say, each of these areas could be the focus of a blog (and that just may happen!), but for today, here is a sampler of some of the things to explore within each.
Will you be an owner or a renter? Do you know what laws protect you? Are you taking climate change into consideration? Is there a sufficient supply of housing to meet changing needs, for example, assisted living, memory care, skilled nursing? What are wait times?
What levels of healthcare are available? For example, emergency care, urgent care, surgery, rehabilitation, palliative care and end-of-life care? How far do you have to travel to access these? How will your insurance coverage change? What kinds of providers will you need and are those providers taking new patients? Are there sufficient numbers of specialists who can see you? What about psychologists, dentists, physical therapy, chiropractic, massage, and other specialists? What is the availability of caregivers?
No matter where you live, it is essential that you evaluate availability and cost of transportation (e.g., busses, Uber, trains, subways), and assisted transport. This includes evaluating frequency (e.g., number of runs per day, week, month), scheduling (24-hour), and how far you need to go to scheduled locations (stops). When and if the time comes when you no longer drive, these factors will play a major role in determining your ability to stay connected with your community.
Food is at the core of staying healthy and enjoying life. Knowing where to source good food, whether it be locally produced or found in a restaurant, is really essential as we age. Researching availability and cost of meals prepared in healthy ways that meet your dietary needs (e.g., culturally-sensitive, visually appealing, and able to be consumed) is key, especially if you no longer cook for yourself.
Life-long learning includes opportunities to learn from others or teach others. Searching out opportunities to share knowledge either through peer-to-peer platforms or in group can make transitioning into a new community easier. You may also find affiliation groups where you can cultivate and share wisdom (e.g., archiving, curating, and preserving).
Just because you have “retired”, doesn’t mean you don’t want to earn some money or share your wisdom. Checking out what the employment market is like, as well as what opportunities exist to continue to contribute to the economy and development of the workforce through volunteering, mentoring, supervising, and/or entrepreneurship, can make transitioning to a new community more lucrative.
I know that one of my priorities is to have access to activities I love, including being in the outdoors and in close driving proximity to some of nature’s most beautiful vistas. Some additional considerations include evaluating accessibility for specific adaptive needs (e.g., wheel chair access, braille, and hearing impairment), as well as adequate parking.
More and more people are seeking opportunities to explore purpose and meaning in life, along with participating in organized religion. Connecting with spiritual communities and/or identifying opportunities to benefit others through service groups is something not usually touted in brochures, but it can be (and personally, I think should be) one of the key factors in deciding where to live.
The Arts (Creative Expression):
Another factor that brings lasting value is creating and participating in all forms of creative expression, including attending performances, productions, shows, or being on the creative end and making music, art, dance and good times. You may already be familiar with what is available in the community you are thinking of moving to, but seeing what is happening year-round can give you a sense of how you might grow or where you can plug in.
Most Important: What is the Role of Elders in the Community?
It is essential that you evaluate how elders are valued in the community you are considering moving to. Where do you fit in? What are you bringing to the community and what will you find supports you as you age? It is more, so much more than a meal plan and floor plan. This is the place where you will spend the rest of your life. Make it as nurturing as possible.