For patients who need nursing home-level care, PACE programs (Programs of All-Inclusive Care for the Elderly) provide in-home service such as occupational therapy, physical therapy, meals, lab services, transportation to medical appointments and more.
State Area Agencies on Aging can connect older residents with in-home services such as chore assistance and meal delivery.
5. Discuss medical care reductions
It sounds counterintuitive to reduce medical care as you age, but “we often rely too much on too many healthcare providers, tests and procedures,” says Arbaje. “These have complications, especially medications.”
Cutting back is “not a refusal of care — rather an evaluation of the burdens versus the benefits of specific care,” says Dr. Tracy English, a nurse practitioner at Long Life Care Management in McDonough, Ga.
For example, the American Medical Association recommends against routine colonoscopies for patients over age 75 because of the risks involved. Some studies show statins (prescribed for high cholesterol) can have more side effects and fewer benefits for older adults. Benzodiazepines (used for anxiety, depression and seizures) can cause memory issues in older patients.
Barlow advises taking time to consider what your physician is ordering or recommending. “Discuss with your doctor how you feel about your care as you age and what is important to you – independence, optimal functioning and quality of life,” she says.
Arbaje suggests older adults “revisit the risks and benefits (of treatments) often, as these change over time.”
6. Maintain relationships
Social and family connections support mental health, such as the ability to manage stress and prevent depression. Tam Perry, associate professor of social work at Wayne State University in Detroit, suggests older adults find ways to both give and receive support. “Helping other people can be just as important and sometimes even more, for our well-being,” she says.
Family relationships are key to managing the challenges of remaining at home. A joint report by the National Alliance for Caregiving and AARP found that 89% of caregivers for older adults are family members.
7. Stay flexible
“Change is necessary and rather than it being forced on you, think of taking the lead,” says Barlowe. “Keep your eye on your goal of living independently and be open to possibilities that will help you.”
A study in Cell Press found aging causes the brain to become less adaptive to change. Older people can become resistant to things like taking new medications or making home modifications. (A separate study found that noncompliance with medication led to 23% of all nursing home admissions.)
Studies also show home modifications allow older adults to maintain their level of activity for at least two years. So, remaining open to these is key.
Additionally, Barlowe points out, “I have met more people that out of vanity refuse a walker but will walk through their home holding on to furniture because they are so unsteady. The use of a supportive device may allow you to safely remain independent.”
8. Start saving money
Remaining at home can be expensive. “[In-home] caregiving expenses are very high and a significant factor to be able to continue to stay at home when someone becomes dependent with multiple medical conditions,” says Gopalan.
Rates for nonmedical aides (for things like housework, meals and errands) range from $16 to $28 per hour depending on where you live. Home healthcare aides may cost up to $30 per hour.
Home modifications can range from inexpensive changes (railings or flashing doorbells) to major expenses such as stair lifts. Medicare does not cover home modifications. Medicaid may provide some coverage, but each state’s program is different.
Start saving for these costs now. “Older people who have paid off a mortgage and invested in adaptations to minimize effects of disability are best off,” says Stephen Albert, professor at University of Pittsburgh School of Public Health and editor of the journal Innovation in Aging .
9. Have a plan
Staying in your own home requires thinking ahead. If you have chronic conditions, talk with your doctor to understand how the disease could progress, so you can anticipate how to manage it in the future.
Plan for how you will get help when needed. “Personal emergency response (PER) systems [also called medical alert systems] are effective and efficient, says Chambers. “PERs allow for quicker response time by first responders and for medical attention to be provided,” she adds.
Arbaje says the most important thing is to talk to family “about what you would want if you were to get sick — who will take care of you, who will take care of the pets and who will take care of your spouse.”
Brette Sember is the author of many books about divorce, child custody, business, health, food, and travel. She writes online content and does indexing and editing.
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