Strategies for 'aging in place'

Lifestyle: Basic home modifications give the elderly more control over where they can live. SENIOR LIFE


It is one of life's most wrenching decisions. As the infirmities of age confront us, do we leave the familiarity and memories of our homes for somewhere more accommodating to illness?

Given a choice, most people would rather remain at home. From that desire has sprung a national "aging in place" movement that helps people adapt their homes to allow them to stay in familiar surroundings, near friends and neighbors, for as long as possible.

Gerontologists estimate that there are at least 1 million older people -- and probably many more -- living with mobility and health problems and that their ranks will soar as the baby boomer generation begins hitting age 65 in 2011.

Most U.S. homes weren't built with growing older in mind. "I call this Peter Pan housing," says Jon Pynoos, director of the Home Modification Action Project at the University of Southern California's Andrus Gerontology Center.

The front steps, staircases, narrow doorways, low electric sockets, high kitchen cabinets and fixed shower heads that work for young families pose hardships -- and hazards -- for elders. One in three Americans over 65 suffers a fall each year, often in the home, which can cause serious injury and depression and propel them into a downward slide toward death. Suburban housing developments that promise green lawns and open space sometimes breed isolation after residents' driving abilities diminish.

A few early studies suggest that some basic home modifications to improve safety and make it easier to maneuver about the home can forestall hospitalization and nursing home care as seniors grow more frail. And the savings that result should be attractive to health care insurers focused on cutting medical spending.

Still, cost and access remain obstacles. Most seniors or their families pay out of pocket for home modifications. And only a well-informed minority discover the scattered government programs that offer financial aid to help people remain in their homes so they can enjoy the comfort of communities where they've raised children and paid taxes.

Martha Griswold of Pasadena, Calif., knows something about improvising to cope with changing physical needs. Born with spina bifida, a spinal cord defect, she obtained master's degrees in religious education and political science before turning to a career in social work.

Now 69 and executive director of the Living Independently in the Valley Center, she uses her own experiences with disability to help others cope with physical limitations that can lead to a sense of hopelessness.

Crutches helped for most of her life, but in her 50s, she says, "my arm and my stronger leg began to say, 'I don't want to do that.' " She began using a wheelchair, which meant making some changes at home.

The tan stucco house on a quiet street where she and her husband live had one major barrier: a two-step entrance. Griswold's father, now 91, generously provided the $1,500 to replace the steps with a gently sloped garden pathway, now a showpiece of aesthetics and practicality.

The Griswolds, who live modestly, made other unobtrusive changes. They made the drop-off from their driveway to the street more gradual and replaced steps to the back patio with another concrete ramp.

"It means I can invite people over. I can have guests in wheelchairs," Griswold says.

The biggest expense was the $7,000 they spent to convert a bedroom closet into a small, tiled second bathroom, with a hand-held shower, floor drain and grab bars.

Griswold also created a bedside office for herself, equipped with easy-to-reach shelves and a pullout work surface for typing.

For low-income seniors, local handyman programs -- which operate with loans, sliding fees or grants -- furnish ramps, stair rails or grab bars that can mean the difference between being driven from home or staying put.

But many aging Americans are reluctant to acknowledge their vulnerability or ask for help until their need becomes acute.

"My experience with seniors is that, much more often than not, a decline in physical ability is a sign of kind of throwing in the towel. They'd almost rather put a sharp stick in their eye than install a grab bar," says Allan J. Browne, president of Extended Home Living Services in Wheeling, Ill. Browne says his clients have spent as little as $100 or as much as $750,000 -- but generally don't come calling until an emergency strikes.

Seniors clinging to their independence change their behavior before altering their environment. They'll stop taking baths because they can no longer climb into the tub. They'll stop visiting friends because they can no longer manage front stairs. They'll move into their first-floor dining room because reaching a second-floor bedroom feels like climbing Mount Everest.

Early research shows such changes do make a difference.

A study in the May-June issue of Archives of Family Medicine found that after 18 months, frail seniors who received intensive services and home adaptations were more independent and experienced less pain than similarly frail seniors who received typical services such as home nursing, Meals on Wheels and help with personal care.

The study looked at 104 frail elderly people. Although all declined in health during the study period, those who got intensive services declined less than those who got the common services.

While more money was spent initially for seniors receiving more intensive services, medical savings were dramatic: an average of $5,630 for their nursing home or hospital care during the study period contrasted with $31,610 in such care for those who got the typical services.

Pub Date: 06/20/99

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