January – Aging in Place?
February – Activity and Aging in Place
March – Drinking Water and Aging in Place
April – Aging in Place Numbers to Know
May – Car Conversations and Aging in Place
June – Advanced Directives are Part of Aging in Place
July – Vacation Time and Aging in Place
August – Grief, Loss and Aging in Place
September – Women and Aging in Place
October – Aging in Place Takes Tough Love
November – Holiday Time is an Aging in Place Opportunity
December – Caring to Age in Place

Scott Funk is the 2006 recipient of the Champlain Valley Agency on Aging’s Aging Advocate Award. He is Vermont’s leading Aging in Place advocate, writing and speaking around the state on issues of concern to retirees and their families.
He provides this column to newspapers and magazines each month. If you’d like to read it in your local paper, please let them know or contact us with the name.
Scott works as a Home Equity Conversion Mortgage (HECM) Specialist.

January 2007

Aging in Place?

More and more we are hearing this phrase: Aging in Place. A national event celebrates it and both Gov. Douglas and Lt Gov. Dubie have called it a factor in healthy aging. Aging in Place is growing older where you choose to in a way that is healthy and safe. It is important to talk about because none of us can accomplish this alone.

Improvements in wellness, healthier lifestyles and, yes, all those expensive pills have transformed our expectations of what it is to be older. Every twenty-four hours, 5,000 Americans turn 65. They are not heading toward nursing homes. Vermont’s Commissioner of the Dept. of Disabilities, Aging and Independent Living, Patrick Flood, was recently quoted in the Wall Street Journal as saying, “We are never going to build another nursing home. It is an outdated model.”

But it isn’t as easy as you might think. Aging in Place doesn’t just happen. It takes planning and support.

I recently met with an 84 years young woman living in a remote farm house in the Northeast Kingdom. She was determined to remain there the rest of her life even though here sight was diminishing. I asked how she would get groceries, “My daughter will do that.” Who would take her to the doctor? “My daughter will do that.” What about cleaning such a big house? “My daughter will do that.” Finally I asked if she had talked all this over with her daughter; “My son will do that.”

Assumptions are made by both elders and their adult children. None of us like asking for help. It’s also tough to know how to offer assistance without interfering. The challenge is to engage openly, honestly and in a positive manner. Equally important is to observe what is happening in the lives of elders. This is critical to quality of life issues. When my dad gave up peanut butter it never occurred to me that he couldn’t open the jar anymore.

So, Aging in Place is about quality of life as we grow older. It embraces wellness, mobility, transportation, and issues of access. It involves each of us because it touches all of us. More than just where we live, it is how we live and who needs to be part of it.

Aging in Place, it doesn’t happen by accident.

February 2007

Activity and Aging in Place

There was a point, as my dad aged, when he moved into the living room. The realization he was doing this came on us slowly. It went from his falling asleep in front of the TV to his always sleeping in the chair, through a series of little adjustments no one noticed.

Looking back now, I recall how hard it became for Dad to get in and out of that chair. He was a short man and I don’t think he could sit on the edge of his bed and reach the floor. Somewhere in his 80’s, climbing out of the chair or hopping out of bed just stopped being an option. Unfortunately, as Dad moved less, he lost flexibility and strength.

Simple acts like getting up and going to bed involve stretching, organization, and mental discipline. How we go about our day, is part of how we see ourselves. As we age some things, which were so automatic they went unnoticed, can become like mountains blocking familiar paths we have traveled for years.

It’s important to remember that getting older doesn’t mean we are different. Changes in behavior or habits are indicators of what we can do, not who we are. Today we enjoy almost unlimited choices to assist us in maintaining a healthy and active lifestyle. Just look at the ads in any elder-oriented magazine. Googling “Aging in Place” offers seemingly endless sites to visit.

There are chairs that tilt forward to help you get out. Beds come in all sizes and heights and can adjust into various positions. Simple grab bars or pulls can make a tremendous difference in mobility. One of my favorite innovations is the step through bath tub.

All these innovations and more are designed to help us stay active and fit. Options are available. Challenges and changes to daily activities can be addressed, often in easy-to-implement ways. Healthy aging is like the Chinese proverb about taking a long journey; it is just one small step at a time.

Aging in Place, it doesn’t happen by accident.

March 2007

Drinking Water and Aging in Place

The moans are almost audible, “Not another article about drinking water”. It does seem every time we turn around, the media is pushing the miracle drink, but it’s still a battle to get some people to drink enough.

Me, for example. It wasn’t until after the third kidney stone that I finally heeded my doctor’s simple advice. “Drink more water.” That was over a decade ago and no kidney stones since. Like most slow learners, once I get it I keep it. So, why is water such a big deal? It’s the stuff of which we are made. Blood is 83% water and muscle is 75%. How about the brain? 74% and bone is 22%. Of course, if it matters when we’re young, it becomes crucial as we age.

Drinking water helps flush things out and keep the plumbing working. It affects our weight and our attitude. When we are dehydrated our blood becomes thicker. That makes it move slower and it should come as no surprise that we go slower too: mind and body.

Kidney stones are just one of many ailments for which lack of sufficient water is a risk factor. What we thought were signs of dementia in my dad turned out to be confusion related to dehydration. (Dad hated to drink water.)

How about a beauty secret that is almost as old as time? Water moisturizes our skin.

According to research at Loma Linda University, water even helps prevent heart disease. Of 20,000 men and women studied, those drinking 5 or more glasses of water a day were less likely to die of a heart attack than those who drank less than 2 glasses a day.

Most of us wake up thirsty. So, start the day with a tall glass of juice or water. Then just keep some water near by the rest of the day. Having water near seems to make us thirsty.

Water: it’s a cheap, easy way to be healthier. After all, Aging in Place doesn’t happen by accident.

April 2007

Aging in Place Numbers to Know

Years ago there was a wonderful thing called Information 411. We could dial it to talk to an actual person and get assistance finding a phone number. But this was long ago, before the internet, the break up of Ma Bell, and a lot of other things which promised to make our lives easier and less expensive.

Here in Vermont, we are very fortunate to have a wonderful new service courtesy of the United Way of Vermont called 211. 211 is free and available throughout the Green Mountain State (8-8 Mon-Thurs, 8:30-4:30 Fri). It’s designed to improve public access to non-profit and government service providers. Just like Information of old, you can dial 211 and get the number you want even if you aren’t completely sure of the organization you are looking for. If you prefer to go on line, they have a website, www.vermont211.org.

There’s another number that should be posted next to the phone: 1-800-642-5119. That’s the Senior Helpline and your call will be answered by a person from your local Area Agency on Aging. This is like a one stop shop for any questions specific to elders. Meals on Wheels, who do I call for what, Medicare Part D — the people at your AAA either have the answers or know who does.

The Vermont Assistive Technology Project’s number is 1-800-750-6355. They have wonderful devices to help us adapt to the challenges of change. From issues of sight to accommodations for opening containers, they’ve got the stuff. There is even a lending program so we can try things out. Again, there is also a web site, www.dail.state.vt.us/atp.

As you can see, we can’t avoid the internet. Everything from AARP (www.aarp.org) to Social Security (www.ssa.gov) is on the web. The National Aging in Place Council at www.naip.org is a great resource. One of our favorites is www.seniorresouce.com. It has a great jokes page and links which can take you far and wide.

Successful Aging in Place is like being the conductor of a great orchestra, utilizing the many and varied parts to produce the best possible experience. Access to information is a critical component. You need to know where to find it or who can help you get it.

Aging in Place, it doesn’t happen by accident.

May 2007

Car Conversations and Aging in Place

“Driving! Dad’s driving? What do you mean, Dad’s driving? He’s nearly blind!”

“Don’t get so excited. There’s nothing to worry about; I’m always with him,” Mom countered reassuringly. “I tell him when to turn left or right and when to stop, don’t I dear?”

“What, what was that?” Dad responded.

Of all the minefields negotiated between generations, driving can be the most explosive. This conversation is about more than safety; it is about independence. It touches who we are as individuals. This is dangerous territory.

So what do we do?

A good place to start is remembering who taught us to drive. Those first few rides were probably white knucklers. Consider the patience and courage we benefited from. How many fender benders or near misses did Mom and Dad forgive? In most cases, our parents have thousands of accident free-miles behind them. Whatever the circumstances, that deserves to be acknowledged.

A quick Google of “senior driving” yeilds plenty. AARP has everything from safety tips to elder driver training. The AAA Foundation for Traffic Safety has an excellent site. There is also a tremendous amount of helpful information at www.seniordrivers.org.

If we are going to ask a parent to change how or when they drive we must also take into account the impact it will have. What are Dad’s alternatives? We can’t expect him to accommodate our concerns without having his needs met. Is Mom expected to wait for alternate Saturday afternoons to go shopping? Are doctor’s appointments going to fit with soccer schedules?

There is also the flip side of concerns about driving: diminished activity. Have Mom and Dad stopped visiting us as often as they used to? Did they stop going to evening services although they had always looked forward to them? These signs may not carry the loud message of the bump and crunch method of parking, but they are just as important to be aware of.

Aging changes how we do things, not who we are. There may be a need to accommodate and adjust, but that doesn’t mean anyone should be asked to give up or give in. Transportation and mobility are essential to being able to Age in Place. A caring and supportive family is as important to that as a tune up and a new set of tires.

Aging in Place, it doesn’t happen by accident.

June 2007

Advanced Directives are Part of Aging in Place

During our Caring Conversations around the state, one of the topics that invite lots of comments is Advanced Directives. No matter the age or professional make up of the audience, everyone has questions and interesting stories to tell. Commonly, someone expresses that he or she is too young to worry about these. Just as often, someone else has completed their directives, but not shared the information with their prospective medical agent.

Advance Directives are the documents which enable others to act on our behalf in medical situations when we cannot speak for ourselves. Although there is some confusion about them, their purpose and form are really very straight forward:

Vermont Advance Directive for Health Care enables you to appoint an agent to make health care decisions for you. It also provides guidance so that person can act in a manner consistent with your wishes for care, organ donation and funeral arrangements.

Durable General Power of Attorney for Finances is the only document that needs the participation of an attorney. That is because it appoints a person to make financial decisions on your behalf if you are unable to.

HIPAA Medical Release, because of your rights to privacy, you need to designate those you want to have access to your medical information, should you be incapacitated.

All these forms can be downloaded from the Health Department’s website, healthvermont.gov/vadr/index.aspx. If you don’t go on line, the Health Dept.’s number is 802-863-7300.

The Health Dept. is also the home of Vermont’s Advance Directive Registry. This is new service which makes your Directives available on a need-to-know basis to health professionals. In an emergency situation, having your information available through the Registry is critical to ensuring your wishes are carried out. Unfortunately, of the estimated 150,000 Vermonters who have Advanced Directives, only about 200 have utilized the registry.

Finally, it is important to review and update your Directives every few years or after significant changes in your life. Laws change and so do you. During one of my talks a person acknowledged that, although he was recently remarried, his ex-wife was still designated to act as his medical agent.

Aging in Place, it doesn’t happen by accident. You need to do the paperwork.

July 2007

Vacation Time and Aging in Place

Summer’s here and for many of us that means vacation time. This is when families gather at the lake or campground, extending traditions for yet another year and to another generation. Everyone together, grandparents, parents, children, grandchildren and even great grandchildren, maybe even uncles, aunts and cousins, all together at one time for fun in the sun.

Aging can present challenges to these traditions, but if they are acknowledged, many are easy to resolve. Most are issues of mobility and access.

If everyone is going to be able to come to camp, the family needs to look for simple ways to make it elder- accessible. Maybe a ramp is undesirable, but some landscaping could eliminate the need for those two steps at the front door.

Not all problems require big solutions. A grab rail for the bathroom to make negotiating the tub safer and easier is now available in a portable model. It has suction cups that hold it to the wall. You can even get a small one that fits the hand. (These can also make getting in and out of bed easier.)

While we are in the bathroom; how about a low cost adapter to elevate the seat and make the toilet easier to use? Is the walker to hard to transport? That’s an easy one, they make a collapsible model. There is even a telescopic cane.

It is also important to consider transportation. Is the reason Grandpa stopped coming to camp really because he is too tired? Maybe it’s that long drive or difficulty packing. Perhaps sharing the ride or helping him get ready will make all the difference.

Summertime is family time.

Aging in Place, it doesn’t happen by accident.

August 2007

Grief, Loss and Aging in Place

“It seems like every day I learn of someone else who has died or discover something else I can’t do.” The 87 year old client who shared this with me summed up perfectly the constant state of loss and grief which is part of aging.

As I approach 60, gardening has become something I get in shape for each spring. Driving at night is more difficult. Skiing the big bumps is no longer possible for the same reason I need to wear elastic supports around my knees when I dance. My body has lasted long enough to have earned a little accommodation.

Whether it is the death of a friend or realizing we can’t carry the air conditioner down from the attic anymore, it is a loss. Some are significant to everyone. Others are private and difficult to explain. All matter and deserve to be grieved. That is not always easy.

When my knees couldn’t take the moguls anymore, I decided to stop skiing. It just wasn’t the same. An old ski buddy had faced the same decision a few years before. He adjusted and continued to ski. I didn’t and we drifted apart. More loss, more grief.

It wasn’t until I attended a class on grieving that I appreciated what was happening. Not only had I stopped skiing, I no longer enjoyed winter at all. Because I hadn’t allowed myself to grieve, I couldn’t process the loss and move on. Once I did, I was able to replace one winter sport with another. Now, I thoroughly enjoy snow walks with my camera in the woods behind my house.

So, when Dad shares that he can’t do this or that anymore, don’t minimize it. Inquire about how he feels; acknowledge how tough that must be. When Mom’s friend passes, ask about the person and encourage a few stories of the times they had together. We can help to bring the grief out into the open where it can heal.

Sometimes the best support we have to offer is taking the time to listen.

Aging in Place, it doesn’t happen by accident.

September 2007

Women and Aging in Place

On many levels, Aging is Place is women’s work. Because they outlive men, a wife is often the caregiver for her husband. Left alone when he passes, her care is usually provided by a daughter. In between providing care for him and needing care from her is often a period of years spent struggling on a reduced income.

According to the Society of Certified Senior Advisors™, the average care provider is a 46 year old female, working a full time job on top of caring for her mother 18 hours a week. 18.6% of women providing care do so at least 40 hours a week. 72% of all care providers are women.

The comics had the wrong image. In our society, the real Wonder Woman is zooming from her responsibilities at work and home to the many tasks she has taken on in caring for one or both of her parents. I’m reminded of my own sister. On her only day off, she was giving her grandson a birthday party, picking her husband up from work, and zipping over to our dad who needed some assistance before coming to the party.

So, Aging in Place has a much broader meaning for women. It is not only about how they will age, but how they will deal with others’ aging. For working women this means having a financial planner who takes these realities into account. It also means building emotional bridges and overcoming relationship challenges before finding oneself conscripted into care.

Care is a gift which should bless both the provider and receiver. It is an opportunity for a unique kind of closeness. Distance prevented me from being available to our father during his final years. Now he is gone. The stories my sister shares with me are not of the hardships; they are the tales he told her during the many hours they shared. The depth of her knowledge of his life, his youth and beliefs is incredible to me. She has made it very clear that she gained much more than she gave.

My daughter is fond of reminding me that Ginger Rogers danced every step Fred Astaire did, but she did it backwards and in high heels. How can women do so much that is so difficult with such elegance and grace?

Aging in Place, it doesn’t happen by accident.

October 2007

Aging in Place Takes Tough Love

Aging in Place means taking the long view. After all, we are talking about the rest of our lives; for most people that’s longer than anticipated. For many of us, our retirement years will exceed our working years. At some point, time can force choices about money. This is not just a financial problem; it often creates a challenge of values.

Most of The Greatest Generation were raised with the expectation of inheriting their parents, home. Of course, back then the aging parents came with the home. That was in the days before Social Security, Medicare or Medicaid. For people now in their seventies or older, there is a very strong need to pass things along to the kids. They see themselves as the custodians of wealth, not the owners, but the situation has changed dramatically.

Now, families are spread out all over the country. Most adult children have prospered far beyond their parents’ wildest dreams. Inheriting the house no longer means taking care of the occupants. So, while elders struggle not to spend down their wealth or keep the house mortgage free, the children are saying, “Don’t worry. I’d rather see you enjoy your money. I don’t need it.”

It isn’t just that we are living longer. We are also staying more active. Living a longer, fuller life means needing more money. Giving ourselves permission to access that money can be a very tough emotional decision, even when the kids are yelling, “Do it!” from the sidelines.

Even tougher is when retirees are struggling, but they also feel a need to assist their adult children. How do we choose between making sure we have enough to last the rest of our lives and our son or daughter’s urgent need for cash right now?

That’s where tough love comes in. Sometimes it’s necessary to say, “I love you and when I die everything I have left will be yours. But, between now and then, either I need to provide for myself or you need to provide for me. What I don’t need, you will get.”

Aging in Place, it doesn’t happen by accident.

November 2007

Holiday Time is an Aging in Place Opportunity

The holidays are an excellent time to build bridges of understanding between generations in a family. This is especially true for families who live further apart.

For the adult child, it is an opportunity to notice changes in their parents. Is Mom or Dad slowing down a little? Has the cleaning begun to slide or are there signs of deferred maintenance on the house? Is Mom still active in church? Why did Dad give up golf? What happened to their plans to take a trip?

This isn’t about looking for problems. It is seeking opportunities to appreciate what is behind changes so we can provide support. After all, if Mom is having trouble rising from her favorite chair in the living room, she may also be having trouble negotiating the step into the bath tub.

When our dad gave up peanut butter it never occurred to us that he couldn’t open the jar anymore. It’s called diminishing expectations, and solutions can be found.

For retirees, now could be good time to share how confusing keeping track of all the bills has become or that it’s starting to get harder to drive at night. If those big holiday feasts are becoming more exhausting, maybe the tradition can be passed on to the next generation. After all, whatever the satisfaction of roasting the turkey, there is also great pleasure in being served.

For many, the toughest conversation can be about a change of venue. Cost, time and energy can be overwhelming when it comes to entertaining several generations of loving family. What comes as a surprise to many is that rotating the festivities shares not only the work but the fun as well.

These are sacred days ahead for all of us. We share traditions of faith, values as a people and memories of family and friends. It is also a time of sharing and teaching, giving and receiving. Whatever our age, this is a joyous season.

Aging in Place, it doesn’t happen by accident.

December 2007

Caring to Age in Place

Roselyn Carter said, “There are for kinds of people: those who provide care, those who have provided care, those who will provide care and those who need care.” The issues of caring are universal; they touch everyone eventually.

Caring can feel like a hardship. Whether one is receiving or giving, it can lay heavily. For one side there are demands on time and energy; for the other, challenges to concepts of dignity and independence.

When we are young, our parents nurture us as they cultivate the person we are becoming. The weight of each day’s requirements is made lighter by our progress toward independence.

When we are older, we need support as we strive to remain independent. Illness can reduce what we can do for ourselves. Time can place limitations as our bodies age and change. This is not something wrong or a failure. It is just the way life is. In spite of all the progress in extending life, we still get older, slower and frailer.

Caring that takes place at the end of life is far different than at the beginning, but it is just as natural. It also offers as much opportunity for joy and for growth. In caring for elders, it is the giver who often grows.

As our dad declined, my sister spent countless hours assisting him. During those visits he shared stories which revealed a far more interesting and complex person than the dad we had known. The depth of the bond which grew between them is something I will always envy.

Caring for anyone, young or old, can be a tough job. With an older person there is the added complication that even with our best efforts, things are likely to get harder and eventually that person is going to die. That’s why support for the care provider is as important as care itself. Giving of oneself, often weeks or months without end, is draining. It takes a tool emotionally and physically. Most care is provided by one person. That’s why taking time for rest and rejuvenation is so important. There is a reason the flight attendant says, “Put your own oxygen mask on first.”

Care is an opportunity for a very personal kind of sharing. With grace, it blesses both those who give and those who receive.

Aging in Place, it doesn’t happen by accident.