Language is important. Aging in Place and Aging in Community mean different things to each person who hears them. Then think about livable community, age friendly city, encore careers, productive aging and many other descriptors. Which is the right approach to aging for society and individuals? And which verbage to describe that to whom? I will not resolve that discussion. But I am committed to insuring dignity for people who are aging. I recently wrote that Long Term Care at Home was the best description. I am writing to change/retract/refine that statement.
Long Term Care @ Home (LTC@Home) is a subset of dignified aging. LTC@Home is the scary, important and expensive part near the end of life…how ever long that end is… best described as when you need regular help with the activities of daily living (ADLs). ADLs is technical health care jargon about the capability for self care. This is the point traditionally associated with suggested or forced moves, the formalizing of in home care and the release of governmental funding and long term care insurance benefits. I often describe it as “when push comes to shove”.
This is the time when people are forced to make dreaded decisions about what to do, too often giving up a chosen and loved home, spending lots of money or paying down assets. It is the time when dignity, control, self esteem and respect are too often abandoned in the pursuit of ‘safety’…desired or not. See Atul Guwande’s Being Mortal for a fabulous discussion of this topic.
It is also the time when we who are dedicated to preserving dignity in aging and want to change the world have a great opportunity to serve. Encouraging people to prepare can help avoid unwanted outcomes. Developing valuable products and services people are willing to pay for will create functional markets. Forming easy ways to access and navigate better services preserves financial resources and makes the LTC@Home alternative not just desirable but possible.
Sure there is plenty of work to do in positive aging, active aging, healthy aging, productive aging and let’s not forget Woo Hoo FUN aging! They all need proponents and all have great potential to enhance dignity and society.
For now, I am concentrating on the foundations and infrastructure for long term care at home with dignity – LTC@Home. Please join me. I am working with dedicated colleagues and business leaders on important actions for the the first quarter of 2015. Please get in touch to learn more and join in the effort. The future is bright. The time to create the future is NOW!
Happy New Year, Louis
Louis Tenenbaum, one of the nation's leading authorities on aging in place, is the founder of HomesRenewed, a coalition of business, consumers and nonprofits, driving policy and investment to increase the number of age-friendly homes.
{ 5 comments… read them below or add one }
Louis,
Love these terms, more than “aging in place”!
“positive aging, active aging, healthy aging, productive aging and let’s not forget Woo Hoo FUN aging!”
I’ll stay in touch, I’ll be following you!
Take care,
Chuck
Those of us involved with working on improving everyone’s ability to remain safely and comfortably in their homes have been struggling with semantics since the first time we saw someone recoil when we used the word aging, or senior, or elderly. We have been trying to delicately dance around the subject with terminology like lifespan design and comfort height toilets. While I fully embrace the reality that universally designed homes are good for all of us, and I look forward to the day when all homes are built this way, I can’t help but wonder if we should be bolder in our clarion call to plan ahead and get ready for the age wave. Because it has only just begun.
For good reason both terms remain ‘murky’ in the common understanding when public health issues relating to geriatrics well up from time-to-time in the media. These terms are a journalistic contrivance from what has always been a rather normal and predictable life progression by the majority of long-lived citizens in the western nations. Aging-in-place, by it own natural progression, has been going on for millennia in most parts of the world. It is the expected and predictable progression of slowing down, staying in place, often with extended family and if we are lucky abetted by a collection of comfortable associates and friends that in turn define one’s community. It has been mostly in the US where this is somehow characterized as an alternative to what most journalists assume is a normal ageing journey. For too long the assumptions was that it is a natural preference by healthier early seniors to pull up roots for warmer climes. Starting in the 50’s and until recently this was a popular plan to decamp to the numerous “sunbelt ghettos” from the colder northern states. Age-in-community recognizes the strengths of life long support from neighbours, neighbour hoods, and all the civic resources that create meaning and identity in life. Thus, age-in-community is a relational sub set of that same natural aging progression – at least until senescence deals it shadowed biological hand. Typically some unmasking health episode manifests, and all realize that mom, or dad, or auntie cannot self-maintain and needs professional help. The real issue is neither age-in-place, nor age-in-community … but rather starkly it is the compelling need for “care-in-place.’ Without skilled para-care assistance, adaptive and assistive medical devices, and and ever expanding, often imposed “community” of clinical specialists, poly-pharmaceutical interventions, wholely frustrated by a rapidly shrinking world in terms of mobility … “care-in-place” … is the real dilemma.
The good news is that there are some incredible novel assistive/telemedical technologies on the horizon that can render a hospital-at-home that functions as remarkable home-based ‘ADL care pod.’ These revolutionary home/nursing-homes in development operate at a fraction of the per diem cost of most institutional venues. Often just when we think the worst is about to happen innovations do emerge in time to provide a relief-valve before the whole system implodes. The innovations I have seen will offer much needed improvement through high- tech/high-touch compassionate technology. So don’t give up hope… it is not all bad out there in the geriatric jungle.
Hi Louis,
I’d be happy to help any way I can. You probably haven’t heard of my company, BeBloomin, but we have been quietly developing and testing for several years our community model of technologies and services to support aging in place or, as we prefer, “Thriving in Place (sm)”. I think you’ll start hearing a lot about us, now that we are ready to become more visible. And, again, I’d be happy to help any way I can to support your efforts.
— Joel Ackerman
Hello. My name is Ana and I am an OT in Fort Collins, CO. I am interesting in you Aging in Place Institute because I would like to get information of how to get certification and training to be qualified to do home modification for the elder and disable population to stay at home safely and happier.
I just want to find information on what to do next
Thanks
Ana