The Decision:  A Difficult Choice To Age-In-Place or Move to Assisted Living

Aging in Place refers to the choice of older adults to remain in their homes and communities as they age, rather than relocating or moving into an institutional setting.

Nearly 90% of seniors want to stay in their own homes as they age, and respecting their aging in place preference is an important way to support them. Aging in place promotes life satisfaction, a positive quality of life, and self-esteem — all of which are needed to remain happy, healthy, and well into old age.  Statistically, it is evident that it simply is not possible for the same 90% to actually stay at home.

The choice of where to spend your senior and final years is far more consequential than most people are prepared to consider.  Unfortunately, by the time the consequences become “real”, your loved one is often unable to consider their reality to the fullest extent; leaving those caring for them to make really hard decisions on their behalf.  It’s also difficult to change direction once you start down a single path.  This is one of the touchpoints that helped launch Golden Agreements.  Sometimes, it's more important that you understand your loved ones priorities and values more than the specific wishes.

Golden Agreements emphasizes the importance of proactive planning and open communication as families navigate the complexities of aging loved ones. It encourages families to address the specific needs and problems that often arise, such as "how to help aging parents," "what to do when parents can't live alone," and recognizing the "signs aging parents need help." By facilitating these crucial conversations early on, families can work together to manage care, find necessary resources, and provide support for caregivers. This approach aims to alleviate the stress associated with these transitions and helps families find quality "home care services" and "elderly care products" that promote safety and well-being.

Unforeseen Challenges 

• Agency vs. Independent Hires of Aides:

  • Deciding between an agency and independent caregivers presented a complex choice, each with its own set of pros and cons (see below).

• Cost of Indefinite Aide Support:

  • The escalating and sustained costs of 24/7 care quickly became a significant financial burden.

• Morale of Aides After Months/Years of Caregiving:

  • The emotional and physical toll on caregivers over extended periods became a real concern, impacting morale and consistency.

• Familiarity and Reliance on Caregivers:

  • Building trust and familiarity with caregivers was essential, but high turnover disrupted this crucial element.

• Time Requirement for Staff Management:

  • Managing schedules, communication, and addressing issues required a significant time commitment.

• Aide Support Needs:

  • The ever-changing needs of our loved one created a constant adjustment to the aides duties and responsibilities.

• Social Isolation:

  • Staying at home can lead to social isolation, impacting mental and emotional well-being.

• Lack of Exercise and Mental Stimulation:

  • Maintaining physical and mental activity requires deliberate effort and planning.

• Graduated Available Help:

  • Having a system of help that can grow with the progression of aging is very important.

• Safety Concerns:

  • Ensuring a safe home environment, particularly with declining mobility, requires careful consideration.

• Hired Patient Management:

  • Someone needs to be the point person for all the needs of the patient.

• Access to Doctors:

  • Transportation and accessibility to medical appointments can become challenging

Financial and Legal Assistance

• Elder Law Attorneys:

  • Provide legal advice on issues such as estate planning, guardianship, and long-term care.

• Financial Advisors:

  • Help with financial planning, budgeting, and long-term care costs.

• Long-Term Care Insurance:

  • Helps cover the costs of long-term care services.

• Medicaid:

  • Provides financial assistance for eligible individuals needing long-term care.

Golden Agreements seeks to build harmony and a unified vision among family members/loved ones, and professional support, for the aging process.  By facilitating difficult discussions, and helping the Golden Client (you, your aging parent, your loved one, etc) make important decisions based on values and priorites, families can set expectations and honor independence and dignity with love.

Preparing and Managing The Home

Safety, convenience, and independence are the cornerstones of preparing for Aging In Place.  Early preparation is the best way to accomplish all of those goals. 

The following guide is a checklist of items that may be beneficial. Everyone is different, but the earlier assistive devices are offered, the more likely you/your aging parents/aging loved ones will adapt to their changes and live a more quality life.  Many of these items are available on the GoldenAgreements.com store and can be found by clicking on the name.

Safe At Home… Adapting Your Space for Aging in Place

Staying safe at home as you age requires practical changes to maintain safety and comfort.  Here is a list of common items to assist with decreased mobility, loss of strength, vision change, and cognitive decline. Additional items for fall prevention, arthritis, medicine management, grandparent gifts, and advanced care on the website.

Underlined items will link to a product if you click on it.  There may be more items like it on the website to search for.

Bathrooms

• Grab Bars near toilet, shower/tub, and sink

• Shower Seat

• Non-slip bath mats

• Handheld showerhead

• Shower caps to reduce hair washing

• Self adhesive non slip mats for bathtub and shower floors

• Raised Toilet Seat for standing or sitting

• Toilet handlebars to assist sitting, rising, and balance

• Bidet attachment

• Motion Sensor Nightlights

• Improved Room Lighting

• Safe Medication Storage

• Easy to Hold Toothbrush

• Dry Wash for Hair

• No Water Bath Wipes

• Standing/Moveable Toilet Paper Holder

• Easy To Use Faucets

• Lever-style Door Handles: Easier to grip than knobs.

• Temperature-Controlled Faucets: Reduces risk of scalding.

• Walk-in bathtub or shower: Eliminates the need to step over a high threshold.

• Shower caddy/organizer: Keeps toiletries within easy reach.

• Long-handled Sponge or Bath Brush: For easier reach.

• Non-Fogging Mirror: Helpful for those with vision impairments.

The Kitchen

• Pull-out Shelves or Drawer Organizers

• Step Stool with Tall Handle

• Improved Countertop Lighting

• Appliances with Large, Easy-to-Read Controls

• Auto shut off timers

• Stove Knob Covers

• Automatic shut-off features

• Fire extinguishing blanket

• Small fire extinguisher

• Non-slip grips for slippery floors

• Knife Safety

• Refrigerator Organizers

• Meal Prep Containers

• Easy to Use Faucets

• Full Hand/Fireproof Oven Mitts

• Fire Detector

• Carbon Monoxide Detector

• Jar Opener: Assists with opening stubborn jars.

• Reach Extender: Grabs items from high shelves.

• Anti-Fatigue Mat: Cushions feet while standing at the sink or counter.

• Microwave with Large Buttons and Simple Controls: Easier to operate.

• Adjustable-Height Countertop: Accommodates different needs and abilities.

• Voice-activated Assistants: For hands-free control of appliances and other devices.

The Living Room

• Furniture Arrangement without Clutter

• Support for Getting In/Out of Chairs or Sofa

• Portable Table

• Lamps and Overhead Lighting

• Remote Control On/Off Outlets

• Secure Rugs for Tripping Hazard (double-sided tape or a non-slip backing so the rugs won’t slip)

• Coil or Taped Cords: Make sure there are no cords to trip over.  Coil or tape cords and wires next to the wall so you can’t trip over them.

• Spare Accessories Organizer:  Keep spare glasses, pens, paper, charging cords, etc. to avoid unnecessary extra hunting around the house for comforts.

• Organization:  Having a dedicated place for mail or other items can help keep everyone organized and able to find what they are looking for.

• Loose Item Containers

• Tabletop Magnifying Glass

• Throw Blankets

• Comfortable, supportive chairs with armrests: Makes it easier to get up and down.

• Adjustable-height coffee table: Can be raised or lowered as needed.

• Large-Button Telephone: Easier to see and dial.

• Voice-Activated Remote Controls: For easier control of TV and other devices.

• Assistive Listening Devices: Helps those with hearing impairments.'

The Bedroom

• Bed Height Adjusters 

• Bed Position Adjusters

• Adjustable Bed Table

• Bedside Lighting

• Motion Detector Night Lights

• Reachable Storage

• Bedside Charging Station

• Medicine Organizer

• Medicine Reminder

• Reminder Station

• Remote Control On/Off Outlets

• Adjustable Bed: Allows for customized positioning for comfort and easier entry/exit.

• Bed Rails: Provides support and prevents falls.

• Pressure-Reducing Mattress: Helps prevent bedsores.

• Long-Handled Shoehorn: For easier dressing.

• Clothing with easy closures: Velcro or snaps instead of buttons and zippers.

Stairs/Stairways

• Stairlift: Provides a safe way to navigate stairs.

• Handrails on Both Sides: Offers additional support.

• Non-Slip Stair Treads: Reduces the risk of slipping.

• Ramps

General, Every Room

• Emergency Call System: Consider a personal emergency response system (PERS) for added safety and peace of mind.

• Non-Slip Socks:  Wearing non slip socks around the house can help prevent falls.

• Medical Alert Bracelet or Necklace: Allows for quick access to help in an emergency.

Beyond the Rooms

• Stairways: Install sturdy handrails on both sides of stairways. Ensure adequate lighting. Make sure loose floorboards are fixed.  Have an electrician put in an overhead light and light switch at the top and bottom of the stairs. You can get light switches that glow.   Make sure the carpet is firmly attached to every step, or remove the carpet and attach non-slip rubber treads to the stairs. Fix loose handrails, or put in new ones. Make sure handrails are on both sides of the stairs, and are as long as the stairs.

• Entryways: Ensure entryways are well-lit and have secure handrails if necessary. Consider a ramp or zero-step entry if there are steps.

Outdoor Spaces 

• Lighting:  Make sure the lighting is bright and steps and stairs well lit. 

• Shade:  Make sure outdoor spaces are available with adequate shade to avoid sunburn and overheating

Golden Agreements seeks to build harmony and a unified vision among family members/loved ones, and professional support, for the aging process.  By facilitating difficult discussions, and helping the Golden Client (you, your aging parent, your loved one, etc) make important decisions based on values and priorites, families can set expectations and honor independence and dignity with love.

Aging is a Team Sport!  Even though it may seem counter intuitive, building your community of support is essential to maintaining independence and dignity throughout aging.  The best way to be surrounded by loved ones at the end of life is by having a coordinated team approach during life.  Golden Agreements is available to you and your family to build a blueprint for success, but there are many resources available to help.  

Enlisting Help

• Start early: Begin exploring resources before a crisis occurs.

• Assess needs: Determine your/aging parent/loved one's specific needs and preferences.

• Build a support network: Connect with family, friends, and community resources.

• Seek professional help: Don't hesitate to consult with healthcare professionals, legal experts, and financial advisors.

• Remember to take care of yourself as a caregiver.

Government and Non Profit Organizations:  click name to link to site

• Area Agencies on Aging (AAA)  

  • Provide information, referrals, and services for older adults and their caregivers.

  • Offer assistance with home care, transportation, meals, and other needs.

• Eldercare Locator 

  • A national public service that connects older adults and their families with local resources.

  • Provides information on a wide range of services, including home care, transportation, and legal assistance.

• The National Council on Aging (NCOA) 

  • Offers programs and resources to help older adults age well.

  • Provides information on benefits, health, and caregiving.

• The Alzheimer's Association 

  • Provides support and resources for families affected by Alzheimer's disease and other forms of dementia.

  • Offers education, support groups, and care consultations.

• The Parkinson's Foundation 

  • Provides support and education for those dealing with Parkinson's disease.

• The Department of Veterans Affairs (VA)

  • Offers resources and support for elderly veterans and their families.

  • Provides assistance with home care, medical care, and financial benefits.

• Meals on Wheels

  • Delivers nutritious meals to homebound seniors.

  • Provides social interaction and a safety check. 

   RHIHub (Rural Health Information)

• Provides information for aging in Rural Areas

Healthcare Services

Search your local directories for some of these services as you need them.

Home Health Agencies

• • Provide skilled nursing care, physical therapy, and other medical services in the home.

• Hospice Care

  • Provides comfort and support for individuals with terminal illnesses and their families.

  • Offers medical, emotional, and spiritual support.

• Geriatricians

  • Physicians specializing in the care of older adults.

  • Can provide comprehensive medical assessments and develop care plans.

• Home Care Aides (see chart above)

  • Provide assistance with daily tasks such as bathing, dressing, and meal preparation.

• Visiting Nurses

  • Provide medical services in the home.

Community and Social Support

Search your local directories for some of these services as you need them.

• • Senior Centers:

  • Offer social activities, meals, and educational programs for older adults.

  • Provide opportunities for social interaction and engagement.

• Support Groups:

  • Provide emotional support and practical advice for caregivers.

  • Offer a safe space to share experiences and connect with others.

• Respite Care:

  • Provides temporary relief for caregivers.

  • Allows caregivers to take breaks and recharge.

• Adult Day Care Centers:

  • Provide supervised care and social activities for older adults during the day.

  • Offer a safe and stimulating environment.

• Transportation Services:

  • Provide rides to medical appointments, errands, and social activities.

Online Senior Community Groups

• AARP Online Community: A large and active forum covering a wide range of topics relevant to older adults, including health, finances, relationships, and hobbies.

• SeniorNet: Focuses on providing seniors with computer and internet education, and also offers online forums and discussions.

• ElderChat: A chat room and forum for seniors to connect with each other, share experiences, and discuss various topics.

• Seniors Meetup Group: While Meetup has groups for various interests, many cater specifically to seniors, both online and offline.

• Facebook Groups: Many specific groups cater to seniors based on location, interests, or specific health conditions.

Golden Agreements seeks to build harmony and a unified vision among family members/loved ones, and professional support, for the aging process.  By facilitating difficult discussions, and helping the Golden Client (you, your aging parent, your loved one, etc) make important decisions based on values and priorites, families can set expectations and honor independence and dignity with love.

Managing The Job of Caretaking  (see chart on website Articles Page)

Hiring An Agency

Pros of Using an Agency

• Vetted Caregivers:

  • Reputable agencies typically conduct background checks, verify credentials, and perform interviews, reducing the risk of hiring unqualified or unreliable caregivers.

• Liability Coverage:

  • Agencies usually carry liability insurance, protecting you from financial responsibility in case of accidents or injuries.

• Caregiver Replacement:

  • If your assigned caregiver is unavailable due to illness, vacation, or other reasons, the agency can provide a replacement.

• Supervision and Management:

  • Agencies handle caregiver scheduling, payroll, and performance monitoring, relieving you of these administrative tasks.

• Established Care Plans:

  • Agencies often develop personalized care plans based on your loved one's needs, ensuring consistent and professional care.

• Bonded Employees:

  • Many agencies bond their employees, protecting you from theft.

• Reduced Stress:

  • Agencies handle many of the stressful parts of hiring care, but not all of them…

Cons of Using an Agency

• Continuity Of Care Issues:

  • Agencies often need to shift personnel and there can be a high degree of turnover.  Relying on the same people gives you and your loved one peace of mind.

• Higher Costs:

  • Agencies charge higher rates than independent caregivers to cover their overhead and profit margins.

• Less Control Over Caregiver Selection:

  • You may have limited input in choosing your caregiver, potentially leading to a mismatch in personality or care style.

• Less Flexibility:

  • Agency schedules and care plans may be less flexible than those of independent caregivers.

• Potential for Impersonal Care:

  • Depending on the agency, you may experience less personalized care due to high caregiver turnover or rigid protocols.

• Third Party Involvement:

  • Having a third party involved can make communication slightly more difficult.   While they help manage the aides, it still requires time and attention to help manage the Agency.

Hiring Independent Aides

Pros of Hiring Independent Contractors

• Lower Costs:

  • Independent contractors generally charge lower hourly rates than agencies, as they don't have agency overhead.

• Greater Control Over Caregiver Selection:

  • You have more freedom to interview and select a caregiver who matches your loved one's needs and personality.

• Increased Flexibility:

  • You can often negotiate flexible schedules and care plans that suit your specific requirements.

• Potential for Personalized Care:

  • Building a direct relationship with a caregiver can lead to more personalized and attentive care.

• Direct Communication:

  • Direct contact with your caregiver makes communication easier. You are more likely to get instant and complete feedback than if the aide communicates through the Agency.

Cons of Hiring Independent Contractors

• Increased Responsibility:

  • You are responsible for background checks, verifying credentials, and managing payroll and taxes (if not an independent contractor).

• Liability Risks:

  • You may be liable for accidents or injuries that occur in your home.

• Lack of Backup Care:

  • If your caregiver is unavailable, you are responsible for finding a replacement.

• No Supervision or Management:

  • You are responsible for monitoring the caregiver's performance and addressing any issues.  Be sure to write down all relevant employment data such as hourly rate, overtime pay, vacation and holiday pay, car insurance requirements, and expectations of communication to alert changing needs.  

• Potential for Unreliable Care:

  • Without agency oversight, there's a higher risk of hiring an unreliable or unqualified caregiver.

• Tax Implications:

  • You may be considered an employer, which brings tax responsibilities.  Check with an accountant for details.  It is possible to hire aides as Independent Contractors.

• No Bonding or Insurance:

  • Independent contractors normally do not carry bonding or insurance, increasing your risk.

At some point, you may need to hire assistance to help your loved one manage their lives. The goal is to live as independently and safely as possible, and to be flexible as circumstances change. The box represents the options for hiring in help; as may be required

Golden Agreements seeks to build harmony and a unified vision among family members/loved ones, and professional support, for the aging process.  By facilitating difficult discussions, and helping the Golden Client (you, your aging parent, your loved one, etc) make important decisions based on values and priorites, families can set expectations and honor independence and dignity with love.