Friday, October 9, 2015

Understanding Aging in Place (Part 1)

When we hear the term, aging in place, we think of keeping our loved one in the comfort, convenience and safety of their own home, as opposed to a health care facility. What exactly does this encompass?

Aging in place implies that an older person, ideally with adequate assistance from a caregiver, can help maintain a full range of normal daily activities, including transportation, shopping, cooking, cleaning, home and garden maintenance, and a host of ordinary tasks that are taken for granted among younger, healthy people.

And a living situation that works at 70 years of age—when independence is less likely to be an issue—may not be the case for a frail 90-year-old still residing in the family home. Along with the older person’s caregiver, family, friends and neighbors can pitch in from time to time, but the optimal scenario requires a community effort to make aging in place a reality over the long term.

Aging in Community offers a more broad-based approach than the limited notion of staying in the family home or down-sized condo. Baby Boomers have watched their overtaxed parents struggle with aging by themselves, often isolated and lonely. Now these mid-lifers are seeking a more expansive model for their own aging, which embraces the idea of being "in community."

The newer model has two primary elements: staying active and involved as long as possible in their chosen home and reimagining existing care facilities. This could easily incorporate living in a long-term care facility—assisted living or skilled nursing—but without the trappings of an institutional setting, which are habitually overcrowded, understaffed, impersonal, and monotonous.

Eden Alternative 

Dr. Bill Thomas was primarily concerned with emotional well-being when he conceived of the Eden Alternative in the early 1990s as a way to alleviate the loneliness, helplessness and boredom that permeated the nursing home he operated in New York.

"What good is quality of medical care if your life is miserable?" he asked. Thomas’ original vision of the Eden Alternative focused on partnering with nursing homes to help them change their culture and environment to "create a habitat for human beings rather than facilities for the frail and elderly."

An Eden-certified nursing home moves away from the sterility of the long-term care environment toward creating a setting where personal care dominates and cohesive principles enliven both residents and staff. Eden homes aim to:

1) Create a home-like atmosphere;
2) Make a difference in elderly people’s lives;
3) Change the culture of care;
4) Train and support staff; and
5) Love, care, and live together as a family.

The Eden principles have been incorporated in pre-existing long-term facilities, where a menagerie of dogs, cats, birds and children (who may be part of an in-house daycare program) create appealing and warm living spaces. Happily, measurable medical benefits followed Thomas’ inventive approach. After two years, his first Eden facility had 50 percent fewer infections and 25 percent fewer deaths than a comparable non-Eden nursing home. Other studies show that even bedsores and dementia can be significantly reduced using the Eden Alternative.

Green House Project

Moving away from institutional settings, Thomas went on to develop another innovative method: The "Green House Project." Now, more than 100 homes have been built, starting with the idea of helping companies and individuals convert or build residential homes.

The Project’s primary goal is to provide high levels of care for persons who do not wish to be in a nursing home setting. Among other supporters, the Robert Wood Johnson Foundation has funded an innovative design, involving clusters of smaller "green" homes, built for six to ten senior residents, with outdoor space and gardens. Each resident has a private bath and bedroom, and has access to shared areas of the house at any time, enhancing sociability and autonomy, streamlining delivery of services and creating a homey environment.

Excerpt from The ABCs of Caregiving, Part 2: Essential Information for You and Your Family, available in paperback and Kindle on

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