"Only the needs have changed"

My colleague Bonnie recently wrote of the concept of aging in place, which is gaining traction in the United States. Geriatric care managers are frequently consulted to help a family pull together the supports and resources that are necessary to facilitate an elder's ability to age in place. This usually means supporting an older person who wishes to remain in their family home, but can also involve facilitating a relocation to a congregate living community and ensuring that the community and its staff are prepared to adapt to the person's changing needs over time. Beyond the physical adaptations that may need to be made to a home environment, there are important psychological and emotional adaptations to be made as well, new agreements to be forged between the elder and those who care for them. As ramps are built, tubs are cut out, and grab bars are installed, it's important to remember that all physical and cognitive changes aside, who we are as we age remains essentially unchanged. William Thomas, MD, addresses this idea in his 2004 book, What Are Old People For?

"Elders whose health has declined to a substantial degree are the same people they have always been; what has changed is the manner in which they collaborate with others. Their longevity has changed the nature of their daily lives, making close cooperation essential ... the person is the same and only the needs have changed ..."

A home safety evaluation is an important feature of Elder Care Guides' assessment process. While identifying safety risks that can be mitigated through adaptations to the home, we're also looking for opportunities to foster our clients' continued development in whatever physical space they occupy. Does the home provide opportunities for the elder to safely pursue their interests and passions, and maintain relationships with others? Can the person easily access their much-beloved garden? Is it a space that is comfortable for their grandchildren to visit? 

While different relationships of give-and-take are being negotiated between elders and their spouses or children, or new relationships with paid caregivers and/or facility staff are being established, maintaining our focus on the essence of that recipient of care - who they have always been and continue to be - ensures that we will create a modified environment that supports their continued development as an elder. 

Aging-In-Place

• As the Boomer generation gets closer to their senior years they may have thoughts about if and how they can continue living in their own homes. Aging often brings about changes both in one’s cognitive as well as physical abilities but physical transitions can take place at any time in our lives. Two concepts which have a like purpose are called Aging-in Place and Universal Design. Their similar purpose is to simplify life, making the structural environment more usable for everyone at little or no cost. Both concepts “allow us to move through the transitions of life and still enjoy equal opportunities, self determination, self respect, quality of life and safety!”
  
  Home modifications are interventions that change the physical environment of one’s surroundings in order to promote functioning and quality of life as well as safety. Some modifications can be major such as structural changes like a low cut tub or adding a ramp into the home. Others changes can be on a much smaller scale like installing locks on doors or cabinets, rearranging furniture, decreasing clutter and even posting reminders.
  
  Today many builders, interior designers, physical therapists and others interested in preserving home safety are becoming Certified Aging-in-Place Specialist (CAPS). This designation program through the National Association of Home Builders (NAHB) teaches the technical aspects, business management, and customer skills needed for the fastest growing segment of residential remodeling – home modification for those aging in place.
  
  Some resources to check out Universal Design and Aging-in-Place:
  Jordan, Wendy. Universal Design for the Home: Great Looking, Great Living Design for All Ages, Abilities, and Circumstances. Beverly, MA; Quarry Books, a member of Quayside Publishing Group, 2008.
  National Aging-in-Place Council - http://www.naipc.org/
  And Senior Resource for Aging in Place - http://www.seniorresource.com/