"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.