As from. The four main categories of living

As someone begins to age, he or she is faced with decisions regarding where he or she will live. For some, this decision comes when they decide to retire from work, and for others, this decision comes from being unable to live on their own due to health or other reasons that prevent them from preforming daily activities safely. Whether this is a decision that someone voluntarily makes while in good health right after retirement, or he or she needs to make this decision for health and safety concerns, there are many options that vary in services that can accommodate each individual. While some services do overlap with other services provided with each living arrangement, each service offers a unique option that may be appealing to those seeking a new living arrangement. There are four main types of living arrangements for elderly people, however some categories may have multiple options for elderly people to choose from. The four main categories of living arrangements are living in your own or other’s home, special retirement settings, living in communities with support for eldercare, and nursing homes.
One of the first decisions a person needs to make as they begin to age is whether or not they can live on their own or if they need to live with assistance. One option is living in your own home versus living in someone else’s home such as a family member. If the person decides to stay at home, they are opting to “age in place” (Pfeifer, 2016). Age in place means that the person has chosen to remain in their home and age independently. Pfeifer stated that a study completed by AARP in 2005 found that nearly ninety percent of adults fifty years or older prefer to age in their own homes (2016). Choosing to age in place is one of the most popular and normal choices that the elderly person makes as most people prefer to stay in their own home. As elderly people continue to age in their own homes, they must keep up with the advancements of society, particularly advancements that will help them stay safe and remain independent for as long as they wish.
An advancement of society that has impacted how and where seniors age is technology (Simpson 2010). In the article “Technologies Enable Seniors to Age in Place,” Simpson wrote that if an elderly person has access to technology or is even able to use it, will help the senior live independently in their own home (2010). Technology is something that is relatively new to current seniors as they did not grow up with it, so if an elderly person can adjust and learn the basics of using computers, they are able to open themselves up to opportunities they previously did not have. Simpson lists some ways that having an understanding of technology and how to use it can be impactful on seniors wishing to age in place. He wrote, “Computer usage links seniors with the outside world, allowing them to order products and services they need, enjoy the social interaction that comes from connecting with friends and colleagues, track stocks and business news, and even keep up with sports teams (2010). These services can help seniors age productively and from the comfort of their home. While these services help seniors socially, there are also some technological advances that help seniors medically age in place. These advances include “virtual assistants,” “memory mirror,” and “a digital family portrait placed in the caregiver’s or family member’s location” (Simpson 2010). The “virtual assistants” are sensors placed throughout the elderly persons home that monitor their movements and activities. If the senior misses a step in a medical process, the virtual assistants use a pop up on the computer screen to recommend the correct action (Simpson 2010). This allows elderly people to live on their own and age in their own home while still being monitored and ensuring that they are safe and healthy. If the senior requires medication and other tasks that are on a schedule, he or she may decide to use a “memory mirror” to help him or her be able to age in place independently. The mirror shows medication and information including time and dosage for the senior to visually see and remember the correct medication (Simpson 2010). This helps seniors who may be forgetful and monitors that medication is taken correctly. The digital family portrait is more for the family of the elderly person as opposed to the other options which directly help the elderly. The digital family portrait goes in the family’s home and shows the senior’s picture and daily activity reports allowing family members to monitor and spot changes in the activities (Simpson 2010). The digital family portrait gives local family members the option to monitor their elderly family while still allowing them to age in their own home. Each of these medical technological advancements help allow seniors to age in place independently, but they rely on the senior having an understanding of this technology. If the elderly person does not have an understanding of technology and is not able to age in place, they may choose to live with a family member who can assist them with daily activities and medication.
The decision of the elderly person to move out of their own home may be influenced by many things such as financial problems or he or she is unable to safely live independently in their own home. Once the elderly understands or accepts that he or she is no longer to live alone, he or she will need to decide whether they want to live with family or in another living setting. If they choose to live with family, both the elderly person and the family will need time to adjust to new living arrangements for all involved. The first adjustment for the elderly is not being as independent as they previously were when living alone. They now have someone who is caring for them and helping them with daily activities. The family caregiver will also be adjusting as sixty-seven percent of family caregivers are women who also care for their spouse, they will need to adjust to caring for the elderly family member while working as well (Bookman and Kimbrel 2011). The family care is often referred to as an “informal care” where the elderly person is cared for by the family as opposed to “formal care” where the elderly person is cared for by “trained health and social services staff” (Bookman and Kimbrel 2011). Family, or informal, elder care has many dimensions that can vary and change from elder to elder depending on the care giver and care needed.
The dimensions for informal elder care are time, geographic, residential, financial, health, legal and ethical, and emotional, moral and spiritual. The first dimension, time, can be short, intermittent, and long-term (Bookman and Kimbrel 2011). Short-term care is for elders who may have a procedure or accident that temporarily causes them to need assistance, but when the elder has healed, they move back home or live independently again. Intermittent care requires assistance in doctors’ visits, medication, and routines. Long-term care is required for months to years and requires daily assistance for the elderly (Bookman and Kimbrel 2011). The geographic dimension is the distance between caregiver and the elder receiving the care. The distance between the two effects the type of care and the frequency of care as someone who is local or nearby can provide more frequent care than someone who has to travel further to assist (Bookman and Kimbrel 2011). The residential dimension assesses the question and decision of whether or not the elder should move or stay in his or her own home. If the elder does decide to move, he or she will also need to decide whether staying with family is an option or staying in another assisted living setting (Bookman and Kimbrel 2011). Along with the decision of whether or not to live with family is if the family is financially able to support another person. Bookman and Kimbrel address this under the financial dimension regarding being able to support the elder with their medication, doctor appointments, and alterations to the home if needed (2011). The health dimensions differentiates the levels of health when caring for an elder. Some elders are able to complete daily activities with little to no assistance while others are not able to do it unless they have help for their caregiver (Bookman and Kimbrel 2011). The health dimension also ties in with the time dimension as short-term care can mean the person needs more help at first, but he or she is eventually able to complete daily activities without assistance. Another dimension that Bookman and Kimbrel note is the legal and ethical dimension of caring for an elder. This dimension covers who is to take control of medical decisions should the elder become unable to make those decisions on their own (2011). The emotional, moral, and spiritual dimension covers what the caregiver provides for the elder that is not medical. Some elders have spiritual needs that are important to the emotional and moral health. While some elders may not be able to drive or attend religious outings, the caregiver is tasked with assisting where they can and assessing the emotional and moral well-being of the elder (Bookman and Kimbrel 2011). The family caregiver is responsible for each of the seven dimensions when caring for an elder. Because of the assistance and number of tasks the caregiver is responsible for, often time the caregiver may often cut back hours at work or even quit their job to care for their elder family member. In some cases, however, the caregiver may also rely on siblings or a paid caregiver to assist if the caregiver must work and be out of the house (Bookman and Kimbrel 2011). Whether it is short-term or long-term, or the elder needs minimal assistance or a lot of assistance, caring for an elder in one’s own home is a decision that the elder and caregiver must consider before making the decision to move. Sometimes, however, elderly people make the decision to move right after retirement even if they do not need any assistance. They may decide to move into special retirement settings and out of their own home.
One retirement setting in particular that elders may choose is a “continuing care retirement community” (Stone 2013/2014). A continuing care retirement community provides many services for the people that live there. Typically, couples join the community together and voluntarily. To join the community, the older adults or couples sign long-term contracts that provide, “a place to live, access to a range of wellness services, supportive services, and health services, and an opportunity to move to higher levels of care should they need to as they age” (Stone 2013/2014). The higher levels of care that residents are able to utilize are services such as assisted living and nursing homes. The older adults and couples are able to age in communities with other older adults, couples, and services that are more specific and geared toward their current and upcoming needs as they age. As this service is considered to be in the private sector, it can be expensive. Normally middle to upper class couples are the only adults able to afford to join a continuing care retirement community. Stone reported that in 2010, the average fee at entrance was two hundred forty-eight thousand dollars with fees ranging from twenty thousand dollars to one million dollars (2013/2014). Most continuing care retirement communities are non-profit organizations linked with religious affiliations or college organizations (four out of five) (Stone 2013/2014). Although the entrance fee can be expensive and residents sign a long-term contract, most continuing care retirement communities offer some kind of refund or repayment of the entrance fee should the resident decide to move out of the community (Stone 2013/2014). While continuing care retirement communities seem like a great option, it may not be for everyone. In the article, “Continuing Care Retirement Communities: What Could go Wrong?” by Allison Bell, Bell points out five aspects of continuing care retirement communities that prospective residents should consider before deciding on moving into a continuing care retirement community (2016).
Bell discussed five issues that should be considered when deciding where to move once one begins to age and decides not to age in place. The five points are aesthetics, neighbors, value, unit price shifts, and reliability (Bell 2016). When choosing a continuing care retirement center, the resident does not design or choose the decorations, so he or she should consider the aesthetics when touring and deciding to ensure that where they will be living is not uncomfortable. Most continuing care retirement communities provide individual rooms for the residents, so if an elder is looking to meet or share a space with someone or needs more help, he or she should consider an independent living facility or assisted living facility instead. Bell reported that some residents may feel as though the money they invested and paid was not valued and went to corporate managers and investors (2016). One important issue that Bell noted was unit price shifts when moving from one level of care to another. When the resident moves levels, he or she may be responsible for out of pocket payments to cover the new living arrangement within the continuing care retirement community (2016). The last point was reliability of the continuing care retirement community. Some residents may have concerns of whether the community originally promised to provide for the resident (Bell 2016). Continuing care retirement communities are one option for seniors who wish to live and age in community, however, there are other options that may cost less for the elder and the elder’s family. There are a couple options for elders to live in communities with elder care if they are unable or do not want to live in a continuing care retirement community.
One option that elders may look into transitioning into instead of a continuing care retirement center is independent living facilities. Independent living facilities house the residents in apartment style buildings where the resident is able to take care of him or herself. The attraction of independent living facilities is that the resident does not or is unable to care for the home, so the facility offers these services to the residents (Davidson 2015). Some services that Davidson listed that are unique to independent living facilities when compared to assisted living facilities are, “transportation locally to places such as grocery stores and malls, and they provide organized social and recreational activities that residents may choose to participate in” (2015). Independent living facilities are similar to assisted living facilities in that both are regulated by state and local law only, so each facility and the services it offer may vary from state to state. While independent living facilities give some room for residents to live while only assisting in home care, transportation, and other aspects of the community, assisted living facilities offer more personal care for residents.
Assisted living facilities are designed for elders who are unable to live independently and need help with activities of daily living, however, assisted living does not provide as much care as a nursing home. According to Tish Davidson, author of “Assisted Living Facilities,” assisted living facilities may often be called or referred to as multiple different names including, “residential care, personal care, board and care, adult living facilities, supported care, enhanced care, adult homes, sheltered housing, and retirement residences” (2015). Most of these names simply mean that elderly men and women move into a facility that is able to provide support, care, and services that he or she may not be able to do completely independent and safely. Assisted living facilities can also offer specific services and specialize in specific medical disorders. One example that Davidson gives is an assisted living facility for men and women with Alzheimer’s disease (2015). Assisted living facilities vary from state to state depending on the different requirements. However, most assisted living facilities share the same basic services. Davidson listed these services as, “24-hour staffing, three meals a day, personal supportive services (e.g., bathing, dressing), medication management and basic health oversight, recreational services, social services, housekeeping, laundry services, and transportation to medical and other appointments” (2015). Along with a basic list of services provided by most assisted living facilities, assisted living facilities have some advantages and disadvantages according to Davidson (2015). Some advantages that Davidson noted were twenty-four hour security, access to healthcare personnel, little to no responsibility of homemaking, assistance in activities of daily living, disability accommodations, and ensuring that medication is taken correctly through supervision (2015). However, when moving from being completely independent to living in an assisted living facility, there are some adjustments and drawbacks that one must become accustomed to. These drawbacks include a lot of loss of freedom of personal choices, having a nonfamily member assist in personal activities, restricted access to the community, routine that may differ from previous routine or schedule, and the financial cost of living in an assisted living facility (Davidson 2015). If an elderly person is looking for more individual and in depth care, he or she may want to consider living in a nursing home.
A nursing home is a facility that provides long-term, sometimes lifelong care to people who are unable to live independently and complete activities of daily living without assistance (A Dictionary of Public Health 2018). Nursing homes also help manage medication and meals that a resident receives daily. Nursing homes receive the majority of their residents from hospitals. Mukamel et al wrote that most patients enter nursing homes directly from hospitals, about ninety percent (2016). Nursing homes and hospitals must work together when referring and transferring patients to ensure that no patient information is lost and that the patient has all the information available in order to make a decision. LaMantia et al describes the relationship and passing of information between the hospital and nursing home as “fundamental to providing quality care to all patients” (2010). Ensuring that the patient is transferred from the hospital to the nursing home safely and with all the information needed is the first service that nursing homes provide to their residents. There are short-term and long-term care options in nursing homes. Short-term care may be offered when someone has just be released from the hospital but still needs to gain strength and ability to live independently again. Once he or she has recovered, they may go home (Residential Facilities, Assisted Living, and Nursing Homes 2017). However, most residents are long-term residents who will need life-long assistance. Nursing homes offer similar services to assisted living facilities with the exception that most nursing home residents need more assistance than those in assisted living facilities. Some service that are offered at nursing homes are “nursing care, 24-hour supervision, three meals a day, and assistance with everyday activities” (Residential Facilities, Assisted Living, and Nursing Homes 2017). Nursing homes are also unique in that they offer a variation of therapy rehabilitation services such as physical therapy, occupational therapy, and speech therapy (Residential Facilities, Assisted Living, and Nursing Homes 2017). Nursing homes typically house residents with chronic, debilitating, or serious ongoing disabilities. Residents who live in nursing homes need may assistance with activities such as bathing, dressing, eating, managing medication, and moving (walking, wheelchair). Elders who are needing to move into a nursing home may need more assistance than family is able to give, or if no family is able to provide, they are not able to live on their own.
As people age, they face multiple decisions about future or current living arrangements. There are many factors that influence where an elderly person may decide to live as they continue to age. Some of those factors are finances, health status, family, or age. Some of the living arrangements for elders can be expensive, such as the continuing care retirement community. Whereas some can be more affordable, such as aging in place or living with family. Some living arrangements may also be necessary for safety and health reasons, such as the nursing home. Whereas, other living arrangements may be by both choice and necessity such as the independent living facility where there is someone managing the home and property but the elder is able to live independently still. Regardless of financial status, health status, family proximity or willingness to help, or age, there is an option that may suit each elder looking to change or alter their current living arrangement.


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