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Rotting in Place?

Rotting in Place

Laurie Orlov’s Age in Place Tech blog cited the recent Washington Post Article that claims the notion of “aging in place” has been over sold. But has it?

The article features Professor Stephen M Golant, whose simplistic and sweeping view of seniors has a “you punks git off my lawn” feel to it. He even compares the notion of aging in place to “rotting in your own home”.

In an industry that has been struggling for attention and which has been dedicated to improving lives for the past ten years, this article does us no favors.

We all know that one size does not fit all, and that there will always be a need for more acute, specialized care. But we can certainly do better than the current model. As with any disruptive demographic (that’s the impending aging/silver tsunami), there is almost always an enabling technology solution that comes along and helps us out. Just as it has done with industries such as agriculture, manufacturing, and transportation, we are now finally reaching into the aging and healthcare space trying to use supportive and more cost-effective technology.

While the article does touch on some excellent points, I think it’s a bit too easy to cast aspersions. It’s harder to actually participate in the solution.

Aging in place starts when you are born, there are so many stages of life that we don’t even consider when examining the notion of aging at home. What age is it that folks are no longer able to do this? It all depends on their own self health management, chronic diseases, mobility issues, cognitive decline, etc. Many of these factors can be mitigated using enabling technologies, accessibility and home modifications as well as proactively managing health. We fail to focus on preventative measures and instead just make sweeping statements like above. We need to proactively intervene before a crisis takes place and not wait until someone “can no longer be at home.” What happened before that? Why can they no longer remain at home? Was it preventable? Would they have been healthier had they been more active? If the home had been modified to alleviate fall risks would that broken hip still have occurred? It is simply not possible for us to put every single senior in congregate living. We do not have enough brick and mortar, let alone the physical caregiving staff, to tackle the job. Most importantly, many of them do not need or want institutionalized care.

This movement must start now. Stating that aging in place has been oversold is a detriment to this movement–the movement that I, members of grandCARE and other industry experts (e.g Laurie Orlov, Patrick Roden, Mary Furlong, Donna Cusano, Peter Radsliff) have been nurturing for the past 10 years. We need support. We need the promotion of solutions We need visionary thinking. Having more folks stay at home with enabling care and technology solutions will save everyone money. There will be people that need more acute care, and this will always be the case. There will always be a need for skilled nursing care, rehab, hospice care and memory care. But why use it prematurely? Why not make every attempt to avoid costly and unnecessary interventions? At the very least we could stay put within a current state within the continuum of care for longer. For example, if I can stay in independent living within a care community for longer–with the help of some technology, some cognitive assists and perhaps some added caregiving–why not strive for that?

After all, ‘rotting in place’ can occur anywhere along the care continuum.

3 replies
  1. Dr. Stephen Golant
    Dr. Stephen Golant says:

    I appreciated the discussion generated by my book, Aging in the Right Place (Health Professions Press, 2016). http://www.healthpropress.com/product/aging-in-the-right-place/ Yes, I am plugging my so-called simplistic book that took me over two years to complete. I am a slow writer but I also took the time (unlike many journalists– although the Washington Post account was extremely thoughtful) to exhaustively examine the pros and cons of older people staying put in their own homes as opposed to downsizing or relocating to such senior housing options as active adult communities, independent living communities, assisted living, or CCRCs. I emphasized the importance of older people being proactive and coping with their inappropriate places and examine a host of options (e.g., family support, smart home technologies, and elder villages) now available to them. Many of these strategies will be successful; others not. Much depends on whether older persons are rich or poor, how serious are their health conditions, their personalities and importantly, the quality of their alternatives. The bottom line of my book was to avoid hyping any options and seriously recognize both the potentials and limitations of strategies designed to help older people age successfully—whether in their homes or elsewhere. As I frequently emphasize in my book, older persons in poor health, with disabilities, or unfavorable demographics are not precluded from happy lives, if they make the right living choices. However, as true for selecting any product or services–whether linked to aging in place or moving), informed older consumers must be vigilant and make choices that fit their particular needs. Aging in place will work for some, but not for all older Americans.

    • Laura Mitchell
      Laura Mitchell says:

      Hi Dr. Golant,
      Thanks for your thoughtful comment and for your book to spark such an exciting discussion.
      I do agree with what your book sounds to be about, I have not yet read it but I certainly intend to.
      The Washington Post article simplified the thought of aging in place and I felt so easily disregarded anything in between total independence and congregate living.
      I am certain that we all agree on any of these things: we should proactively engage and empower seniors to remain independent for longer (using enabling technologies and other resources), we should implement a seatbelt vs. airbag mentality in our aging population and most importantly for their children, and we shouldn’t condone denial to be misconstrued as respecting ones wishes. If we always did that, there would be no memory care.
      Anyways, thanks for finding my blog and posting on it and I look forward to reading your book!
      LM

  2. David Sanders
    David Sanders says:

    Very nice article. So much of empowering seniors to remain independent is a function of their physical surroundings and social dynamics over time. As physical abilities change, and companionship dynamics are modified, the ability and the motivation to remain mentally and physically active declines. In almost all cases this accelerates physical, mental and social decline.
    It is not so much about a single family house vs. a senior apartment, as it is about the location and the ability to remain socially active.

    UrbanseniorLiving was first presented to an Ohio based client in 1978 in the form of a diagram which envisioned senior housing in the heart of the community, rather than a corn field. Over some period of time, seniors are almost always becoming less social and less active. The best way to empower them, and assist them in their desire to remain independent, is to offer housing options that encourage self-sufficiency for as long as it is possible. Whether it is an apartment or a singe family house, it should not be on a corn field or buried on a cul-de-sac somewhere in suburbia.

    The most powerful and effective senior technology for health is to remain physically, mentally and socially engaged in living with other people. When people continue to use their muscles, their minds and their natural social skills, they always do better longer.
    We have enjoyed watching this since 1987 when we built Pacific Place, our first urbansenior community in Webster Groves, Missouri. urbanseniorliving.com, pacificplaceseniorliving.com

    Your photo says it all. It can happen in a single family home, and it can also happen in a self contained independent living community which is removed from the things seniors need to be doing outside of their home.

    Thanks for the thoughts.

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