By Peter Kelman Ed.D.
“Aging in Place” is generally understood to mean spending the rest of your life in your own home. As such, aging in place may seem primarily about making your home more senior-friendly. In reality, however, home renovation is only a small part of a complex and challenging process that is more about “aging” than it is about “place.”
Understanding and preparing to address the challenges of aging in place is further complicated by the fact that each of us has a unique perspective on this matter, depending on our age, health, and finances, as well as whether we own our home or rent; live with a partner, housemate, relative, or alone; live in town or out in the country; own and drive a car; have a disability or chronic illness; and a variety of other factors that could impact our ability to live safely and comfortably in our own home.
Nevertheless, in fairness to our partners, our children, our friends, our neighbors, and ourselves, it is incumbent upon us all—whether a senior or middle-aged, with health issues or without, a homeowner or a renter, single or coupled, financially comfortable or living on a fixed-income, etc.—that we take seriously the planning needed if we are to successfully age in place during the final stages of our lives. We cannot wait until a sudden change occurs in our health or for the accumulation of gradual changes that move us beyond the capacity to plan and make decisions for ourselves.
Below are the top 10 issues that need to be understood and addressed by people who wish to age in place now or in the future.
It’s never too soon to consult appropriate experts to help you evaluate your home for its suitability for aging in place and to plan to make needed additions and alterations, including:
- a ground floor bathroom and sleeping quarters
- grab bars, ramps, and wheelchair accessibility
- evacuation plan and emergency exits
- personal alert and home security systems
- weatherizing and energy efficiency
- decluttering and downsizing belongings
Recommended resources: Vermont Center for Independent Living (vcil.org), W.A.R.M. LLC (warmvt.com), Vermont Housing Conservation Board (vhcb.org/our-programs/housing), Vermont Move Management (vtmovemanagement.com)
As we age, we need to recognize when we can no longer manage tasks such as the following on our own and to arrange to get the help we may need:
- Home maintenance and repairs, including painting
- Seasonal chores: snow and ice removal from driveways, walks, roofs; lawn-mowing, gardening, and other landscaping; changing screen and storm windows; spring cleaning, stacking wood, cleaning gutters, etc.
- Regular house-cleaning
- Organizing (and disposing of) mail, paperwork, books, cooking and dining materials, old photographs, and other mementos, etc.
- Occasional activities that require strength, such as moving furniture and heavy lifting, or that could be dangerous, such as ladder-work
- Responding to household emergencies, both large and small (e.g., leaks, breakage, finding misplaced items, etc.)
Information regarding possible resources in the relatively near future: Montpelier Village Group (email: firstname.lastname@example.org)
Independent Activities of Daily Life (IADLs)
Although it may be hard for some of us to imagine, we all need to understand that sooner or later we are likely to need help with everyday activities and that this could happen suddenly no matter how young or healthy we may now be. Examples are:
- Household management: errands, shopping, paying bills, appointments, maintaining calendar of events, recycling, etc.
- Preparing and eating healthy meals regularly
- Managing finances and personal affairs (balancing checkbook, tax filings and payments, insurance, etc.)
- Using personal technologies: smart phones, computers, TV, etc.
- Caring for partners, parents, or dependents with disabilities
- Driving when we no longer do so ourselves
- Coping with loneliness and isolation, especially if living alone or out in the country
Recommended resource: Central Vermont Council on Aging (cvcoa.org/options-counseling.html)
Although it may be even harder for many of us to imagine, there is a high likelihood that we, our partners, parents, or dependents will live to an age at which we may need help with some very basic activities of daily life (ADLs) such as eating, personal hygiene (bathing, dental care), toileting, dressing, walking, or other means of transferring from place to place. So, if we intend to age in place, we are almost certain to need home health care for ourselves (or others) to assist us with these ADLs, as well as to perform some or all of the following health-related functions:
- Managing medications
- Managing home-caretaker and visiting nursing arrangements
- Making medically related appointments (e.g., primary care visits, specialists, lab work and other diagnostic procedures, eyeglasses, hearing aids, dental work)
- Responding to medical and related emergencies
- Patient advocacy with hospitals, doctors, visiting nurses, etc.
- Respite for home-caretakers (especially if family members)
Recommended resources: Central Vermont Home Health and Hospice (cvhhh.org/private-care-services), TLC Homecare (tlchomecare.com)
One of the most emotionally difficult decisions we face as lifetime drivers is knowing when to stop driving and give up our car, and, once we have done so, as citizens of Central Vermont, we face the challenge of the paucity of public and private alternatives for getting where we need or want to go and obtaining the goods and services we need or want. Transportation is a social, political, and financial issue about which we all should be more aware and perhaps politically engaged.
Information regarding possible a pilot micro-transit program in Montpelier: Montpelier Sustainable Coalition (sustainablemontpelier.org/transportation) and the current Vermont Public Transit Program (legislature.vermont.gov/Documents/2020/WorkGroups)
It is critically important for us to understand the ever-changing costs and benefits, pros and cons, and ins and outs of Medicaid, Supplemental Security Income (SSI), Medicare, private insurer Medigap and Medicare plans, and long-term health care policies. If you are currently enrolled in any of these health insurance programs, you should review your options annually to be sure you are in the best program for your needs. And, if you are not yet enrolled in Medicare because you are under 65 or you are still working and covered by a company plan, be sure you understand the requirements for you to enroll in Medicare when you stop working.
Recommended resource for assistance with any Medicare questions:
Vermont State Health Insurance Assistance Program (SHIP) (shiptacenter.org/about-medicare/regional-ship-lo)
Long Term Health Care
It is similarly important to understand the various institutional alternatives to home healthcare for one’s long-term physical, mental, and cognitive health care needs, including:
- Assisted living
- Residential care
- Nursing homes
- Continuous care or lifetime communities
It is strongly recommended that people visit a range of institutional alternatives in the region to see for themselves what each of the above types of long-term health care may offer and at what cost.
Recommended resources: Central Vermont Council on Aging (cvcoa.org/options-counseling.html),
Vermont Adult Services Division (asd.vermont.gov/services/residential-options)
Financial and Tax Planning
Depending on one’s financial situation, financial and tax planning might involve:
– working with a financial advisor to reconfigure one’s investment portfolio to meet needs throughout an extended old-age
– a discussion with a knowledgeable counselor at Central Vermont Council on Aging (cvcoa.org/options-counseling.html) about making a timely disbursement of one’s modest assets to heirs in order to qualify for low-income programs.
– consulting with a tax accountant about the possible capital gains implication of selling a residence that has appreciated substantially versus leaving it to heirs.
Estate and Other Legal Planning
- Even people with modest or no estate to speak of should be sure to have an up-to-date (no older than 5 years) will with an identified executor and successor executor, as well as durable powers-of-attorney, health proxies, and advanced health directives (registered with the state) in case of one’s incapacity.
- People with larger or more complicated estates, especially those involving their primary residence or other property, should consult an estate lawyer about setting up an appropriate trust.
- People with low incomes who own property or other assets may also wish to consult a lawyer about timely asset transfers that could enable them to qualify for assistance programs that might make it more possible for them to age in place.
Recommended resource for health care decisions and advanced directives: VT Ethics Network (vtethicsnetwork.org/decisions.html)
Alternative living arrangements for aging-in-place:
- Homeshare Homeshare Now (homesharenow.org)
- Duplexing one’s house
- Additional Dwelling Units (ADUs) for oneself, a live-in caretaker, or retirement income; see article about a possible ADU pilot program in Montpelier (timesargus.com/news/local/council-approves-resolution-to-help-with-housing-issue/article_dcf1d617-1857-5cc1-ba3a-7251c3be6e9e.html
- Tiny homes
- Mobile homes
- ADA-compliant modular housing Vermod Homes (vermodhomes.com)
- Senior-living facilities
- Intentional communities (e.g., Montpelier Silver Maples Community)
- Independent living communities (e.g., Copley Woodlands in Stowe)
Recommended resource: Vermont Housing Conservation Board (vhcb.org/our-programs/housing)