We are aging in place, right where we are

April 2023
Harvey Starkman

I knew they were in trouble when Pam cut her finger one morning and couldn’t staunch the bleeding. Pam and Lorne live in a downtown one-floor walk up condo. They are frail and elderly, both with degenerative conditions that make mobility increasingly difficult. They have no children, and their closest family members live outside Ontario.

We discovered Pam’s injury when we arrived for an afternoon visit. We wanted to drive her to a local walk-in clinic, but there is no elevator or stair assist to the ground level. Simply put, Pam can no longer leave her home without significant support. We scrambled unsuccessfully to find a doctor who would stitch and dress the wound at home. In the end, we called 911 and two paramedics carried Pam down the stairwell and conveyed her to the hospital by ambulance.

Think of Pam and Lorne’s story as a cautionary tale. 

A participant in a recent Seniors in Ontario webinar nailed it perfectly: “Aging in place is one thing; aging safely in place is something else.”

Think about it. Regardless of our age, we are all aging in place. And consciously or not, safety is always a concern. That’s why we have smoke detectors and why we put baby gates on staircases when our babies start to crawl. That’s why we install grab bars, remove trip hazards, and modify our living spaces to whatever degree we can to accommodate our changing physical needs as we age.

Not only is everybody aging in place, survey data reveals that over 90 per cent of seniors want that place to be in their homes, or at least in their community. That’s understandable, and in many ways the ability to age in place is easier than it’s ever been.

Factors that used to ‘push’ seniors from their homes, like the loss of the ability to drive, or the presence of physical barriers, have been blunted by the availability of ride sharing services, needs-based home renovation, and the expanding ability of e-commerce to bring goods and services to the front door. 

Even the feeling of isolation that seniors with limited physical mobility or without family or friends nearby experience, can be somewhat mitigated by tools such as FaceTime or Skype. There are still qualifiers and potential barriers like cost, local accessibility, and familiarity and comfort with technology —none of them minor. Some can be addressed by government grants and home care and community support services, resources that will make it possible for more seniors to age in place longer.

But things happen. The body wears down, progressive illnesses progress, a fall leads to a break, a diagnosis of dementia is confirmed. Pam’s condo—already a major concern—will never accommodate a wheelchair, and her ability to perform the basic activities of daily living will require more and more assistance. Lorne may not be far behind. In time, independence gives way to the need for increasing levels of care.

I have friends who tell me that the only way they are leaving their house is feet first through the front door. John Bernstein, a caregiver services operator, agrees that it can be done— but often at significant financial and emotional cost to the caregivers. 

An older person’s desire to remain in their own home may seem unreasonable to family members who, looking objectively, see a high risk, untenable situation. However, reason always has a difficult time opposing emotion. Seniors, assessing the risks, often decide that the rewards of preserving their identity, their dignity, and, above all, their independence are worth it.

While we strive to be independent, we must also accept that the physical and cognitive consequences of aging will, in different ways, affect us all. We can work to extend the time that we can live safely and securely at home, independently at first, then likely with increasing degrees of support. 

But for many of us there will come a time when our own needs —or the needs of our caregivers —will necessitate a change. We will continue to age in place, but it may be a different place.

It is usually an unplanned ‘event’ rather than a conscious decision that drives the change. Pam and Lorne’s situation has taught me that we don’t know what our own future will bring.  Perhaps the best that we can do for ourselves and for our families is to imagine a number of different futures and plan for each. We need to take responsibility for ourselves. 

Let’s learn what we need to know and change what we can to live safely and comfortably in our homes for as long as we can. Let’s consciously build and maintain support networks with friends and neighbours. 

Let’s discuss and make known our preferred alternatives if being at home is no longer realistic. And let’s use our political power to advocate loudly for the changes we want to see in the quality of care and support for all seniors, wherever they are aging. 

Harvey Starkman is a regular contributor to the HJN. Contact him at harveystarkman636@gmail.com.