Aging in Place
Imagine you are an older adult who has difficulty cooking meals and getting around. If you had a choice of where you wanted to live, where would it be? Maybe some of your family members are urging you to move to a place where your meals are provided and you can be driven where you need to go, while others are urging you to stay in your own place even though there will be challenges. What do you do?
Based on the competence-environmental press model described earlier, older adults have options (Scheidt & Schwarz, in press). As the environment in which one lives becomes more restrictive, many older adults engage in selection and compensation to cope. They may select a different place to live. Or they may adapt their behaviors in order to compensate for their limitations, such as using microwave – able prepared foods instead of cooking meals from scratch. Using a cane or other device to assist in walking is another example of compensation.
The idea of aging in place reflects a balancing of environmental press and competence through selection and compensation. Being able to maintain one’s independence in the community is often important for people, especially in terms of their self-esteem and ability to continue engaging in meaningful ways with friends, family, and others. This is very important psychologically (Rowles,
Oswald, & Hunter, 2004). Older adults who age in place form strong emotional and cognitive bonds with their residences that help transform a “house” into a “home.” Having a “home” provides a strong source of self-identity.
Throughout adulthood, people adapt to changes in the places where they live, sometimes even having to sever connections with past settings (Rowles & Watkins, 2003). Making a change in where one lives, and having to psychologically disconnect with a place where one may have lived for many decades, can be difficult and traumatic. There is no question that people develop attachments to place, deriving a major portion of their identity from it and feeling that they own it.
Rowles (2006) discusses the process of how a place becomes a home. Because of the psychological connections, the sense that one is “at home” becomes a major concern in relocation, especially if the relocation involves giving up one’s home. Later in this chapter, we will consider how a nursing home might become a home, but for now the important idea is that a key factor is a sense of belonging.
Feeling that one is “at home” is a major aspect of aging in place. Providing an older adult a place to call one’s own that supports the development of the psychological attachments necessary to convert the place to a home is the basis (Scheidt & Schwarz, in press). Aging in place provides a way for older adults to continue finding aspects of self-identity in where they live, and to take advantage of support systems that are established and familiar.
The growing understanding of the importance of aging in place has resulted in a rethinking of certain housing options that provide a way for frail older adults to stay in their communities. Such options are important for frail older adults who are poor and cannot afford more expensive formal assisted living or nursing home facilities (discussed later). One alternative is cluster housing, which combines the aging in place philosophy with supportive services (Golant, 2008).
Golant (2008) describes several types of affordable cluster housing care. A key feature is that services are provided to the residents by staff hired by the owner or by a service provider under contract.
These services might range from having a service case manager only to actually providing information, caregiving assistance (e. g., meals, housekeeping), transportation, or health care. The aging in place philosophy in these settings emphasizes individual choice on the part of residents in terms of what services to use.
Although cluster housing and other approaches to aging in place make sense as lower-cost alternatives to nursing homes that help keep people in their communities, funding is often difficult. Unlike nursing homes, cluster housing develop – ments are not covered by Medicaid or other insurance. Finding solutions to the funding issue will be an important aspect for keeping costs down yet providing supporting environments for older adults who need support. For many, making modifications to their existing housing represents a more cost – effective option, and provides a research-based way to remain in a familiar environment. We will consider this approach later in this section.