Home Alone

In late 2013 Sharon and I founded Age-Friendly Innovators (www.agefriendlyinnovators.org) a 501(c)(3) nonprofit organization with a mission to help older adults safely stay in their home for as long as possible.  This is called “aging-in-place.”  Perhaps you have come across this term as it is appearing in the mainstream press (New York Times, Wall Street Journal, USA Today, etc.) quite often.  As a matter of fact if you are interested in these articles I have linked many of them to our Facebook page www.facebook.com/agefriendlyinnovation.  They make great reading and have a lot of good ideas.

One project underway by Age-Friendly Innovators is the development of a Fall-Risk, Home Safety and Accessibility Assessment tool that we hope to convert into an “app.”  The assessment tool consist of a fall-risk assessment based upon Centers for Disease Control and Prevention (CDC) research, a health profile with 32 questions to better understand the health of the resident and 87 specific questions relating to home accessibility, fall hazards and fire risk.  Late last year we received a grant from the Chaney Foundation to conduct 50 free in-home assessments as part of the beta testing of the app.

To date Sharon and I have conducted dozens of assessments.  It is a delicate task to be invited to meet with someone (most often a single woman) in their home to discuss health issues, fall risk and accessibility.  However, fall prevention is a high priority for older adults and we have written on that subject in previous blogs.

What we have learned to date is that each and every home situation we encounter is unique.  However, there are some common threads.  In the case of older single women often times the “home” is the last remaining vestige of a long happy marriage where the husband has passed and there is a sense of loss and loneliness.  In some cases children have moved away from the valley and perhaps don’t call or visit as much as one would hope.  Sometimes the home has not been maintained as well as in the past and shows signs of disrepair.  In other cases mobility issues have created challenges that have been met in unusual ways, including sleeping in the living room in front of the TV, or not leaving the home for extended periods of time because of lack of transport or fear of falling.

I bring up this subject because according to the 2010 U.S. Census for Jackson County there were 13,400 households made up of a woman living alone, representing 16.1 percent of all county households.  In addition, the number of females 65 years and older living alone totaled 7,039 (8.5 percent of all county households).  The rate of females 65 years and older is almost two and half times higher than males over 65 living alone.  (Note:  these figures do not include those living in nursing homes, assisted living facilities, etc.).  As baby boomers reach age 65 (10,000 per day nationwide and continuing at that rate for another 18 years) these numbers locally will only increase.

Age-Friendly Innovators is planning to create a fund to help those we encounter in our assessment process who have limited fixed income but need some minor modifications such as CO detectors, grab bars or carpet tape to secure throw rugs.  We are calling this “Grandma’s Porch.”  We are also collaborating with Rogue Valley Habitat for Humanity to help make larger home repairs or modifications to improve accessibility.

As a community we need to be more aware of these thousands of older adults living alone among us.  Sometimes they live right across the street but are never seen.  Can we do better in reaching out to those that are alone or may need help with transportation, small repairs, a little yard work or other chores?  Isn’t this what “livable communities” as all about?

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“Back at you–Alexa!

This blog borrows heavily from the Changing Aging website (www.changingaging.org) and a May, 2015 blog by Alexa Elheart, who I’m concluding is a young woman who wants we oldsters to shape up a little.  I did some heavy-duty editing of the original blog but her main points are worth thinking about…

Alexa writes…”Many older people feel embarrassed to reveal their true ages. The truth is society has it completely backwards, Getting older is actually the best part of life! Don’t believe me?” She raises three considerations….

1) You Have Better Social Skills?

Alex believes, “As people age, social skills increase. In a study conducted in 2010 at the University of Michigan, 200 people were given “Dear Abby”-style letters asking for advice. Researchers found that “subjects in their 60s were better than younger ones at imagining different points of view, thinking of multiple resolutions and suggesting compromises.”  Dear Alexa.  “I think we may need a few more illustrations here but the concept is rather heartening.”

2) You Gain Perspective?

Alexa says, “Another great part of getting older is realizing what’s most important and what you don’t really need to spend time worrying about.”  She cites Oprah Winfrey’s comments,  “Recognizing the time that you wasted and the things that you worried about that really didn’t matter…that’s really the hardest part, that’s really the only regret that I have.”  Alex agrees with Oprah,  “When you’re young, you tend to give yourself an inordinate amount of stress, However, as you get older and have the luxury of looking back on your experiences , you can start to see the unnecessary pressure you may have put on yourself.”   Fair point Alexa–but there may be other perspectives than just Oprah’s on this topic. Hope my response to your blog is not a stressor.

3) You Have the Opportunity to Give Back?

Alexa says, “While there are some twenty somethings who have the means to contribute substantially to their communities, the majority of people in their twenties don’t have that privilege–whether that’s due to a lack of funds or an inflexible work schedule. However, when you get older and find yourself with a much more stable lifestyle, both professionally and economically, it becomes less prohibitive to donate money, time or talent to your community. Alexa challenges older folks to “Go on–take your superior social skills, perspective, and sense of community and make the world a better place! You have amazing and unique things to offer, and your experiences really have the capability to improve the world around you.”

I say to Alexa. “You can contribute at any age–you did by posting your blog. What’s next? Make it good.”

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Little Free Libraries

Have you heard about the Little Free Library? I am borrowing with a abandon from a recently published blog describing their presence in on lucky neighborhood in Seattle, Washington. In this case, a loving husband gave his writer/reader/blogger wife the sturdy little structure as a gift.

According to “The Little Free Library Book” (Coffee House Press, $25), there are 25,000 of these pedestal libraries worldwide, spread across 50 states and 80 countries. “The basic definition: a box of books, posted in an accessible spot, often in a residential yard near a sidewalk. The key to having a Little Free Library is to release control. Take a book, leave a book. A lot of people feel an obligation to reciprocate.”

As the happy, but a little hesitant-at-first Seattle blogger (Mary Ann Gwinn) phrases it, “Do I want my neighbors to think that I actually bought and read “How to Hook a Hottie,” which sat in my Little Free Library for a week before someone took it away?” She adds,”I think of … reader-service librarians, and how their mission is to find each person their book. Who am I to judge? Why worry if people are judging me? My motto is, Every Book Its Reader. And someone did finally take that Bob Hope biography.”

We have a little free library built by a creative, woodcraftsman friend sitting on a table on our patio ready to be installed. I am starting with children’s’ books. Maybe we could place a bench nearby and we would get to observe—parents and grandparents reading to their little ones—or vice versa. I have numerous copies of “Good Night Moon.” I bet they disappear quickly.

What is your Little Free Library story? Send them — bizarre, inspiring, off-the-wall, to mgwinn@seattletimes.com, or leave a comment online. Want to start your own? Go to littlefreelibrary.org.

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Don’t Fall for This Part 2

Sharon and I have both blog about fall prevention in general but I want to get very specific….floor coverings such as mats and throw rugs are dangerous.  Two questions.  1. Are these floor coverings in good condition or noticeably worn or torn?  2. Do the floor coverings bunch up or slide when you walk on them?

If you answered “yes” to either question the best advice we can give you is to get rid of those rugs or mats.  If you can stand the thought of getting rid of grandma’s old throw rug or that cute fuzzy mat in the bathroom here are some suggestions from the National Association of Geriatric Care Managers and the International Rug Safety Insitute:

  • Recognize surface changes from one room to another (i.e. carpet in living room to linoleum in the kitchen) can present balance issues.
  • Purchase carpets, rugs, runners and mats with “slip resistant” backing or padding, remembering that such materials become less effective with repeated washings.
  • Consider thick, cut-to-fit rubber shelf liner under a carpet.
  • Carpets should be high density, low pile.  If replaced, use the same color as previous carpeting to reduce likely visual disorientation.  Recognize that color changes can visually cue the resident to the boundaries between surfaces.  Note:  bold patterns, and black on blue backgrounds can lead to misjudgments of spatial distances.
  • If a new mobility devices is required (such as a cane or walker), assure the introduction to walking on various surfaces is well monitored.  Older adults with delays in light/dark adaption, decreased contract sensitivity, poor depth perception or limited peripheral vision will also need more careful monitoring.
  • If mats, scatter rugs or runner replacements are not possible due to financial constraints, etc., apply double-faced adhesive carpet tape or heavy duty masking tape (rolled around spread fingers five times) and secured around the edges of the rug or mat.
  • Consider Press and Stick Rug Grippers (available at Lowes, Home Depot, local flooring and carpet outlets or Amazon).  Press into each corner of the carpet.  Recheck adhesive periodically and replace if you see a powdery substance that indicates deterioration.
  • Choosing aesthetically pleasing carpets, rugs and runners that meet personal preference is always balanced against functional floor coverings that promote safe navigation.

Falling can be a lifetime game changer.  Get a grip.

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You and Me at 83…

Let’s say I’m eighty-three years old. I’m not that old—but let’s assume I am, just for the purposes of this blog. Let’s assume you’re in your eighties too.

Where would we like to live? It’s a relatively easy question for both of us, I suspect. We’d like to be comfortably situated in our own homes. I know I’d like to be independently observing my personal morning rituals and managing my own activities of daily living.

If either of us were in chronically ill or physically frail and had a need for constant medical attention, living independently might not be possible.

That’s what I used to think. An article in the “Atlantic” (www.theatlantic.com) and a new report in Kiplinger (April 2015) titled “6 Simple Things You Must Know About Aging in Place” altered my view.

Here’s the story. It’s about Ellen, who is an 82 year old widow living in Anaheim California. “One Wednesday morning last year she got on the scale, as she does every morning, and It read one hundred and forty-six pounds—wasn’t that a little high? Ellen felt vaguely troubled as she poured herself a bowl of oat bran.” As Ellen ate her cereal, the phone rang, and a friendly voice from the health clinic where Ellen was a patient expressed concern about Ellen’s weight—which “had jumped three pounds from the previous day.”

The friendly voice knew that because Ellen’s scale had transmitted the information through a wireless connection. Because Ellen had a history of congestive heart failure, a three-pound weight gain in a 24-hour period was a potentially dangerous situation. There was likely to be fluid build-up that would complicate her already-existing medical issues. She needed treatment immediately.

So now you may be thinking—that friendly voice (not a mechanized one by the way—a real person) probably told her to come into the clinic. Or maybe, the voice said “Call 911 and get to an emergency room.” Nope. The friendly voice said, ‘We’re sending a car to pick you up,” which they did. Ellen’s health provider gave her no-fee transportation from her home to the health clinic over the next few weeks, as well as appropriate medical treatment, until her health situation stabilized.

Had this not occurred, Ellen might have languished. Perhaps she would have eaten less because she was afraid she was gaining too much weight. She may have experienced a life-threatening cardiac event. She could have ended up in the hospital for days or weeks undergoing painful—and expensive—treatment.

The California-based clinic system that supported Ellen in this way is appropriately named CareMore (www.caremore.org) and it specializes in patient-centered approaches that also seem to avert huge medical costs. As their website says—“That’s what we do.”

This is impressive health care. According to the Atlantic article, CareMore has a hospitalization rate 24% below average and hospitals stays are 38% shorter. Overall costs are 18% lower than average. And the surveyed satisfaction rate is well above 90%. (And remember 80 year olds can be hard to please…)

When I’m in my eighties—that’s the kind of health care I want—coordinated, integrated, tuned into my personal needs and preferences. You too?

Whatever you may think about the Affordable Care Act President Obama signed into law in 2010, these are the kind of innovative approaches included in it. These ideas effectively combine common sense with technology— or as some system-watchers put it, “It’s about improving the quality of our country’s health care, but at a reduced cost.
It’s really about–you and me at eighty-three.

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What about Lucy?

Last month Sharon and I presented at the American Society on Aging (ASA) “Aging in America” conference in Chicago.  The program was packed with presentations on a wide variety of subjects relating to aging, but one in particular caught our attention.

In recent years we have tried to plan for aging and end-of-life decisions and issues.  We drafted wills; we executed durable powers of attorney and updated our advanced directives.  We purchased plots in the Jacksonville Cemetery.  We even built a lovely, age-friendly, Lifelong Housing Certified single story home that features all manner of innovations to help us “age-in-place.”  All set right?  Well, what about Lucy?

If you have followed this blog for long you know that we added a new member to our family last September; a cute little Cavalier King Charles Spaniel puppy we name Lucy.

At the Chicago ASA Conference we attended a workshop titled “Aging in Community with Pets:  Insights, Innovations and Advance Planning.”  There it was….advance planning for Lucy.  How could we forget Lucy?

We heard from Amy Shever, Executive Director, 2nd Chance 4 Pets, an all-volunteer animal welfare organization that strives to reduce the number of companion animals that are unnecessarily euthanized each year due to the death or incapacity of their human companions.  The facts are stunning, after the tragedy of September 11 over 800 pets were orphaned.  At present over 500,000 pets are orphaned each year due to the death or disability of their human companion.

Here is what 2nd Chance 4 Pets (www.2ndchance4pets.org) recommends:

  1. Identify Caregivers – Identify individuals who would be willing to care for your pets in the hours, days, or weeks after an emergency as well as individuals who would be willing to adopt your pets should you die or become incapacitated.
  2. Prepare Written instructions – Describe, in writing, how your pets should be cared for.  To make sure your wishes are carried out, document your instructions and let others know where your instructions are located.
  3. Set Up a Fund – You currently pay for food, supplies, and medical care for your pets.  Should anything happen to you, these expenses will still need to be taken care of.  Consider setting aside funds to cover temporary or permanent care of your pets.  Pet trusts are legal in Oregon.

Ok Lucy.. We’ve got you covered.


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Better Living By Design: A Symposium You Must Not Miss

Even if I were not one of the people organizing and planning it, I would absolutely want to be present for this event!  Saturday May 16, 2015, thinking homeowners and forward-looking building professionals will come together to rock the house (literally and figuratively)!

The all-day (9-3 pm) Symposium is titled “Better Living By Design: Making Our Homes More Adaptable for All Ages.” The location in downtown Medford, Oregon is the Rogue Community College/Southern Oregon University Higher Education Center (RCC/HEC). The fee is $20 and includes lunch and morning snacks. CEUs available too.  Does it get any better than this?

Here is the line-up of speakers:
Alan Delatorre PhD Portland State University, Institute on Aging, Age-Friendly Cities Project; Title: “Baby Boomers Evolving Housing Preferences Will Shape New, Innovative Options: Stand Ready!” Overview of demographics and the opportunities on the horizon across the state and in southern Oregon.

Susan M. Duncan R.N., National Accessibility and Home Modifications Specialist. Designer and founder of The ABCs of Accessibility® Topic: Home Modifications Title: “Peeling Back the Layers of Home Access Modifications” You have questions about renovating an older home to be sure you can still easily live in it at age 80-plus…. even if you or your spouse needs a wheelchair or walker … ?  Susan has the answers. She is a pistol of a presentor!

Leigh Anne Jasheway MPH, Faculty, University of Oregon, well-regarded area Humorist. Her presentation is titled: “Watch Your Step: Oh, I Forgot, There Aren’t Any.” Leigh Anne uses all-to-true stories and anecdotes plus hilarious “Improv” routines to prompt us to laugh out loud at the decisions we make and  at our aging selves. (Laughing is aerobic exercise so this event even has some calorie-burning opportunities.)

The day ends with the tour of two local homes certified to the Lifelong Housing Standard. There are only five of these in the state and you will see the exterior of all five and the interior of two of them.  It will change the way you think about aging.

Register on the Age-Friendly Innovators website www.agefriendlyinnovators.org or by calling 541-261-2037.  Space limited so make the reservation now!

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Fire Safety

It takes a bit to shock me these days but when I saw a statistic recently regarding fire safety I was stunned.  According to a report by the U.S. Fire Administration, older adults (age 65 and older) are more than twice as likely to die in fires than the Nation’s population as a whole.  Individuals aged 85 and over are more than four times likely to die in a fire than the general population.  Clearly older adult mobility is a major contributing factor.

As frequent readers of this blog know, Sharon and I are the Executive Director and Deputy Director of Age-Friendly Innovators, Inc., a 501(c)(3) non-profit, dedicated to helping older adults remain in their homes as long as possible.  But certainly not if those homes are fire traps.  One of our foundation-funded projects is the development of a tool to evaluate the homes of older adults with respect to fall-risk, in-home safety and accessibility.  While we have conducted over 20 in-home assessments to date, we had not specifically targeted fire risk.  That will now change.

The U.S. Fire Administration has a short fire safety check list of yes or no questions the identify fire risk:

  • Do you have working smoke alarms on every level of your home?
  • Do you stay in the kitchen while you are frying, grilling, or broiling food?
  • Are space heaters placed at least 3 feet or more away from things that can burn?
  • Are all electrical cords in good condition (not damaged or cracked)?
  • Do you know two ways out of every room in your home?
  • Do you know what to do if your smoke alarm sounds?

If you checked NO to any of these questions, you are at greater risk for being injured in a home fire.  You can download the entire Fire Safety Checklist for Older Adults as:  https://www.usfa.fema.gov/downloads/pdf/publications/fa-221pdf

A few final excerpts from the Checklist brochure:

  • Smoking is the leading cause of home fire deaths for adults 65 and over.
  • Cooking fires are the number one cause of home fires in America.
  • Install CO (carbon monoxide) alarms, especially if the home is heated by any source other than electricity.
  • Candles look pretty but represent an open flame that can easily ignite anything that burns around it.

If you have parents living in their own home, get the checklist and take it with you when you next visit.  If you have an elderly neighbor living alone, take note of the items on this checklist next time you visit.

Sharon and I will be at the Southern Oregon Home Show (booth #1) on April 24-26.  Stop by and we can continue the conversation.  We knows, the life you save may be your own.

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Denial is Not a River in Egypt

Here’s a scenario most of us have experienced in some form. It’s the middle of the night and the phone rings. It’s your son in Seattle calling to tell you his 70- year old father-in-law took a fall and he’s with him in a hospital emergency room. He has a fracture—or did he say “fractures”—plural. Or maybe it’s an early morning call; your 80-something sister in Florida is calling; she just received a diagnosis that will keep her homebound–maybe even bedbound–for months.
Those calls are “911 look-alikes.” You’re not the one in crisis, but the family member at the other end of the line is dealing with an emergency and wants/needs your assistance. Even if you have been fortunate enough to avoid any kind of personal health crisis or life-changing accident, someone else’s 911 situation is about to impact you. Be ready—use that moment well.
You are a good and caring person, of course, and you will provide gentle counsel and offer information and resources appropriate to their emergent situation. Maybe you’ll do follow-up calls or make a cross-country visit to the individuals(s) in distress. You’ll probably send a get-well card or flowers. Maybe you’ll use the internet to assemble ideas that address “their” issues. And then, quite probably, time will pass and you will move on to the other things in your life. Opportunity lost.
“Opportunity,” you say? “Yes,” I reply.
Here’s how I see it. As older adults, we are in active denial–about “being old” of course, but also about the likelihood we’ll have a debilitating fall or be diagnosed with a medical condition that displaces us from our circle of comfort. According to aging expert, Dr. Mary Doheny, we are unwilling to talk about aging “until something really traumatic happens to us like the death of a spouse, the illness of a partner or the need for hip or knee replacement.” And at that point, “denial often turns to despair” and any ability to make informed choices is reduced—dramatically.
Denial does not work. Aging keeps happening. And many people do not have a strategy for dealing with that reality. When a “911 look-alike” occurs—maybe we should use that moment as a reminder to develop that strategy. Here’s why. The Federal Commission on Long-Term Care indicates “70% of us who live beyond the age of 75 will need some sort of caregiving, on average for three years.” Do you have a plan for that?
Perhaps, as are many, you’re “counting on family members to provide any needed caregiving” But are you talking to them about your care preferences?” This is not a conversation about death and dying—this is a conversation about “defining how you want to ‘live,’ despite changing health needs and the daily physical struggles that emerge as you age.“
Maybe you won’t need a middle of the night call to ignite your interest in developing a personal long-term care strategy. Maybe this information will do it. I like to think it will, at minimum, prompt more conversation. Prove me right?
Excerpted from 2014 Mail Tribune column.

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The Future is Now

The front page feature in today’s Mail Tribune was an article on Medford’s plans to expand their urban growth boundary to accommodate anticipated population growth over the next 20 years.  Having spent five years on the Jacksonville Planning Commission I am familiar with the process (and have the scars to prove it).  This expansion is expected to result in the construction of 15,000 new homes.

What is unsettling to me after reading the article was that there is no mention of accessibility in the article and indeed the city planners apparently do not take that under consideration.  The criteria used to score properties under consideration to expand Medford’s boundaries are:  transportation, affordability, environmental, infrastructure, required density, neighborhood integration and housing diversity.  The final criterion, housing diversity, potentially offers an opportunity to plead my case for accessibility.

Last year Harvard University’s Joint Center for Housing Studies published a report titled “Housing America’s Older Adults, Meeting the Needs of an Aging Population.”  The report stated very clearly “affordable, accessible, and well-located housing is central to the quality of life for people of all ages, but especially older adults.  Accessibility is essential to older adults’ health and safety as physical and cognitive limitations increase.  But the existing U.S. housing stock is unprepared to meet the escalating need for affordability, accessibility, social connectivity and supportive services.”

Will Medford allow 15,000 new homes to be built without attention to accessibility?  Who will purchase these new homes?  By 2020, according to census projections, 23.2% of Jackson County residents will be over age 65.  Medford has long been a retirement Mecca of sorts, drawing Californians to our Valley.  Will these retirees find accessible homes they can “age-in-place?”

The Harvard study states that the five most important “universal design” features in a home are:  no-step entries, extra-wide hallways, accessible living spaces on the ground floor and accessible light switches and door levers.  According to the study only one percent of the housing units in America have all five of these features.  Today with a few notable exceptions, most developers are still building homes without these necessary universal design features.  Are we going to allow development of homes for the future or the past?

One additional item from the Harvard report should give us all pause.  They cite the disconnect between housing programs and health care systems which put older adults with disabilities or long-term car needs at risk of “premature institutionalization.”  Put simply this means that if a homeowner develops a health issue or suffers a major injury, say from a fall, it is possible that person will not be able to stay in their own home because it lacks accessibility.

There is a solution to this issue.  The planners in all major Southern Oregon cities (indeed throughout the country) should adopt as part of their criteria for scoring properties the first level of the Rogue Valley Council of Governments” Lifelong Housing Certification Standard.  This first of three levels of certification requires that homes be “visitable” for all guests.  This means a person in a wheel chair can easily access the main entertainment area of the home including a hallway with sufficient width leading to an accessible bathroom.

If you want to see what these homes look like drive out to the Twin Creeks Development in Central Point and follow N. Haskell St. to the Age-Friendly Homes sign.  The future is now.

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