Chapter ll:

Aging in Place—

Safely and Independently

Part Il:    Aging in Place

And it is still true, no matter how old you are, when you go out into the world it is best to hold hands and stick together

—Robert Fulghum, All I Really Need to Know I Learned in Kindergarten

THE FAMILY CONVERSATION #2

CREATING AN AGING-IN-PLACE PLAN

Like older people nationwide, three out of four Long Islanders say they want to “age in place,” living in their current home as long as possible, according to surveys by AARP.

But the ability to age in place—safely, comfortably, and independently—will likely change over time, as people move from their 60s into their 70s, 80s and beyond. And as most of us know well, staying in places like Long Island is expensive, with high property taxes, home maintenance and living costs. For some, aging in place may involve relocating to another residential community locally where changing needs can be better accommodated.

There are two critical parts to successful aging in place.

The first part is the ability to age in community—having opportunities to continue engaging in recreational, learning, cultural, volunteering, spiritual and social experiences as you get older. As your loved one’s physical condition changes, there also should be options for in-home health care and assistance with activities of daily life, including reliable transportation alternatives. AARP’s Livable Communities initiative (www.aarp.org/livable) is one widely recognized approach aimed at helping communities become more “livable” places, not only for seniors, but for people of all ages.

The second part is making sure that the overall design and features of your loved ones’ home continues to meet their evolving needs and physical limitations. Activities such as climbing stairs, bathing, or doing household chores or routines may become more challenging in later years. Ensuring your loved ones’ safety and comfort, while also maintaining their independence, may require modifications or special accommodations in their home.

Aging in place involves intentional planning, a process that includes older family members and their caregivers, as well as professional experts. A comprehensive plan centers on the safety of your loved ones’ home, but also incorporates a holistic strategy for maintaining their physical health, cognitive fitness, and social engagement.

Here are several resources to help you get started with your aging-in-place plan

RESOURCES BY SUBJECT

WHAT'S YOUR LOVED ONE'S 'RETIREMENTALITY'?

How and where your loved ones decide to spend their later years is their choice, of course. But it’s important to be aware of their plans, since these decisions may have a major impact on their future caregiving issues—and yours.

While “retirementality” typically centers on where one lives, location become just one part of a larger set of goals relating to health, family and friends, personal interests, and yes, work, for those who are the “unretiring type.” Laying out that broader context is key to a more holistic approach to caregiving: ensuring that your loved ones achieve their desired longevity and quality of life.

Here is a lifestyle checklist for your loved ones and you to discuss and consider.

THE LIFESTYLE CHECKLIST

A SHORT GUIDE TO HEALTHY LIVING FOR YOUR OLDER LOVED ONES
(AND YOU, TOO)

As caregivers, we tend to worry more about the health of our loved ones as they get old. But what they do to maintain their physical and mental health now, in their earlier years, can make a big difference later on. That goes for us, too, as caregivers. It’s important for all of us to keep immune systems strong, not only to survive the coronavirus and other viruses to come, but to stay healthy and productive throughout our lifespan.

Of course, your loved ones are ultimately responsible for their own health and fitness.  Still, it’s worth keeping an eye on their wellness during their independent years as they age in place. Today’s behaviors and habits may affect their risk to chronic diseases, disabilities, and even dementia later in life. And the consequences of these health risks will not only impact your loved ones’ quality of life but determine the cost and level of caregiving they require in the future—as well as your responsibilities as caregivers.

Recently, I’ve had the opportunity to serve as a Community Educator for the Alzheimer’s Association’s Long Island chapter, providing presentations to the public on “Healthy Living for Your Brain and Body.” What I have learned from a consensus of experts is that taking care of ourselves as we age generally comes down to focusing on five basic components that together have a major impact on our long-term health and wellness:

  • Basic health: Monitoring and managing key medical indicators of the body’s health.
  • Exercise & Physical Activity: Creating a consistent and sustainable habit of exercise and physical activity.
  • Diet and nutrition: Following nutritional guidelines that can reduce the risk to serious diseases and disabilities.
  • Cognitive activity: Integrating mentally stimulating activities into our daily lives that can keep us sharp, but also may provide protection against dementia.
  • Social engagement: Cultivating relationships with family, friends and other social networks on a regular basis.

Of course, there are few guarantees in life, but several research studies suggest that putting all these pieces together will achieve maximum benefits toward achieving healthy longevity, including lowering the risk of dementia.

Several years ago, a major European research project known as the FINGER study (Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Dementia) found that collective interventions to improve diet, increase exercise, and enhance cognitive training and social activity appeared to have a significant effect on overall cognitive performance. In the U.S., the Alzheimer’s Association is following up the FINGER study with research known as the U.S. Pointer study, evaluating whether similar lifestyle changes (such as exercise, diet, cognitively stimulating activities) can protect memory and thinking in older adults.

That doesn’t mean that we need to rush to address all these issues with our loved ones or ourselves. As Gary Small, director of the UCLA Center on Aging and author of several books on longevity, has said: “Simple everyday lifestyle choices have a major impact on how long and how well we live.”

Here is a sampling of local organizations, programs, and initiatives that promote healthy aging:

HEALTHY AGING RESOURCES

Monitoring Your Loved Ones’ Health

  • Just as you would monitor a few key indicators to keep your car in good condition (for example, tire pressure, oil level, mileage), caregivers should make sure their parents keep track of their health numbers:
    • Blood pressure or hypertension: High blood pressure can lead to heart attacks or strokes, as well as increase the risk of cognitive decline.
    • Blood sugar: High blood glucose (hyperglycemia), a symptom that characterizes diabetes, also can increase the risk of heart disease and stroke, kidney disease, vision, and nerve problems.
    • Weight: Being overweight or obese may increase the risk of many health problems, including diabetes, heart disease, and certain cancers.
    • Cholesterol: While our bodies need cholesterol to build healthy cells, high levels of cholesterol may increase the risk of cardiovascular diseases.
    • Alcohol consumption: High-risk drinking is considered more than a drink a day for women and more than two drinks a day for men, according to the National Institute on Alcohol Abuse and Alcoholism.
  • Make sure your loved ones visit their primary doctor regularly.
    • Help ensure “preventive maintenance” through regular eye and ear exams,  exams like breast and prostate cancer and procedures like colonoscopies. Remember, there are no symptoms for certain risks like high blood pressure or high cholesterol.
    • If one of your loved ones appears to be experiencing a health problem, urge them to see their doctor as soon as possible. People often wait too long before going for help. If, say, your father’s leg is swollen, make sure he doesn’t wait a month before checking it out.
    • As your parents age, be alert to their mental health as well. Even before the pandemic, depression, anxiety, and loneliness have been pervasive among the elderly. (They’re also common in younger generations today.) If needed, people should seek treatment. They shouldn’t suffer in silence.
  • Encourage your loved ones to get sufficient sleep.
    • Productive people may feel that sleep is “a waste of time” and that they can get more done on four or five hours of sleep a night. While the amount of sleep each person needs may vary, most researchers agree that we should get seven to eight hours of sleep a night—and that doesn’t change as we get older, no matter what misinformation you’ve been told.
    • Adequate sleep is not only important to your older loved ones, but to you, the caregiver. If you’re sleep-deprived, you’ll end up wasting the time when you’re awake, because your cognitive function will be deficient.
    • Not only is sleep NOT a waste, but researchers have found that it crucial to your immune system health as well as serving another critical function: Your brain cleanses itself as you sleep, a kind of “mental flossing,” an important maintenance process for helping prevent dementia later.
    • Your parents (and you) should follow a routine that helps you get to sleep: Don’t put your mobile phone next to your bed. Keep the room dark and cool (between 60 and 65 degrees, which stimulates the production of melatonin); and don’t eat or drink just before you go to sleep.

    Sustaining Daily Exercise

    Physical activity is good for all of us, whether we’re talking about older parents or family caregivers.  A long-term study by the National Institutes of Health and AARP showed that people aged 40 to 61 who started exercising after years of physical inactivity could still extend their longevity, lowering their risk of mortality by 32 to 35 percent.

    Staying active every day can help prevent or delay some diseases like strokes and diabetes; improve strength so you and your loved ones can stay independent; reduce levels of stress, anxiety, and depression; and help maintain a healthy weight.

    • There’s no single approach to staying fit. You can choose physical activities that get your body moving, like gardening or taking stairs instead of the elevator to your office. Or you can choose structured exercise such as weight training or aerobics. What’s important is movement, getting your heart rate up, and consistency.
    • Talk with your doctor before you start. Ask whether there are exercises you should avoid because of any surgery or illness you’ve had. Your doctor can help choose activities that are best suited for you and reduce any risks.
    • To get the full benefits of physical activity, consider four types of exercise:
    • Endurance or cardiovascular activity that makes you breathe hard.
    • Strength exercises that build muscles, such as weightlifting, so you can lift other things, like your grandchildren or bags of topsoil in the garden.
    • Balance exercises, which along with strength training, can help prevent falls and enable you to get up from sitting without support.
    • Flexibility or stretching exercises that will help you move more freely to make it easier to do routine tasks like tying your shoes. 
    • Choose physical activities you enjoy and ask friends to join you—that way, you’re more likely to make them part of your weekly routine.
    • Go take a walk. For me, walking has become the new jogging as I’ve gotten older. It’s one activity where I can command the time, place, and pace. I don’t need to schedule walks with others; I can do them alone, allowing for thinking trough problems or ruminating about my day. Or I can accumulate steps throughout my day, deciding to take stairs instead of elevators or parking my car farther from a building where I have an appointment so I can build in a short walk on the way to a meeting.
    • A comprehensive, yet user-friendly, guide to exercise and fitness is the National Institute on Aging’s website (https://www.nia.nih.gov/health/topics/exercise-and-physical-activity). In addition to the many articles on the website, the institute offers a terrific publication, Exercise & Physical Activity: Your Everyday Guide from The National Institute on Aging, which can be downloaded as a PDF (click https://order.nia.nih.gov).

    Sticking to a Healthy Diet

    Like your loved ones’ overall health, their diet remains primarily their own responsibility as they age in place. But it’s important to be aware of your parents’ dietary habits for two reasons: First, by following certain dietary guidelines they can reduce the risk of heart disease, Alzheimer’s, diabetes, and stroke. Second, a healthy diet can not only help prevent disease, but keep their body’s systems optimal as they age. And once again, the basic tenets of a healthy diet apply to caregivers as much as the people they care for.

    While there’s a plethora of information available about diet and nutrition today, here’s a short checklist of recommendations that most experts agree on:

    • Eat regular meals. As people get older, the appetite starts to go, so the risk of being underweight may actually be greater than being overweight. Your body doesn’t care that you don’t feel like eating, it still needs nutritious food.

    Avoid the latest diet fads. Most nutrition experts recommend following the Dietary Guidelines for Americans, provided by the U.S. Department of Agriculture and the U.S. Department of Health and Human Services. These government guidelines are generally reflected in two widely recognized diets, the Mediterranean Diet (the traditional cooking style of countries bordering the Mediterranean region) and DASH (Dietary Approaches to Stop Hypertension). Check out www.choosemyplate.gov, a website developed by USDA, offers personalized eating plans to evaluate your food choices from each food group and get maximum nutrition from your calories.

    • Consider these basic elements of a healthy diet:
    • More fruits and vegetables. Generally, fruits and vegetables with vibrant colors provide indicate higher levels of heart-protecting antioxidants. Examples: spinach, blueberries, black beans orange sweet potatoes, and black beans.
    • More fiber-rich foods. Almost no adult eats enough fiber, which stabilizes blood sugar level, a key to preventing diabetes. Consider dried beans, fruits, vegetables, and whole-grain foods.
    • Lean cuts of meats, poultry and fish. Older adults need proportionately more protein in their diets than they did when they were younger. Also consider eggs, nuts and plant sources like chickpeas and lentils.
    • Adequate amounts of calcium and Vitamin D.  Bone mass for most people peaks in their late 20s and then declines for years, so it’s important to get these nutrients to keep bones strong and lessen the risk of fractured bones. Consider cheese, yogurt, leafy greens, broccoli, and beans.
    • Eat more vegetable oils rich in polyunsaturated fats.  Avoid saturated fats (mostly from animals), processed foods and trans fats (found in many cakes and cookies).
    • Cut down on sugar. Sugar consumption (watch out for refined flour and hydrogenated fats) can lead to chronic inflammation, causing all kinds of health issues.
    • Drink enough fluids. This is especially important for older adults because they often don’t feel thirsty, even if their bodies need fluids. Every issue and organ in your body needs water to work properly. How much water should people drink? Needs vary, depending on factors such as your health and how active you are. On average, experts recommend 15.5 cups of fluids a day for men, 11.5 cups for women (about 20% of fluids come from foods with high moisture content).
    • When Eating Out: Focus on moderation and portion control. Share a portion or eat half an entrée and take the rest home. Avoid meals high in calories, fat and salt; Ask for dressing on the side to control how much to use.
    • Balance “energy in” with “energy out.” That is, the calories from food and beverages you consume should balance with calories burned through basic body functions and physical activities. When you do this, your weight will remain stable.
    • Be Careful of Dietary Supplements. These substances, which are intended to lower your risk of health problems, may contain fiber, vitamins, minerals, herbs, amino acids. Generally, generally, do not need a prescription. May be helpful, but also may be harmful, when taken in combination with prescription or over-the-count medications. Do you or your loved ones need to take a supplement? Talk to a doctor and registered dietitian; they can review your health needs and recommend whether certain supplements are right for you.

    Bolstering the Brain’s ‘Cognitive Reserve’

    Research studies show that when we engage in intellectually challenging activities, we not only keep our minds sharp, but benefit our brain in several other ways. An active mind stimulates blood flow to the brain, and your brain forms new pathways for connections among brain cells. And such physiological activity helps build your brain’s “cognitive reserve,” providing potential protection against developing dementia later in life.

    So it’s important for your loved ones, no matter how old they are, to continue stretching their minds through activities that involve learning new things or solving problems. Researchers maintain that mental acuity is a “use it or lose it” phenomenon—and that goes for caregivers, too.

    Thankfully, there are lots of easy-to-implement ways to build our neural reserves. The key is to pick new things that are enjoyable and interest you—that will increase the likelihood that you will continue over time. A few examples:

    • Learning to speak a new language or play a musical instrument. (I have one long-time friend who decided to relearn French, which she studied in high school; another friend who decided to take up clarinet lessons.)
    • Doing challenging puzzles like Soduku or interactive games. (I particularly enjoy playing online trivia games on my mobile device, competing against my friends.) For more information about free interactive games and puzzles, check out https://games.aarp.org/.
    • Trying new cooking techniques or recipes.
    • Reading aloud with your grandchildren. Experts say that reading and listening promote interaction with both sides of your brain, while reading silently activates a much smaller part of the brain.
    • Doing familiar things in unfamiliar ways. Try using your non-dominant hand to do routine daily activities or do something blindfolded, such as sorting coins.
    • Engaging in formal education—that is, learning administered by professionally trained teachers.

    With the gradual ending of the pandemic, most museums, art galleries and other cultural institutions have reopened to daily visitors, although some members of the public and workers continue to wear masks in public spaces. At the same time, new opportunities for your loved ones (and caregivers, too) have opened up to explore intellectual and cultural interests through virtual events, webinars, Zoom courses, and other online programs.

    The Long Island chapter of AARP has been sponsoring a diverse array of free online seminars though its Lifelong Learning Series. The online offerings via Zoom range from seminars in public speaking and creative writing, to hand-on workshops for 50+ business owners and entrepreneurs, as well as specialized classes teaching technology skills for older adults. AARP has also added a lively series of cultural events, including a virtual art show for 50+ artists, in collaboration with the Islip Arts Council.

    “There is a high interest in personal enrichment and lifelong learning,” says Bernard Macias, AARP Associate State Director for Long Island. “”It allows people flexibility—they can do it in the comfort of their home.” For more information visit www.facebook.com/aarplongisland. For more listings of events and programs in your area, visit www.aarp.org/nearyou.

    Here’s a sampling of additional resources to bolster your cognitive health as you age:

    • Libraries. There are 117 public libraries across Long Island, and many of them are streaming events like concerts, book talks and theater performances.
    • Museums and galleries. Whether you’re interested in local venues or international institutions like the British Museum, many of these places are conducting free virtual tours and exhibit openings. Visit Google Arts & Culture (https://artsandculture.google.com/) to find more than 2,500 museums and galleries that offer virtual tours and online exhibits to the public.
    • Senior and Community centers. As these centers gradually reopen with limited attendance, they continue to offer online activities such as exercise classes, yoga, and meditation.
    • iHeart Radio (www.iheart.com). This website offers free radio, music and podcasts in dozens of genres.
    • www.edx.org. This nonprofit organization offers more than 2,500 free courses from schools such as Harvard and MIT. EdX offers MOOCs (Massive Open Online Courses) and interactive online classes in subjects including law, history, science, engineering, business, social sciences, and public health.
    • Several local colleges and universities also offer continuing education, discounted tuition, auditing opportunities, and lifelong learning programs for seniors. Some of the major programs:
    • Long Island PEIR (Personal Enrichment in Retirement)https://lipeir.org/This continuing education program for those age 55-plus provides classes, discussion and interest groups, trips to cultural venues, volunteer opportunities and social events. The fee-based program offers both in-person and Zoom programs. Activities are planned and led by PEIR members and change every year. Currently the group has more than 215 members, from age 57 to 97. For information about linking to current online programs and activities, contact Steve Wettan at ddsslw@aol.com.
    • Hutton House Lectures at LIU Post www.liu.edu/CWPost/ (Search for Hutton House) 516-299-2236. This non-credit enrichment program offers more than 160 classes in art, music, philosophy, history, literature and political science—both online and on campus. It’s like a small liberal arts college with all courses taught on a quarterly basis by exceptional professors—but without tests or homework.
    • Stony Brook University Osher Lifelong Learning Institutewww.stonybrook.edu/spd (Click Outreach) 631-632-7063 or 631-632-OLLI (6554) Administered by the School of Professional Development, the Osher Institute is open to all retired and semi-retired individuals. Avenues for participation include peer-taught workshops, lectures, special events, committees, and social activities, currently presented via Zoom. The Institute is among 120 such lifelong learning programs at colleges and universities across the country, launched through grants by the Bernard Osher Foundation. Annual membership is $325.

    Promoting Social Engagement—with Some Caution

    Traditionally, many older Long Islanders have led active social lives, involved with friends, hobbies, travel, library activities, volunteer work, clubs, houses of worship, community and civic organizations.

    While public officials continue to be vigilant for health threats that may affect our lives,  it’s important that your loved ones (and you) remain as socially connected as possible—particularly because research studies have shown that socialization is vital to the health of both young and old. Socially connected people live up to 20 percent longer, and good partnerships and friendships can make a big difference, especially when people look after each other and share a positive attitude about life.

    “As human beings, we’re just wired for relationships,” notes Carol Waldman, the former executive director of the Glen Cove Senior Center and now a consultant with Nassau County’s Age-Friendly Community initiative. “Find out what resources are out there,” says Waldman, one of my long-time friends. “Who’s in your life now, and how can you deepen or strengthen those relationships? Ask yourself: ‘Am I comfortable reaching out? Am I making the most of conversations I have? Am I moving forward if I need new relationships in my life?”

    While most in-person gatherings have resumed, many digital platforms that kept us connected during the pandemic are likely to remain. My friends and colleagues tell me they continue to meet virtually, whether with co-workers or old high school friends. And besides Zoom, there are other platforms that offer ways to meet virtually, including Skype, Freeconferencecall.com, Webex, Googlemeet, Microsoft Teams, Facetime and WhatsApp. The challenge for caregivers and their loved ones is to devise a hybrid strategy of socialization, blending safe personal gatherings with virtual social activities.

    The key, of course, to virtual social engagement is making sure your loved ones have enough tech savvy to use these platforms. If you need to boost their skills, there are some organizations that can help, including:

    SeniorNet

    www.SeniorNetLI.org

    631-470-6757

    SeniorNet brings technology to 50+ adults through webinars, in-person classes and private instruction in a warm and welcoming environment.  Topics include computer basics to advanced applications, smartphones, the iCloud, streaming video, buying a new TV, preventing identity theft, and many more.  SeniorNet also provides Tech Tips and a Helpdesk.

    Senior Planet from AARP

    https://seniorplanet.org

    Senior Planet from AARP is a great resource whose purpose is to enable older adults (actually, people of all ages) to come together and find ways to learn and thrive in today’s increasingly digital age. It’s the flagship program of the national nonprofit Older Adults Technology Services (OATS), which trains and supports older adults in using technology to improve their quality of life and enhance social and civic engagement. After a series of successful collaborations, Senior Planet formally joined AARP as a charitable affiliate.

    In addition, there are lots of opportunities for your loved ones to get computer and social media training through YouTube videos. And for more personalized training, there are experienced local consultants like Wendy Weiss, who founded TechTime (www.techtimetutor.com) to provide one-on-one or small-group training sessions with lessons tailored to individual needs, including computer basics, internet searching, social media and office skills. “Technology provides you with the ability to FaceTime, Zoom, texting with children and grandchildren, sending and receiving photos,” says Wendy Weiss. “Do people know that your iPhone has a built-in scanner? And that you also have the ability to sign a document with your signature?”  To learn more about Wendy’s services see her YouTube video: https://tinyurl.com/3u47e2ss

    Addressing Mobility Issues

    One of the barriers to social engagement for people with mobility issues, including many seniors, is the lack of accessibility to cultural and recreational venues. About 20 percent of the U.S. adult population has some sort of mobility challenge, and while a growing number of locations have become more accessible in recent years, it’s not always easy to know how accommodating a place really is—until  you get there.

    The goal of Destination Accessible (www.destinationaccessible.org), a Long Island-based nonprofit organization, is to be a resource for families with mobility challenges so they can decide whether a destination is suitable for them and know what to expect when they get there. “We don’t want to tell you where to go,” says Roberta Rosenberg, the co-founder of Destination Accessible. “We just want you to ‘know before you go,’ to ensure the best experience possible.”

    Some venues say they are “handicapped accessible,” but do not provide a detailed description of what that means; even their website usually doesn’t tell the whole story. There are lots of specific questions people should ask. For example:

    • Is the facility easy to enter?
    • How far is the parking lot from the entrance?
    • Will there be someplace to rest?
    • Will there be more steps than I’m comfortable with?
    • Is the restroom truly accessible, with the stalls large enough for people to easily maneuver themselves, handrails, and an accessible sink?
    • Ask the person managing the venue, have you personally seen these accommodations? If not, could you please check them?

    The website currently includes descriptions of more than 600 venues, concentrating on popular leisure locations such as theaters, museums, parks, dining establishments and kid-friendly places in the New York metro area, as well as select locations nationwide. Each place has been personally visited. The site includes a comprehensive, downloadable checklist of tips to ask venues about their accessibility.

    “Knowing specifically what you are going to find at a venue can reduce your anxiety by helping you plan for that visit,” Roberta says. “Or perhaps it may help you decide to choose a more appropriate venue.”

    YOUR LOVED ONES' HOME:

    SOME PRAGMATIC QUESTIONS

    When considering aging in place in their current house, it’s important that your loved ones—and you—take a good look at some nuts-and-bolts issues.

    • Can they afford to maintain their single-family home, taking into account the costs of property taxes, insurance, utilities, and maintenance of a home that is also aging as they are?
    • Does their home meet their needs, physical or otherwise?
    • Have they (and you) researched property tax exemptions and eligibility?
    • Have they compared the cost of renting, compared to continuing to own and maintain a home?
    • Are their assets tied up in the home when cash is needed for other purposes?
    • Do they want to be mortgage-free, or are they comfortable managing debt in their later years—possibly taking out a reverse mortgage down the road?
    • Is their current neighborhood safe for an aging family, accessible to recreation, shopping and other social activities?
    • If they’re reluctant to drive or no longer driving at all, is available public transportation adequate?
    • Is their home and yard too large or costly to properly maintain?
    • Have they factored in housing transitions for later in life when they might need day-to-day assistance?

    The website currently includes descriptions of more than 600 venues, concentrating on popular leisure locations such as theaters, museums, parks, dining establishments and kid-friendly places in the New York metro area, as well as select locations nationwide. Each place has been personally visited. The site includes a comprehensive, downloadable checklist of tips to ask venues about their accessibility. “Knowing specifically what you are going to find at a venue can reduce your anxiety by helping you plan for that visit,” Roberta says. “Or perhaps it may help you decide to choose a more appropriate venue.”

    HOW ‘LIVEABLE’ IS YOUR LOVED ONES’ HOME?

    AARP’s “Livability Index” (www.aarp.org/livable) evaluates several factors affecting a person’s neighborhood and community, but for most of us, livability starts at home.

    People may not realize that the design of their house no longer meets their evolving needs. Physical activities such as climbing stairs, bathing, or doing household chores or routines, have become more challenging. Nevertheless, there are ways to modify existing homes to meet the needs of older residents, helping to prevent accidents while also increasing comfort and maintaining their independence.

    Many experts recommend assessing the future “livability” of your loved ones’ home by checking whether it measures up to the standards of “universal design.” Widely recognized by architects and builders, universal design focuses on making houses adaptable for people of all ages, with a wide range of physical abilities or disabilities.  For example, designing wider hallways and entrances can help accommodate both elderly or disabled residents who are wheelchair-users, as well as younger, able-bodied parents pushing baby strollers.

    “Choose furniture for seating that is firm, yet comfortable, and sofas of chairs with arms so it's easier to get into and out of the seat,” advises Dafna Adler, an experienced New York interior designer. “Also, pay attention to specific colors, since our perception of colors can change as we get older. Color contrast becomes more important in certain key areas for safety considerations, especially when there is a change in elevation, such as a step.”

    Some of the features unique to universal design include:

    • At least one step-free entrance into the home
    • A bedroom, full bathroom, and kitchen on the main level
    • Wide doorways and hallways
    • Lever door and faucet handles
    • Multi-height kitchen countertops that can be used while standing or seated
    • Kitchen and bathroom cabinets and shelves that are easy to reach
    • A bathroom or shower with a non-slip floor
    • Blocking in the bathroom walls so grab bars can be installed as needed
    • Well-lit hallways and stairways
    • Secure handrails on both sides of stairways

    Modifications to the home can be the key to increasing the chances of older people staying independent and active in their community for as long as they desire.

    One local expert is Kim Kuester, president of 101 Mobility of Long Island and Queens, whose firm offers consulting, planning and installation of products (ramps, custom stairlifts, handrails, walk-in tubs, door widening) with a minimum of social contact. Much of the planning of the modifications can be done over phone and email conversations, she says, followed by visits to the home to assess situations first-hand. “Our goal is to keep you safe in your home,” she says, “for as long as you want to be there.” 

    General Home Safety Checklist

    In addition to assessing your loved ones’ home for livability, caregivers should review the household for overall safety—especially if a parent lives alone. Take at least one day each year to perform a thorough safety check.

    Consider the following list of questions:

    • Are people safe walking in and out of the house?
    • Are there loose throw rugs that may be tripping hazards and should be removed?
    • Are telephones within easy reach on each level of the house?
    • Are emergency telephone numbers kept in convenient locations?
    • Are smoke and carbon monoxide detectors tested every six months?
    • Is there a fire extinguisher on every level of the house?
    • Are portable heaters and other fire sources located away from flammable objects?
    • Are flashlights working and within easy reach?
    • Are assistive devices (such as eyeglasses, canes, walkers) within easy reach?
    • Are medications within easy reach and up to date?
    • Are all areas of the home well maintained and uncluttered?
    • Is a first-aid kit within easy reach?
    • Is an emergency medical alert device or Personal Emergency Response System (PERS) within easy reach?
    • Can people easily reach everything in the kitchen?
    • Does the house have enough electrical service capacity and overload protection?
    • Are people’s favorite spots (such as a TV armchair) comfortable and safe?
    • Is there someone who can come to help at a moment’s notice?

    Aging Life Care Association (www.caremanager.org) offers experts who can help families assess a home for livability and determine what kinds of modifications are needed to successfully age in place. The website maintains a list of licensed professionals, searchable by ZIP code or city.

    For a comprehensive list of livability criteria, including more specific elements of universal design check out AARP Livable Communities (www.aarp.org/livable-communities).  Go to the Livable Communities website, click Tools Tool Kits & Resources, then Home Fit Guide, to find a downloadable guide that includes extensive room-by-room checklists and other home-modification topics.

    DECLUTTERING AN OLD HOMESTEAD

    If your parents have been living in a single-family suburban home for many years, there’s a good chance that they’ve accumulated a ton of stuff along the way. A cluttered house can present safety hazards for older residents, increasing the risk of falls, as well as several other negative effects.

    Living with disarray can create elevated levels of stress in the family, notes Diana Zagariello, co-owner of Caring Transitions of Long Island, which specializes in relocation services, including decluttering, downsizing and estate sales. Clutter can also lead to health issues like dust and mold, she adds, and an unclean and unpleasant living space that attracts household pests.

    Ultimately, procrastination could burden family caregivers with the monumental task of getting rid of a decades-worth of household things when their parents move to smaller residence, a retirement or adult care community—or pass away.

    Zagariello offers a helpful “right-sizing exercise” for families looking to declutter:

    • Start with a small space.
    • Take a manageable time frame for the work.
    • Try to make non-emotional decisions.
    • Stick to the project; get rid of distractions.
    • Take before/after pictures.
    • Take time to cool down and enjoy the space.

     When devising a strategy to declutter my mom’s house—which included lots of memorabilia, toys, books, papers, and belongings left behind by my brothers and me— started small, as Zagariello suggested, one room at a time. When evaluating items, we used a strategy recommended by many professional organizers, dividing things into three buckets:

    1.) things to sell or donate to charity

    2.) things to throw away or recycle

    3.) things to keep and eventually distribute among the four sons and other members of the family

    “You don’t need to be a minimalist,” Zagariello says,  “just pare down.”

    Besides Caring Transitions of Long Island (www.caringtransitionsli.com), there are a  number of regional firms that specialize in organizing, decluttering and clearing out homes, including Full of Surprizes Estate and Tag Sales (www.fullofsurprizes.com), Quality Cleanouts (www.qualitycleanoutsny.com), and The Organized Guy, (www.findmyorganizer.com, to name a few.

    Here are some more resources about how to declutter your life

    DECLUTTERING RESOURCES

    THE DANGER OF FALLS
    AND HOW YOU CAN PREVENT THEM

    Every year, millions of older people—in fact, more than one out of four adults age 65 and older—suffer from a fall. And you or your loved ones may have been one of them.

    Such incidents can be devastating, resulting in broken bones or head injuries that require hospitalization. They can also make a person vulnerable to isolation, and ultimately leave them unable to continue living independently.

    But families can significantly lower the chances of falling by paying attention to two broad risk factors:

    • The overall health of your loved ones, especially conditions may contribute to their risk of falling
    • The physical design and potential hazards in your parents’ home present risks to falls, slipping or tripping

    Fall-prevention is a team effort.  Family caregivers should confer with their parents, appropriate health and geriatric professionals, and home design aging-in-place experts. Enlist their help. And consider broadening your team with an extra layer of support, in case one of your parents do fall: Hire a Personal Emergency Response System (PERS) provider who can link your loved ones to professional responders as well as family members in case of an emergency.

    Fall-prevention action plans should include several elements:

    • Consulting with health professionals about a risk assessment for falls
    • Making sure the home environment is supportive and free of hazards
    • Reviewing the care recipient’s medications periodically and making sure vision and hearing checks are conducted annually
    • Engaging older loved ones in a physical activity program with balance, strength training and flexibility components

    Assessing Your Loved Ones’ Physical Condition

    First, your loved ones should have a realistic assessment of how various health issues could potentially affect their vulnerability to falls. Parents, accompanied by their adult children, should consult health-care professionals to check their overall health, eyesight, hearing, gait and medications.

    • Make sure your parents visit their primary doctor regularly.
    • Find out if they are experiencing any problems managing their own health.
    • Notice if they’re holding onto walls or someone else when walking or if they appear to have difficulty walking or arising from a chair.
    • Pay attention to any muscle weakness, especially in their legs, and joint problems, stiffness in their knees and hips. Pain in their legs can affect their stability or gait, but pain anywhere puts them at risk of falling because it can cause distractions, taking focus away from things that might be tripping hazards.
    • Make sure they tell the doctor if they’ve fallen, even if they weren’t hurt.
    • Check your loved one’s vision and hearing annually. 
    • Caution your loved ones about using tint-changing lenses, which can be hazardous when going from bright sun into darkened buildings.
    • Bifocals can be problematic on stairs, so it’s important to be cautious.
    • Note that with hearing impairment, a person becomes less aware of their environment, sometimes making it harder to determine where the body is in relation to surrounding objects.
    • Ask your parents’ doctor or pharmacist to review their medications.
    • Identify medicines, both prescription and over the counter, that may cause side effects such as dizziness, drowsiness or dehydration, leading to falls.
    • Ask about combinations of medications that might have side effects that could affect a person’s balance or coordination. Medications for high blood pressure can cause dehydration, which can make you dizzy or less alert. Some, like antidepressants, can cause drowsiness.
    • See a podiatrist for regular foot and shoe exams.
    • Even minor foot problems, like calluses or overgrown toenails can throw off one’s gait without knowing it. And even slight alterations in gait can make you susceptible to falls.
    • Make sure your loved ones wear shoes that provide good support, with non-slip soles.
    • If your parents’ walking is sometimes unsteady, suggest an assistive device, like a cane or walker. But also consult a physical therapist, since poorly fitted aids can increase fall risk.
    • Be mindful of how much alcohol your parents drink. Even small amounts can affect balance and reflexes.
    • Remind your loved ones to get up slowly after eating, sitting, or lying down. Low blood pressure can cause dizziness at these times.
    • Make sure that your loved ones drink lots of water, as dehydration is a major issue in a person’s later years and impacts overall health.
    • Encourage your parents to establish a regular exercise routine. For much more about exercise and fitness, see “A Short Guide to Healthy Living for Your Older Loved Ones (And You,Too”).
      Consider obtaining a Personal Emergency Response System (PERS), an alert service, designed to enable your loved ones to call for help in case of a fall or medical emergency. For more information, see "Obtaining Durable Medical Equipment".

    Fall-Prevention Programs

    Over the last few years, many local fall-prevention programs for older adults have been offered, often free, at health care facilities, in collaboration with senior centers, public libraries, fitness clubs or other community organizations. Stepping On, a well-known, 7-week fall-prevention program for seniors, which originated in Australia, has been presented in various locations in Nassau and Suffolk Counties. Here is a sampling of resources that may offer fall-prevention programs:

    • The Stony Brook Trauma Center offers virtual classes, “Tai Chi for Arthritis and Fall Prevention,” a twice-weekly program for eight weeks. For information, visit https://trauma.stonybrookmedicine.edu/ and click Injury Prevention.
    • NYU Winthrop Hospital has offered many fall-prevention programs, such as Tai Chi, for older adults, as well as partnering with organizations that provide services aimed at keeping people injury-free. For information about current programs, call 1-866-WINTHROP.
    • The Suffolk County Department of Health Service’s Division of Preventive Medicine has offered a Falls Prevention Program, including a “Staying Independent for Life” workshop, and “Tai Chi for Arthritis and Fall Prevention.”  For current status of these programs, visit: https://www.suffolkcountyny.gov/Departments/Health-Services/Preventive-Medicine
    • Northwell Health’s Trauma Center has offered Stepping On workshops at multiple facilities and Tai Chi for Arthritis fall prevention programs. For information, visit https://www.northwell.edu/doctors-and-care/locations/trauma-institute then scroll down to  “Adult and Elderly Programs.” For information about current programs call  516-562-1579 or 718-226-4800.

    Here are additional resources about fall-prevention

    FALL-PREVENTION RESOURCES

    If Your Loved Ones (Or You) Do Fall…

    There are ways to hit the ground as safely as possible to avoid injuries,  Here are a few general tips from articles in AARP publications, citing the expertise of several professional stunt performers:

    1. Stay loose and bent. If you sense you’re falling, don’t panic and become rigid. Bend your elbows and have some give to your arms to soften the impact.

    2. Protect your head. Falling forward, turn your face to the side. If you’re backward, tuck your chin to your chest so your head doesn’t hit the ground first.

    3. Try to land on the meaty parts of your body. These would be the muscles in your butt, back or thighs. Keep your knees and elbows bent; that way, you’ll be less likely to crack your elbows, knees or tailbone.

    4. Keep falling. Your instinct will be to stop as soon as you can, but don’t. It’s safest to keep rolling—the more you give into a fall, the safer it will be. Spread the impact across a larger part of your body.

    And when you get up…

    1. Don’t try to get up too quickly. Doing so could make an injury worse.

    2. Don’t try to stand up on your own. Look for a piece of furniture, like a sturdy chair, or the bottom of a staircase.

    3. Roll over onto your side. Turn your head in the direction you’re trying to roll, followed by your shoulders, arms, hips and finally your leg.

    4. Push your upper body up. Lift your head; pause for a few moments to steady yourself.

    5. Slowly get up on your hands and knees. Crawl to the chair.

    6. Place your hands on the seat of the chair. Then slide one foot forward so it’s flat on the floor.

    7. Keep the other leg bent, knee on the floor. From this position rise slowly and turn your body to sit in the chair.

    8. Sit for a few minutes before you try to do anything else.

    Making the Home Fall-Resistant

    In my own family, my brothers and I dealt with several instances of Mom falling while she was still living alone. The first time, she was walking outside alone and fell on the lawn. She was found by a neighbor, but that ended her habit of walking outside, at least without company. The second time, years later, she slipped and fell in the living room, again while alone. Her living room and dining room and hallways were carpeted with fine Persian rugs with little padding underneath. They were potential tripping hazards. We rolled up those carpets and replaced them with inexpensive wall-to-wall carpeting with the thickest padding possible.

    We also installed grip bars in all the bathrooms, night lights in many places, removed the bathroom door in her bedroom to improve her access and added a toilet top seat so she didn’t have as far to crouch while sitting. And outside the house, we replaced the original brick stairway to the main entrance, adding handrails and using bluestone slabs that minimized the number of steps up from the driveway.

    If family members need to make some design modifications in their home, there are several useful resources—including local government programs—that can help make such changes.

    Here is a checklist for evaluating the safety of your home environment:

    FALL PREVENTION CHECKLIST

    TRANSPORTATION RESOURCES
    FOR INDEPENDENT SENIORS

    One of the biggest challenges for seniors as they age in place is finding adequate transportation in suburban communities like Long Island, especially when they no longer feel comfortable driving in heavy traffic or at night. The inability to get around not only makes it difficult to carry out daily chores, but it also creates a significant barrier to maintaining regular social connections—and a healthy sense of independence.

    There are several ways to help loved ones find rides or make use of public transportation, but check for service changes before setting out, because the pandemic and budget pressures have caused much disruption in regional train and bus services. For seniors and people with disabilities who are unable to use fixed-route, accessible public transportation, there are other “paratransit” options (See “Special Needs Transportation” )

    Other possibilities: private transportation services like Uber and Lyft are now available in many parts of our local area.

    Long Island Rail Road

    516-822-5477

    www.mta.info/lirr

    The LIRR provides extensive east-west transportation, including 124 stations. Individuals age 65 and over may ride for half-fare at any time, except during morning rush hour (6 am - 10 am weekdays). Individuals age 65 and older and people with qualifying disabilities are entitled to a discounted fare. The reduced fare is half of the one-way peak fare and can be used for single-ticket purchases at all times except certain morning peak periods. An application form listing the qualifying disabilities is available on the website.


    Bus Transportation

    Nassau County

    The Nassau Inter-County Express (NICE)  www.nicebus.com

    516-336-6600

    The NICE system provides dozens of routes across the county. Recently, NICE has been expanding a pilot program in which buses arrive at regular intervals, rather than at a set time, to improve the travel experience for riders. Individuals age 65 and older and people with disabilities are entitled to a discounted fare. Buses have lifts or ramps for wheelchairs.

    Glen Cove: Glen Cove Bus Loop circles Glen Cove during the day (9 a.m.-3 p.m.) at more than a dozen locations (https://agefriendlyglencove.com/transportation/; 516-676-4402).

    Long Beach: Residents age 60 and over may ride the local buses at half fare during non-rush hours and all day on weekends (516-431-4445).

    Suffolk County

    Suffolk County Transit  www.sct-bus.org

    631-852-5200

    The transit system offers north-south and east-west fixed routes in each of the 10 towns. Buses have lifts or ramps for wheelchairs as well as audible and visible announcements. There are reduced one-way fares for seniors age 60 and older and disabled individuals.

    PROGRAMS THAT SUPPORT AGING AT HOME

    There are several local programs and services that can help some seniors age independently at home and continue to be engaged in their community. One is a Naturally Occurring Retirement Community, known as a NORC, where a group of senior residents in a certain community can receive a broad range of social and health services provided by a network of public and private entities. There are four NORCs on Long Island, two in Nassau County and two in Suffolk.

    Another program is HomeShare, a program of the Family Service League, which helps older residents in Suffolk County remain in their homes by matching them with young, responsible adults who can share some household tasks and costs.

    NORCs:
    Naturally Occurring Retirement Communities

    A Naturally Occurring Retirement Community, or NORC, is a community not originally designed for older adults, but one that evolved into a place where a large percentage of older adults currently reside. In New York, specific communities can apply to the state Office for the Aging to receive official designation as a NORC, thus becoming eligible for programs that provide supplemental funding for medical and social services, recreation and education activities, and financial services.  There are two basic kinds of NORCs: 1) a multi-unit housing development or complex; and 2) a defined geographic area, often older residents in single-family homes, known as a Neighborhood NORC (NNORC).

    NORC programs are often partnerships of housing, neighborhood organizations, residents, health and social service providers, and other community stakeholders. Each NORC program is tailored to the needs of its own community and has its own unique combination of services.

    You can find out more about NORC programs across New York State, including eligibility, regulations and standards, visit https://aging.ny.gov, click Programs and Services, then look for Additional Housing Programs.

    Here is a current listing of NORCs on Long Island:

    NASSAU COUNTY

    Plainview Assisting Community Elders (PACE)

    Plainview-Old Bethpage Cares

    Mid-Island Y Jewish Community Center

    516-822-3535

    www.miyjcc.org

    POB Cares and Project PACE are programs of the Mid-Island Y JCC in partnership with Northwell Health, the Jewish Association Services for the Aged (JASA), the Town of Oyster Bay and other community organizations and partners.

    Project Independence (Town of North Hempstead)

    516-869-6311

    http://www.northhempsteadny.gov/pi-home

    A program of the town’s Department of Services for the Aging, Project Independence brings together a wide array of community partners, including health care providers, human service agencies, social, educational, and recreational programs, and local businesses. The Town has gradually expanded PI programs and services across six regions, establishing community-center type locations in New Hyde Park, Roslyn, Great Neck, Mineola/Williston Park, Westbury/Carle Place, and Port Washington.

    SUFFOLK COUNTY

    Hands on Huntington (HOH)

    631-351-6610

    www.huntingtonny.gov (Click Services, then Seniors, then Programs & Services)

    Hands on Huntington provides social and health services, information and referral, and educational and recreation programs to seniors in parts of Greenlawn, East Northport and Huntington. HoH is supported by the Town of Huntington, and The Suffolk Y JCC.

    LI Sound Senior Connections

    631-333-2837

    www.fsl-li.org

    The Family Service League, in partnership with the Town of Southold and Stony Brook Eastern Long Island Hospital, offers case management, health care coordination, opportunities for socialization, volunteerism, and educational programs to residents of Greenport over age 60. 

    HomeShare (Suffolk County)

    Family Service League

    631-650-1461

    www.fsl-li.org

    Through the Family Service League’s Home Share program Suffolk County homeowners, age 55 and older, are carefully matched with home seekers, 18-plus years of age, to share a single-family home. HomeShare rents are well below market rate and may be further reduced if the homeowner requires assistance with errands and/or a variety of tasks around the home. Companionship and a sense of security are just a few of the many benefits of home-sharing. HomeShare is primarily funded by the Towns of Babylon, Islip, and Huntington.

    AGING IN PLACE—BUT A DIFFERENT PLACE

    Independent Senior Living & Active Adult Communities

    Even if your loved ones are still independent and active, they may decide that a single-family home is no longer the best place for them to continue aging in place. Their “retirementality” may be changing. Perhaps they’re looking for a new lifestyle or simply want to reduce housing expenses. Maybe they’re finding it difficult to keep up with household chores, or don’t want to climb stairs up to their bedroom anymore. Or perhaps their neighborhood is no longer conducive to providing them with the best quality of life (See “The Lifestyle Checklist").

    Whatever their reasons, there are numerous housing options for independent seniors in our region. There are senior living or retirement communities and multi-unit senior rental housing complexes, as well active adult communities targeted to residents age 55 and older. These options offer a simpler lifestyle, with less maintenance and an array of benefits and amenities, such as fitness centers, active social programs,  meals and housekeeping.  But they also can be pricey, targeted for higher-income residents who are downsizing from upscale neighborhoods. If your loved ones are looking for more affordable government-subsidized options, such as Golden Age Housing in the Towns of Hempstead or Oyster Bay, they should think a few years ahead, since many of these complexes have long waiting lists.

    Here are a few online resources to find local options:

    www.55places.com – A website designed to help people find 55+ communities nationwide that meet their needs, with a locator that lists more than 50 active adult communities on Long Island.
     
    www.apartmentfinder.com – A website that lists available apartments nationwide.  Search for Long Island, NY, click Property Types, then Senior Apartments.

    www.bestguide-retirementcommunities.com –A national website that lists luxury retirement communities and senior apartments, as well as affordable and subsidized housing. Search for Long Island.

    www.seniorsresource.realtor - Seniors Real Estate Specialists are designated by the National Association of Realtors as agents who have demonstrated expertise in counseling home buyers ages 50-plus through major financial and lifestyle transitions. SRES professionals on Long Island can be located through the SRES website. Scroll down to “Find an SRES” and search by city or ZIP Code.

    Continue to Chapter lll: LIVING AT HOME WITH SOME ASSISTANCE