You’ve made the decision to down size and move to your senior apartment or retirement community. The estate sale is complete, furniture moved in and your name is on the door. Now is the time to create a plan that will keep you in that apartment for a very long time: A plan that allows you to maintain your independence and remain safe. We’re going to refer to this as “Aging with Autonomy” versus “Aging in Place”, which emphasizes living long term in one’s home of ownership. Your new apartment is your home now and you can live in it for a long time but you must be assertive about prevention. I like to refer to this as preventative planning in late life. If the goal is to maintain autonomy in late life, you must become pro-active about aging with autonomy.
What is autonomy? Autonomy is the state or condition of having freedom to determine one’s own actions or behaviors. In a senior community, we frame this as your right to make health care decisions for yourself, your right to have free choice with your routine and personal preferences. When this view of autonomy with its emphasis on independence, self-determination and freedom runs up against the rules of a senior living community, it can create a challenge to maintaining your autonomy.
Education + Preventative Planning = Autonomy
Barriers to Autonomy
Functional Decline: ability to perform activities of daily living can create a dependency on caregivers and family. Safety becomes a factor and can be a pre-curser to a fall or other health crisis.
Cognitive Decline: confusion and difficulty with executive functioning puts an older adult at risk of medication errors, being taken advantage of financially or losing the ability to drive.
Loss and Grief: the consistent loss that is experienced by many older adults such as loss of a spouse, friends or other loved ones puts them at an increased risk of isolation and depression.
Facility Culture: some retirement communities take the issue of autonomy more seriously than others. Rules and regulations can create a “fall in line” mentality that chips away at an older adult’s self-esteem and ability to make choices.
These barriers to autonomy, while overwhelming, can be conquered with preventative planning. Not all aging resources are the same: individuals and communities are all different. However, there are starting points that you or your aging parent can educate yourself about. Become familiar with identifying the above barriers and educate yourself regarding community resources. Community resources that you need to know about before you need them: before your autonomy is as risk.
Overcoming Barriers to Autonomy
Functional Decline: if you notice that you or your aging parent are having a difficult time walking, getting in or out of a chair or (God forbid) have already fallen, you need to see a physical therapist immediately. The best place to start with this is your physician, as he or she will need to write an order. This type of therapy can be done on an out-patient basis and should be covered under your Medicare B. Some Medicare B therapist will come to your home; others will have an office that you will need to go to. Your retirement community may have this service available so be sure to ask them first. You need to get to the bottom of why falls, dizziness or poor balance are occurring and a physical therapist should be able to help with this.
Cognitive Decline: If you notice that you or your aging parent are getting medications confused, missing appointments or calling people in the middle of the night asking bazar questions, you need to have them screened for cognitive impairment. This type of screening and testing varies greatly from community to community but the best place to start is with your physician. If it becomes clear that you are dealing with some form of dementia, I want you to ask to see an occupational therapist. An occupational therapist can do additional screening but what they do that the doctor cannot do is translate that information to your activities of daily living and help you strategize ways to maintain your independence. Same as with the physical therapist this service can be covered under your Medicare B, sessions can be conducted in your home or at an office. Start by talking to your retirement community.
Loss and Grief: if you or your aging parent have experienced significant losses and don’t seem to be coping well: isolation, irritation or low motivation, I want you to seek counseling. You start by talking to your physician and communicate the symptoms. The doctor may prescribe an antidepressant but where the real growth and processing can take place is with a good counselor. Although the specifications have changed lately, you may be able to have this covered under Medicare B short term. This is probably the most lacking of services available to you so you may have to play detective to find the right therapist but don’t give up. The ability to maintain a positive outlook and cope with loss can critical in maintaining autonomy.
Facility Culture: your facility may have a lot of rules that don’t make sense to you. These rules may even cause you anxiety and leave you feeling like you have no control over your life. Communicate with the administration, get involved with a resident committee, make as many choices as you can and don’t automatically take no for an answer. Talk to a counselor or find a local geriatric care manager to advocate for you. Tape the serenity prayer to the mirror in your bathroom it can come in handy.
By assessing the above barriers and creating your preventative plan, you can maximize your chances of living in your apartment for some time. It’s critical that you are pro-active, communicate your wishes and reach out for the help you need. I can’t emphasize enough the need to plan ahead because once the barriers start mounting up, without a plan; you lose your choices and autonomy. You may even be forced to re-locate to a less than desirable location…
I hope this information helps in some small way and always remember…. When in doubt, turn to your local area agency on aging. Every county has one!
You can also feel free to contact me at (970) 223-5656, firstname.lastname@example.org or leave a comment on this blog..
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