Aging In Place is the new term that describes how one can live safely at home, while being independent, and comfortable regardless of age, income, or ability level. Americans today can look forward to living longer, for a variety of reasons: healthier living conditions and improved medical treatments are two that first come to mind. Yet, as longer life spans become more common, it’s reasonable to worry about a loss of personal independence. It’s normal to fear becoming dependent on others due to memory loss, frailty, or poor health. The ability to remain independent as we grow older is a valued goal; it allows us not only to retain our dignity but to have more control over living expenses and medical costs as well.
In the early 1900s life expectancy in the United States was 48 years of age for males and 51 years for females. Today, life expectancy is 75 years of age for males and 80 years for females. As our population ages, the number of older adults will continue to rise. And to be perfectly honest, American society is completely unprepared for the impending boom in seniors.
For this reason, it’s not unexpected that current research in aging is focusing on positive aging rather than the “problems of aging”; this in itself is a positive change. There is essential personal value in being able to choose an independent life style and age in place.
Aging in place is a relatively new concept, and today’s seniors are the pioneers. In the course of creating a new blueprint for aging well, today’s seniors must often adapt to new routines and tasks with limited financial resources and/or increased physical limitations. They must also become skilled at new technologies. How many times have you been told, “Oh, just go on the Internet and find the answer”?
Aging in place also means living wisely. There are many creative ways in which this can be done. Yes, there are many seniors who might require access ramps and handrails, but there are just as many who could simply use a few new ideas. Numerous studies have been conducted to document the need for home modifications in the senior population; however, these reports are often complex, detailed, and difficult to locate. For example, the Americans with Disability Act (ADA) of 1990 addresses handicapped access to public buildings (e.g., government buildings, shopping malls, and multifamily dwellings) but there are no ADA requirements for handicapped access or modifications for the private home. In the area of private home modification the individual homeowner must rely on his or her own resources.
Home modifications such as handrail installations and grab bar placement are often left to the suggestions of the licensed contractor, who may or may not be experienced in working with seniors. For example, the appropriate configuration, placement, and location of a grab bar or handrail for one individual may be completely unacceptable and unusable for another—people are not the same shape and size, and they do not age with the same capabilities and strengths.
What you need to know about grab bars but are never told
Grab bars are considered to be one of the simpler home modifications. For anyone needing help getting up from the toilet, in and out of the tub, or even just from one area to another within the bathroom, grab bars provide the necessary extra leverage, balance, and support. Grab bars can be installed in almost any space and almost any direction, depending on what works best. Today’s grab bars come in a wide variety of materials, with colors and finishes to match any bathroom décor. Gone are the days of the stark stainless steel grab bar installations.
A grab bar is defined as a device that can be both pulled and pushed against with enough force to support the weight of a 250-pound person until help arrives or the person can right himself or herself. A heavy-duty towel rack is not an appropriate substitute for a grab bar as both shear force (the perpendicular force towards the wall) and withdrawal strength (the perpendicular force away from the wall) differ from tensile strength (the strength of the towel rack or grab bar itself). Consider the following when considering or planning a grab bar installation:
Will the grab bar be used by more than one individual? The location and positioning of grab bars should be unique to each user to ensure safe accessibility. (Normally a grab bar is set too high to double as a towel rack.)
Does the end user have poor vision? Grab bars come in a wide array of colors and compositions—there is no reason that they cannot be both useful and aesthetically pleasing.
Does the end user participate in some form of regular exercise? It is not uncommon for individuals who exercise regularly to feel a bit overconfident about their physical condition and thus not feel they “need” grab bar assistance.
Will the grab bar be used by a smaller-framed individual? The grips and textures of grab bars can vary greatly to accommodate such differences.
Who will be doing the installation? Yes, it’s always nice when a neighbor or relative volunteers to help out, but proper grab bar installations are not easy. They are serious business! It’s recommended that a licensed contractor be used to ensure a safe installation.
What is the backing within the wall to which the grab bar will be secured? Grab bars must be adequately and properly secured to the interior wall studs.
What is the surface onto which the grab bar is being installed? It can vary from painted drywall to fiberglass or tile. Each of these surfaces has its unique needs and requirements for a safe installation.
How will water intrusion be addressed and prevented?
What could be as hazardous to your health as not having grab bars installed?
It’s something most homeowners don’t think about—water intrusion resulting in mold growth. Improperly installed grab bars can not only break away from the wall, they can also lead to structural damage. Often unseen, mold can cause damage to the structural integrity of a home as well as to the health of an older adult.
Make sure the installation screws and the escutcheon plates are properly sealed by using an appropriate water-repellant product at all points of penetration. Failing to seal the areas properly could allow water to seep into the wall cavity, resulting in notable and costly damage. Allowing even the smallest amount of water into the wall cavity means an opportunity for mold growth, deteriorated framing, or structural damage, not to mention possible failure of the grab bar just when it is needed most.
Ms.Sauceda a gerontologist, has over twenty-five years of real estate development experience in residential housing in the Southern California area. A California-licensed general contractor with the designation of Certified Aging in Place Specialist from the National Association of Home Builders, Ms. Sauceda has provided technical support for various aspects of construction claims and litigation for the past twenty-plus years.
Homecare can provide numerous services in your home. You may consider this service but you want to make sure that the agency is well qualified to care for your loved one. You want to make sure that the service is credible. It is recommended that you have a check list to insure that the service is properly licensed and maintains the appropriate liability coverage.
Senior Home Care Agency Check List
Business license and necessary state licensure (if required by the state where the agency is located)
Caregivers are “Employees” (this means the Agency is responsible for paying all employee payroll taxes, as required by law: Unemployment Insurance tax, Social Security tax, Medicare tax and State and Federal with-holdings)
Worker’s Compensation Insurance
Professional Liability Insurance
Fidelity Bond Insurance (this is sometimes referred to as “theft” insurance)
Active Management of the Caregiver through a direct Supervisor or Manager
Plan of Care Standards
Criminal Background Check performed on all Employees
Training for Caregivers
24-Hour On-Call Service
Satisfactory Survey Results
These check list requirements are especially valuable when seniors are being cared for in their own home and no family members live close enough to monitor the care. By having these standards in place, if the Caregiver suffers an accident while working in the senior’s home, their injuries and care are covered by Worker’s Compensation Insurance. Active supervision of Caregivers allows the agency to professionally work through any performance issues. A 24-hour On-Call service allows for last-minute schedule changes and back-up Caregivers to be scheduled, when necessary. Training programs provide Caregivers with guidelines to follow for performing quality care duties.
In addition, the Caregiver is protected by Unemployment Insurance if they are not staffed between assignments and meet the necessary qualifications. Caregivers also have the guarantee of receiving Medicare and Social Security benefits when they retire because they have paid into these programs as an employee of the agency.
It is important to remember that “Independent Contractors” are not paid as employees and do not provide a senior the insurance protections which a Senior Home Care Agency provide and also do not provide a guarantee the appropriate taxes are being paid.
There are more than 5,000 Senior Home Care Agencies nationwide. Many times the term “Home Health Agency” is used and can be confusing because it may include both Medicare and Medicaid approved Home Care Agencies and Non-medical Senior Home Care Agencies. Non-medical Agencies hire both Companion Caregivers and Certified Nursing Aides, who assist with hands-on care for all Activities of Daily Living. Medicare-approved Home Health Agencies provide intermittent visits by a R.N., Physical Therapist, Occupational Therapist, and Speech Therapist, with pre-approval of these services by a Medical Doctor. These are considered “skilled” care services. Senior Home Care Agencies are referred to as “non-medical” because they are not providing services which would need to be managed by a Medical Doctor.
The Private Duty Home Care Association of America (PDHCA) is a trade association of home care providers and works towards helping Senior Home Care Agencies with all business matters to assist clients to age in place.
The National Association of Health Care Assistants is a non-profit association of Certified Nursing Aides and Health Care Assistants, providing members (anyone who works on the front-line) with experience-based, peer-driven solutions to long-term care.
Caregiver’s Senior Home Care Agency Check List protects both the senior and the Caregiver to insure quality care is provided.
