We Had the ‘What If’ Talk…No, Not That One

How do you plan for those “what if” moments as we age? 

We admit that we’re firm proponents of living in the moment. However, there are some issues we have learned as we age to plan for now, including our estates, health proxies, wills and housing, especially in case we become ill, lose mobility, eyesight, hearing or worse, our memories. 

It’s good to have a detailed road map rather than deal with these issues in a crisis and have someone take charge, who may not know our wishes. 

A few of us, all 70-plus, had a dinner table dialogue recently about this topic. 

Scene: Upstate New York. Dining room in Barbara’s home. We approach “what if” topics gingerly. 

The conversation veers to where we want to live during our declining years. Like mortality, few of us want to think about the end and where to live, even in the later stages of our lives—not now! We still consider ourselves in relatively good shape. We’ve also heard our peers often say, “I feel I’m too young to deal with this right now.” Or, “We’ll just stay in our home and bring in caregivers.” 

But we know situations change and sometimes in a split second. We like to take charge. which is why we ended up talking about the possibilities for the rest of the evening. 

The main question we posed to each other was: What do we want our lives to look like over the next two decades if we’re so lucky to live that long, where will that be, with whom do we see ourselves living, what can we realistically afford and finally, do we stay put, age in place, and make accommodations where we are or make one more move, probably downsizing, as we near the end of our lives? 

Among people aged 50 to 64, 71 percent say they want to age in place. (Source: AARP PPI, "What is Livable? Community Preferences of Older Adults.”) Other studies show that more than 90 percent of seniors want to live the rest of their lives at home. 

But is aging in place realistic and the best path? If you’re living independently in your own home, it’s important to evaluate whether you can perform the six routine activities of daily living--eating, bathing, getting dressed, toileting, mobility and transferring –going from bed to chair and vice versa.

If not, and you want to stay put, can you afford to bring someone in to help or do you have a family member who will step in and live with you? If you age in place, you’ll need to adapt your home so you can live on one level and avoid steps, accommodate wheelchairs, walkers, aides, certain machines,  grab bars, safe flooring—which may mean removal of rugs that could cause you to trip and fall, change knobs on drawers and cabinets to make them easier to grab, turn and open. 

We write in our new book, Not Dead Yet, about agencies that can help with these decisions and how home auditors will help clients analyze what changes to make. Some insurance companies such as Chubb North America offer a personal risk service in which an agent visits an insured client’s home and recommends resources that a homeowner can tap into to stay safe. Aetna Medicare offers a program to help members and caregivers access and supplement benefits through such services as meal delivery or transportation. 

However, it can be lonely and isolating to age in place if you’re a single. At the same time, caregivers are expensive to hire and difficult to find, especially now as the pandemic variants continue. And you have to like the person who spends so much time with you, or it’s better if you do. 

Here are two programs that are designed to help those who want to age in place and have free or low-cost services available if needed. 

Village to Village Network & Naturally Occurring Retirement Communities—SSP (supportive services program) 

There are more than 125 Village communities in the U.S. today with many more getting started. These operate as a mix of paid staff and volunteers who assist older residents with everything from transportation and technology training to home repairs and grocery shopping. They offer social activities, classes and lectures as well. Members pay annual dues. Some encourage members to volunteer.   

A NORC-SSP is a neighborhood subdivision, building or geographic area that has a sizable percentage of residents over age 60, often coordinated by local nonprofits or government agencies. They provide health, social and technology services, classes and lectures that support independent living and aging in place. There are volunteers who help with small household tasks such as changing a light bulb or fixing an appliance. 

And then there’s technology, with new offerings constantly emerging that will help many age in place or live out their years more comfortably if still on their own. There are Smartphone and Smartwatch apps that will lower and raise the heat or air conditioning, turn on the oven, turn off a burner, lock and unlock the doors, lower and raise the shades, monitor a security camera and monitor our hearts, lungs, sleep, steps, calories and even sweat. Robots can vacuum, mop and bring food. There’s now a ring that we put on our finger to measure how regular cardio exercise affects our sleep, or a bracelet to monitor blood pressure. And there are a variety of medical alert devices that can be worn around the neck or on the wrist that will dispatch EMTs. And more smart watches perform these tasks. Design expert and author Lisa M. Cini of Mosaic Design Studio mentions many in her books about aging and technology, including multigenerational living. 

In addition, computer programs now hook up to TV screens that enable an aging person to check in with medical professionals or other professionals and even family in the comfort of their home.

Here are other housing options that offer social interaction, which is key to prolonging one’s life and helping seniors thrive. 

Co-housing involves living with roommates of your choice or in a location of your choice. It’s a variation on the “The Golden Girls” paradigm but often without a funny version of Betty White. This is a social option, and you get to help write the rules. It can be a single-family home, a town house, apartment or condominium. Each resident has their own bedroom and bath and share common facilities such as a dining room. Location is important for many aging folks who want walkability to grocery and drug stores, coffee and wine shops and restaurants. Some may still drive so parking is also important. More co-housing communities focus on a senior rather than multigenerational niche. 

Multigenerational housing consists of two, three or even four generations living together—the way life often was decades ago. Living under one roof eliminates huge caregiving costs and each generation can benefit from the other. The older generations can cook and be a fountain of knowledge about the family history, help kids with homework, maybe fix things and even clean, if able. The younger generations can take care of the older ones—drive them to appointments, read to them, make sure they take their medications and tend to other needs.

 Age restricted or age 55-plus communities are independent living communities for single folks or couples over age 55 who have their own rental, co-op or condo. They share dining and other public spaces as well as activities with the other residents. Some of these communities offer services and activities that the resident pays extra for using such as hair and nail appointments, field trips, day help with an aide if needed, cleaning, deliveries and more. Two or more meals might be included in the cost and often there is a choice of restaurants on the campus where the residents may dine. 

Agrihoods (a blog we wrote in Oct. 2020) represent a riff on the 55-plus community. The term is a portmanteau of agriculture and neighborhood—think paths lined with blueberry bushes and veggie gardens. Agrihoods are sprouting everywhere in this country. They rely on a farm, sometimes professionally managed, as the centerpiece of the design. These new developments also typically are sustainable and include other healthy related features such as a community-supported agriculture cooperative (CSA), farm store, walking trails, fitness center, community garden and acres of preserved conservation land. 

Life care or continuing care retirement community (CCRC) as the name implies offer care for (the rest of one’s) life with a continuum of health assistance—independent living, assisted living and long-term care within the same building or campus. As more care is needed, the resident steps up to the next level that’s still part of the complex where they live, so it presents a relatively easy transition. 

Long-term care aka nursing home is the place most of us aren’t eager to end up in, but it may be unavoidable. Fortunately, long-term care facilities have changed in some cases for the better with good ventilation—post the pandemic, fewer double and more single rooms, private showers and toilets and better healthier food. Some are less institutional looking and more flexible about meal plans and activities. In our book, Not Dead Yet, we talk about The Green House project where seniors who need full-time care live in their own building in a home-like setting with their own bedroom and bathroom and several other “housemates.” There may be several of these buildings on one campus. Residents share a living, dining room and kitchen. Skilled caregivers are on hand 24/7 to provide care, food, dispense medications and more. 

Whatever choice most appeals now, why not visit an example of each and find what may work best down the road. Seeing them while you still have all your faculties and you can make the decision rather than have a grown child, spouse, partner, friend or even legal representative do so is wise. Or a grown child might accompany you to help decide. Ask about the costs and potential extra fees and research what the government may help pay for—and not, what any long-term plan insurance you have might cover and what’s tax deductible. Doing all of this sooner rather than later also makes the choice less dramatic and heart-wrenching. You know better what to expect. 

Each of us needs to realize that these choices require months or even years of decision and preparation. In these cases, it’s prudent to think ahead while still living fully in the moment.