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Reflection on the NJAAW Housing Series

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A guest blog by William Cotrone, NJAAW intern

As the global population continues to grow/age, appropriate housing for older adults is now more important than ever. Most of NJ’s current housing stock was built for young able-bodied adults and nuclear families.

Currently, 30% of homeowners in the US are single and live alone. By 2030, 20% of the US population will be considered “senior citizens,” and most older adults would prefer to live in their own homes for as long as possible. But what if their home is not designed to accommodate them as they age? Fortunately, there are solutions.

Staying in Your Home

Adaptations and renovations can allow people to stay in their homes safely for longer.

For example, AARP has a free HomeFit Guide that explains how to incorporate universal design principles and products into homes, which are safe and easy to use. Most of the elements in the guide can be done without professional assistance

Another option is to hire either an occupational therapist (OT) or physical therapist (PT) who is also a Certified Aging-in-Place Specialist (CAPS). These individuals can make recommendations on how to repurpose your home to reflect your functional, mobility, and cognitive needs so that you can live safely and comfortably.

A CAPS will examine such things as the entry and/or foyer (Is it clutter free? Is there a rug that could cause a person to slip and fall? Is there enough light?). If an individual requires a mobility device such as a walker or wheelchair, are doorways and hallways wide enough to pass? In the kitchen, a CAPS will scrutinize chair height so that sitting and rising are made easier, floor space so that mobility devices can pass, lighting to assist people with visual challenges, etc.

Probably the most important place to have examined is the bathroom, especially since 80% of falls occur here.

Probably the most important place to have examined is the bathroom, especially since 80% of falls occur here. A CAPS can make recommendations on toilet height, grab bars, slip mats or bathroom chairs for the shower area.

For the rest of the house, stairs should be well lit and have handrails. Another option is a chair lift to take older adults up and down. Smart technology devices might also be beneficial for such functions as turning on the lights or a faucet.

For outside the home, thoughtful landscaping or therapy gardens make a great addition. Engaging with nature has an immense list of health benefits, so make an outdoor space age-friendly. Comfortable furniture for the patio area, safe walkways, good lighting and smart technology increase the ability to enjoy outdoors safely.

Getting Help in the Home

Knowing when help is needed and how to find it can be challenging. One option is to hire assistance directly or via an agency. While Home Health Care (HHC) covers skilled support services (including RN/PT/OT) and is usually paid for by Medicare or insurance following a hospital stay or during recovery, older adults may need a lower level of care to assist them with activities of daily living (ADLs). These services, such as toileting, bathing, dressing, eating, moving, and grooming, can be provided by Certified Home Health Aides (CHHAs). However, CHHA services often have very limited insurance coverage, leaving most people to pay out of pocket.

When deciding what type of provider to employ, consider the following: A family member/caregiver who hires privately may save money, but the “employee” might not have the proper skill set or be insured. Engaging an agency is more expensive. However, such added benefits as knowing that the agency has supervision, specific hiring requirements, insurance, licensed staff, and compliance policies, are often worth the extra cost.

Another option is Adult Day Care. These programs provide care and companionship for older adults who need assistance or supervision during the day. This provides caregivers with a much-needed break and allows them to go to work, school, do housekeeping, etc. Research has shown that social interaction in a Day Care setting improves an older adult’s mental, physical and emotional health as well as reduces the risk of developing depression and dementia.

Finally, for people who need more help or are near nursing-level care, PACE (Program of All-inclusive Care for the Elderly) programs allow people to remain at home. While limited geographically, the number of PACE programs in NJ is increasing. More information can be found here.

Residential Options

When staying in one’s home is no longer possible, what are the options to choose from and how does one assess them?

First, independent living is an option for older adults who do not have severe physical or cognitive challenges. An independent living environment usually includes age-friendly features like grab bars, walk-in showers, emergency response services, community dining, age-appropriate entertainment, transportation services, etc. They are relatively affordable at market prices and many are designated as “affordable housing.” If needed, home care, paid by the resident, can be arranged.

The next option is assisted living. Residents of an assisted living community tend to have physical or cognitive challenges but are still able to retain some autonomy. Assisted living units are often smaller than independent living settings because they lack some of the customary rooms of a typical house, like a kitchen. Staff can help residents with ADLs and medication management.

The third option is a long-term care (LTC) facility or a traditional “nursing home,” which provides shelter and around-the-clock care for people with ADL and health difficulties. Reasons for seeking LTC might include that a person suffered a severe injury or medical emergency and needs rehabilitation to return home, or their physical/mental state is diminishing, which could make them susceptible to injuries or illnesses. Long-term care facilities can also provide hospice care and many offer memory units.

Pulling these options together is the “Life Plan Model,” also known as a Continuing Care Retirement Community (CCRC). Residents can transition their living situation and care level without having to transfer out of the facility. For example, a typical transition might be going from independent living to assisted living or independent living to rehabilitation. This may be the appropriate option for couples where one needs care services and the other doesn’t.

For all of the options in getting help in the home, or relocating to an age-focused place, it is important to plan ahead.

For all of the options in getting help in the home, or relocating to an age-focused place, it is important to plan ahead. Unless related to a hospital stay, Medicare does not pay for home care or long-term care. If someone qualifies for Medicaid or affordable housing, eligibility should be established as early as possible. Long-term care insurance or private insurance may cover some costs, but most people will be paying out of pocket.

Aging is like the weather. You can plan for it, and anticipate what will happen, but you won’t know until it actually happens. Like the weather, aging and finances can change unexpectedly. Older adults deserve to live with dignity and comfort. They deserve affordable, appropriate and accessible housing and must plan ahead and know their options.

Click here for a summary of NJAAW’s Housing Series and links to the four recorded sessions.

William Cotrone recently graduated from Bates College with a degree in psychology and is and future medical student (hopefully in a field related to aging). He previously interned at senior residential sites in Lewiston, ME.

Sanctuary

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This post was written by author and clinical psychologist Mary Flett, PhD, amid the California fires in October 2020. It is reprinted, with permission, from “Valuing Ourselves as We Get Older,” the first in Dr. Flett’s new three-book “Aging with Finesse” series. Dr. Flett, who worked extensively with aging adults, is the featured guest on the 125th Episode of Aging Insights TV.

I ran away this week. Fled. Gave up the ghost. Abandoned my post. It all finally became too much and so I fled to a place that wasn’t in the pathway of raging fires, appeared to have taken appropriate precautions for COVID and held happy memories of better times for me. I returned home, somewhat chastened, definitely improved in mental state and capacity to face what is a continuing challenge, but also keenly aware of how much I need sanctuary.

I was intimately familiar with the location I chose to flee to. My husband and I had spent untold hours driving around this area, exploring the back roads, dead ends, as well as shopping, dining, and getting to know the locals. Even contemplating it as a place where we would retire. It is incredibly beautiful, has a delightful small-town ethos, not just because it actually is a small town, but also because it has all the big-city amenities that we had come to expect.

But this time it was different. And different in that slightly off-kilter way when the audio is off from the video. The places I remembered were still there, but with new names, and restrictions, because of COVID. Some of our favorite hidden by-ways still remained but were now filled with new buildings and without the quaint, small-town feel. There was an edge to the exchanges with masked store clerks and customer service folks. Lines were long and shelves were thinly stocked.

Maybe it was my mood or maybe it was a combination of the weather, which was overcast but cool, but I could not find what I longed for – that feeling of relief and letting go that comes from being in a familiar, welcoming place.

I stayed in a perfectly lovely hotel, now barricaded with plexiglass because of COVID, but reassuringly hermetically sealed from the room entry to the prophylactic covering on the remote. Still, I felt like a caged animal.

I stayed in a perfectly lovely hotel, now barricaded with plexiglass because of COVID, but reassuringly hermetically sealed from the room entry to the prophylactic covering on the remote. Still, I felt like a caged animal.

I planned on staying for four days, assuring myself that in that time the danger from fire at home would have decreased, and I would have enjoyed a brief vacation. But circumstances conspired to cut the time short. So I returned home.

Not much had changed at home. The fires continued to burn, the air continued to be unbreathable, and there were still bills to be paid, calls to be returned, and appointments to be kept. But I had changed. This is what is so fascinating to me.

I realized that my home is my sanctuary, and in no small part because of the miscellaneous unconscious items that I take for granted.

It was as if I had hit the “re-set” button. I realized that my home is my sanctuary, and in no small part because of the miscellaneous unconscious items that I take for granted. My shower head is adjusted to the way I like it. I know just how long it will take for the water to get hot. My coffee set-up is organized and the muscle memory to get that brew done requires only that I remember to boil the water. My favorite channels are easily accessed on my TV and radio. My bed has my sheets and pillows and my chair is molded to fit my body. The pictures on the walls, always just slightly askew, soothe my soul and bring happy memories to mind.

This level of familiarity is vacated when I am in a new place. And while the novelty of a different shower, coffee set up, working the TV and adjusting to pillows and chairs is an effective way of stimulating my aging brain, when I am depleted emotionally and psychologically, and when I am at my core threatened with extinction, that novelty drops to the bottom of the list and I am left even more fatigued.

I have seen this emptiness in the eyes of people whose homes have been incinerated in the fires. I have seen this surrender in the drooping shoulders of people who have stood in long lines only to be told the forms they need to fill out to start their lives over are located in another line, even longer. I have seen this in the shuffling strides of those who are homeless and now without work or purpose.

Where can I go when home is no longer safe?  I am not the first to ask this question. Whether it be women who are physically and economically tied to partners who make their lives unsafe or whether it is the increasing numbers of people who are becoming climate refugees, where do we go when our homes are no longer there?

Seeking sanctuary

In my reviewing these last few days, I came to the conclusion that I was seeking sanctuary. I was seeking a place of refuge, a place where I would find peace and tranquility. An experience where I would feel connection and belonging. For me, this can be found in nature or in the company of others. What truly brought me “home,” was not just returning to my house, but lingering in conversation with friends who reached out to see if I was OK.

I find myself wondering whether my time here in California is spent. I have lived here for 41 years – the longest I have lived in any one state. While I can go through a checklist of places that have lower environmental risk and are possibly more economically advantageous as I approach retirement, I now realize that what is essential is that I am able to connect with and build community. And that is a daunting prospect in these current times.

I understand better why some people stay behind to protect their property. I have more compassion for those who return and put themselves in what are irrationally unsafe environments. It is hard to leave a place that brings such comfort from the unknown. What all this has taught me is that I am going to have to leave sometime. It will either be by my own choice or because I am forced to leave. The challenge is knowing when to exercise my options.

Mary L. Flett, PhD, is an author, clinical psychologist and nationally recognized speaker on aging. She has just published “Aging with Finesse,” a three-book series of short essays exploring valuing ourselves as elders, connecting with others, and acquiring essential skills for aging well
and aging better. She is the Executive Director of the Center for Aging and Values and is launching Five Pillars of Aging, where she will be offering online seminars on aging.

Home is where the heart is

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by NJAAW Executive Director Cathy Rowe, DrPH

I recently had a discussion with one of my oldest and best friends. Both of her parents, who no longer drive, are facing physical challenges as they age in their bi-level home in the suburbs.

My friend and her siblings help with doctors’ appointments, meals and whatever else possible, while working, raising their kids and doing the things we all need to do.

When I suggested that my friend look into getting help, she immediately replied, “I am not sending my parents to a nursing home!”

This was the inspiration for NJAAW’s Housing Series webinars in February.

I will leave my friend’s name out, just in case she is reading this blog, but I think her reaction is one that many people have because they are not aware of the range of housing options for older adults.

There isn’t one large leap from living independently in one’s home to needing assisted living — there are numerous steps and choices.

There isn’t one large leap from living independently in one’s home to needing assisted living – there are numerous steps and choices.

Housing needs are not clear-cut nor consistent. There are a continuum of needs, finances, preferences and opportunities.

Housing is likely the biggest investment most of us will ever make — our home becomes a place we can call our sanctuary, and build memories. As such, the “where” and “how” we live are among the most important decisions we make. And these decisions cannot — or should not — be made suddenly or in a moment of crisis.

According to statistics, more than 23% of NJ’s total population is over 60 — and by the year 2030, all Baby Boomers will be of retirement age. Additionally, studies show that the majority of adults 50+ wish to remain in their homes and/or communities as long as possible, with a sense of independence and connection.

We need to spend time educating ourselves about available options, planning in advance for adapting our current home, exploring our next home and preparing for change.

We need to spend time educating ourselves about available options, planning in advance for adapting our current home, exploring our next home and preparing for change.

For all of these reasons, we are hosting the NJAAW Housing Series, bringing together experts in the realm of NJ housing to explore options at each stage and need, to help you make informed decisions for yourself or for the older adults in your life.

The series takes place online on consecutive Wednesdays in February at 4 p.m.

Speakers will explain strategies to help you stay in your homes with modifications and built design. They will also discuss options for getting help in the home, downsizing and when assisted and supportive living becomes necessary.

You’ll find more information at njaaw.org/events. Please register once for Zoom links to all four sessions Those who register will also have on-demand access to session recordings.

Special thanks to our sponsors for letting us provide this series at no cost to NJ residents: Raise the Roof Sponsors Parker Health Group, Inc. and Horizon Blue Cross and Blue Shield of NJ, Build the Walls Sponsors AARP NJ and New Jersey Relay & CapTel and Lay the Foundation Sponsor Springpoint.

I hope you can join us!

Testimony given by NJFA Executive Director Melissa Chalker to the inaugural meeting of the Assembly Senior Services Committee, 1/27/2020

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The New Jersey Foundation for Aging’s Executive Director, Melissa Chalker, was invited to testify at the inaugural meeting of the Assembly Senior Services Committee on January 27, 2020. The committee includes Chair Valerie Vainieri Huttle, Vice-Chair Shanique Speight and members BettyLou DeCroce, DiAnne C. Gove, Angela V. McKnight and P. Christopher Tully. This was Melissa’s testimony. To read more about the meeting, see the NJ Spotlight coverage here.

“Good afternoon, Assemblywoman Vainieri Huttle and members of the Assembly Senior Services Committee. Thank you for this opportunity to speak with you today. I am Melissa Chalker and I’m the Executive Director of the nonprofit New Jersey Foundation for Aging (NJFA).

NJFA was founded in 1998 by four County Office on Aging Directors. They wanted to create a statewide organization that would address public policy issues related to the changing and diverse needs of our growing aging population. Since then, we have worked with a wide variety of partner organizations, as well as state government officials, to enable older adults to live with independence and dignity in their communities.

Today, I would like to tell you about NJFA’s advocacy priorities and present some current data related to older adults.

FINANCIAL INSECURITIES

NJFA developed the state’s first Elder Index Report — a cost-of-living table — in 2009. In 2015, the NJ State Legislature passed a bill that mandated the use and updating of the report by the Dept. of Human Services — specifically the Div. of Aging Services, which I am sure my friends from the Division can tell you more about.

From the first report in 2009, through the national database update that was unveiled last week, this Elder Index data allows us to look at the cost of living for seniors in NJ, determine how many fall below the Elder Index Benchmark ($29,616 a year for a single elder renter) and focus on how they can be supported by public benefits and other programs to fill the gap.

Because of the Elder Index research, we know that 8% of New Jersey’s older adults live at or below the federal poverty level. Those seniors are among our most vulnerable — both financially and medically.

Additionally, Social Security is the only source of income for 30% of older adults in New Jersey. The average annual Social Security benefit for a retired elder in NJ is $18,065. We know that number is even lower for women, plus there are many other seniors who receive far less than the average benefit. We have received calls and letters from older adults seeking help, stating that they are trying to get by on their monthly Social Security benefit of $700. After paying their rent and health care premiums, they are often left with $100 or less for groceries, co-pays and other expenses.

In addition to those seniors living below the federal poverty level, there are older adults who may be above that benchmark, but still struggling to meet all their basic needs. In fact, the most recent NJ Elder Economic Security Index indicates that more than half (54%) of New Jersey’s seniors do not have the annual income needed to provide for their basic needs. This is what is referred to as New Jersey’s statewide Elder Economic Insecurity Rate (EEIR). These are the older adults that we refer to as being “in the gap.” That gap is having income too high to qualify for government programs, but too low to adequately cover basic expenses.

The Elder Index statistics influence much of NJFA’s advocacy work, including, but not limited to, affordable and accessible homes, nutrition and food security, and access to quality healthcare. However, this data should serve as a reminder that the state must also consider older adults when discussing tax relief programs — including property taxes — and review the structure of retirement income taxes, compared to that of neighboring states.

HOUSING INSECURITIES

Ensuring that New Jersey’s aging population has safe and affordable housing is also imperative. Two years ago, we convened a stakeholder group, which developed a policy recommendation report. I have provided a copy for each of you to review [see the report here].

In the 10 recommendations listed, you will see that we are suggesting increases in vouchers and units for older adults within existing housing programs. We also identified ways to streamline the process and implement incentives to provide more housing to older adults that is safe, affordable and accessible.

When we consider the housing needs of seniors, we must consider every senior — there is no one-size-fits-all for older adults. When implementing policies and programs, we need to recognize seniors with chronic health conditions and those who are facing economic insecurity.

Additionally, there are middle-income seniors who struggle to find appropriate, accessible places to live in their communities of choice, and worry about being able to afford all their retirement expenses — including the potential need for long-term care services, which can add up to $50,000 a year to their costs depending on the level of care. Along with our partners, we’re engaged in discourse about age-friendly communities, particularly how social and wellness services can better be incorporated.

FOOD INSECURITIES

Much like anyone in any age category, the nutritional needs of seniors are a priority. Protecting the SNAP [Supplemental Nutrition Assistance Program] program from Federal cuts would ensure that those who rely on the program will still be able to access healthy foods. What we have learned from partners doing outreach with seniors is that often an older adult on SNAP is better able to follow a doctor’s dietary guidelines because of this benefit.

One area of need, though, is finding and educating seniors who do not know about the SNAP program, or those who fear the stigma of public benefits and the stories about the difficulty in applying for the program. My friends at the Division of Aging Services can confirm that there has been under enrollment of seniors in SNAP for quite some time.

An improvement to SNAP program would be a Standardized Medical Deduction for seniors applying for SNAP, which would make it easier for seniors to take advantage of the medical deduction provision. Having one max deduction amount that all seniors could utilize would make it easier for them to apply for, and receive, SNAP.

FAMILY CAREGIVERS

The issues and struggles surrounding informal, unpaid family caregivers have been well documented. Family members provide most of the care for older adults and individuals with disabilities here in NJ. Our healthcare system will need to respond to the continued growth of the 65+ demographic over the next decade. Relying on family caregivers to fulfill all facets of care is unrealistic; but we know that it will become a necessity for many. Therefore, we need to not only look at policy changes to the healthcare system, but also the support of caregivers.

There is an urgent need to bring greater public awareness to this issue and to advocate for caregivers. Expanding access to home-based, long-term care services for NJ’s older adults would provide some relief in that area. The state has done a great job increasing the number of people who receive home- and community-based services through the state’s MLTSS [Managed Long Term Services and Supports] program.

Therefore, NJFA continues to participate in dialogue around the need for a policy or program to address those who fall in the gap between eligibility for Medicaid and the ability to pay privately for care.

In conclusion, there is no single answer to “how do we better serve older adults in NJ,” because there isn’t just one issue. Across our nation (and even the world), longevity is increasing, which is good news. However, that means that society’s ageist views, which place barriers on the road to aging well, need to be dismantled now. Investing dollars into housing, nutrition and healthcare services (including those that benefit caregivers) will ensure that everyone in NJ has the opportunity to live a long and healthy life.

Thank you for your time.”