Choosing to Live at Home

You don't need to stay in a nursing home to get good care.

4 min read

May 8, 2000 -- When Sharon Miles' elderly mother grew frail a dozen years ago in Albuquerque, mother and daughter had a problem. "I was taking care of her with no support system here in town," says Sharon Miles. "It was overwhelming. She needed help bathing, eating, getting around. Finally, I had to place her in a nursing home even though neither of us wanted that." It was one of the toughest decisions Miles had ever made.

"Now, by contrast, people don't have to do that until it's really necessary," she says. Staying at home, or "aging in place," as it has become known, while not necessarily inexpensive, is becoming increasingly feasible for many older people. And Miles herself has become part of the solution.

After the experience with her mother, Miles returned to school for a degree in social work, with course work in gerontology, and gained experience arranging care for seniors at an HMO. Then, as a member of the relatively new profession of geriatric care managers, she formed her own company. Her current clients, most of them in their mid-80s, all live at home with outside help -- coordinated by Miles.

As a member of the National Association of Professional Geriatric Care Managers, Miles specializes in helping seniors live independently for as long as possible in their own homes -- which, according to the American Association of Retired Persons (AARP), is what 85% of them want to do. Care managers can assess what's needed, arrange for services, help with legal, financial, and insurance issues, coordinate various government, private, and community services, offer counseling, and act as a liaison for distant families.

A typical new client call comes from a son or daughter, Miles says. "Last year a daughter in Michigan found me through the national association's web site and called about her mother living alone in the Albuquerque home where she'd been for 45 years. The children had noticed that their mother was forgetful and not keeping up with the bills. They worried that she wasn't taking her medications. She had a little dog for company and didn't want to move out of her home.

"The children flew in, and we all met at the mother's home. She'd lost weight, was sloppily dressed, when she'd always been so neat; and the bathtubs were dusty." With the family, Miles developed a care plan. The mother now wears a beeper that she can use to call a neighbor if she falls. She receives hot lunches from the community's Meals on Wheels service. A homemaker/caregiver comes in every morning for about four hours to help her dress, make sure she has breakfast, and take her to doctor's appointments. A shower chair, handheld shower head, and grab bars were installed in the bathroom, with assistance provided by a city program. Miles removed slippery throw rugs and replaced them with rubber-backed ones. She continues to monitor the plan, keep in touch with the children in Michigan, and is ready to respond to any changes in the woman's needs.

Once a geriatric care manager puts a basic plan in place, other support organizations can offer additional help. Sometimes a few home modifications are all it takes to allow older people to stay where they are. Improvements such as ramps, grab bars, improved lighting, and special, easy-to-use door and faucet handles are among the easiest changes, but widening hallways and doors or lowering kitchen counters can also help. The AARP publishes a room-by-room checklist with tips for making a home safer; other publications are available from the National Resource Center on Supportive Housing and Home Modification.

For the challenges of daily living, such as housekeeping, errand-running, cooking, and even companionship, companies such as Home Instead have appeared in many cities and towns. For medical care, nurses and aides from a variety of agencies make house calls or stay around the clock if needed.

Loneliness is another problem. A visit to the local senior center, an outing with a companion to a movie, or a chat with a visitor or neighbor may be all that's needed to solve the problem, but an elderly person living alone may need encouragement and help in making these plans. When seniors can no longer drive, trips to the grocery store, doctor's appointments, or visits with friends can become a challenge. Caretakers or transport services can fill the gap.

Fees for private care managers vary, from about $50 to $150 an hour, with prices typically higher in urban areas. Some long-term care insurance policies reimburse for care managers, and depending on a senior's eligibility, Medicare or Medicaid plans may offer some help. Help with finances is, in fact, usually part of the caregiving plan.

A good care manager can usually put together a plan that fits within a family budget. And some part-time care at home is usually far less expensive than a move to a nursing facility. Most important, a good aging-in-place plan allows older people the familiar comforts of home -- for as long as possible.

Jeanie Puleston Fleming has written for The New York Times and other publications. She is based in Santa Fe, N.M.