Though its been fifty-five or so years ago now, I can still vividly recall sitting around the kitchen table of our rented duplex with nine or ten other third graders for monthly Cub Scout meetings. Were I being honest, my favorite meeting activity was the snacks. I didn’t want to be a Cub Scout. There, I finally said it. This isn’t a critique of Scouting in any way, it’s just that it was only so because my mother was talked into being a Den Mother at a welcome gathering at my new school. Thinking back on this now, I’m amazed that she found time for this, given she also had two kids in daycare, worked a part-time job as a nurse at a crosstown clinic and she and my stepfather were building a new home in another part of town. This meant I was often needed to help keep track of a younger brother and sister in the evenings and on weekends. Free time for any of us was a precious commodity and frankly were it left up to me, I would have spent all of mine outside.
All of that said, I was a Cub Scout long enough to internalize the the Boy Scout Motto, learned from our first days as scouts: Be Prepared. Not coincidently, this is also the Motto of the Girl Scouts. Though I have no idea how many boys & girls participate in Scouting today, I know it was a big deal when I was a kid. If you happened to read the previous blog entry, you’ll may recall that we subscribe to the dictionary definition of being prepared: “to make ready beforehand, for a specific purpose, as for an event or occasion.” The fact that the Boy & Girl Scouts would make this the centerpiece of their philosophy is simply brilliant as life lessons go. For our clients, their families and caregivers, being prepared is one of the most important concepts we share.
Often as not, we begin our work with clients after a life-altering event has occurred. Perhaps it was a fall, medical diagnosis or procedure that triggered a series of steps needed to address current circumstances. In other cases, it’s a call from a concerned family member or caregiver who is noticing signs of disability as the individual goes about performing their daily tasks. One of the truisms I’ve come to understand from working with our clients is that everyone integrates disability into their lives in different ways. This simply means that as individuals discover they’re having trouble with a particular task or process they used to handle easily, their frustrations tend to lead them to some form of adaptation. While this may work initially, as conditions progress, the one-time solution may soon become untenable. And while it would be great to have a helping hand nearby, not everyone is so lucky. Failing a successful adaptation, they are likely to stop doing something altogether.
It’s common for us to hear from elder individuals that their fondest wish is to successfully “age in place.” Nationally, this is the most often recited desire for everyone facing the prospects of later life. The paradox is hearing in the next breath that they aren’t certain they’re ready to objectively assess their situation or they believe they’ll simply “cross that bridge when they come to it.” It’s totally understandable. For many elders, being asked to “look objectively” at their current circumstances is code for needing give up more of their daily lives due to disability, so they simply avoid it. For others, it’s a clear signal that someone feels that they would be better off in some type of managed care circumstance. Here’s the problem: delaying preparation, the “crossing the bridge analogy”, often proves to be a life-changing misinterpretation of future circumstances because the assumption is that there will be a bridge, a way forward, that will help them safely navigate to the next step or stage. Often as not, there is no bridge. The reality is that relatively healthy and active seniors can go from lives in their own homes to living in long-term residential care facilities literally overnight as a result of illness or a fall.
So... What to do? Our advice, “first things first. (Included in our recommendation is that you take a few minutes to review our first post on being prepared. It goes hand-in-hand with the information we share here). Let’s start with something that should be the cornerstone of your efforts if you are truly serious about successfully aging in place.
Fall Proofing the Home
Reality is pretty stark. According to the National Council on Aging & U.S. Centers for Disease Control and Prevention:
Nearly one in three Americans, aged 65 and over, falls each year.
Only one in three of these individuals seeks out medical care.
In 2015, more than3 million older adults received treatment in emergency department for falls and fall-related injuries.
Unintentional falls accounted for approximately 30,000 deaths in the United States in the same. year.
The estimate for for fall-related deaths among U.S. adults aged 75 years and older increased, nearly tripling from 2000 (8,613) to 2016 (25,189).
Falls, including those without significant injury, can exact a heavy toll on the quality of life. Fear of falling can severely limit an individual’s activities and participation in beneficial social engagements. This can result in further physical decline, depression, and social isolation. And while simply aging does not predispose an individual to falling, the risk increases due to overall weakness, frailty, problems with balance, cognitive concerns, problems with vision, medications, illnesses and environmental hazards. The best predictor for an increased risk of falls, is a history of falls.
The term “fall proofing” is really a misnomer. No entity can claim that their means or methods will make someone truly “fall proof.” But that doesn’t mean you shouldn’t work toward the goal of minimizing fall risks within the home. We look at this as a two step process. The first step or recommendation we have is getting evaluated utilizing the tools established by the Center for Disease Control. The program is called STEADI and is a great initial step in the process of determining fall risks. The evaluation is done with your healthcare provider. More information can be found in the STEADI Toolkit.
So lets say you’re getting or have gotten an evaluation. The next logical step is to take the advice of the experts and work to improve conditions within your home environment. Our favorite “checklist,” comes from the (NCOA) National Council on Aging. You can find it & an explanation here. There are a number of good checklists available, but our belief is that this one more than adequately covers the bases for the average individual.
The last of the pieces of advice in the NCOA’s checklist is something we can’t echo enough: Find an occupational therapist for advice. OT’s always begin by asking, “What matters to you” as opposed to “What’s the matter with you?” No medical professional is more qualified to identify hazards and make recommendations to improve the fit and function of your home, keeping you safer & more productive as you go about your daily tasks and activities. The importance of being “fit” to your environment can’t be overemphasized. Let me give you a personal example. I’m 6’7”, and while there are well-known standards for setting the height and positioning of a bathtub grab bar, for all intents and purposes, don’t fit me. Installing them at ADA standard makes them just too low for me to use them safely, so why would I do that? You may not be taller than average, but what if it’s difficult for you to raise your arm or to even grip a bar? Is it just a grab bar that’s needed or perhaps a transfer tub bench and personal shower that would keep you safest? I’d bet there are specifics to your situation, that were they to be uncovered by a home visit with an OT, would significantly inform a plan to help you avoid a fall in your bathroom and in all the other rooms of your home.
Having touched on this early in this piece, it’s important to reiterate that this is the kind of thing that will not take care of itself. Nobody is going to “cross that bridge” successfully without taking specific planning and action steps to prepare for what’s potentially ahead. Ignoring the problem for fear of giving up more of your life flys in the face of your experience in Scouting, and can be seriously life-threatening. Please, please, please don't ignore the warning signs or that nagging little voice in your head telling you to get busy.
Everyone’s situation is unique. Getting a trained pair of eyes to determine opportunties & recommend remedies is an investment in your health and safety that pays dividends every day. And yes, we do that. Please reach out of we can be of help to you, a family member or friend.