Color & Control:

Planning for older age and disability – Or a complex, rich, vibrant and evolving life experience?

By Jane Teasdale

Planning for later life and potential frailty or “disability” is something we might all prefer to put off. It is inevitable you might say, so why make the effort? As someone who has been in home and community care for the last twenty years I can both empathise and sympathise. But, there are many things we can do to help make our later years worthwhile, meaningful and relatively healthy.

When we think of planning, we may think of financial planning and saving for care. Receiving care in the home, over and above the hours provided by public health bodies, and long-term residential care can indeed be expensive for individuals with high support needs. But, as I see it, the financial side is not the heart of the matter. Rather, it is the social, emotional, physical
and spiritual aspects of being, irrespective of your age or the side of the caregiving relationship on which you find yourself, that should be the focus of your forward planning. We are not preparing for the loss of identity but its continued meaning and relevance.

Let us look at some of the non-financial assets, resources and considerations we need to bring into the equation to fund this important stage of our lives.

Social networks

Building and maintaining social connections are important for emotional well-being and physical health. The cliché that loneliness is equivalent to smoking 15 cigarettes a day is backed up by research showing its impact on cardiovascular health, immune system function, cognitive health and decision-making ability.

Social networks also represent resources you can draw upon to help you remain in your home and community, especially as you lose the ability to drive, shop or lift heavy items. Social networks support families, care partners and the person being cared for, and are both a pleasurable and tremendously worthwhile time investment.

Interests and activities

Developing and maintaining interests and activities keeps you active and mentally engaged, and provides reasons for living and the chance to meet new people. Having the opportunity for personal growth, to contribute to our communities and to retain control over our identity is vital for our mental health. And poor mental health is a risk factor for dependency later in life.

Knowing the “assets” within your local communities—particularly those located in the walkable areas surrounding, and including, your immediate neighbourhood—is particularly important. Is your habitat supportive of the type of environment you would like to live in as you age? What opportunities exist for social, physical and spiritual engagement? For those who are living with complex health conditions, or are a care partner to someone who is, knowing the local support groups and connecting with resources within your community are vitally important. Becoming active in our communities is one way in which we can remain engaged with high levels of social support.

Physical activity and eating well

Being physically active supports mobility and limits the impact of disabilities as we age. Research supports the benefits of physical activity irrespective of age and even for those living with chronic health conditions. Far too many of us fail to meet minimum exercise guidelines and underestimate the importance of physical activity, especially strength and balance exercises, in supporting independence later in life. We lose important muscle mass from our thirties onwards, and from the age of 65 years muscle loss occurs at a rate of 15 per cent per decade.

Many of our most challenging health conditions (including diabetes, and cardiovascular and neurological health) are impacted by insulin insensitivity as a consequence of sedentary modern lifestyles and processed foods. Eating a nutritious diet and looking after our metabolic health are two of the most important things we can do to help support our health and functional abilities in later life.

Communicating wishes and preferences

Prepare in advance by assessing the ability of your home, social networks and neighbourhood to meet your future needs, and pinpoint where transitions may be needed. By focusing on the wider picture of successful ageing, we are better able to plan for decisions that might otherwise have only negative connotations. Should you downsize, move to another community or renovate your home to make it more age friendly? Is remaining in your own home, irrespective of your abilities as you age, supportable and realistic, and what would you need to do to facilitate this? Aging is a natural part of life, not its end. Many who experience disability and chronic illness consider themselves to be aging successfully.

Invest in yourself

Engaging in physical activity, looking after your metabolic health, nurturing social networks, and developing interests and activities all support independence, and may help to defer and or reduce the costs of care in later life.

A 2005 paper by Kemper et al titled “Long-term care over an uncertain future: What can current retirees expect?” modelled the risks of long-term care for those older than 65 years using
U.S. data. The model used a moderate assessment of needs: One or more activities of daily living and four or more instrumental activities of daily living or some form of formal, informal or nursing home care. When all was said and done, the researchers calculated that the average man would need 2.2 years of care and the average woman 3.7 years of care, with 79 per cent of women expected to need some form of support.

The model also estimated that 31 per cent of individuals will avoid the need for care of any type, while 20 per cent will require it for 5 years or longer. Of the moderate-care definition, two-thirds of the time was expected to be spent in the home, with the remaining third in nursing homes and assisted living. The researchers predicted that 63 per cent of people would not need any nursing home or assisted living care.

Unfortunately, there is little guidance as to how many hours of care a person can expect to receive from the public health system and it can be difficult to predict our needs and organize care in advance. What we do know is that most people prefer to remain in their own homes until the end of their lives. And to do this, many will need help with performing activities of daily living, connecting with friends, maintaining their interests and participating in ongoing activities.

Prepare for tomorrow, today

Part of planning is to work out when and how to address social, emotional and physical concerns before they get away from you and turn into an emergency. All planning should incorporate an understanding of what care and personal supports can achieve in terms of supporting abilities and independence and the steps that need to be taken to connect with health and other community resources when we reach certain milestones. Research shows that your options are often more limited once a crisis hits, and that you might be forced to consider much higher levels of home care or a nursing home alternative at the last minute.

Home and community care remain overly focused on incapacity and loss. It is time to take a different approach. While we need to be aware of the costs of care in our decision-making, we  need to give much more serious consideration to those non-financial assets and resources we can cultivate to mitigate future time and costs often associated with care provision. Early holistic planning should also hopefully engender a culture of earlier and thoughtful pre-intervention by persons, families, communities and health systems.

Jane Teasdale is the business development director and principal of Mosaic Home Care & Community Resource Centres.

The dollars and “sense” of care

In Canada, although government-funded home care is provided by the health ministry of each province on a complimentary basis, the hours of care supplied are considered by many to be too limited. This leaves families to provide additional care either informally or through private service providers.

Private home care costs for agency-based care are $30 per hour or more. Eight hours of care a day adds up to $1,680 a week before tax, while a more modest three hours a day requires around $630 a week (or $2,730 per calendar month).

Basic long-term care fees are currently $1,891 per month or up to $2,701 for a private room. While long-term care or nursing homes are considered to be 24-hour care facilities, the actual amount of care a person receives on a one-to-one basis can be as little as three or four hours a day, with limited social and emotional engagement. Again, many families find they need to provide additional care within these facilities either informally or through private service providers. For those living in residential retirement communities, home care services may also add to the monthly costs.

For the most part, the point at which we start needing care is viewed as being accompanied by a loss of identity. Consequently, plans are often delayed until—or past—the last possible moment.

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