

Published on Aging In Place Technology Watch (http://www.ageinplacetech.com)
Home > Blogs > Laurie Orlov's blog > Age friendliness -- sounds good, where is it?
Submitted by Laurie Orlov on Sat, 01/14/2012 - 14:13
Not to be a spoilsport…but 'age-friendly cities' aren’t. US News Money ran an article this week about ‘aging in place’ – what a great idea, but… Adding the 'but' is a correct assessment -- senior-friendly communities don’t really resonate as two words in the same sentence, although I suppose that is depending on whether you are imagining a young-aged (in either age or demeanor) senior. The AARP-sponsored state-by-state study cited underpins the issues, particularly with transportation. But what really struck me: "Of Americans over age 65, 21 percent do not drive," the report said. "This reduced mobility has a direct and often debilitating effect on older Americans' independence. More than 50 percent of non-drivers over age 65 normally do not leave home most days, partly because of a lack of transportation options." So let’s count that up, shall we? With 40 million aged 65+, 8.4 million of them are non-drivers, 4.2 million not leaving the home most days because of a lack of transportation. What are these people doing in their homes? Who sees them? How age-friendly is that?
Meanwhile, why are so many 'aging in place?' Because they can’t sell their houses -- and when they do, it is later and later – the average move-in age for assisted living is 86, the average price for assisted living is > $39K per year, according to this 2011 John Hancock study. A Senior Housing News article this week cited "The greatest policy challenge yet to be fully addressed is the need for some type of affordable assisted living for low-income Americans." Yes, but – it seems like the price point of assisted living is a barrier for middle and upper income seniors as well – if you are a woman and live to age 85, you have a good chance of living another 6-8 more years. That potentially means a bank account or willing adult child contributor of $312,000, assuming there are no future price increases! And that price presumes you are not in ‘memory care’ and that you don’t live in high cost East/West coast or in any big city locations. Given that real estate market reports indicate a median sale price US-wide of $169K in 2011, this would seem to be an early indicator that that the assisted living average move-in age may rise again.
How to meet a serious need based on terminology and cost trends. From my various related calls and encounters this week: heard the term ‘forever home’ versus aging in place; heard that builders believe that older adults don’t like the term aging; that senior housing complexes are communities, not facilities; that they are marketed in the context of a business, not an industry, that 55-plus housing is making a comeback among 65-year-olds; that home care (of every type) is hot, and that everything that sounds mobile and health-oriented is HOT and avoiding readmission to the hospital is HOT, HOT, HOT – especially where the government is the insurer of record.
Do you see the collision course we are on? The pending gap between the ability to pay and the need for assistance will only grow. This gap offers opportunity for service and tech businesses that can gear price points to low-income tolerance. It will also likely will result in various stop-gap government measures in a state here or a city there. Let's see more of today's senior housing businesses reach out with services and centralized hub-and-spoke offerings in which the sum of many low-cost services offered adds up to real revenue? Seniors will mostly stay in their unmodified, age-hostile homes. In lieu of assisted living, they will need home care. Home care is unlikely to offer enough hours of (reimbursed) care to fully mitigate isolation and risks – both for the low-income home care worker and the care recipient. Hope this isn't a rhetorical question, but why can’t the standard ('age friendly city') practice be a combination of home care services in partnership with nearby senior housing organizations to offer some type of remote camera-enabled monitoring care that also enables checking in the most isolated-in-place?
Submitted by Dave in MI (not verified) on Sun, 01/15/2012 - 10:01.
Laurie,
Answering the 'partnership' question you pose likely implies responders' trepidation or uncertainly re: reliable revenue and margins. And the old privacy/cameras dilemma still lurks. Perhaps some private/public grant funds somewhere are poised to support an actual model or demo of how your proposed partnerships could be successfully implemented.
Dave Brooks
Beth Giles / 503-709-0791
Professional Organizer/Senior Move Manager
NW Organizing Solutions
We help families bring order to their homes


EXERCISE FOR PEOPLE OVER 50
Begin by standing on a comfortable surface, where you have plenty of room at each side.
With a 5-lb potato bag in each hand, extend your arms straight out from your sides and hold them there as long as you can. Try to reach a full minute, and then relax.
Each day you'll find that you can hold this position for just a bit longer. After a couple of weeks, move up to 10-lb potato bags.
Then try 50-lb potato bags and then eventually try to get to where you can lift a 100-lb potato bag in each hand and hold your arms straight for more than a full minute. (I'm at this level.)
After you feel confident at that level, put a potato in each bag.


Something different -- a positive study of aging and cognitive decline. Last week in the midst of worse and most worse economic news, USA Today published the results of a decade-long study through Duke, Harvard and others that tracked 1049 older adults age aged 56-102 who at the beginning of the study showed no signs of dementia. At the end of the study, two-thirds of the participants showed at most only “slow cognitive decline,” not the level of decline typically associated with requiring assistance or medical care. Why is this interesting? Remember the often-quoted statistic that nearly 50% of seniors aged 85+ suffer from Alzheimer’s? This study undermines that estimate and therefore the domino effect of the assumptions that are derived from it.
Maybe it is time to question entrenched assumptions. The Duke/Harvard study is a chink in the armor of Alzheimer’s fear factoids and their implications. The Alzheimer’s Association and many others, including drug manufacturers, build fund-raising and research efforts and drug business investment assuming that half of the 85+ population will suffer from dementia. More to the point, these assumptions are based on a growth rate from today’s 4 million upwards of 14 million who will have late-onset Alzheimer’s by 2050 -- presumably this can be predicted (along with prospective revenue streams) based on circumstances today.
Less fear could mean a revision in treatment. Of course studies must be repeated and further analysis must be done to actually shake today’s near-immutable assumptions about the prospective cognitive decline of older adults. But just as there is no historical precedent to lengthening life spans, there may be no precedent beyond studies like this one for cognitive fortune-telling. From the study’s press release: "With an understanding that cognitive decline is not normal, however, poor performance can be investigated and preventable or reversible conditions, such as delirium, medication side effects, or vitamin deficiency can be properly addressed." Does that make you wonder how many warehoused seniors who are believed to have dementia – maybe don’t?
Shake off dementia forecasts – and the aging world feels different. For the moment, leave aside other aspects of physical decline – not addressed in the study. So with less anticipated dementia – even in the face of family history -- working and entrepreneurship cycles extend; senior housing companies tighten relationships and investment in home care versus assisted living and memory units; university program offerings for late life education are expanded, providing new revenue streams. Cognitive check-ups become non-stigmatizing standard routines in physical exams of the 90+ and the oldest seniors, who are now sporting their ever-smarter phones, living longer and higher quality lives and becoming fascinated with online games. Who knows, maybe someday, getting lost won’t mean you’re losing your mind, just that you, like everyone else, needs a GPS.


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(Money Magazine) -- Is Dad mixing up his pills? What happens the next time Mom falls?
If you have an elderly parent, chances are you've spent more than one sleepless night worrying about such things.
Sure, moving him or her to an assisted-living facility or a nursing home might help. But the average annual cost is $38,000 and $67,500, respectively, and that doesn't include the hefty emotional price: Surveys show that seniors fear nursing homes more than they do death itself.
Thankfully, the past few years have seen a boom in technical innovations that can prolong their independence and help you to be a more effective caregiver, even from afar.
They include automatic activity sensors, smart pillboxes, and communicators that share health data with you or a medical pro. These gizmos (and the monitoring services that typically come with them) can be pricey, ranging from a few hundred dollars to several thousand a year -- and neither Medicare nor most private health insurers typically cover them (though some will if they're prescribed by a doctor).
Still, because these devices can extend the time your parent is able to live safely at home, the best ones may save money and heartache in the long run, says Laurie Orlov, founder of market research firm Aging in Place Technology Watch.
"We've entered a really great new world," she says.
Navigating this new world isn't easy: There's little regulation or independent testing of many of these products. And it's hard to comparison-shop because many manufacturers don't post prices on their websites or quote them over the phone but rather direct you to salespeople.
So MONEY interviewed a dozen experts who are familiar with the latest elder-care technology -- and identified cost-effective choices for three challenges, starting with the most common.
MANAGE MEDICATIONS
The Challenge: Mixing up pills, forgetting them, or taking them at the wrong time can have dire consequences. "It's one of the primary reasons elders can no longer live alone," says Elinor Ginzler, a vice president at AARP.
The Old Fix: Those $2.99 plastic pillboxes you get at the drugstore, with a compartment for each day of the week. Many pharmacists will pre-sort meds into them. But seniors who are forgetful or have complicated drug regimens need more help, says Julie Menack, a geriatric-care manager in Oakland, Calif.
The New Fix: High-tech pillboxes that set off alarms if your parent fails to take a dose. They range from basic $17 models to $75-a-month machines that connect to a monitoring service via a phone line and send alerts if pills are missed.
Jeffrey Gornstein, the founder of comforthouse.com, a seller of household gadgets, says he's been pitched dozens of these devices, many of which have "terrible instructions or buttons that are too small."
A good pick for most people, experts say: the pie-dish-size Med-Ready 1650FL (medreadyinc.com; $218 and up, plus $16 a month).
Load prescriptions into a carousel, then program it to open internal boxes up to four times a day. Mom doesn't take a pill on schedule? The MedReady flashes and beeps. If the meds haven't been removed after 30 minutes, the device sends voice or text messages to you or another caregiver.
Since her parents got the MedReady, says Karen Ballou, 53, of Livermore, Calif., they've stopped sleeping through their scheduled pill-taking times: "It's a blessing for us as caregivers."
The Caveat: If an alarm will upset your parent, or if he or she might not swallow a pill after removing it, this isn't a good choice.
Covered by health insurance? Not by Medicare or big private insurers. Most long-term-care policies (and Medicaid in 16 states) will cover it if prescribed.
MAKE FALLS LESS DAMAGING
The Challenge: Installing grab bars and making other home modifications reduce the risk of falling but don't eliminate it. Research shows that seniors who get quick help after a tumble are about 20% less likely to need hospitalization.
The Old Fix: One of those "I've fallen and I can't get up" pendants. Many seniors are reluctant to wear the conspicuous devices because they advertise frailty. And a 2008 British study of people over the age of 90 who wore such pendants found that 80% never pushed the alert button after a fall, either because they didn't want to bother anyone or were unable to do it.
The New Fix: A wearable device that can automatically sense falls, thanks to a built-in accelerometer that measures movement and orientation. When it detects a fall, it sends an alert, typically to a monitoring service and to you. Several companies now offer such devices, which run from $30 to $60 a month, hardware included. Among them, Halo Monitoring's MyHalo (halomonitoring.com; $49 a month) was singled out for an award recently by a panel of nurses and caregiving pros assembled by a health trade publisher.
MyHalo looks like a pager and can be clipped to a belt. When it detects a fall, a base unit plugged into a phone line beeps. If your parent doesn't hit the unit's reset button, you get a voice or text message, and a Halo staffer calls your parent's home (then you if there's no answer). Can't get over there right away? Halo calls 911.
Choose this device only if you're confident your parent will wear it and keep it charged. Otherwise, says Stacey Pierce, a certified aging-in-place specialist in Charleston, S.C., you're better off installing a fall-alert system in his or her home. The latest include wireless motion-detecting sensors that can alert you if they don't pick up movement typical of your parent. For example, if Dad gets the paper and eats breakfast every morning, put sensors on the front door and the refrigerator and program the system to call or text you if they aren't opened by, say, 9 a.m.
Installing such detectors kept Karla Barham, 52, of Shreveport, La., from having to rush to her mother's apartment in a panic several times a week whenever her phone calls went unanswered. Now Barham spends her time with Mom cooking dinner or going out: "We have a much better relationship."
Top-of-the-line systems may include audio and video and run into the thousands of dollars. But you need not spend that much. Susan Estrada, an independent seller of caregiving products who has a reputation among elder-care experts for posting reliable product reviews at happyathome.me, suggests the following cost-effective system:
BeClose (beclose.com; $300 for enough hardware for a small apartment, plus $49 a month).
The Caveats: A wearable monitor is no help at times your parent doesn't have it on. Motion-detector systems work well only if you place and program them correctly -- and some parents dislike the "little daughter turning into Big Brother" aspect. (To convince them, stress that motion detectors also work as burglar alarms.)
Covered by health insurance? Usually not. But these devices are covered by some long-term-care policies (and Medicaid in 44 states) if prescribed by a health pro.
MONITOR HEALTH PROBLEMS
The Challenge: Seniors who fail to follow standard medical guidelines for chronic ailments such as diabetes and heart disease -- for example, neglecting to measure blood sugar or pressure -- get sicker and have to be hospitalized far more often than those who do.
The Old Fix: Blood-pressure gauges and other devices for home use. But there's no way to check that your parent is using them or to read results remotely.
The New Fix: "Telehealth" devices that automatically transmit data to medical pros or caregivers. A recent Department of Veterans Affairs study shows that people with chronic conditions who use the kind monitored by doctors are 20% less likely to wind up in the hospital. What's more, they're keeping more than 49,000 veterans from having to enter nursing homes, says Adam Darkins, a physician who oversees the VA's telehealth program.
One system proved effective in Medicare and VA studies: the Bosch Health Buddy (boschtelehealth.com; available only by prescription). A small video console plugs into your parent's phone line; another device -- a blood-sugar monitor, for example -- gathers data. The console reminds your parent to use the monitor and transmits the reading to his or her doctor's office. The doctor's staff keeps an eye on the info and intervenes if necessary.
"It really gives me peace of mind," says Shelley Costello, 57, of Wenatchee, Wash., whose 81-year-old mother uses the device to keep tabs on her high blood pressure.
However, most medical pros don't yet work with the Health Buddy. Your parent's doctor doesn't?
Joseph Sharit, a research professor at the University of Miami's Center on Aging, recommends this easy-to-use, reasonably priced alternative: Ideal Life (ideallifeonline.com; $200 to $450 upfront plus $8 to $50 a month). The main difference: This system doesn't automatically send health data to a doctor but to you (or someone you designate), via a smartphone alert or a website you can check.
The Caveat: Getting the data yourself won't do much good unless you know how to interpret it. Consult your parent's doctor to find what numbers are worrisome and what to do if he or she hits them.
Does Insurance Cover It? Usually, if the system is prescribed and overseen by a health pro.
Fortunately, competition to provide newer and better elder-care aids is accelerating, which promises to drive down prices, Orlov says. That's good news for older Americans -- and for caregivers who want to help their parents stay at home, worry-free, as long as possible.
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My office closet before After I cleaned it
I attended a lecture today at the Wilsonville Community Center. I got more tips on organizing and downsizing that I hadn’t thought about until today. Our speaker was Beth Giles of Northwest Organizing Solutions. Beth has a wonderful website that will acquaint you with all of her services. I don’t know about you, but I like someone to lend a little moral support as I decide whether or not to keep everything I’ve ever owned. She told us downsizing can involve more than a few emotions as we decide what to keep and what to re-purpose. You can sign up to receive her newsletters; they offer valuable insight about organizing for a move or downsizing in general.
I was thrilled to hear her repeat what I say so often. I feel really stressed and sometimes overwhelmed when there is lots of clutter around the house. I begin to feel life is getting away from me. When everything is put in its place and I can see lots of open space, I feel calmer. I can say I even feel rejuvenated.
When the kids were little I had a harder time getting things picked up - let’s just say there were others in the household who conspired against my well-laid plans…. It has gotten much easier now that there are only two of us at home. I’ve been training my husband for many years now. He has completed about 80% of his training. I do wonder if 80% of his compliance involves the need to hear fewer of my reminders…. Of course, they’re very kind reminders….
I’ve listed a few of Beth’s motivational tips to get you started. If you still can’t do it, give her a call. I know she’ll have you living serenely very soon.
Downsize means to economize; rationalize.
Organize means to arrange, to make more effective.
What are the benefits of doing all of this?
1. Save time
2. Restore order
3. Reduce stress
4. Free up space
5. Save money
First, determine the amount you need to downsize.
Are you planning a move to smaller quarters? Are you trying to find more storage areas? We are not a storage area for our adult children and we don’t need to hang on to all the games and toys they once used. What about all those crazy butter containers you’ve saved all these years – do you really need all 50 - and by the way, why can’t I ever find a lid that fits? I think they multiply when we’re not looking. Maybe they’re hanging out with all the socks that disappear from the dryer, never to be seen again.
Instead of looking at the entire project, Beth says we need to break down the work into small tasks to make it more manageable and less overwhelming.
I’ve suggested to friends and clients they take a drawer or cupboard each week and organize it. There are 52 weeks in a year. Of course, you’ll be too busy around the holidays, but still – that’s a lot of space. I don’t know if Beth would agree with my way of doing it. I think she looks at the bigger picture, but if you need to start slowly, you could try one drawer a week.
Make a list of things that are most important you.
All the work you are going to do will bring you FREEDOM. This is how Beth spells it out for us:
F Focus on goals – What is important to you? Why are you organizing or downsizing?
R Round up – gather all like items together from all locations.
E Evaluate – think about each item. Do you use it? Need it? Love it? What is the condition of each thing? Does it fit the space? Quantity: should you add or subtract from the number of items? What type of memories does each item have for you?
E Edit: Parting with your things - Determine what you want to dispose of because they aren’t in good condition or you can't use them anymore. Sell items you wish to sell – there are many resources, EBay and Craig’s List being two resources. Give to the community. Could something you have that’s in good condition be useful to someone else?
D Decide – where you’re going to store your things. Think about the location of them, the frequency of use, and the accessibility of each item. She gave good examples.
O Organize and contain – contain your things. Limit the amount of things you have, label the containers, and decide whether you are a person who needs to have open or closed containers to remind you where you’ve put items. She said not to overfill the containers as you may want to add more things later – but don’t save too much space or you’ll find yourself back where you were with overflowing areas.
M Maintain – Yes, you need to set aside a few minutes each day to put things away and keep things “tuned-up” so you don’t have to start over after all your hard work.
I have to share another suggestion she had – one with lots of practicality. Most of us have saved every
art project and gift from our children’s early years. Beth told us she is one of 10 children. There are now 38 grandchildren – all of whom have made their grandmother numerous gifts over the years. Her mother kept every gift and put them in boxes. Her solution for so many boxes? She took pictures of each item then had the pictures made into a beautifully bound book for the coffee table. Isn’t that great? I’m going to do the same thing!
If you are downsizing and moving to a smaller space, you might not have room on the walls to display all the framed photographs that once lined your long hallway. What to do? Beth says take a digital picture and display them in one digital frame. Those have been popular these past few years and I think this is a great way to use one. I’m going to go through the many boxes of 35 mm pictures we took of the kids when they were small. I’m going to scan them and put them in the digital frame. Think of the closet space that will open for me.
NW Organizing will have a booth at the 2011 Pacific Northwest Organizing Expo this Saturday (January 29) in Montgomery Park from 10am to 3pm. The address is 2701 NW Vaughn St. in Portland. Admission is free; stop by and get some advice from the experts.



