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Is Staying Home a Better Choice or just an Easier Solution for all Concerned?

Staying home is promoted as the first and sometimes only choice, with all other choices imagined as “second best,” worthy of apologies, and justifications. This is a commonly held belief and assumption that older adults must do everything in their power to remain at home and their adult children should do everything in their power to help them achieve this.  The idea of senior living often provokes anxiety and resistance on the part of the senior and significant guilt on the part of family. For an older adult, the idea of senior living is equated with weakness, loss of independence and entering “God’s Waiting Room.” Moving out of one’s home to a senior residence means one has lost ground, lost the ability to care for oneself independently. Many adult children succumb to the resistance of their older family members out of respect, guilt, and/or obedience, and they remain unwilling to challenge their parent’s resistance.

The idea of staying at home wields a powerful psychological, emotional force. It entangles the very people that are likely to benefit emotionally and physically from the opportunities that senior living can afford them.  What is so appealing about the idea of staying home? Is it a better choice or just an easier solution for all concerned? Perhaps the idea that “there’s no place like home” is a mythical belief, a concept that is grounded more in imagination than in reality. If the latter is true, how can we work with families to help them make better choices for their older family members who are struggling at home and are good candidates for senior living?

 Working with Families to Help them Make Better Choices for their Older Family Members

For many older adults, the idea of “home” takes on magical dimensions. For those who have been in their homes for many years, “home” becomes synonymous with memories of relationships, connections with spouses, children, family and friends. It may have been the location of creative endeavors in home design, décor and renovation. For some, the kitchen is thought of as the epitome of hearth and home, a room filled with the sweet and savory, a place where well-used tools and utensils bring kitchen memories and connections to life once again. For men, the garage often represents the “other workplace” a refuge, perhaps a place of solitude, filled with the successes of repair, creative tinkering, and home to the revered automobile. Home is filled with connections, some real, some imagined and some revised through the haze of time. The negative memories often wane and the delicious recollections of warmth and satisfaction nurture us in our real-time loneliness and isolation. In our own homes, we can avoid the reality of aging and instead live among the vestiges of earlier times as though we are still of “that age”- healthy, vibrant, attractive and strong.

Many put significant effort into to making home, “Senior Friendly”

Reducing the living space to one floor or a few rooms neutralizes the fearsome stairs. Sometimes lift chairs are installed. Bathing becomes less frequent in order to avoid climbing over the bathtub. Sofas and chairs are deliberately placed so that “furniture surfacing” can forestall the use of a walker.   Elaborate technology systems are purchased to track movement in the house and provide emergency responses. The ads for home tech systems suggest that these systems will give adult children the kind of “peace of mind” that only remote monitoring can deliver. Even the government has gotten on the “Go Home” bandwagon” with funding directed into home care demonstration grants so that hospitals can reduce readmissions.

The painful reality is that for many older adults, home has become less a place of safety and warmth, (except in the smoke and mirrors of memories) and more of a place that is filled with real potential risks and obstacles. Home often becomes a tomb of isolation for the older adult, with fewer and fewer opportunities for human engagement.  The idea of what “home was” when folks were more able-bodied and cognitively fit is seductive and can tempt the older adult to take risks. For instance, using the microwave may seem like a simple task without much danger. But if the older adult has short term memory loss or visual impairment it can result in an unintended fire.   Social isolation is a hazard to cognitive fitness. Social engagement keeps the brain active and exercised.

 The very strengths that older people want to hold on to are the ones that are being whittled away and diminished because of inactivity and social isolation

The TV often becomes the singular one-way interaction for the senior living alone at home and countless hours are spent sitting and watching, napping and watching. Memory and brain fitness are supported and nurtured by social interaction and stimulation, not by passive watching. We all need to participate in conversation with another person which is a basic acknowledgment that we are alive in this world and that our presence matters to someone every day.

Nutrition is challenged because shopping is a burden, cooking is fraught with complicated maneuvers, and may be risky (ovens and burners left on, pots dropped, kitchen falls and accidents.) Stay-at-home seniors depend on family or the kindness of friends for shopping and meals or may resort to cold foods or grazing. How many new residents are hospitalized with poor nutritional status because vanity wins out over accepting help? Many seniors just “forget” to eat because the social stimulus of dining with others is no longer an option like it was when the family was together.

The Physical Environment of Home is Rife with Accident Triggers and Safety Challenges

Oriental carpets, while beautiful, pose trip hazards.   Reaching for items in closets and shelves are common reasons for loss of balance and subsequent falls. Managing the heat and the air conditioning may be difficult and result in unsafe temperatures because of the location of thermostats and poor eyesight. Home may be where the heart is but it is also where dangers, suspecting and unsuspecting lie. It is an agonizing irony that the “stay at home senior” becomes a prisoner in the very home s/he is reluctant to give up. It is a bitter trade – social, psychological and physical isolation and risk for the imagined perception of independence and youth.

I want to Respect my Mother’s Wish to Stay Home

From the point of view of the older person, the idea of moving to a senior residence is equated with different degrees and levels of loss. First, many think that their individuality and personhood will be comprised. Anxiety can take over, depression may be right around the corner and their spirits begin to tumble. If one can’t manage to stay at home, it is equivalent to a failure and it feels like it is all downhill from there. No matter how beautiful, lively, energetic or engaging the senior community appears, there is still the feeling that it is an ”institution” and ultimately “God’s Waiting Room.”

The perspective of the adult child is complicated. The obedient, respectful, and compliant child part of the “adult child” goes into drive when the question of a parent’s staying home or moving is on the table. How many times have we heard the statement, “I want to respect my mother’s wish to stay home,” or “I want my parents to make the decision” or some variation of this theme? The impulse to accept a parent’s decision is powerful; after all, they are still the people we were trained to look up to, to respect, to learn from and trust and the people we have the most complicated relationships with in our lives. Adult children may see the red flags but still relinquish their better rational sense to the emotional power of the family system relationships and expectations. They may be reluctant to “have the conversation” about their parent’s changing capacities for several reasons. One is the fear that their parent will be resistant at best and furious at worst. Or, the adult child may be unaware of or unable to recognize their parent’s decline. “This is not the mother we knew” is a frequent comment. Perhaps it is more palatable to hold on to the remembered and revised version of mom and dad rather than the picture of the parent who is losing physical and cognitive ground. Acknowledging the latter means confronting the reality that one day soon, we may live a life without our parents.

Often adult children will enable their parents to remain at home by “tweaking the environment,” e.g. shopping, cooking, cleaning or by engaging home care services. The time and financial drain may not be immediately apparent but the costs, financial and in terms of time will eventually come to light when the needs for care increase and care becomes a full-time endeavor. Despite the sacrifices, the adult child will move heaven and earth to keep the parent at home so that “all seems right with the world.” The adult child is actually joining the parent in their illusory version of “home.” The perception of independence is valued at any cost and the absence of safety, social engagement, and having purposeful days are conveniently overlooked.

Redefining the Concept of Home

Is there a way to reframe the narrative, “There’s no place like home?” What would happen if we took on the challenge of redefining the concept of home, maybe even breathing new life into the idea that “home is where the heart is.” When I think about the “homes” I have had in my life, I think less about the bricks and mortar than about the people who helped me create that particular nest and nurtured my growth, helped me manage through life changes and “showed up” for me when I needed some help. The memories bound up with homes past and present are mine to keep, treasure and come to life once more in the retelling. This is a resource most of us can draw on, and it is ours to keep wherever we may be. The version of what we knew as “home” doesn’t go away because we move away. The new version of “home” is something we can help older folks create through building meaningful relationships with them.

Bricks and mortar build houses. It is much more complicated to build a daily life that embodies meaning, purpose and connections with others but it can be done. In the senior community in which I work, we create a unique version of home every day for each resident and help them live the American dream of independence, with “a little help from their friends”. While we honor what each resident brings with them in terms of history, culture and experience, we emphasize not what is “lost” but what can be accomplished each and every day in the “new home.” We are re-writing the narrative of home.

 A home filled with Caring, Purpose, and Laughter

Everyone needs a challenge to look forward to and each one of us needs to be hopeful. How wonderful it is to wake up in the morning and anticipate what the day will bring, whether it is as simple as sharing a meal with friends, or joking around with a staff member, or as complex as rehearsing for a part in a play, or building a bird house. Moving from “the house” to a senior community is not easy and may bring with it some transient anxiety and sadness. But that comes along with any new experience and that doesn’t break most us but instead makes us stronger and more resilient.   Adult children must have faith that our parents will not “break” and that we are not disappointing them by not buying into the myth that there is no place like home. As for our older folks, put on your red shoes, click them 3 x and we show you that there is somewhere just like home filled with caring, purpose, and laughter.