Dr. Patricia Farrell on Medika Life

The Benefits in Dignity, Savings, and Health of Aging in Place

Nursing homes and residential care facilities are undergoing a sea change as the many benefits of aging in place are seen, and people are beginning to refuse to leave their homes.

If home is where the heart is, then remaining in your home rather than being shuttled off to a nursing home isn’t the option many elderly want. And now, research is providing evidence of the benefits of remaining in one’s home and engaging in all needed activities, either independently or with a bit of help.

Nursing homes are not the paragons of safety they would have us believe by providing an allegedly “safe,” racially accepting place to live out your final years. Nor are they necessarily the place that meets all the needs of older adults.

Home environments are especially important for older adults whose lives are more home-based than earlier life stages. Despite a focus on ageing in place, there often remains a mismatch between housing options prioritised by government and industry, and the needs and preferences of older adults.

Thinking of these eldercare facilities, I am reminded of two things; the Rene Spitz studies with orphans in Albany, New York, and my experiences in an upscale nursing home, aka residential senior care facility.

Spitz saw that after WWII, an excessive number of infants required care in large facilities. These orphanages or hospitals would provide food, medicine, and a safe place for the children.

One thing they failed to consider that was not provided was frequent touching and interaction with an attendant staff. Spitz’s studies emphasized maternal deprivation and its relationship to later life development and depression. He called it anaclitic depression. Sometimes, it was referred to as hospitalism.

While provided all that was needed to maintain life, the infants were not vigorous, and many died of what we might call not a failure to thrive but a failure of emotional connection. Others in the field, such as Bowlby and Harlow, would continue to investigate this connection, albeit a maternal one.

But what of this type of deprivation in adult life when our needs are increasing, and our connections may be withering? Are nursing homes or residential care facilities the answer?

One thing nursing home placement does is uproot older or disabled individuals from familiar settings of psychological and physical comfort to one of regimentation and unfamiliarity. Neighbors and friends are now no longer close at hand. Instead, a paid staff is there for them. Does this honestly respond to the emotional needs of these individuals?

The Concept of Aging in Place

Given a choice, which would you want; total care where your wishes might be dismissed and the ability to control your own life removed for semi-independence? The choice, to me, would seem obvious, and now the idea of aging in place is receiving research attention. One study indicated a need to consider the person and the changing neighborhood over time and how community development plans and social institutions play a role.

The conclusion suggests that further attention must be given to the changing dynamics of the places where people grow older. It also makes policy suggestions for how aging in place could be supported, taking account of the needs of people as they grow older as well as changes in the communities in which they live.

Although the neighborhood in which they lived and had strong ties may be emotionally desirable for older individuals, there may also be a degree of exclusion. This new detachment can stem from upheavals in the structure of the community, newer perceptions of housing accommodations that favor renting over ownership, and other factors leading to social exclusion.

Indeed, research in the UK has shown that age is associated with an increased chance of exclusion, with people aged 80 and over more likely than their younger counterparts to feel excluded from social relationships, and be detached from leisure and cultural activities and basic services.

The Census Bureau has outlined the increasing challenge of families to several factors, including childlessness, divorce, and an aging population. “According to the US Census Bureau, older adults (ages 65 and older) are projected to outnumber children under the age of 18 for the first time in US history by the year 2035.”

How many of us have considered where we’ll be living once we reach the last decade of our lives? Often, this is a question too many are reluctant to ask, and many families are loathed to consider. But in today’s world, it is becoming more acceptable for older adults to remain in their homes, aka aging in place, and to form a multi-generational group living situation once again.

Anyone interested sufficiently in sociology will quickly find that in the 19th and early parts of the 20th century, multi-generational living arrangements were typical. Structures were built to accommodate the needs of each generation. The nuclear family had the main house, possibly a smaller house next to it or attached by a walkway, and younger members might be living in a third-floor apartment. Yes, houses were large as family groups were at that time.

Technology, however, began to change the face of housing, as Louis Wirth pointed out in his sociological exploration of cities. We live in groups, but the elderly and the poor often were left to the undesirable sections of cities as the affluent younger generation moved to large homes in the suburbs.

A Return to the Past

Now there is a reversal of sorts, and a hybrid form of living may become more acceptable. Almost half of the American workforce that has the option will continue to work from home rather than returning to the office in the city. How will this affect the elderly population? Will it be a benefit to them and will it have unexpected pleasant aspects we hadn’t considered before?

The nursing home, equivalent to warehousing the elderly in either meager circumstances or opulent ones (considering their income streams), is not desirable. Who would find them so? Imagine having everything taken away from you and being placed in a sterile environment meant to serve your physical needs but perhaps not your emotional and social needs. This social need is endemic to human beings and must be considered in any living situation we may concoct now or in the future.

Medical research continues to advance, and we will extend our lifespan due to breakthroughs. The more members of a population that live beyond the age of 90 or 100, the more we need to consider their humanity. The terrible stories associated with large nursing homes run by corporations are still plastering the front pages of newspapers and hitting the Internet with an impact that cannot be denied.

One facility even, during the height of the pandemic, stored bodies in a tool shed on their property. This is only one dreadful example of what can happen when there is insufficient oversight, too much emphasis on bottom-line thinking, and a total disregard for the decency of human beings.

Yes, we may be in for a new age that may mimic what we had a century ago, but with appropriate upgrades that enable the frail and the strong elderly to remain in their homes. Designs for the layout of homes that meet the needs of the elderly are already available, and groups are willing to provide labor for individuals who cannot afford remodeling for their increased need for accommodation.

Aging in place is not a new idea but requires sufficient consideration from all of us for those who made our lives possible and enabled us to have a better life than they may have had in the past.

We talk about “the Greatest Generation,” but are we treating them in that same frame of reference, or are we dismissing them? Think hard and frequently about this because we will all be there one day.

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Pat Farrell PhDhttps://medium.com/@drpatfarrell
I'm a licensed psychologist in NJ/FL and have been in the field for over 30 years serving in most areas of mental health, psychiatry research, consulting, teaching (post-grad), private practice, consultant to WebMD and writing self-help books. Currently, I am concentrating on writing articles and books.

DR PATRICIA FARRELL

Medika Editor: Mental Health

I'm a licensed psychologist in NJ/FL and have been in the field for over 30 years serving in most areas of mental health, psychiatry research, consulting, teaching (post-grad), private practice, consultant to WebMD and writing self-help books. Currently, I am concentrating on writing articles and books.

Patricia also acts in an editorial capacity for Medika's mental health articles, providing invaluable input on a wide range of mental health issues.

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