In communities across the United States, older adults find themselves displaced every day. No longer able to stay in their homes, they shuffle through a series of facilities offering varying levels of care and support, many of which start to seem more like warehouses than homes and actual places to live. They are forced to move away from their homes and families, they lose the connections they had with friends and neighbours, and they enter a strange twilight, human contact limited by who happens to live around them and which family members manage to visit.
The shifting of the older population to ‘care homes’ and similar facilities started occurring during the 20th century and marked a radical departure from more traditional modes of caring for aging family members. While families had once housed their grandparents, great aunts, and other aging relatives, now they shunted them into care facilities, even as younger family members also moved out from under the family wing. Likewise, disabled family members were shifted to institutions and group homes. Government benefits programs began to actively support this by structuring their assistance in a way that forced people into institutions even if they didn’t want to be there.
One of the aims of the universal design movement is to support aging in place. Universal design has obvious benefits for people with physical disabilities, by increasing accessibility in homes, businesses, and other structures. Making it more likely that people will be able to move through their communities with facility, and will not have to wonder about how they will navigate a given part of town or building. Universal design also has tremendous benefits for older adults, as one of the things that forces older adults into institutions is the inaccessibility of their homes and communities.
Falls are an extremely common cause for institutionalisation. When an older person with frail bones slips in a shower without grab bars, trips on the stairs up to the front door, or falls while trying to go upstairs to get into bed, there’s a risk of serious injuries. Hip fractures require long recovery periods and may leave a person trapped in bed for weeks or months. Families may not be able to provide adequate care at home, or the patient may have been living alone. When the government won’t pay for nursing assistance at home but will pay for a stay in an institution, there’s really only one ‘choice.’ That ‘choice’ is not easily reversed, and the patient may be stuck in the nursing home.
When older adults vacate their homes, family members may pressure them to sell them. They could be forced to sell to cover their own expenses, even without being leaned on by the family. After you sell your home and that money trickles away, you may find yourself in a position where you cannot leave an institution, although you may be stepped up to a more independent area or unit. Meanwhile, your contact with younger family members as well as the community in general is limited, because an institution is a purpose-built facility, not a community.
There’s no reason older adults shouldn’t be able to age in place. Or, for that matter, why older adults who need some extra support and cannot get it at home couldn’t move to community-based facilities. Group homes do not have to be isolated and dire; they can be located centrally in a community to give their residents full access and to make it easy for friends and family to visit and interact. There’s no reason to trap older adults behind institutional walls. No reason not to create mixed housing where people of all ages and ability levels could live together; maybe grandmother needs skilled nursing care, but she doesn’t have to locked away where she cannot interact with anyone.
Isolation can have tremendous impacts on mental health. Being cut off from friends and family, especially in the wake of an injury like a fall, can be extremely traumatic and may add considerably to existing stress. Stress, depression, and other mental health syndromes can prolong healing time and make it harder for people to recover from injuries. All it takes is one fall, and you can be propelled into a rabbit hole you will never escape from. Many older adults are acutely aware of this. My own grandmother made it vociferously clear to my father than she refused to go into a home, that she was terrified of the idea, and insisted on living at home, motorcycle parked out front, until her dying day.
Yet, she knew that despite her objections to instututionalisation, despite her fears, she was very much at the mercy of fate and her body. If she had taken a serious fall, if she had developed cognitive impairments, she would have been forced into an institution. Far away in California, there was nothing we could have done for her. Her fear of what might happen to her was so intense that it’s one of my most vivid memories. All she wanted was to age in place after the loss of my grandfather, to live in her community and keep up with her increasingly shrinking group of friends. As her friends and neighbours died or were forced into institutions, her social circle narrowed and she had fewer opportunities for interaction and human contact. Her life didn’t have to be like that, but the social structures that surround aging and older adults made it almost inevitable.
Aging in place should be a priority, especially now, with a growing older population. In the discussions about economic recovery I see scant attention paid to the older adults who have been severely impacted by the economy; people who might have stood a chance at aging in place have had pensions, retirement accounts, and savings wiped out. There is a very real risk that their only option will be institutionalisation if they fall, break a hip or take a blow to the head, develop memory loss.