5 Ways to Age in Place

EDITOR'S NOTE: This article was originally published in the June 2011 issue of Kiplinger's Retirement Report. To subscribe, click here.

It's the small things that can mean the difference between remaining in your home and having to move to a care facility. Perhaps you no longer drive and need a ride to a doctor's appointment. Or maybe you can use some help preparing meals. When you change a ceiling light bulb, are you afraid of falling from the step stool?

The recognition that assistance in everyday matters can go a long way to maintain a senior's independence has spawned what's become known as the "aging in place" movement. Communities nationwide are experimenting with new living options and services that are designed to help older individuals stay put as long as possible. "We think it's what people want, and we think ultimately it's less expensive than institutionalizing people," says Greg Case, director of home and community-based services for the U.S. Administration on Aging. We've reviewed five types of aging-in-place housing options.

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It Takes a Village

If you want to stay in your house, perhaps you can help turn your neighborhood into a "village." Residents pay an annual membership fee to gain access to free and discounted services, such as handyman services, transportation, prepared meals and financial advisers. "It's citizen run, the essence of a grassroots movement," says Elinor Ginzler, vice-president of health at AARP.

The village concept began more than a decade ago in Boston's Beacon Hill neighborhood. It has grown nationally to 56 villages with another 120 in development, says Candace Baldwin, co-director of the Village to Village Network, an information group. Each village differs slightly, as do annual membership dues, which range from $50 to $900 per individual.

Villages are usually started by neighborhood residents. In 2007, three older Chicago couples decided to create a village in their Lincoln Park neighborhood after seeing Beacon Hill's success. Lincoln Park Village opened for business in 2009, today counting 215 members age 50 and older.

Lincoln Park Village provides members with access to a full range of services and activities. Services include house watching, yard work, pickups and deliveries, pet sitting, and car rides to appointments. Volunteers and neighbors provide many services, but the village also has vetted a network of trusted providers, such as home-health services.

Dianne Campbell, the executive director of Lincoln Park Village (www.lincolnparkvillage.org), says she makes sure her members get their needs met with one phone call. "It doesn't take too much to be independent or safe," says Campbell, who is the only paid staffer. A board of directors and an advisory council, made up of members, make the decisions.

The village helped Estelle Spector, 81, make the transition to retirement last year when she left her position as an associate professor of theater. With the village, she says, "you meet people all the time." She has taken movement, water aerobics and art classes -- all for little or no cost -- through Lincoln Park Village. She's also involved in a village book club.

Spector turns to the village for help in caring for her ailing husband, a retired violinist. The couple has sought transportation, sidewalk shoveling, and leads on a handyman for the installation of shower grab bars and house painting. The couple pays $780 a year (individual memberships cost $540 a year).

The village offers classes in digital photography and sketching as well as trips to cultural events, such as theater outings. Spector praises the free experts, including one who spoke on understanding Medicare coverage. "I cannot tell you how that helped," she says.

If your neighborhood would like to start a village, go to the Web site of the Village to Village Network (www.vtvnetwork.org). Also, Beacon Hill Village (www.beaconhillvillage.org) sells a how-to manual on various aspects of creating a village, such as provider recruitment and setting up a board.

Mi Casa Es Su Casa

Senior home sharing is a living arrangement in which a senior provides an unrelated person a place to live. Each housemate has a private bedroom, and they share the kitchen and other common areas. Home sharing can defray housing or living costs, but it can also be a way for seniors to get help with chores, rides to the grocery story and other kinds of assistance. The housemate also can watch out for medical emergencies.

Retired engineer Joe Karnicky, 67, of Menlo Park, Cal., says he would be in a nursing facility if not for his home-share partner. Karnicky is confined to a wheelchair because of multiple sclerosis.

Every day for five years, José Puente, 69, has helped Karnicky get in and out of bed. Puente also helps around the house. In exchange, "José pays a substantially reduced rent," says Karnicky. Puente says he moved in with Karnicky because he was looking for companionship and lower-cost housing in the high-rent Menlo Park area. "We are very compatible," Puente says.

The best and safest way to find a home-share partner is to use one of about 70 home-share organizations nationwide. You can find a group at the Web site of the National Shared Housing Resource Center (www.nationalsharedhousing.org).

Karnicky and Puente were matched by HIP Housing, a nonprofit in San Mateo. The program provides seniors with an extra hand. "The high cost of home care can be challenging for many families," says HIP associate director Laura Fanucchi.

HIP Housing matches more than 300 people a year. "The program does a lot of the legwork for you," Karnicky says. HIP staff interviews home seekers and home providers, vets references and conducts background checks. After a placement, it regularly follows up with clients.

HIP house-sharers sign an agreement that covers rent and other money matters, as well as issues regarding cleanliness, visitors, pets, use of alcohol, quiet time, food and laundry. To protect against elder abuse, Fanucchi will not accept home providers who have memory impairment issues.

You've Got a Friend

Remember the communes of the 1960s? Cohousing is sort of an upscale version for the 21st century senior set. Individual homes, or apartments, are clustered around shared open space and a common house. Residents maintain their privacy in their own living spaces, but they can get together for weekly group dinners, socialize in comfy common rooms, and gather in courtyards or pedestrian pathways.

Cohousing communities in the U.S. number 124 in 26 states with another estimated 100 under way, according to the Cohousing Association of the United States (www.cohousing.org). Most cohousing developments are intergenerational, where seniors can babysit for youngsters, and younger families can run errands for older residents. But some communities are for elders only.

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One such development is Santa Fe's ElderGrace, a condominium neighborhood for people over 55. ElderGrace is composed of 28 one- and two-bedroom "green" homes with energy-efficient appliances and in-floor radiant heat. The common house includes a communal kitchen.

Cohousing is ideal for Pam Gilchrist, 71. She likes her privacy but also enjoys participating in a close-knit community and in different projects. For example, she is helping to start a car-share program, which would provide a fleet of electric cars for resident use. Gilchrist is a retired minister from Massachusetts who moved to ElderGrace when it opened in 2009.

Residents serve on teams. Gilchrist is on the outreach, gardening, and buildings and grounds teams. Another team arranges educational sessions on advanced directives and hosts exercise programs. Decisions are reached by consensus. Individuals own their own homes, but a housing trust owns the property.

Craig Ragland, of the cohousing association, says "each community makes its own agreements about what levels of care they provide for each other." For now, most ElderGrace residents are relatively healthy. Residents take other members to doctors' appointments. Gilchrist says the residents have agreed that "we will care for each other until it is more than we can manage, figuring it out as we go along."

Ragland says at the Songaia Cohousing Community in Bothell, Wash., where he lives, members provided most of the care for a resident who was dying from ALS, known as Lou Gehrig's disease. "At the end, he was completely incapacitated, and community members provided about two-thirds of the required care," Ragland says. Visit the cohousing association's Web site or call 812-618-2646 for a list of cohousing developments.

Give an Hour, Take an Hour

Consider the concept of a babysitting cooperative: In return for watching another member's child, a parent will earn a free sitter for a night. In central Vermont, Reach Care Bank uses this kind of cooperative system to keep aging Vermonters independent.

Reach Care Bank, which was launched last summer, is known as a time bank. Each of its 100 members pays an annual $25 fee, and each is expected to make a monthly commitment of time or money. If you spend an hour doing something for someone else, you earn a time dollar, which you can use to "buy" a service.

Members look to the network to help with activities such as shopping, pet sitting, yoga lessons and respite care. "The goal is to create an affordable and reliable network of volunteers who support the whole community as it ages through the mutual exchange of services," says Rachael Rice, Reach's director of outreach, development and training.

Polly Paulsen, 90, of Montpelier, uses Reach for rides to the grocery store, home repair and computer help. She accrues care credits by participating on Reach's advisory board, playing Chinese checkers with other members and helping with fund-raisers. "Reach has helped me to feel alive," she says.

Some members join to build up hours for an elderly relative. All members undergo reference checks, and those participating in wellness and caregiving programs also undergo criminal record and background checks. Members can find and offer services on the time bank's Web site. The bank's organizers keep track of the credits.

Dozens of time banks operate in 31 states, according to TimeBanks USA (www.timebanks.org). Check out its directory for an option near you. To start your own time bank, the Web site sells a kit for $70.

Doing It Yourself

Many people don't have access to aging-in-place models, such as cohousing and villages. "The vast majority of people muddle through, and family members chip in," says Mia Oberlink, senior research associate of the Visiting Nurse Service of New York.

If that includes you, some planning can reduce the amount of muddling. One of the first steps to take is to identify a network of family, friends and neighbors. You can call on them when you need help, perhaps with grocery shopping, if you feel ill or just to socialize.

Use AARP's Livable Communities Checklist (www.aarp.org/homedesign) to assess your home's safety and senior-friendliness. Your home may need minor changes, such as securing handrails or installing non-slip flooring. Major changes could mean putting in a full bath or bedroom on the first floor.

You can hire an expert to make these home modifications. The National Association of Home Builders, with the help of AARP, has developed a certified aging-in-place specialist program to train remodelers. You can find a local specialist at www.nahb.org/aginginplace (or call 800-368-5242, extension 8216).

Consider switching your physician to a geriatrician. Doctors trained in geriatric medicine are more in tune with issues of aging.

Hire a geriatric care manager to conduct a geriatric assessment, which identifies physical, emotional or social issues that may prevent you from aging well. For instance, the care manager could make sure that you're not being prescribed similar medications by different doctors. Or the expert could determine whether you're not socializing enough and arrange for you to get out of the house more. The manager could even decide that your home needs better lighting.

Contact the National Association of Professional Geriatric Care Managers (www.caremanager.org; 520-881-8008), or ask your doctor or a hospital discharge planner for the name of someone who performs geriatric assessments. Arrange for the care manager to check in regularly to make sure you're doing okay.

A care manager can help you find community resources. So can the Eldercare Locator (www.eldercare.gov) and your local Area Agency on Aging (www.n4a.org). They can provide names of home health aides, homemakers, transportation services, senior centers, adult daycare and home-repair contractors.

Consider your social life. Put a plan in place to help you pursue favorite activities. Perhaps that could take the form of regularly scheduled outings to a senior center, which can offer everything from theater trips to a game of bridge.