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Aging & Society

Thriving in Place

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Travel through a region like Scottsdale or Tampa and you might believe that all of America’s elderly are destined to move to warm-weather climates. But the reality is much different.

The idea of staying at home, widely known as “aging in place,” is going through a revolution as new services and technologies become available and are integrated to enable the aging to have the best possible care and life at home. As Notre Dame professor and noted expert in American housing Marianne Cusack says, “It’s time to rebrand ‘aging in place’—generally seen as an activity for old people—and start a discussion, instead, on ‘thriving in place’—as a goal for everyone.”
Many people in or approaching retirement age and their families postpone this planning until a serious incident, such as a fall in the home, or a major life event, such as the death or custodial care of a companion or spouse. Often elders and their families mistake a measure of “accessibility” for “livability” and believe that the addition of ramps and some grab bars are all it’s going to take to age in place.
One of the big myths about renovating a home for growing older is that these renovations will irreversibly damage the character of the house and hence, its value, says David McManus, a partner in the home remodeling firm McManus & Father. “The reality is that some smart renovations can be valuable for people of all ages. Features such as highly convenient kitchens, wider doorways, living level laundry facilities and ground floor master suites can add to the overall value of a house, not detract from it.”
Integrating facilities and services
A growing number of organizations, both public and private, are working to develop and implement concepts for later-life care. One of them, the National Aging in Place Council, ( has brought together a network of public, private and not-for-profit organizations devoted to the cause of “thriving in place.”
In addition to planning for home alterations, those planning on thriving in place should also consider options for in-home caregiving, including the hiring of live-in assistance. Despite being less expensive and better tailored care, when compared with nursing home living, in-home care is one of the nation’s most fragmented and misunderstood health care segments. People looking for such care have options ranging from certified home health aides provided through local agencies to untrained workers advertising themselves on either actual or virtual bulletin boards.
Can a new model work?
A California-based venture called Honor ( is working to try to change the face of in-home care. Honor uses a smartphone app to connect home health care professionals, called CarePros, with those in need of their services. Honor’s app aims to make hiring a CarePro easy, whether the engagement is for a few hours or for several years.
Steinberg stresses that the convenience of the app is only a small part of Honor’s appeal. “Before we solicited funding for Honor, we did tons of research, both to learn what those who were hiring caregivers wanted, and what those who were caregivers themselves needed from us. There weren’t many surprises on the customer side. They want integrity, reliability, quality, compassion and value.”
He continues, “There were, though, surprises on the caregiving side. They wanted flexibility in setting their own schedules, ease in getting paid for their work and expenses, and above all, a greater sense of respect for contributions to health. Society greatly undervalues the contributions of home health care workers, to the point where their work in many cases is generally categorized as ‘unskilled.’ If that’s the way you make your living, imagine how that characterization makes you feel.”
Says Steinberg, “As a nation we are destined for a great change in in-home caregiving. The demand is there, exploding really, and technology is coming to bear at full force. But the first thing we as a society have to do is to demonstrate that caregiving work is viewed as valuable and important.  Just that mindset gives us all a much better chance of turning ‘aging in place’ to ‘thriving in place.’”

Five Tips for a Successful Partnership with a Home Health Care Professional
1. Plan ahead. Just as the best time to fix a hole in the roof is when the sun is shining, the best time to plan for home health care is when you don’t urgently need it. Groups like AARP and the National Aging in Place Council have loads of information on home care on their websites.
2. Understand responsibilities and boundaries. It’s important to have a complete, and written understanding of what the home health care professional is going to do, the hours to be worked, how living arrangements will be shared, what weekly budgets may be, and what the expectations are for issues such as use of a car.
3. Have clearly defined channels of communication. Home health care professionals are often concerned that they have to respond to orders not only from their agency and from the person being cared-for, but also from many other family members and even from neighbors. Have a way for the caregiver and the family to express concerns constructively and resolve small issues before they become big ones.
4. This is a job and even a career, not a volunteer assignment. Make sure that caregivers are paid on time and that agreed-upon reimbursable expenses are swiftly reimbursed. In-home caregiving is not highly paid work and many home health care workers face problems if payments are delayed, even briefly.
5. Assume good intentions. Even the most patient people in the world will be tested by the rigors of in-home care. When dealing with the inevitable problems that arise, begin by assuming good intentions on the part of all parties. That makes it much easier to analyze and resolve issues.

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