Planning for Older Age

Planning for older age and “disability” is something we might all wish to put off. It is inevitable you might say, so why make the effort?

As someone who has been in home and community care for the last twenty years I can both empathize and sympathize. But, there are many things we can do to help make our later years worthwhile, meaningful and relatively healthy.

When we think of planning, we may think of financial planning, of saving or insuring the risks of care. Providing for care in the home, over and above the hours provided by public health, or long-term residential care can indeed be expensive for those individuals with high support needs. But the financial side is not the heart of the matter. The social and emotional, physical and spiritual aspects of being, irrespective of age or the side of the care relationship you are situated, should be the central focus of forward planning. We are not preparing for the loss of identity but its continued meaning and relevance.

There are many non-financial assets and resources and considerations we need to bring into the equation to fund this important stage of our lives and these include the following:

• Building and maintaining social networks.
• Developing interests and activities to address your wider needs.
• Being physically active, especially with respect to cardio-vascular and muscular skeletal health.
• Eating healthily and taking care of our metabolic health.
• Engaging with and knowing the local community, its places, social, cultural and physical assets necessary for supporting socially connected and engaged lifestyles.
• Considering what is important to you as a person so that you can effectively communicate wishes and preferences regarding care, especially towards the end of life.
• Assessing the ability of your home and local environment to meet your future changing needs, and where transitions may be needed to prepare in advance for them.

The first 5 points are all important intergenerational issues.

Building and maintaining social connections are important for emotional well-being and physical health.

The cliché that loneliness is equivalent to smoking 15 cigarettes a day is backed up by research showing its impact on cardio-vascular health, immune system function, cognitive health and decision-making ability. Social networks are also important in that they represent resources you can draw on to help you remain in your home and community, especially as you lose ability to drive, shop, or do heavy lifting. Social networks support families, care partners and the person being cared for and are a worthwhile investment.

Developing and maintaining interests and activities keeps you active and mentally engaged, provides reasons for living and opportunities to meet new people. Having opportunities for personal growth, to contribute to our communities and retain control over our identities are vital to our mental health. Mental health is a risk factor for dependency later in life.

Being physically active supports mobility and limits the impact of disabilities as we age. The research is supportive of physical activity irrespective of age and for those living with chronic health conditions. Far too many of us fail to meet minimum exercise guidelines and underestimate the importance of physical activity, especially strength and balance exercises, in supporting independence in later life. We lose important muscle mass from our thirties onwards and from age 65 onwards muscle loss rises to 15% per decade.

Many of our most challenging health conditions (diabetes, cardio-vascular and neurological health) are impacted by insulin insensitivity, a consequence of sedentary modern lifestyles and processed foods. Addressing nutrition and metabolic health is one of the most important things we can do to help support our health and our functional abilities in later life.

Knowing the “assets” within your local communities, in particular those situated in the walkable areas surrounding, and including, your immediate neighbourhood is particularly important. Is your habitat supportive of the type of environment you would like to live in as you age? What opportunities exist for social, physical and spiritual engagement? For those who are living with complex health conditions, or are a care partner to someone who is, knowing the support groups and connecting with resources in your community is vitally important. Becoming active in our communities is one way in which we can remain engaged with higher levels of social support

By focusing on the wider picture of successful ageing we are better able to plan for decisions that might otherwise have only negative connotations. Should you downsize, move to another community or renovate your home to make it more age friendly? Is remaining in your own home irrespective of your abilities as you age supportable and realistic and what else would you need to do to facilitate this? Aging is a natural part of life, not its end. Many who experience disability and chronic illness consider themselves to be aging successfully.

Physical activity, metabolic health, social networks, interests and activities support independence and abilities may help defer and or reduce the need for expensive care in later life.

The financial costs of providing care in later life can be considerable. A 2005 paper by Kemper et al, “Long-Term Care Over an Uncertain Future: What Can Retirees Expect?” modelled the risks of long-term care for over 65s using US data. The model used a moderate assessment of needs; one or more activities of daily living and four or more instrumental activities of daily living or some form of formal, informal or nursing home care. It calculated that the average male would need some 2.2 years of care and the average female 3.7 years of care, with 79% of women expected to need some form of care. The model estimated that 31% would avoid the need for care of any type and 20% of people would need it for 5 or more years. Of the moderate care definition, 2/3rds of the time was expected to be spent in the home with the remaining third in nursing homes and assisted living. The model estimated that 63% of people would not need any nursing home or assisted living care.

In Canada, while government funded home care is free, the hours of care are restricted leaving families to provide much care either informally or through private service providers. Private home care costs for agency-based care are $30 an hour or more. Eight hours of care a day is some $1,680 a week before tax while a more modest three hours a day adds up to $630 a week or $2,730 a calendar month. Basic long-term care fees are currently $1,891 a month or $2,701 for a private room (2020 data). While long term care or nursing homes are considered to be 24-hour care facilities, the actual amount of care a person can receive on a one to one basis within a care home can be as little as 3 or 4 hours a day, with limited social and emotional engagement. Many families find they need to provide additional care within these facilities either informally or through private home care. For those living in residential retirement communities home care services may also be additional monthly costs.

Unfortunately, there is little guidance as to how many hours of care a person could expect to receive from the state for a range of scenarios making it extremely difficult for most to independently plan and organize for care in advance.

Most people would prefer to remain in their own homes till the end of their lives. To do this many may need assistance to help perform activities of daily living and to connect with friends, interests and activities. Part of planning is to know when to address social, emotional and physical concerns before they transcend into the type of emergency that forces you to consider often much higher levels of home care or a nursing home alternative. All planning should incorporate an understanding of what care and personal supports can achieve in terms of supporting abilities and independence and the steps that need to be taken to connect with health and other community resources when we reach certain milestones. For the most part the point at which we start needing care is viewed as a loss of identity, and consequently often delayed until or past the last possible moment.

Home and community care remains overly focused on incapacity to the detriment of successful aging and aging stereotypes. While we need to be aware of the costs of care in our decision-making, we need to give much more serious consideration to those non-financial assets and resources we can cultivate to mitigate future time and costs often associated with care provision. Early holistic planning should also hopefully engender a culture of earlier intervention by persons, families, communities and health systems.