Be Prepared, Part Two

Though its been fifty-five or so years ago now, I can still vividly recall sitting around the kitchen table of  our rented duplex with nine or ten other third graders for monthly Cub Scout meetings.  Were I being honest, my favorite meeting activity was the snacks.  I didn’t want to be a Cub Scout.  There,  I finally said it.  This isn’t a critique of Scouting in any way, it’s just that it was only so because my mother was talked into being a Den Mother at a welcome gathering at my new school.  Thinking back on this now, I’m amazed that she found time for this, given she also had two kids in daycare, worked a part-time job as a nurse at a crosstown clinic and she and my stepfather were building a new home in another part of town.  This meant I was often needed to help keep track of a younger brother and sister in the evenings and on weekends.  Free time for any of us was a precious commodity and frankly were it left up to me, I would have spent all of mine outside.

All of that said, I was a Cub Scout long enough to internalize the the Boy Scout Motto, learned from our first days as scouts:  Be Prepared.  Not coincidently, this is also the Motto of the Girl Scouts.  Though I have no idea how many boys & girls participate in Scouting today, I know it was a big deal when I was a kid.  If you happened to read the previous blog entry, you’ll may recall that we subscribe to the dictionary definition of being prepared:  “to make ready beforehand, for a specific purpose, as for an event or occasion.”  The fact that the Boy & Girl Scouts would make this the centerpiece of their philosophy is simply brilliant as life lessons go.  For our clients, their families and caregivers, being prepared is one of the most important concepts we share.  

Often as not, we begin our work with clients after a life-altering event has occurred.  Perhaps it was a fall, medical diagnosis or procedure that triggered a series of steps needed to address current circumstances.  In other cases, it’s a call from a concerned family member or caregiver who is noticing signs of disability as the individual goes about performing their daily tasks.  One of the truisms I’ve come to understand from working with our clients is that everyone integrates disability into their lives in different ways.  This simply means that as individuals discover they’re having trouble with a particular task or process they used to handle easily, their frustrations tend to lead them to some form of adaptation.  While this may work initially, as conditions progress, the one-time solution may soon become untenable.  And while it would be great to have a helping hand nearby, not everyone is so lucky.  Failing a successful adaptation, they are likely to stop doing something altogether. 

It’s common for us to hear from elder individuals that their fondest wish is to successfully “age in place.”  Nationally, this is the most often recited desire for everyone facing the prospects of later life.  The paradox is hearing in the next breath that they aren’t certain they’re ready to objectively assess their situation or they believe they’ll simply “cross that bridge when they come to it.” It’s totally understandable.  For many elders, being asked to “look objectively” at their current circumstances is code for needing give up more of their daily lives due to disability, so they simply avoid it.  For others, it’s a clear signal that someone feels that they would be better off in some type of managed care circumstance.  Here’s the problem:  delaying preparation, the “crossing the bridge analogy”, often proves to be a life-changing misinterpretation of future circumstances because the assumption is that there will be a bridge, a way forward, that will help them safely navigate to the next step or stage.  Often as not, there is no bridge.  The reality is that relatively healthy and active seniors can go from lives in their own homes to living in long-term residential care facilities literally overnight as a result of illness or a fall.  

So...  What to do?   Our advice, “first things first.   (Included in our recommendation is that you take a few minutes to review our first post on being prepared.  It goes hand-in-hand with the information we share here).  Let’s start with something that should be the cornerstone of your efforts if you are truly serious about successfully aging in place. 

Fall Proofing the Home

Reality is pretty stark.  According to the National Council on Aging &  U.S. Centers for Disease Control and Prevention:

• Nearly one in three Americans, aged 65 and over, falls each year.

• Only one in three of these individuals seeks out medical care.

• In 2015, more than3 million older adults received treatment in emergency department for falls and fall-related injuries.

• Unintentional falls accounted for approximately 30,000 deaths in the United States in the same. year.

• The estimate for for fall-related deaths among U.S. adults aged 75 years and older increased, nearly tripling from 2000 (8,613) to 2016 (25,189).

Falls, including those without significant injury, can exact a heavy toll on the quality of life.  Fear of falling can severely limit an individual’s activities and participation in beneficial social engagements.  This can result in further physical decline, depression, and social isolation.  And while simply aging does not predispose an individual to falling, the risk increases due to overall weakness, frailty, problems with balance, cognitive concerns, problems with vision, medications, illnesses and environmental hazards.  The best predictor for an increased risk of falls, is a history of falls.  

The term “fall proofing” is really a misnomer.  No entity can claim that their means or methods will make someone truly “fall proof.”  But that doesn’t mean you shouldn’t work toward the goal of minimizing fall risks within the home.  We look at this as a two step process.  The first step or recommendation we have is getting evaluated utilizing the tools established by the Center for Disease Control.  The program is called STEADI and is a great initial step in the process of determining fall risks.  The evaluation is done with your healthcare provider.  More information can be found in the STEADI Toolkit.  

So lets say you’re getting or have gotten an evaluation.  The next logical step is to take the advice of the experts and work to improve conditions within your home environment.  Our favorite “checklist,” comes from the (NCOA) National Council on Aging.  You can find it & an explanation here.  There are a number of good checklists available, but our belief is that this one more than adequately covers the bases for the average individual.  

The last of the pieces of advice in the NCOA’s checklist is something we can’t echo enough:  Find an occupational therapist for advice.     OT’s always begin by asking, “What matters to you” as opposed to “What’s the matter with you?”  No medical professional is more qualified to identify hazards and make recommendations to improve the fit and function of your home, keeping you safer & more productive as you go about your daily tasks and activities.  The importance of being “fit” to your environment can’t be overemphasized.  Let me give you a personal example.  I’m 6’7”, and while there are well-known standards for setting the height and positioning of a bathtub grab bar, for all intents and purposes, don’t fit me.  Installing them at ADA standard makes them just too low for me to use them safely, so why would I do that? You may not be taller than average, but what if it’s difficult for you to raise your arm or to even grip a bar?   Is it just a grab bar that’s needed or perhaps a transfer tub bench and personal shower that would keep you safest?   I’d bet there are specifics to your situation, that were they to be uncovered by a home visit with an OT, would significantly inform a plan to help you avoid a fall in your bathroom and in all the other rooms of your home. 

Having touched on this early in this piece, it’s important to reiterate that this is the kind of thing that will not take care of itself.  Nobody is going to “cross that bridge” successfully without taking specific planning and action steps to prepare for what’s potentially ahead.  Ignoring the problem for fear of giving up more of your life flys in the face of your experience in Scouting, and can be seriously life-threatening.  Please, please, please don't ignore the warning signs or that nagging little voice in your head telling you to get busy.  

Everyone’s situation is unique.  Getting a trained pair of eyes to determine opportunties & recommend remedies is an investment in your health and safety that pays dividends every day.  And yes, we do that.  Please reach out of we can be of help to you, a family member or friend.  

Be Prepared, Part One

Late one Friday night a few weeks back, an ambulance raced past on the way to a neighbor’s home at the end of the block.  If you’re at all like me, no matter how many times you’ve had this experience, its always a bit unsettling.  Because an ambulance, by definition, is the primary vehicle for the delivery of emergency medical services.  Secondarily, they're tasked with transporting individuals in need of more extensive medical attention to the nearby facilities that provide it.  All of this is accomplished under enormous amounts of pressure to respond to conditions quickly.  So for all practical purposes, lights and sirens mean something is very wrong.  I know, thanks Captain Obvious.

As I was thinking about all of this, a couple of questions came to mind.  God forbid it should ever come to that, are we prepared for everything associated with first responder dispatched to our home?  And what could we do to help those first responders, given a that the common denominator in all emergencies is that time is of the essence?  So let’s stop here & define what it means to be prepared.  If you were to look in the dictionary, you’d find something along the lines of “to make ready beforehand, for a specific purpose, as for an event or occasion.”  That’s spot on.  And while being prepared is second nature for some, for others of us, it something that not much thought is given to.  So for the first of our being prepared posts, let’s talk about preparing for emergencies.

Because we live in Oak Park, Illinois, some of what will be mentioned here will be specific to preparing for some types of emergencies in our village.  In reality, most metropolitan communities have very similar sets of programs.  If you’re interested in pursing emergency preparedness, we’d recommend focusing on the village, city, township and county websites in your area to begin your search.  In the meantime, and acknowledging this is not an all encompassing list, here are four really good starting points that will be important everywhere:

1. Make sure your house number can be clearly identified from the street in front of your home. Ideally, the numbers should be close to the front door and easily illuminated by a bright porch light. It’s best for them to be in contrasting colors to the paint scheme of your home, and the larger, the better. If your home is set back significantly off the street, house numbers on a yard mailbox, the fence or yard sign adjacent to the street are the next best thing. One of our earliest clients had a beloved Japanese maple, planted adjacent to the entry steps. It had gotten so tall that it was now completely covering the house numbers. There wasn’t a viable option in terms of moving them to another spot on the home so in our recommendation, we provided resource options on monument signs that could be installed adjacent to the steps or near the public sidewalk. Anything that helps a first responder or visitor be able to clearly identify the home will be a plus.

2. Provide ample warning of pets on the premises. Our front door mat notes this fact for everyone arriving at the door. There are a wide variety of types of signs and decals, (pets inside stickers & yard signing), that can be displayed that will help first responders and visitors prepare as they enter your home. Remember, your dog may be a lovable companion for you and your family, but may be a significant threat to first responders given the frenzied nature of strangers entering your home in an emergency situation. For additional information on pet handling during times of emergency, advice from the CDC can be found here.

3. Have an In Case of Emergency name & number (ICE) on a laminated card in your wallet and if you still have one, next to your landline phones and extensions. If you’re carrying a cell phone, it would also be helpful to have a contact in your phone labeled as (ICE). This would be someone who can make decisions for you in case it’s needed, most likely someone who is next of kin. There are cellphone applications that will help with this, and found in both the android and iPhone app stores.

4. Establish a support network to call upon in case of emergency. This is likely family, friends and neighbors who can quickly provide assistance if/when needed. It’s important that they have a spare key and codes to the alarm where applicable. Make sure you share your emergency plan(s) and practice executing those plans with them. When they enter your home, they should know where to find your emergency contact information (if they’re not family members) and where any emergency supplies are kept. Ideally, they can use lifesaving equipment or are able to administer medicines, but that shouldn’t preclude anyone from being included in your network. If you undergo routine treatments administered by a hospital or outpatient facility, find out what their emergency plans are and work with them to identify back-up service providers. Finally, if you have a communication-related disability, make sure there are instructions available that note the best way to communicate with you.

So you’ve already addressed these points.  What’s next?  

In our village, the 911 Emergency Needs Registry (click the link) authorizes Oak Park to transmit important medical information to first responders in the event of an emergency at your home.  Along with the general identification, the form outlines disabilities, medical equipment that you may employ and emergency contact information that will be vital should there ever be a need for these services.  The registry is a great option for those who don’t utilize cell phones as yet.  

For those employing cell phones, an even better option in our village is a smart phone application called SMART911.  In addition to being an emergency registry, the application also pushes emergency messaging to the residents and business entities in the village on an opt-in basis. These notifications can be received as texts, emails or voice messaging.  To opt in, you can find more information on the community notification system here.  SMART911 allows individuals to craft & manage a free safety profile linking their home and work addresses to cell phone numbers.  The profile includes specific information that will be invaluable to first responders including  emergency contacts, medical conditions, pets in the home, other individuals living on the property, vehicle descriptions and property details including utility information.  It works incredibly simply: after the profile is created and submitted, should anyone in household dial 911 from the phone associated with the profile, the information is immediately displayed to the emergency dispatcher.  Because this is an opt-in service, folks utilizing it can provide as much or as little relevant information as they wish and that information can only be viewed by emergency dispatch personnel when 911 is called from a registered number.  The program works on both Android and Apple IOS phones.  At this point, as we’ve noted, our village, the City of Chicago and any number of surrounding villages, cities and Counties in Northeastern Illinois are utilizing the application.  

The Oak Park Fire Department also participates in the Knox HomeBox key security program.  This allows firefighters to access your home in the event of an emergency.  Knox Boxes are commonplace for commercial or industrial facilities.  A highly secure KnoxBox is installed on the outside of your home, the key to the adjacent entry is housed in it & the master pass key to the box is secured by the fire department.  There is obviously a cost involved, but from what we’re told, it’s approximately the cost of repairing or replacing the entry door the first responders come through for whatever reason.  As a program, it’s another option for consideration in your preparation for emergencies.  

Finally, one last important point of overall preparedness, since we’re discussing emergencies.  I highly recommend spending time on www.ready.gov.  There are comprehensive checklists that will help you plan ahead to address any concerns you may have regarding emergency preparedness, including this one specially focused on Seniors.    The Centers for Disease Control (CDC) has a section on emergency preparedness for Seniors as well, as does the American Red Cross.  In our village, Oak Park additional information and links to other preparedness sites can be found here.

Everyone’s situation is unique.  Getting a trained pair of eyes to determine opportunities & recommend remedies is an investment in your health and safety that pays dividends every day.  And yes, we do that.  Please reach out of we can be of help to you, a family member or friend.  The reality is that this information applies to everyone. 

  Up next in the discussion of being prepared, what I learned when I was a Boy Scout.  

Social Participation

“No man is an island, entire of itself; every man is a piece of the Continent, a part of the main.”

    - John Donne from a sermon captured in Devotions (1624).

As you may know, I retired from “corporation work” a few years ago.  I went from interacting with literally dozens of customers and co-workers each day, to moving within a significantly smaller circle, composed primarily of family, friends, clients and business partners.  At the time, the prospect of moving into retirement didn’t sound so bad given the fact that our youngest daughter would soon be entering high school, my wife and I were literally ships that passed in the night, and I’ve never felt there was time for those things I'd like to do, were I to have anything resembling free time.  Being able to spend more time with family has been an enormous blessing, but it became clear to me not long thereafter that there were other facets of my life that have become more quiet than I might like.  No, I truly don’t miss working the long hours, days away from home, bureaucracy, and dealing with everyone else's agenda.  As it turns out, what I miss is the daily person-to-person interactions.  For me, the old adage of not missing the work, but missing the people was all too true.  

In reality, unless you live many miles from your nearest neighbor, there are typically no end to the opportunities you have to be social participants while simply living life.  Be it with family, friends or other like-minded individuals, we participate in life events and activities that are meaningful to us and to those we care about.  And because our social circles are typically larger when when we’re younger, raising families and perhaps in the workforce, the frequency of our social participation is exponentially greater than when are older.  Twenty or more years ago now, a friend of ours once remarked that he had sat down with a calendar and mapped out the social occasions and various other commitments for that year.  He came to the unscientific conclusion that he would have about eight weekends a year that weren’t already reserved for a commitment likely as not,  wrapped around a social activity.  And while I laughed about that at then, had I taken the time to map our social circumstances in that way, I’m not sure we wouldn’t have seen the same results.   For those reasons, it’s unusual for many of us to have too much “me” time.   And that’s looking more and more like a good thing, particularly as we age. 

When you’re not heading off to work every day, the reality is that you may be missing out on important social interactions that can serve to promote and maintain good physical &  emotional health as well as cognitive function.  Research shows us that those who find ways to continue social interactions as they age live longer than those who become isolated.  Let that soak in for a minute.  Social isolation can involve any number of factors including living alone, health related issues that may include a disability, and or sensory impairment like hearing loss or failing vision.  If the individual has lost a spouse or significant other, they may be even more susceptible to emotional and social isolation. If one truly wants to remain independent as possible within the familiar surroundings of their own home & community, one of the the worse things they can do is to socially disengage.  

Working to sustain family connections, friendships and social interaction as we age actually helps us protect against illness by boosting immune system functions.   Though not an all inclusive list, some of the specific benefits of remaining social active as you age include:

• A potential reduction in the risk for cardiovascular problems, some cancers, osteoporosis and rheumatoid arthritis.  
• Lower blood pressure
• A potential reduction in the risk for Alzheimer’s disease and mental health issues such as depression.
• Increased self-confidence resulting from a sense of accomplishment.
• Maintaining close friendships and being socially active helps keep you from losing cognitive function.  It’s even more effective when coupled with a overall healthy lifestyle, including proper nutrition and physical activities.  

So how does someone sustain strong connections to family & friendships and grow opportunities for social interaction as they age?  It begins by making a conscious effort to do so.  It may be easier to keep to oneself, not wanting to impose on others.  Family member or valued friends may have moved out of the immediate area, making it more difficult to stay connected.  Trust me when I say that keeping to yourself or not reaching out because someone isn't in close proximity anymore is not going to be a winning strategy if you truly want to age gracefully.   In addition, 

• Why not volunteer within your community?  Your work and life experiences are incredibly valuable assets.  Why let that go to waste simply because you’ve stepped away for the work-a-day world?
• Visit a senior center and get involved in the activities offered.  It’s a great way to meet new people and helps you remain a social participant.  Why not bring along a friend?
• Join a group or club that helps you share a passion around the activities you enjoy , book clubs, woodworking groups or perhaps a charity organization.  What do you have a passion for?  
• Take a class - learn something new or get help with rekindling an interest that may have been put to the side previously for lack for time.  Hopefully, someone has the stamina to help me with my non-existent golf swing.
• Join a fitness program.  Staying physically fit has any number of positive health benefits and doing so with others can help keep you socially engaged.  This is vital because it helps reduce your risk of developing a disability with activities associated with daily living, as you age.  

 In addition to what I’ve already mentioned, benefits can include slowing the decline in motor function, (e.g., muscle strength), decreasing the risk of developing a disability in activities associated with daily living, improvements in memory, and helping aging adults stem symptoms of depression.  Activity-based social participation may also help the individual to gain knowledge, self-confidence and contribute significantly to their emotional well-being.  As importantly, it may allow the individual to continue building & sustaining a much needed sense of accomplishment by enabling them to continue contributing to their communities through the sharing of their energy, passion, knowledge and experience.   

I’ve made a lot of claims about the benefits of or the perils of not remaining social participants as you age.  If you’re interested in the detail and depth of research behind what I’ve shared, here’s a link to a comprehensive study published by the Centre on Aging at the University of Manitoba in 2013.   Or if you have a few minutes with your internet-enabled device, just google “benefits of social participation to the aging process.”  There’s a great deal of information available from any number of trusted sources like AARP, to help individuals remain a social participants and ways in which we can get started or continue doing so.  If you have roughly twenty minutes to spare, I'd like to share a video from TEDx in Des Moines from 2013.  John Cacioppo speaks to the Lethality of Loneliness.

If you’re a Senior, reach out to family and friends and look for opportunities to engage socially.  If you’re the adult child, family member, caretaker or concerned friend of a Senior, reach out.  The benefits it will afford can’t be overstated.    

As always, we’re very interested in your perspective and experiences.  Please let us know what you think.  Thanks very much for your time. 

Commission on Aging - Oak Park

Early in January, Monika and I attended the first of the regularly scheduled community forums held by Oak Park Mayor Anan Abu-Taleb.  The topic that evening was Aging in Oak Park.  Joining the Mayor on the panel was Lydia Manning, PhD, associate professor of Gerontology at Concordia University Chicago Center on Gerontology and former Oak Park trustee and Wednesday Journal columnist Marc Blesoff.

Marc writes on the issues of aging for the Wednesday Journal & kicked off the forum conversation with a short video that we would like to share with you. 

Among the many takeaways I had upon watching this video is that in the broadest sense for villages like Oak Park and concerned citizens groups within, there is an incredible opportunity to apply more diverse & creative thought processes to addressing the difficult issues that many elders and disabled individuals face as they look to remain actively engaged in their communities.  

There's a quote widely attributed to Albert Einstein that I think is appropriate to this conversation, "We can't solve problems by using the same kind of thinking we used when we created them."  Applying  "different thinking" to the challenges of aging and for those living with disabilities in communities like Oak Park is a cornerstone of the services provided by Living Fully At Home.  Recognizing this as an important initiative, we've volunteered our expertise and experience to assist the efforts of the Mayor and Oak Park Trustees with the Commission on Aging they're planning to launch in the near future.  More on this later. 

As the conversation progressed, another of the issues that stood out to me was the need to continually communicate the ready availability of relevant Township services to those individuals who would most benefit from them.  There were stories shared by neighbors who didn't know about services like transportation and meal services offered by the Oak Park Township.  In addition, the Township also offers a number of additional services including case management.  If you live in Oak Park Township and are interested in learning more about the services it provides for Seniors, please click here.  You can also inquire by phone at (708) 383-8005.  

One more thing on thinking differently.  It's important that we "think differently" especially when we're looking to solve problems because that's how we innovate.  Thinking differently is really the definition of innovation.  It will take innovative thinking to solve the problems facing those wishing to remain safe, active, and productive as they age or are presented with disability.  

What do you think about the information shared in the video?  I'm also interested in hearing ideas  you might have on reaching Seniors with information like the services the Township provides.  The individuals who participated in the Mayor's forum were likely "connected" in some way, shape or form, yet there were a significant number who had no idea the Township provided transportation or meal services.  And this isn't meant as a criticism of the Township, but an opportunity to help find innovative ways to get the message of their services out in as effective a manner as possible because it's vitally important to the health and well-being of a number of seniors in our community.  

Thanks very much for your time...

Creating and Recreating Home: Options for Aging in Community.

In late November, Monika and I attended the Arbor West Neighbors forum at the Oak Park Public Library titled "Creating and Recreating Home:  Options for Aging in Community."   Arbor West Neighbors is a grassroots, inter-generational organization of neighbors connecting to empower adults to thrive as they age in the community.  Their goal is to support the residents of Oak Park, River Forest, Forest Park, and Austin who desire to age in the home of their choice through the promotion of an age-integrated society that recognizes the voices, power, and needs of engaged adults.  You can learn more about Arbor West Neighbors by clicking here.  

The forum was broken up into a pair of panel discussions lead by a variety of subject matter experts, housing advocates and village resources, followed by a number of smaller group conversations, leveraging the audience, that continued to share ideas around topics like cooperative housing, adaptive re-use, and alternative housing opportunities for consideration in the overarching conversation around aging in suburban communities like Oak Park.  

I joined the group discussing "tiny homes", a conversation facilitated by Paul Schultz, the designer and builder of the Toybox tiny home.  Where zoning convention allows, tiny homes are becoming increasingly popular home options for those wishing to live more simply and affordably.  The conversation at our table focused on the kinds of options and opportunities that might exist around the utilization of a tiny housing strategy within a village like Oak Park.  That included blocks of houses on open properties, multi-story tiny housing and using the footprint as a model for a coach house on the properties with larger footprints.  This was just one of a number of discussions around the opportunity to think differently as it regards solving the problems of a population wishing to age in place. 

Living Fully At Home has opted to become a member of Arbor West Neighbors and we're looking forward to supporting the programs, advocacy activities and events like the recent housing forum.  If you have an interest in helping empower seniors or disabled individuals as they seek to continue living in their communities, we'd highly recommend seeking out groups like Arbor West Neighbors.