Contributed by Margot McWhirter, MA, OT Reg. (Ont.) who is a Consultant on Inclusive Aging, Aging-in-Place, & Accessibility (www.inclusiveaging.com)
Margot, how long have you been an aging-in-place and accessibility consultant? Please tell us in more detail what you do. I’ve been involved with aging-in-place and accessibility issues throughout my occupational therapy career – so, for over 25 years now. In 2019, I started consulting on a full-time basis. I make it possible for people to stay in their own home as their needs and abilities change by reducing the barriers that limit independence, health and safety. This includes working with people who are planning ahead for empowered, resilient aging. As well, I work with individuals and family caregivers who are facing unexpected challenges in daily routines and activities, due to medical or mobility issues – which can include COVID. Specifically, I assess, recommend and guide people through their options for home modifications, equipment, health care and community services. I also help bridge the gaps within and between disjointed systems, to enable clients to access resources and optimize their well-being at home.
How would you describe the state of aging-in-place in February of last year, before the virus? Aging-in-place is typically defined as being able to continue living in the home of your choice while getting the help you require, as your abilities and needs change. On the one hand, (pre-COVID) research shows that 90% of Canadian homeowners aged 65+ want to stay in the family home as they age. (And we know that the vast majority of them have done this, and continue to do so.) On the other hand, public data for the past several years shows ballooning wait lists for admission to long-term care homes. This suggests a potential mismatch between a personal desire to stay put and the physical capacity of the home itself – and/or the availability of formal or informal services within the home and community – to meet the needs of elders with declining abilities.
To what extent were the accessibility needs of seniors being accommodated in February of last year, before the virus? Accessibility needs encompass mobility, vision, hearing, cognition, etc. relative to the design of physical spaces (e.g., public, commercial and private) – as well as issues related to information, communication, customer service, transportation, and housing. In general, more can and ought to be done to design products, spaces and services that are usable to the greatest extent possible by everyone, regardless of their age or ability. (This is a modified definition of the term “universal design”, as first coined by Ron Mace, founder and program director of The Center for Universal Design.) Accommodating accessibility needs is as much attitudinal as it is structural, and society has a way to go to be more inclusive of older persons with diverse abilities.
How did things get worse for seniors living by themselves at home? For some older adults living alone, especially those who are housebound by chronic health problems, COVID-19 hasn’t changed their daily lives very much. They continue to see Meals on Wheels volunteers, personal support workers and other care or service providers, on a regular basis. For others though, the pandemic has meant a significant change in their usual routines and social interactions, in or outside the home. This may leave them feeling lonely, anxious or depressed. The lack of socialization, when combined with a lack of stimulation, can contribute to or worsen cognitive losses such as impaired concentration, memory or thinking. It’s not yet known what the long-term impacts might be, nor if these losses are reversible.
How did things get worse for seniors with accessibility challenges? One of the things I’ve noticed since the start of the pandemic is an increase in the number of older clients who have fallen. Impaired balance is more common now, even among some active older adults. This is worrisome because we know that, irrespective of COVID, approximately one-third of older Canadians fall each year, with half of those experiencing a second fall within 12 months. Of those who fall and require hospitalization, almost half are unable to return home – at least not without major modifications and/or access to ongoing care and support. The physical, emotional, social and economic consequences of falls on individuals, families and the health care system are significant. Now more than ever, we ought to be encouraging older adults to practice evidence-based fall prevention strategies, and advocating that public, commercial and residential spaces be designed, built and maintained to minimize the risk of falls or other injuries.
What changes were made, if any, to deal with these problems? Have new resources been made available? A few of the innovative programs, services and resources that help support older adults during COVID include:
• Recruitment and coordination of volunteer (grocery) shoppers
• Dedicated shopping hours (at some stores) for older adults and vulnerable persons
• Digital literacy classes, to teach older adults how to use technology for recreation, socialization, and accessing online services (e.g., banking)
• Online programming for seniors-oriented entertainment, fitness and learning opportunities
• Online support for family caregivers (i.e., caring for those with dementia)
• Card/letter-writing campaigns (sent to isolated seniors)
• Specific to aging-in-place and accessibility, the Ontario government announced a tax credit for accessible home modifications, and enhanced funding for eligible home care clients who would otherwise be admitted to a long-term care residence.
Please describe the situation as it is now, and as things might evolve during the rest of the winter and 2021.
With regards to aging-in-place, one of the primary differences between now and pre-pandemic has to do with the tragic loss of life and widespread exposure about the appalling conditions inside long-term care settings. This reality has spurred families’ interest in protecting their older loved ones from harm, and in taking a closer look at how they can maintain and extend their ability to stay safe at home – either on their own, or by moving in with family. Staying put (or with family) is not a viable option for every older person. Yet, by working with experts in health, housing, finance, and care services, it can be an option for many of the 2.37 million Ontarians over the age of 65. Essential services continue to be delivered during periods of emergency lockdown, and some assessment and planning work can be done remotely. This includes the work that I do.
What is your outlook for 2022? The need for accessible housing that is attractive and functional for all ages and abilities existed before COVID-19, and it will continue to be needed long after the virus has been eradicated. The same goes for care and support services that target the management of chronic diseases, which are more typical of older populations than acute illness. The number of older Ontarians is projected to accelerate over the coming decade as more Baby Boomers turn age 65. I’m optimistic that 2022 (and beyond) will be a period of hope, healing and healthy housing – one that fosters proactive aging-in-place. Both publicly and privately funded programs and services will emphasize safe, community-based solutions as society demands alternatives to retirement and long-term care. Individuals and families will continue to need trusted advice and guidance about their options, and how to access them.
Do you have any advice for seniors or their family caregivers as they try to cope right now? My primary advice is to remember that you are not alone. Whether it’s a friend, family member, volunteer or professional – there are people who care about you, who are willing to listen and help out as best they can. It may look, feel and sound a little (or a lot!) different than it did before the pandemic. But help is available, whatever your circumstances might be. Focus on what you can control, and the options that are available to you – rather than on what you can’t control, or what’s lacking. Healthy aging involves being able to cope with change. I’m always impressed by how resilient older adults and their caregivers are. Even if you don’t feel particularly resilient right now, know that this too shall pass. We will get through this. We are getting through this. Stay safe. Stay home. Stay safe at home.
FOR THINKING AND DISCUSSION
Do you know seniors with relatively few nearby family members that need support? How can you help?