Dementia Reimagined by Tia Powell

Author:Tia Powell
Language: eng
Format: epub
Publisher: Penguin Publishing Group
Published: 2019-04-01T16:00:00+00:00

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What would it take to provide better support at home? You’d have to start with the home itself. Is it accessible for a person who uses a wheelchair or has trouble walking? Are there steps to the house or inside? Are doors, including to the bathroom, wide enough to fit a wheelchair? Who could assess the home and recommend changes? Who would pay? In recent years there has been an increased focus on rehabilitating homes to help people age in place, with ramps, wheelchair lifts, bigger doors, and better lighting.22 Putting money into rehabbing housing may help delay the far larger costs of a nursing home. Even putting in a bidet, or the more expensive bidet/toilet combination, may be one cost-effective way to stave off the nursing home.23 Lots of elders with dementia hate to bathe; when you add that to incontinence, you have a bad situation. It’s easier and safer to help someone keep clean using a bidet, and that might make all the difference in terms of how long care at home is manageable. Elevators are tough to install, but chair lifts can make some homes accessible. Some problems can’t be fixed. A man may love the fifth-floor walk-up apartment he’s lived in for sixty years, but if he can’t walk, he can’t get out in a fire.

If we look beyond the home to the neighborhood, an intriguing set of programs supports aging in place. These programs are not just for those with dementia, but are immensely helpful to them. A NORC, or naturally occurring retirement community, is a residential community not specifically designed for the elderly, but that has a majority of residents older than sixty. The first NORC was described in 1986 in a large apartment complex in New York City,24 but today there are NORCs across the United States that connect elders with services for health and social interaction. NORCs tend to operate in urban areas for residents with economic vulnerability and functional impairment, and to rely on paid staff and government funding. A NORC can make all the difference between living at home or being forced into a nursing home. A social worker in an office off the lobby, an easy sign-up for transport to doctor’s appointments, coordination with Meals on Wheels programs, outings, and exercise classes—these factors can be enough to keep an apartment building full of elders safely at home.

Similarly, the Village Movement got its start on Beacon Hill, an affluent section of Boston. There are now many Villages across the United States; these tend to serve clients who are financially more stable and have fewer functional impairments. Villages rely on volunteer service exchanges and are mainly financed by membership dues.25 NORCs and Villages vary, but all facilitate access to services, enhance social interaction, and decrease social isolation. NORCs are more likely to link residents with government services, while a Village might provide a registry of discounted providers for home repair. Either may help organize grocery delivery for someone just home from the hospital, and both encourage a range of social activities.

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