As we discussed in The Dynamics of Decision Making in the Getting Older Happens topic section, Place is a very important dynamic in our lives.  It is often where we interact with those people who are most important to us and engage in those activities that are most rewarding and fulfilling to us.  We progressively associate peace, comfort, safety and even control with place.  It is said that home is where the heart is but increasingly, as we age, the place we call home takes on all of these aspects.  We find peace and comfort and safety in the place we call home.  And we have a sense that we are in better control of all of the circumstances of our lives if we have a place called home.

There are many whose career has moved them from place to place.  But I have noticed even those who have moved frequently in their lives seem to feel a need to settle as they mature and, yes, age.  One of the most debilitating events in an aged person’s life is to be moved especially when it is not of their choosing.  It is often the beginning of the downhill slide that leads quickly to death.  We often associate the beginning of this descent with a fall especially if it results in a broken bone.  But I think it is not the fall but the loss of security and safety in their home and surroundings that leads to the downhill slide – especially if it also results in a forced move.

The conclusion I have reached is that home is as much a decision as it is a place.  Consider the elderly person who is told that they really need to move into a retirement home or assisted living facility in order to have the care and safety they now need.  If that decision is brought to them from the outside – family or friends – and is not at their own initiative, they have lost control over one of the most important decisions in their life, where I am going to live and call home.

Home is also more than just a structure.  It is a community of relationships.  It is not something that you can just move into.  It is something you have to create once you move into it.  This takes time and an investment of yourself in others.  It requires participation in the lives of others and in the life of a community.  The tragedy for many is that they move just at the time when they no longer have the capacity to engage in the lives of others that may be apart of their new community.  That new community can be a town, a retirement community, a retirement home, an assisted living facility or even a nursing home.  If you move there unwillingly or unable to actively engage (the level of activity required will vary depending on the nature of the community you have moved into) in your new community you will feel lost and alien; certainly not at home.  The secret is to be in control of the move and to make the move while you are still able to actively engage in your new community.  The real question becomes when and where.

The answer is simple but the application is difficult.  You should move before you need to move so that you can be actively engaged in the process of making your new location into a home.  If you wait until you need to move you are likely not to have the capacity to initiate the actions necessary to make your new location a home.  The answer to where you should move depends on what gives your life meaning.  What are your interests in life?  What gives you a sense of fulfillment?  What support do you need to engage in and pursue to activities and interests.  This requires time to get to know yourself and to learn about other communities that you might move to that would provide the activities you find fulfilling and the support to help you pursue them as you age.

Many already live in a wider community that provides an outlet for them to pursue all of the meaningful activities of their life.  It then becomes a question of whether or not the physical circumstances of their residence within that community can be made to accommodate their needs as they age.  Is it accessible as their physical capacity diminishes?  Is there accessible transportation if they can no longer transport themselves?  Can changes be made, that are affordable, to their residence to make it more accommodating to diminishing capacity?  Or do they need to consider a different residence in their home community?  If so moving into it sooner than later might be a smart move.  Even a new residence within a familiar community needs time to become your home.

The purpose of the exercise we described in essay entitled Discovery of Self in the Getting Older Happens topic section is to help you determine those relationships that are most important to you, to determine those activities that are most important to you and to determine where those relationships and activities take place.  If they seem to be focused around the Place called home then your housing decision is extra critical.  Even if those relationships and activities are no longer currently active or pursued, the memory of them may be focused in the Place called home.  Home can be the emotional hub of your wheel.  You may not engage with others or in activities that are meaningful within the confines of your home but it is the emotional foundation upon which it is all based.  All this can make it very difficult to leave.  But leave you must if you can no longer care for yourself and your spouse in your home or be cared for by others within your home.  Now is the time to make this determination; not later when others begin to notice that you, your spouse and your home are not being cared for as has been the case all of your lives in that home.

Under the heading Staying in Place in this topic section – Home is Where? -- we will discuss how you can go about making the determination whether or not your home can be made to accommodate your needs as you age and whether or not it is affordable.  If it is determined that your current home can’t be modified appropriately to accommodate the potential for diminished physical capacity as you age or can’t be modified in a way that would permit live-in assistance or even if it can, it is determined that is not affordable, then your choice might be to move now in to more accommodating circumstances.  We will discuss this option in more detail and offer some decision-making guidelines.

One choice, under these circumstances, is to move into senior housing community.  These communities are usually built to accommodate those who are retired and still living very active lives, until they can no longer live independently.  But they usually do not provide for gradations of care within the community.  Moving to one of these communities usually happens during your senescence and prior to reaching your Elderhood.  In other words, this move usually happens early in your retirement and before your physical capacity begins to diminish.  However, you need to realize this move probably will not be your last.  Eventually you may need increasing assistance that can not be accommodated in a community such as this.  Under the heading Retirement Towne we will discuss this option in more detail and offer some decision-making guidelines.

Another choice is to move into a Continuing Care Retirement Community.  Typically this move happens once you have reached Elderhood.  However, we would argue that is too late to really make it your home.  In any event, it usually happens instead of or after one has moved into a senior housing community.  A Continuing Care Retirement Community makes a lot of sense within the context of establishing a home that will accommodate your changing needs as you age.  These communities have gradations of care starting with independent living within your own stand alone home or apartment that advance through assisted living and nursing home care and, often, dementia care.  It allows you to find the level of care you need without the need to move or be moved out of your community of relationships.  It allows one spouse to have the care that is needed without the need for both spouses to move or be separated by great distance – at most a short walk is all that separates the spouses.  Under the heading One Stop Retirement Towne in this topic section – Home is Where? --  we will discuss this option in more detail and offer some decision-making guidelines.

Because some housing decisions can or will require subsequent decisions to move into Assisted Living or Nursing Home care facilities we will discuss this option and offer some decision-making guidelines.  We will discuss these decisions and offer some decision-making guidelines under the heading After Retirement Towne in this topic section – Home is Where?.

Consider where you call home now.  Is it a place that will accommodate you as your capacity diminishes and your needs increase?  Look around you at others who have stayed too long.  What has been the result of forced moves late in their life?  Is it a trauma that you want for yourself, for your spouse and for your children?  If the answer to these questions is No then perhaps you should begin to investigate a move now while there is opportunity and choice and you can exercise control over the decision and its timing.  Whether you choose to stay put or move we hope the discussion of the various choices and the decision-making guidelines will make it easier to address the decisions you will have to make eventually before they are forced upon you or require someone else to make them for you.

Before we get to these three alternative housing decisions it is important to point out some common elements to each of these choices.  These elements are often a major part of the reasons people give for staying in their current home as long as they can.  The first thing we often hear from those who move into either a senior housing community or a continuing care retirement community is that “there are only old people there!”.  Both Sarah and Cita voiced this concern – or was it a complaint – in the Stories topic section.  Sarah was probably younger than the vast majority of the people living in the continuing care retirement community her sons selected for her.  When Cita’s husband first began to encourage a move into a senior housing community she was probably younger than the vast majority of the people living there.  By the time they moved in, a few years later, she was only slightly younger.  When Cita was later moved by her daughters into a retirement home she made the same comment even though she was 90!  A client called the continuing care retirement community he and his wife moved into “shuffles” even though they were of the same age as the average person moving into such communities.  So whether this statement is true or not, it always seems true to the person making it.  Perception becomes reality.  Recognize that this perception is common to all who make these moves and deal with it in advance.  Either decide to accept it or decide not to make the move.  Unmaking this decision can be expensive and emotionally difficult, if not impossible.

The second thing we often hear from those who move into either a senior housing community or a continuing care retirement community is that there is a loss of privacy.  In senior housing communities there are often common walls and, if not, there are often “zero lot lines” or vary small lots.  There can be a sense of being crowded and congested.  Hearing your neighbors when they argue, flush their toilets, play their music or have parties can be disturbing at best.  Many communities and facilities have done a good job of mitigating the reality of the noise factor but the perception can still be reality.  Talking with those who already live there is important in dealing with this perception.  It will let you know if it is reality to them and give you some idea as how they have dealt with it.  Again, it is important for you to deal with perception/reality before you make your move.  As you move on to Assisted Living housing and Nursing Homes this loss of privacy becomes even more dramatic.  A roommate is a lot closer than a neighbor on the other side of the wall.  It is also important to point out that even if you stay in your own home it is likely that you will eventually experience a loss of privacy as others enter your life and home to assist you in your care needs.  Staying where you are will not necessarily avoid this problem.

The third thing we often hear is a complaint about the perception/reality of a more regimented life that is associated with living in a senior housing community or a continuing care retirement community.  In a senior housing community there are the rules, regulations and expenses that come from being a part of a homeowners’ association.  For many this is a brand new experience.  Most of us are used to putting the trash out on the same day but being told what colors schemes are acceptable when painting the house (the fact that this is often taking care of and paid for by the HOA is a positive to most people) or what types of improvements and additions can be made to your home is grating to many.  There can be many other rules and regulations that impact your every day life.  In a continuing care retirement community there are many more rules and regulations.  You have to go to dinner or any other meals within certain preset time schedules.  They same is true for any housekeeping and laundry services that are provided.  It has been likened to be on a cruise ship.  It seems kind of nice at first but can become grating to some over time.  As you progress through Assisted Living and Nursing Home care this regimentation only increases.  It will also increase over time even if you stay in your own home.  Increasing care where ever it happens requires an increasingly level of regimentation and scheduling.  So again, as our children would say, “deal with it”.  And deal with it now before you make your decisions.

These perception/reality elements are common to whatever housing decision you make.  It is important to discuss them with your spouse as well as with others who have already had the experience of dealing with them.  Come to your housing decisions fully aware and prepared for the new world in which you will be living.