A version of this post appeared in Chapel Hill News August 17, 2014.
In the mid-1950s, I was a reporter for the Kansas desk of the Topeka Daily Capital. The Kansas Territorial Centennial fell in that period and led to some colorful celebrations, including beard-growing contests. Part of my job was finding authentic old-timers to interview.
I read the country weeklies that came in the mail, and any announcement of someone’s 100th birthday was an event rare enough to send me halfway across the state to find that person.
Some centenarians lived in private homes, those of their children or grandchildren. The other option was one of the nursing homes, found in even very small towns.
Often, they were sponsored by a church. I remember one 100-year-old woman who advised me to find “a nice Christian girl” to marry. I think she would have been pleased with my choice. I found Sue in Topeka, and we came to Chapel Hill on our wedding trip.
Six decades later, we’re the old-timers, and options for dealing with aging are more complicated. Between our own home and the nursing home lies a broad range of choices.
That’s a problem I never anticipated. Decision-making under uncertainty is difficult enough when you are young. Age makes it worse.
The continuum of services begins with those that help keep us in our own home. Carolina Villages, a nonprofit serving Chapel Hill and Carrboro started providing such services last year. We joined it as soon as we found out about it. Sue and I downsized to a townhome in 2007, and the hassle of that move made us reluctant to ever consider another.
A more surefire way to manage the uncertainty would be to put up with one final move: to a Continuing Care Retirement Community (CCRC). The first one in Chapel Hill, Carol Woods, opened in 1979. The newest, The Cedars of Chapel Hill, started in 2004. A CCRC provides the whole continuum of choices from independent living through various levels of assisted living, and finally to a nursing home, but all in the same location. Starting at the first level, independent living, is a requirement. You have to be healthy enough to walk in the door, or they won’t let you in.
Once you make that financial commitment, it can be complicated to get out, depending on how the CCRC is structured. But at least you have reduced the hassle of further lifestyle decisions.
Our current strategy is to dig in and look for every resource we can find to help us stay right where we are until our infirmities are great enough to make our long-term care insurance policies kick in. Those would help support us in an assisted living facility like Wynwood, where our friend Chuck Stone spent his last years.
Chances that we’ll both use those policies are slim. Invoking them requires medical certification that you need help to perform at least two of five specified activities of daily living: bathing, dressing, toileting, eating, and getting in or out of a chair or bed. Only 44 percent of men who reach the age of 65 ever get to that point. For women, the risk is higher: 72 percent. These numbers come from the American Association for Long-term Care Insurance.
It helps to think about it if you prioritize your outcomes. Think of it as a game with nature the opponent. Nature has two cards to play: disable us or not. Our cards: move to a CCRC or age in place as long as we can.
That yields four possible outcomes. Not everyone will have the same priorities. For us, the ranking is:
1. We age at home, and nature never interferes.
2. We age at home, then move to assisted living when nature demands it.
3. We move to a CCRC and nature impairs us, so we’re glad we did.
4. We move to a CCRC, but never need it.
In classical decision theory, the goal is to assure the least of the worst possible outcomes. On that basis, we ought to go with aging at home.
But wait. Your rankings might be different. One advantage of the CCRC is that the transition from independence to assisted living is seamless. You don’t have to plan, you don’t have to move. Everything you need is on one campus. You can spend your golden years thinking about other things.
For a couple, a compromise might be to age in place until one needs assisted living. The other would still be able to make decisions and do some heavy lifting in the transition. Based on the figures above, the probability that at least one of us will need assisted living is high: 84 percent.
Aging in place is a national trend now, and Chapel Hill-Carrboro has several neighborhood associations that try to help. Carolina Villages is the only one with professional staff.
We try to be active in both: our neighborhood group for its social functions and Carolina Villages for practical help when and if we need it. It’s a gamble, but we’re rolling our own dice.