Business

Living out your years at home can be challenging

Updated: 2011-05-04T19:55:48Z

By DIANE STAFFORD

The Kansas City Star

A treasured collection of china doll heads watches over Winnifred Whited from shelves in her cozy living room in the Kansas City house where she has lived since 1942. “I’m plugging along by myself,” said Whited, 98, who worked in a bag factory for 30 years. “I pray every night to be able to stay in my own home.”

Whited is doing what most old people want to do: to “age in place” — with a little bit of help when needed.

She has Snowball, her cat, and nightly phone calls from a niece. These keep her company between Meals on Wheels deliveries, visits from an aide who gives her a bath, and outings with relatives or friends who take her to the grocery or the doctors.

“I’m happy here,” said Whited, whose husband and son have died. “I crochet big afghans. I work my word puzzles. I sit out on the porch when it’s nice.”

Whited is among the fortunate. It isn’t easy to age in place.

In the coming decades, more of us are going to find that out.

For the next 20 years, as 79 million baby boomers age, 10,000 people a day will turn 65, an average of one every 13 seconds.

And here’s another wrinkle: At least a third of Americans who reach age 65 are likely to reach age 90, perhaps frail and needing lots of help.

Kansas City will be in the bull’s-eye of this unprecedented demographic shift. Just under 200,000 people aged 65 and older live here now. In our five-county metropolitan area, that will almost double by 2030. Johnson County will be hardest hit, with the number of seniors growing from about 60,000 to 130,000.

This surge of elderly residents will provide a difficult test for Kansas City. More than in many cities, we live in sprawling suburbs dominated by two-story, single-family homes and rely on cars to get around.

When the elderly can no longer climb their stairs or drive their cars, we’ll pay dearly for decades of building a spread-out, car-centric culture.

And consider another factor particular to the Kansas City area: We smoke more and are fatter than the average metropolitan area, raising the likelihood that more people will age with physical problems.

Beginning today, The Kansas City Star examines the transportation and in-home care issues at the heart of aging in place.

The challenges will be enormous. Among the needs:

•An affordable, on-demand and door-to-door system to transport frail seniors across city and county lines. The patchwork of transportation services that exists now often depends on volunteers and can’t take someone from, say, Raytown to a doctor in Leawood.

•Retrofitted houses to accommodate those who no longer can climb stairs, turn door handles or use their bathrooms.

•New and affordable technology and devices that assist the elderly with daily living and remote monitoring of their health.

•More well-trained and affordable in-home care aides, both around-the-clock and short-term.

•More trained volunteers and family members to work with the elderly.

“We need to keep people in their homes, but we need builders to renovate them and care givers to come to their homes,” said Eugene Wilson, a volunteer concerned with aging issues. “We need the medical community to think more about delivery of care at the home level and use hospitals only as the last option. We need to revisit the now-radical view of doctors making house calls.”

Beyond the desire of the elderly to age in place, there’s a practical matter to consider: Because of money, their options may be limited. They won’t be able to afford to retrofit their houses and add technology to assist them, or pay for help with transportation.

Most also won’t be able to afford costly residential centers that specialize in “active senior living” and a progression of life-care services. Many centers have a buy-in price of a quarter million dollars or more. Note, too, that the midpoint cost of a nursing home room in 2010 was $75,190 a year — $15,000 higher than five years ago.

So there’s at least one more huge challenge for the area. For those who decide to give up the dream of aging in place, we’ll need more affordable senior living communities.

Fred Bentley, director of the affordable-housing tax-credit program for the state of Kansas, sees firsthand the growing demand for lower-cost senior apartments. This year, for the first time in his 20-year career, applications for senior housing outpaced those for family units.

“This need goes up and up, and it won’t abate in our lifetime,” Bentley said.

A phalanx of service providers is working on solutions for the coming elderly surge and the desire to age in place if they can. But so far there’s no widespread public will or money to tackle senior housing, transportation and care needs. As the needs continue to soar, governments and major philanthropies must dedicate more of their resources to those purposes.

“Home is where the heart is,” said David Baxter, senior vice president of AgeWave, a national think tank on aging. “Moving away from memories is a challenge. But aging at home is not always the ideal solution.”

Reluctant to seek help

Today there are about five people under age 65 for every older person. By 2030 there are expected to be only three for each over-65 person.

Throughout history, the younger generation has been called on to help their elders. But what happens when there aren’t as many young people to help support — physically and financially — the needs of the elderly?

Families have been getting smaller. And many young professionals have followed jobs to other cities, reducing the number of adult children available to help with Mom and Pop.

It was the desire not to be a burden to her two sons that dominated Gloria Schlossenberg’s thinking.

“My children have been wonderful, but they have their own lives,” said the 87-year-old Overland Park resident. “I don’t want them to feel guilty if they don’t call or can’t rush over.”

Schlossenberg’s husband, Irving, died in February. After that she couldn’t see continuing to live in their longtime home.

As a couple, they had adapted to using a network of help from family, friends, taxis and agency bus services to shop for groceries, visit their doctors’ offices or keep up with the community activities they had long valued in Overland Park.

But “it was very difficult,” she said. “I can’t stress what it does to you to ask for so much help.”

Schlossenberg, just one among thousands whose wishes about staying in their homes will play out daily across the metropolitan landscape, had the desire and money to move into a complex that specializes in older adults.

“Fortunately, I can afford it,” she said. “But, oh, I do worry about those who can’t.”

Staying in their homes

Nine in 10 elders will never be in an elder-care campus setting, said Bill Bergosh, who is affiliated with John Knox Village in Lee’s Summit. “They are going to have to stay in their own homes … with assistance.”

And that is where Marie Norrise finds herself. The 92-year-old Kansas City woman hasn’t left her midtown Kansas City home in four, maybe five, years — and she’s fine with that.

“I don’t feel lonely,” she said. “I read The Living Word, the Bible, Guideposts, the newspaper, all the junk mail. I watch TV in the evening … not in the day. I don’t have time for that. It takes longer to do things when you’re in a wheelchair.”

For 46 years she has been happy in her home. It’s paid for. It’s full of things she loves. She knows every nook and cranny, and has the furniture arranged so that her motorized chair can move from room to room.

Her mobility is limited by diabetes and high blood pressure, Norrise wears a panic alert button in case she needs help. Once emergency crews had to break a pane in her front door to get in after she fell.

From the chair she cleans with a long-handled duster. She cooks, mostly in the microwave, since she now keeps her pots and pans within reach in her conventional oven.

“I do just fine,” Norrise said, pointing out a long wooden pole with a coat-hanger loop stuck on the end. She motors to her front door and uses the hook to pull in the daily paper, left on her front porch by her delivery agent.

“I thank God I can still read,” she said. “First thing I thank God for every morning is for keeping me in my right mind.”

Norrise worked in a dress shop for about 30 years before retiring. With her husband, who died 12 years ago, she enjoyed gardening. The rosebushes in the back yard, untended for years, are gone, but she keeps a rainbow of plastic flowers potted on her front porch.

“It’s not a busy life like I used to have, but I’m satisfied. I’m hoping that when it’s time for me to move, it’s time for me to go home,” she said, waving her left hand heavenward.

Meanwhile, she relies on some help to stay in her home. Nieces do her grocery shopping. Nuns visit from St. Therese Little Flower, the Roman Catholic church where Norrise said she proudly served on the altar guild.

Perhaps most important, her physician makes house calls. Nevada Lee, the doctor, said it’s a mission she felt compelled to do.

“She’s a prisoner in her own home,” Lee said. “She can’t get out.”

But Lee pointed to low reimbursement rates from Medicare and long driving distances between homes in the Kansas City area. Those facts have made it nearly cost prohibitive for physicians to serve homebound patients.

“There are probably just a handful of us who make house calls in the area, but the demand is there,” Lee said.

The burden on families

When Lee makes house calls, she sees how aging in place affects generations of family members.

“There are so many families in the metro area who are providing 24/7 care for someone in their homes,” she said.

Count Norma Jean Bernard and her daughter, Debbie Denton, among those struggling to provide round-the-clock care.

Bernard’s husband, Eugene, 80, a TWA mechanic for 32 years, has been incapacitated by strokes, heart attacks and lung disease. Unable to stand or walk since September, he requires a $4,000 EZ Stand lift for his wife and daughter to move him from bed to chair and back again in the Bernards’ snug, memory-filled home.

Most of the work these days falls to Denton, who retired early from a secretarial job and now is the prime caregiver. In her late 50s, she has back and shoulder problems of her own. But her mother, 80, has neuropathy in her feet and no longer has the strength to handle her husband.

“I used to do it all, but after his last stroke I couldn’t,” Bernard said. “If Debbie weren’t available, I don’t know what I’d do.”

Since last fall, Denton has had little time for her own husband and home. She’s at her parents’ home in western Wyandotte County to get her father out of bed in the morning and to put him to bed at night.

It is a labor of love. She’s not paid.

“We don’t have the money,” Bernard said. “We can’t go anywhere fancy. And if I got him in a home, where would I be? I’d have nothing to live on. So our goal is to stay here. It’s hard on both of us, but we have wonderful friends who help. And I’d be completely up a creek without Debbie.”

Every week the cost of adult diapers, of bed pads, of medications eat away at the Bernards’ savings. Higher gasoline prices dig into Denton’s pocket for her daily commute. Property taxes have skyrocketed.

“His pension of $786 a month isn’t much,” Bernard said. “I’ve sold his coin collection and his car. We’re running out of money, but we make too much to get (government) help.”

But it’s not the financial strain that bothers them the most. It’s the emotional drain.

“People don’t understand until it happens to them,” said Bernard, who admitted she struggled with depression. “This is a complete change in your life.”

Denton, who tends to bring laughter and a positive outlook to her care-giving role, also admitted the occasional regret: “I’m bummed. When I retired I wanted to travel up one coast and down the other.”

“This is very much a sacrifice for her,” Bernard said, dabbing tears with a tissue.

In the midst of a make-the-best-of-it conversation about preventing bed sores and rashes, Eugene awoke in his recliner and was drawn into the conversation.

“I want to stay here,” he said when asked. And he smiled.

Change is necessary

At the Shepherd’s Center, which dispatches volunteers to help the homebound elderly, executive director JoEllen Wurth said the Kansas City area needed to do far more to help those who wished to age in place.

“We need to get into the (legislative) chambers, into city halls to affect policies and planning and funding for housing and transportation. This is more than just a family issue,” Wurth said.

Linda Wright, an adjunct lecturer at the University of Missouri-Kansas City and former director of the Kansas City Area Agency on Aging, rues that the area already is “late to the party.”

“We have a lot of aging housing stock that people are growing old in,” Wright said. “Those homes won’t accommodate them well as they develop mobility problems. Their neighborhoods aren’t aging-friendly. Transportation? Ay-ay-ay! It’s critical. … There’s no cohesive effort across cities and counties. There’s no grand plan.”

Indeed, some experts on aging say far more radical moves are needed.

“Maybe we need to take those blocks of split levels in Prairie Village or those blocks of two-story houses in Brookside and raze them,” suggested Dave Ekerdt, a sociology professor at the University of Kansas. “Anything with stairs isn’t a good idea. We need downsized housing in retirement communities with all the services they need.”

Ekerdt said part of the challenge was creating a mindset in which seniors let go of things they’ve accumulated over a lifetime — and that would require a wholesale rewiring of American materialism.

Indeed, in home after home, seniors readily admit that they’re attached to their furniture, their knick-knacks, the rooms in their homes.

For Lee Rathbone-McCuan, a professor of social work at the University of Missouri-Kansas City, the bigger concern is that aging brings illness, frailty and dependence on others.

“I really believe that longevity is putting the American family at grave risk,” she said. “We’re calling on people to be care givers without the support system needed. We have huge mobility barriers. Middle-class families have trouble paying for long-term housing and care.

“The missing component is not just money. It’s decision-making authority. It’s time to bring out the big sticks. We’re past community forums. We know the problems.”

Tomorrow: Beefing up transportation for the elderly.


Help lines for elder care and transportation questions
KC Caregiver Support Line: 816-444-1122

United Way 211 Line: 816-474-5112

MidAmerica Regional Council, (Jackson County): 816-421-4980 or 800-593-7948

Johnson County Area Agency on Aging: 913-715-8861

Clay County Senior Services: 816-455-4800

Platte County Senior Services: 816-270-4100

Wyandotte/Leavenworth Area Agency on Aging: 913-573-8531


About the Series
This three-day series addresses the challenges of “aging in place” in Kansas City.

Today: A burgeoning elderly population prefers to grow old in their own homes, but the area’s spread-out geography and single-family dwellings make that difficult.

Monday: When seniors can’t drive themselves, the area’s existing transportation systems can’t meet all their needs.

Tuesday: Remodeling, technology and in-home care can help people age in their homes. The alternative is moving to a senior residential center.

The series was written by Diane Stafford, a business writer and columnist, who has been a writer or editor on The Star’s business and metropolitan desks since 1974. Photos were taken by staff photographer Tammy Ljungblad. The series was edited by business editor Keith Chrostowski and copy edited by Kerry Schmidt.


Strong warnings
In an impassioned address to the 2010 joint convention of the National Council on Aging and the American Society on Aging, Ken Dychtwald, one of the nation’s foremost gerontologists, sounded these warnings:

•Medical breakthroughs “have given us old people,” but we haven’t yet figured out how to keep them healthy.

•Dementia lasting for 20 years “will be the sinkhole into which America falls.”

•By 2030 the 65-plus population will grow by 70 percent, but the payroll tax-paying population will grow by only 10 percent.

•Age discrimination is rampant in the workplace, and more retirees are “doing nothing except watching TV.” Meanwhile, the percentage of elderly with poverty-level incomes is growing.

•We need to create more programs so that “elders in society can give back. … We have not yet created a purpose for aging in this society.”

To reach Diane Stafford, call 816-234-4359 or send email to stafford@kcstar.com.

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