Independent Living: Finding the Right Fit

How do we know when it’s the right time to give something up? We’ve all seen examples of this before. Your favorite athlete continued to compete well past their prime and ends with an all time low performance. Your favorite band continued to make albums that should have been given up years ago. Your old boss disrupted work productivity and innovation because he/she wasn’t willing to step down from their position. At the end of the day, we commend these people for their amazing work. But, it doesn’t draw away from the fact that the person went through some form of harm and struggle before they decided it was time to hang up the gloves. 

Unfortunately, this happens to the best of us. In particular, some older adults continue to live in their homes despite their decline in physical health and growing numbers of chronic and acute health problems. How might this look? Maybe you’ve had a couple stumbles in your home that resulted in a fall or a near fall. Clutter around your home has grown larger and more difficult to manage. You may have put off many of the household chores and noticed that your routines have become more physically taxing. 

Recognizing when it’s time for a lifestyle change may save you and the longevity of your independence in the long run. “Independent living” has offered many older adults a new lifestyle that has brought a new sense of meaning, community, and relief. Is independent living right for you or is there something else more suitable according to your needs, abilities, and affordability?

We tackle the basics of independent living, detail who’s a good fit for independent living, and offer intimate struggles and concerns of residents that have lived in independent living communities. 

What Are Independent Living Communities? 

Just as the name implies, independent living communities are for older adults that are completely independent in their activities of daily living in the home and can typically participate in community activities without difficulty. Here are some examples that an older adult in an independent living community can do without assistance: 

• Get dressed without losing their balance
• Get in and out of the shower without losing their balance
• Complete a bathing activity without feeling exerted
• Be able to cook a simple meal
• Complete light housekeeping tasks around the home
• Take their own medication without missing doses
• Understanding the purpose of their medication and not taking the incorrect prescription
• Run errands in the community such as grocery shopping, delivery of items, driving or navigating public transportation 

Independent Living Communities 

When an older adult has decided to make the transition from their home to independent living, the two popular options include senior apartments and senior co-housing. 

Senior Apartments

Senior apartments are not limited to just apartments. Choices range from:

• Private one to two bedroom apartments or condominium styles from 600 to 900 square feet. 
• Suite style apartments with private rooms and a shared common kitchen, living area, and bathrooms. This style is great for those looking for a little more social interaction, social support if needed, or looking for something more economical. 
• Large single-family size luxury apartment units ranging from 1,500 to 2,000 square feet. 

Residents of senior apartments have the option of renting or owning a unit. Affordability is also inescapable when discussing senior apartments. If choosing to own a unit, most seniors use their savings or sell their assets (i.e., usually their former home) to afford the costs of senior apartments. But let’s face it, curve balls happen in life and not everyone fits this scenario. For this specific reason, affordable or low-income seniors apartments are also at your disposal for those that qualify. 

• Affordable senior apartments: Pricing of rental units are fixed according to the cost of living in your immediate region. Property managers at senior apartments will typically charge you no more than 30 percent of your income on rent and utilities. This is an economical option that will always fit around your budget.
• Low-income senior apartments: This option fits perfectly for those with limited income. As an applicant, you will need to qualify for the “Section 8 Housing Choice Voucher Program”. In order to qualify for this program, applicant’s income must not exceed 50 percent of the median income for the county. Because this is such a popular choice, it’s a good idea to get a head start and start the application early as there tends to be a long wait-list of other applicants. With this voucher, residents can have their apartment partly or fully paid for by Section 8. 

Accessibility is a main attraction for older adults moving into senior apartments. Senior apartments are thoughtfully structured and built in communities with older adults in mind. You can expect the majority of senior apartments to be free of stairs, have one level units, or have access to elevators. 

Amenities are offered on a spectrum from none to premium. As you’ve probably guessed, the more amenities offered at a facility, the more you can expect to pay as a resident. We suggest carefully giving it some thought when choosing senior apartments with amenities as finances are also a significant factor into making your decisions. See below for common amenities provided by senior apartments: 

• Bathrooms with installed grab bars, step in or roll in shows, built in shower seats, raised toilet seats, and wheelchair accessibility. 
• Central heating and air conditioning. 
• Lounge room for social events. Social activities are also held for mingling. 
• Media rooms that include computers, laptops, printers, and TV. 
• Prescription drop-offs and deliveries. 
• Community trips out to the city for entertainment. 
• Transportation for shopping, medical appointments, or attending religious practices. 
• Assistance with housekeeping. From daily to weekly or at your own convenience, staff complete heavy chore work. This also includes daily linen changes for your bed. 

Senior Co-housing

Senior co-housing is a relatively new concept but has been growing traction as a very population option among older adults. Communities in this type of living include older adults aged 50 years of age or older. It is described to be a form of group living which clusters individual homes around a ‘common house’ – otherwise known as the shared space with amenities (i.e., large kitchen, dining room, laundry, recreational area, open space, and gardens). Imagine a close knit block of private homes with neighbors that gather frequently around a common house to socialize, cook for one another, share tools, and work collaboratively. 

The living philosophy for senior co-housing is based on mutual support, self-governance, and active participation among residents and neighbors. As residents living and sharing a home together as independent older adults, social interaction and building camaraderie is a priority among older adults that choose this lifestyle. Let’s take a look at more specifics:

• Based on intentions to live as an active participant in a group of similarly aged people who agree to be ‘neighborly and cordial’. 
• Considered an investment from the older adults residing in the home to build social relationships and mutual support. Especially during dire times of need. 
• Offers optional information assistance and housing needs for older adults that are having an increasingly difficult time managing a single family home alone. 
• Opportunities for leaning or benefitting from a roommate’s unique skills as everyone comes from various backgrounds of work and skilled hobbies. 
• Balance of privacy and communality. 
• Promotes participation in staying physically active and healthy. More importantly, social isolation is prevented. 
• Encouragement and problem solving with others to plan ahead for the future. You have the ability to bounce ideas off one another and provide knowledge about your plans, what has worked, and what hasn’t worked. 
• Co-housing diversity: Ranges from mixed gender, created by specific groups such as women, LGBTQ, specific ethnic groups, or a group of older adults that share similar interests. 

While many benefits can be harvested from co-housing communities, chemistry among residents and neighbors do not occur overnight. Well known to everyone, gathering people together with shared interests do not necessarily equate to peaceful living without first butting heads. Strong communal efforts and specific goals need to be established from all co-housing participants to nurture cohesion and harmonious living. What are the steps to success? Here are some learned lessons we can take from successful co-housing communities: 

• Group building activities.  
• Training workshops: Courses focusing on consensus decision making, conflict resolution, mutual assistance and diversity and equality education. 
• Core values: Run by members of the community to agree on a set core of values that must be adhered by all residents and neighbors. Ideas such as ‘mutual support’ and outlined policies addressing specificities of membership, pets, noise, curfews, etc. 
• Consensus decision making: No structured hierarchies. Community members take pride in the mantra of ‘No-one is in charge here’. Whether by majority vote or through collective listening and problem solving, each community develops a democratic solution that will be agreed upon by all members when making tough decisions. 
• Commitment: People will inevitably come in and out of the co-housing communities. Many residents invest significant amounts of their time and money to establish their co-housing community, with new members adding in additional ingredients. To effectively manage these new ingredients, senior members of the community make a commitment to provide new members with a soft introduction into the core values and policies established to allow for a smooth and welcoming transition. 
• Vision: Setting group objectives and reviewing them on a regular basis. It is stressed heavily that listening to one another, taking the initiative to be well informed with the objectives, and establishing a culture of approachability should be practiced. Most importantly, taking the time to ‘celebrate often’ during recreational activities and during shared meals make for a more meaningful community. 

Who’s a Good Fit for Independent Living? 

When it comes down to it, a person must truly be independent without being at fall risk and have the ability to manage their daily routines without confusion. This comes down to two abilities otherwise known as your ‘physical’ and ‘cognitive’ capabilities. There are several dangers that come with an older adult transitioning to independent living that is actually at ‘fall-risk’ or has undetected memory issues. Before we look into depth with these issues, it’s important to understand how to detect these impairments. 

Fall Risk

A good indicator that you’re at fall risk includes a thorough assessment. For a quick assessment, think back to the past few months and ask yourself: In the past few months, 

• …how many times have I stumbled both in my home or outside? 
• …have my legs suddenly given out without warning?
• …do my legs get shaky and weak when walking short distances? 
• …how many times have I actually fallen or slipped and ended up on the floor or ground?
• …do I have to sometimes rely on holding onto the walls, counters, or furniture in my home when getting around? 

If you’ve answered yes to any of these questions, there’s a chance you’re at risk for falls. You want to pay attention to patterns that occur at home when recounting these episodes of losing your balance or falling. Everyone stumbles from time to time with the occasional freak accident of slipping on water, tripping over a cord, or perhaps your pet jumping on you. It happens to the best of us. These things are out of our control and aren’t considered being at risk for falls. But stumbling, holding onto walls, slipping off your bed to the floor, or your legs feeling weak and falling are signs for fall risk. 

Two formal ways that are assessed either by occupational or physical therapists to see whether you’re at risk for falls include a balance test and a walking test. These two tests have been heavily researched and depending on your score relative to your age, it is a very accurate predictor whether you’ll have a fall when both tests are used together. 

Berg Balance Scale

Balance in the home and out in the community is incredibly important and often taken for granted. If you have been having concerns about your balance at home, it’s likely that you may already be at fall risk. It’s not the end of the world if your balance is a bit off. What’s most important is that you recognize that you’re having difficulty, get professional advice from an occupational or physical therapist about modifications that can be made, and follow through with the advice. A balance test that is well researched for predicting a person’s fall risk is seen as follows:  

1. Sitting to standing. You’re expected to stand without using your hands and stabilize yourself with one attempt while not losing your balance or becoming unsteady. 

2. Standing unsupported. You’re expected to stand safely for two minutes without losing your balance or becoming unsteady. 

3. Sitting with back unsupported but feet supported on floor on a stool. You’re expected to sit safely and securely for two minutes. 

4. Standing to sitting. You’re expected to safely transition from standing to sitting with minimal use of your hands while being steady. 

5. Transfers. You’re expected to stand up from a chair and sit down on a different chair that is positioned right next to you without losing your balance and with minimal use of your hands. 

6. Standing unsupported with eyes closed. You’re expected to stand still for 10 seconds with closed eyes without losing your balance or becoming unsteady. 

7. Standing unsupported with feet together. You’re expected to place both your feet together so that they’re touching, not hold onto anything, and maintain this positioning for 1 minute without losing your balance. 

8. Reaching forward with outstretched arm while standing. You’re expected to stand still, reach with both your arms positioned straight out at shoulder height, and reach/lean forward. The goal is to be able to reach at least 5-10 inches from your resting position. 

9. Pick up object from the floor from a standing position. You’re expected to pick up an item that is positioned in front of your feet without difficulty while maintaining your balance. 

10. Turning to look behind over left and right shoulders while standing. You’re expected to twist/turn to look directly behind over your right and left shoulders one at a time without losing your balance. 

11. Turn 360 degrees. You’re expected to turn completely in a full circle towards the right and left, one at a time without losing your balance or becoming unsteady. 

12. Placing alternate foot on step or stool while standing unsupported. You’re expected to place one foot at a time on a threshold that is approximately 12 inches high without losing your balance or becoming unsteady. 

13. Standing unsupported one foot in front. You’re expected to place one foot directly in front of the other so one of your heels are touching the lead toes of the other foot and hold this position for at least 30 seconds without losing your balance. 

14. Standing on one leg. You’re expected to stand on one left for at least 5-10 seconds without losing your balance or becoming unsteady. 

Timed Up and Go (TUG) Test

Your speed and ability to navigate in your home and community is measured by the TUG test. Heavily backed by research, the test is a strong predictor of your safety walking around the home and if you’re safe to walk outside in the community. The timed test looks a bit like this:

1. The clock starts when the therapist is finished saying, “Ready, set, go”. 

2. You stand from a chair. 

3. Take any path you’d like to walk to distance of 10 feet (generally marked by tape on the floor or a cone) as quickly as you feel safe and comfortable. 

4. Turn around from the marked point and walk back to the chair. 

5. The clock stops once your back touches the back of the chair.” 

6. You have once practice round and an additional two trials will be taken. 

One fall as an older adult is one too many, especially as your bones are more fragile and poses higher risk for potential fractures. Recovering from hip fractures pose a long road to recovery, with the high risk of never regaining full strength, range of motion, and having to deal with chronic pain for the duration of your life.

If you’re stumbling in your home and having to hold onto the walls and furniture, reach out to your primary care physician and ask for a home health occupational and physical therapy referral. A professional and comprehensive home assessment will be completed to decrease your risk of falling at home. Exercise programs and use of assistive devices will also be recommended that is suitable for your current physical needs. Word of advice – although you may not like the use of a walker or cane because you find that it makes you look older or incapable, it may save you from a devastating fracture that will cause long lasting issues.

Transitioning to Independent Living

You’ve made the decision to transition from your home to independent living, but how do you know if you’re a good fit? A looming issue that isn’t talked about often enough – moving into independent living when you’re not independent. Several dangers can arise from the ‘wrong type’ of resident moving into independent living.

A thorough investigative research study offers an intimate look into the concerns from residents, staff, and nurse practitioners at an independent living facility. 

Falls

Falling was the number one concern expressed by residents. Many residents reported having fallen in their homes and several denied the seriousness of falls. Due to fears of falling or having a history of falls in their apartment, some residents purchased emergency alerts. A resident stated:

• “…and I was on the floor. It took me an hour of turning and twisting on the floor till I moved over to a piece of furniture to hoist myself up. And I thought of calling…All I needed to do was, be picked up off the floor. And I didn’t do it [call] because I was embarrassed. Then I found out later that they don’t pick you up, they call 911! Which would have been even worse.” 

Nurse practitioners that work at the independent living shared similar concerns with residents’ fall risks. Concerns included seeing may of their residents with impaired balance, Parkinson’s disease, failing vision, muscle weakness after a stroke, and resistance to using adaptive equipment (i.e., walkers or canes). The nurse practitioner stated: 

• “She has severe Parkinson’s, lives alone and her apartment is very crowded, has a cat and also has problems with her shoulder and sat on the toilet and couldn’t get up. She was there for probably six hours. She didn’t have a LifeLine. I had seen her about two months ago and suggested getting a raised toilet seat…I got one there, I positioned it, we had to move the cat litter around and she called me two days later to take it away because it was making the bathroom too crowded. So some of this resistance on the part of some of the elders [is] to use adaptive equipment.”

Medication Management

Many of the residents were not able to manage their own medications appropriately. Issues with medication management included having too many new medications, failing memory or poor eyesight. Residents admitted moving into independent living because they were experiencing medication compliance problems at home. A nurse practitioner stated: 

• “…her neighbor came down to tell me [that] she was doing her neighbor’s meds [filling her friend’s medication organizer for her] and said her medications were not matching. I went up…and I noticed one of the bottles had no label. She tried to tell me what it was, but it wasn’t matching up, so I ended up calling the cardiologist and we did it get it straightened out.”
• “I’ve tried several times to fill up her medications…but [the residents] have no real concern of what they’re taking…And that’s how they’ve got into trouble. And what prompted them to move into the building in the first place, hope of trying to get their medicines square away.”

Forgetfulness and Confusion 

Among housing staff at the senior apartment, forgetfulness and confusion were the most frequently reported concerns. Themes that arose included residents frequently:

• locking themselves out of their apartments
• assisting residents find mundane items that they’ve lost
• receiving paranoia complaints that someone entered their homes and stole their personal belongings

Staff stated:

• “Yeah, paranoia is often sort of one of the precursors to real Alzheimer’s and so that [is] one of the things that you get called on. A lot of them [residents] are forgetful. A lot of them call me to reinforce the day of the week, time of day, today’s date. They’ll call in the beginning of the day, the middle of the day, and again towards the end of the day…during the beginning of the week it’s more or a harder time for them, because of the weekend and we’re not here, the offices aren’t open.”

Residents also expressed that they realized there were particular residents with impaired memory and confusion: 

• “…and there was a resident from this building floating around on my floor. He was out of it. He knew he lived on the second floor, but he couldn’t find his apartment. He couldn’t remember where he parked his car.” 

Independent Living, Not Assisted Living

Housing staff reported that although they are an independent living facility, there are some residents that actually need to belong to an assisted living facility. Because of family and financial pressures that influence residents’ decision to move into independent rather than assisted living, housing staff stated:

• “You get a few from assisted living who can’t afford it. So they come here. Very often financially, it’s not in the family persons’ best interests to notice that mom is getting more and more demented. If in fact mom needs assisted living, they’re going to pay a lot more money than they pay here. I mean this is like one of the least expensive ways to sort of assure a safe environment for mom there is.” 
• “I’ve been seeing more and more, families who come and bring their parents and they try to present that their parents can live independently. And myself or ___ would express our concerns and they promise that they’ll get services in place, that they live in the area and they’ll be here all the time. And you never see the family again. We realize we have to look at those people a little closer as to why they’re coming here.” 

Undeniably, new issues certainly can arise that may have been underlying but unrecognized when living at home. When you’ve lived in a home for decades with old routines, you get by fine. Adjusting to a new environment in independent living brings new routines and things to memorize. A nurse practitioner reported:

• “…when they [new residents] came in [for application interview], they were fine, no problems, no memory loss or anything. They, then I guess coming here, it’s a whole other atmosphere for them. It’s not in their daily routine, so when they come in here they’re kind of all over the place. So… we would get these calls all the time; that they wouldn’t know how to use a thermostat or the microwave is not working when actually it’s working.”

What Can We Learn From This Research?

It cannot be stressed enough – recognize your current physical and memory abilities and make a responsible decision. Even better, ask your close companions, family, and primary physician about their honest opinions. Seeing these things in others but not yourself is all too true in this particular situation. Don’t let your pride get the better of your health, future, and independence. 

Conclusion

Independent living can bring new meaning to older adults after a hard working career and arduous task of being a parent. Convenience, chore-free, and a new community to engage in – more excitement lays ahead of you. Enjoy doing the things that you really love again, the things you may have given up because you didn’t have enough time, and being part of a supportive and lasting community. 

Before you take a step into this new journey, take a second to analyze if you’re the right fit. Stepping foot into territory that may not fit your personal life puzzle can actually cause more harm than good. Consult with your family, ask the hard questions, and inquire with your primary physician for occupational and physical therapy home health consults that will ensure you’ll be getting the correct puzzle pieces for the next steps.