Home is where the heart is for most older people, but if you want to live in your own cherished place for as long as possible, you need to plan ahead - before your children's quip to, 'watch out, we'll be picking your nursing home' becomes a reality.
With Department of Health figures predicting that one in four Irish people will be over the age of 65 within 20 years, it's something more and more of us will have to think about as we approach the traditional retirement age.
In the case of yours truly, that's just seven years away, although like many of my vintage, I consider myself far from old. Like it or not, many of us will continue working long past 65. Most of us have bucket lists of things we want to do, we look forward to continuing lifelong relationships with our families and friends, and anticipate decades yet of rich, fulfilling lives. We've got plenty to give, and it's anathema to think of spending these years living anywhere but in our own homes, surrounded by a lifetime of treasured memories.
My late mother-in-law did precisely that, living independently at home until she was 93. In her final few years she benefited from a home help and care package that brought people into her home to help her with washing, dressing and household chores, and sometimes just to sit and chat with over a cup of tea.
However, those supports didn't happen overnight. It took time and steely determination by family members working with those angels of our community - public health nurses - to get the care hours she needed.
"There aren't nearly enough funds or staff to meet demand," says Audry Deane, Health Policy Officer with Age Action. "Consequently, many older people who would rather stay in their own environment end up in nursing homes. The only way to remedy this is through Sláinte Care, the 10-year plan launched last year by the Oireachtas Committee on the Future of Healthcare.
"For older people it sets out an integrated system with access to healthcare closer to home. It moves away from our current hospital-centric approach and co-ordinates health and social care to meet the needs of older people. We're already a year behind in its implementation, but we can't continue living with a hybrid mix of healthcare that's inefficient, expensive and results in poor outcomes. There is no Plan B."
However, while we wait for the wheels of Sláinte Care to start turning, a new and innovative venture is being piloted by the Abhaile Project, a collaboration between architects Ciarán Ferrie and Dermot Bannon, and founder Michelle Moore. The initiative offers a way to adapt family homes to suit the needs of their ageing owners, while also generating income for them and helping to ease the homelessness crisis to boot.
"Following the 2016 ESRI report on the housing crisis and older people, we took on the challenge to resolve two societal issues: how could we help older people stay in their homes, while also providing much-needed rental accommodation to help ease the housing shortage?" says Ciarán Ferrie.
Their answer seemed blindingly simple: convert the empty nest into two self-contained units, the homeowner living downstairs and renting the upstairs to a paying tenant. Currently being piloted in Clondalkin and Castleknock on Dublin's northside, the first two houses are due to be completed by the end of this year.
"In a classic three-bed semi, we upgrade the ground floor with an accessible downstairs bathroom and bedroom," says Ciarán. "We look at modifications like widening doors and lowering the height of light switches to make the accommodation more adaptable as the resident grows older.
"Upstairs we convert two bedrooms into a kitchen with a living/dining space and leave one bedroom as is. This allows the homeowner to rent the upstairs to a single person and it comes under the 'Rent a Room' scheme, which allows homeowners to earn up to €14,000 a year tax-free. Yet it's still a family home, and can easily revert back to a classic three-bed set-up."
The basic retrofit costs about €45K-€50K, with optional extras like sound-proofing and energy upgrades available at extra charge. The project beat off stiff competition from over 60 entries to win last year's, Smart Ageing Universal Design Competition, and featured at this year's, 'This is Not My Beautiful House' conference, one of the highlights of Age and Opportunity's renowned Bealtaine festival.
"Abhaile is aimed particularly at people who are asset-rich and cash-poor, those planning for their retirement who may not have much savings," says Ciarán. "We'd like to see government supports to make it accessible to more homeowners who want to stay in their own homes well into old age. With the Housing Adaptation Grant that's currently in place, an applicant has to have an existing disability or special need. We'd like to see grants being made available for pre-emptive works, not as a response to a crisis."
A range of local authority grants and schemes already exists for the over-65s to help ease the financial burden of home improvements like repairs, rewiring and upgrading heating systems. These vary from region to region, so you need to contact your own local authority to see what's available in your area.
"We get a lot of calls from older people looking for information about installing a downstairs bathroom or a chairlift," says Gerard Scully of Age Action. "The Mobility Aids Grant Scheme helps fund things like handrails, a level access shower, access ramps or a stairlift. The Warmer Homes Scheme and Better Energy Homes Scheme offer help with attic and wall insulation."
He says the late 50s is the ideal age to start addressing the challenges that might lie ahead. But please, at 58, this writer is not ready for a stairlift. I don't want handrails in my bath. I don't need a mobility scooter or an adjustable height homecare bed. Thankfully, Gerard says we don't have to turn our houses into nursing homes.
"It's about planning ahead," he says. "Think about measures you can put in place to make your home accessible should your needs change in the years to come, whether that's putting in a downstairs bathroom, or lowering light switches, for instance. It makes sense to future-proof your home rather than waiting till there's a crisis.
"At 65, it's definitely worth considering getting a personal alarm. Even if you don't feel at risk now, if you have a fall, it's a lifesaver, and the first year of monitoring is free."
If you are struck by serious illness or have a disability, you can apply for a Housing Adaptation Grant to make the house wheelchair-accessible, create extra space, or add a ground-floor bathroom or wetroom, although it will take some months from application to completion.
"Applicants need to get a medical cert and have an occupational therapist (OT) do a report," says Gerard. "The OT will observe your physical mobility and how you interact with your environment. They'll assess what your individual needs and priorities are, what height handrails should be, how big a shower you need, whether you need a shower seat, and other things. You can wait for a public OT to become available, but if you get this assessment done privately, the grant application will be processed quicker."
However, advocacy groups argue that such grants should be made available at an earlier stage, long before older homeowners are struck by illness, stroke or dementia.
"The 2016 census shows that two-thirds of people over the age of 65 have two or more chronic conditions, but with the right supports, they can often be managed at home," says Audry Deane. "It's not cheap to keep people in their own homes, but if it keeps them out of acute settings and supports them in having a good quality of life, then it's money well spent."
A knock-on effect is that when more older people live at home, different generations interact together, something that's welcomed by equality and human rights expert Niall Crowley.
"Our society promotes youth culture and stereotypes older people, and we manage that through segregation," he says. "We move older people out into nursing homes, or seniors-only complexes, instead of recognising them as a valued part of our community.
"There are supports in place to adapt a house, but we also need supports that value inclusivity and diversity. We need a radical shift in our understanding of diversity so that people are no longer squeezed out of communities because of their age. If we don't get our cultural values right, we don't get an inclusive society."
● Next week, in part 2 of our Age Well series, we look at nutrition and dementia
Gerard Scully of Age Action offers the following top tips for ageing well at home:
● If you decide to move house, pick somewhere within walking distance of shops and amenities, or close to public transport.
● Choose a bungalow, or single level apartment that doesn't involve climbing stairs.
● Find out beforehand whether the local GP will take you on - some have their books full these days.
● If you're designing or adapting a home, think about whether you might need a live-in carer in the future, and build with that in mind.
● Don't move far from your social network. Keeping in touch with friends gives us a reason to go out and meet people.
● Stay active, physically and mentally. Age and Opportunity and Siel Bleu (Blue Sky) run a range of programmes in local community centres across the country.
Health & Living