Written By Donna Engle

When a massive stroke knocked out Jimmy Henderson’s vision in one eye, hearing in one ear, and his ability to eat and balance, the Westminster house painter and his wife confronted a decision that millions of older Americans face: How can I live as independently as possible, and what services do I need?

As the 80 million Baby Boomers retire and life expectancy continues to increase, more people will be looking for sources of support. According to the U.S. Census Bureau, the number of people over 65 was 35 million in 2000 and will swell to about 55 million by 2030.

Calls to the Carroll County Bureau of Aging Senior Information and Assistance Unit reflect an increasing need for help with late life planning. Such calls have increased steadily in the last four years, from approximately 17,700 in fiscal 2005 to about 27,700 in fiscal 2008.

Henderson, now 65, suffered his stroke a decade ago. He and his wife of 37 years, Dottie, knew he could not stay at home alone during her workday. He could not feed himself, and if he tried to walk, he would fall. They chose adult day care.

“It was either that or a nursing home,” he said, “and my wife said, ÔNo way.’ She said as long as she’s healthy, we’re going to stay right where we are.”

The Hendersons’ support system looks like this: Jimmy goes to West End Place, a nonprofit Westminster day care program for physically or mentally impaired adults, Monday through Friday. Day care centers for people with medical needs must be licensed. Carroll Area Transit System buses transport him, and Dottie rides the bus to her part-time job. When he returns home, Dottie connects the feeding tube that provides his nourishment.

Elder care options include living independently at home with support services and perhaps social contacts at a senior center or senior citizens group; adult day care; assisted living; nursing home, and continuing care retirement communities.

The county has two continuing care retirement communities, two adult day care centers, approximately 20 assisted living facilities, 11 nursing homes and one specialized facility for care of Alzheimer’s Disease victims.
Caregivers can find help through a Bureau of Aging program, an Alzheimer’s support group, and respite care.
Many elderly people live with a spouse or other relative. The Census Bureau reports that 78 percent of men and 59 percent of women 65 or older live with spouses or other relatives.

After her husband died in 2000, Lou Fowble, 74, of Manchester, lived with her son and daughter-in-law, and later with a daughter. Fowble kept busy, but missed social contacts during the day. Her daughter said, “Mom, you need to get into some activities.”

The answer was adult day care. “It was a good idea, because I’m active and I like to do things,” Fowble said. At the center, she strings beads, paints posters and loves singing and dancing.

The path to elder care may begin with a difficult conversation. An adult child notices that Mom seems depressed or is not keeping up the house, or Mom herself realizes she can no longer manage alone. But how to broach the subject?

Sue Ingalsbe, a Westminster clinical social worker, educates medical professionals about older patients. Learning to understand means stepping into the older persons’ shoes, helping them assess their situations and empowering them, she said. “People need something to do, someone to love and something to hope for,” she said.

The Carroll County Health Department Adult Evaluation and Review Services (AERS) program can provide a picture of what Mom needs. On request, a social worker or nurse visits the home and checks medications, ability to handle daily living activities such as bathing or eating, and safety, such as knowing what to do in case of fire. Evaluators give a mini-mental test to check for signs of dementia. The evaluator then recommends a care plan.

“Our whole goal is to keep the person in a home-based community setting as much as possible,” said Gail Myers, B.S.N., program manager. The AERS service is free, and the Carroll unit averages 580 evaluations a year.

Once Mom and her family know what she needs, the Bureau of Aging has information about home services and housing options. Planning ahead is good, because many programs have waiting lists, advised Deborah Frame, senior information and assistance coordinator. If the family is considering placement in an assisted living or nursing home, it is wise to visit the facility and talk with staff and residents, she said.

Living at home with support may mean modifying the house. The National Association of Home Builders has a certified aging-in-place specialty for builders who have been trained to meet the needs of elderly or disabled persons. (See Aging in Place, Maryland, at info@aginginplacemd.com for contacts.)

Available support includes Meals on Wheels, which provides one hot and one cold meal on weekdays to homebound persons, who pay fees on a sliding scale. The meal delivery program serves 110 Carroll Countians.

Private agencies, including the Visiting Angels nationally franchised group with an office in Eldersburg, offer services ranging from personal errands and light housekeeping to live-in caregivers. Others can provide skilled nursing personnel. Transportation is available through Carroll Area Transit System.

People may need five or six different services to make aging in place work, said Linda Musiani, coordinator of the Bureau of Aging caregiver support program. She helps locate supplies and equipment, such as wheelchairs, and has a small budget for respite care.

Adult day care centers offer music, exercises, arts and crafts, word games and spelling bees, cooking, sewing and gardening. Participants attend one to five days a week.

Assisted living facilities must be licensed. They offer housing and support, supervision, assistance, and health-related services for people who need help with activities of daily living. In a 2004 survey, the median fee for assisted living facilities in central Maryland was $35,000 a year.

Nursing homes must also be licensed. They provide skilled nursing care. The average cost in Maryland for nursing home care in 2008 was $55,000 a year. The Maryland Nursing Home Guide, available from the state Health Care Commission, includes a comprehensive list that includes results from inspections and satisfaction surveys.

Continuing care retirement communities offer independent living, with assisted living and skilled nursing care facilities on site if needed.