{"id":1066,"date":"2015-07-01T07:25:50","date_gmt":"2015-07-01T12:25:50","guid":{"rendered":"http:\/\/arcaregiving.org\/littlerock\/?p=1066"},"modified":"2015-07-01T07:25:50","modified_gmt":"2015-07-01T12:25:50","slug":"at-home-many-seniors-are-imprisoned-by-their-independence","status":"publish","type":"post","link":"https:\/\/uamscaregiving.org\/littlerock\/2015\/07\/01\/at-home-many-seniors-are-imprisoned-by-their-independence\/","title":{"rendered":"At Home, Many Seniors Are Imprisoned by Their Independence"},"content":{"rendered":"<header id=\"story-header\" class=\"story-header\">\n<div id=\"story-meta\" class=\"story-meta \">\n<h1 id=\"story-heading\" class=\"story-heading\">At Home, Many Seniors Are Imprisoned by Their Independence<\/h1>\n<div id=\"story-meta-footer\" class=\"story-meta-footer\">\n<p class=\"byline-dateline\">JUNE 19, 2015<\/p>\n<\/div>\n<\/div>\n<\/header>\n<div id=\"story-body\" class=\"story-body\">\n<div class=\"lede-container\">\n<figure id=\"media-100000003751457\" class=\"media photo lede layout-large-horizontal\"><span class=\"visually-hidden\">Photo<\/span><\/p>\n<div class=\"image\"><img class=\"media-viewer-candidate\" src=\"http:\/\/static01.nyt.com\/images\/2015\/06\/23\/science\/23SPAN\/23SPAN-master675-v3.jpg\" alt=\"\" \/><\/p>\n<div class=\"media-action-overlay\"><\/div>\n<\/div><figcaption class=\"caption\"><span class=\"caption-text\">Solange DeLaPaz, 67, who has chronic obstructive pulmonary disease, needs constant oxygen and struggles to leave her Manhattan apartment.<\/span> <span class=\"credit\"><span class=\"visually-hidden\">Credit<\/span>Ruth Fremson\/The New York Times<\/span><\/figcaption><\/figure>\n<div class=\"lede-container-ads\">\n<div id=\"MiddleRight\" class=\"ad middle-right-ad marginalia-anchor-ad nocontent robots-nocontent\">\n<div class=\"accessibility-ad-header visually-hidden\">\n<p>&nbsp;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div id=\"byline-sharetools-container\" class=\"byline-sharetools-container\"><\/div>\n<p id=\"story-continues-1\" class=\"story-body-text story-content\">What she mourns most, says Solange DeLaPaz, are the mundane pleasures and rituals of her once-active life. A weekly manicure at the corner nail salon. Saturday excursions to Macy\u2019s shoe department.<\/p>\n<p class=\"story-body-text story-content\">\u201cI miss going to Sunday brunch on Second Avenue with my friends,\u201d she said. \u201cI miss going to church.\u201d<\/p>\n<p class=\"story-body-text story-content\">Though only 67, Ms. DeLaPaz retired early with <a title=\"Times Health Guide page.\" href=\"http:\/\/www.nytimes.com\/health\/guides\/disease\/chronic-obstructive-pulmonary-disease\/overview.html\">chronic obstructive pulmonary disease<\/a> and now struggles to leave her Manhattan apartment. She needs constant oxygen, and carrying even a portable oxygen unit troubles her breathing.<\/p>\n<p class=\"story-body-text story-content\">Climbing or descending the few steps from the elevators into her building\u2019s lobby presents another obstacle. \u201cI wouldn\u2019t dare do that on my own,\u201d she said.<\/p>\n<aside class=\"marginalia collection-marginalia collection collection-type-column collection-tone-feature collection-section-health collection-theme-latest-headlines nocontent robots-nocontent\">\n<div class=\"nocontent robots-nocontent\"><\/div>\n<\/aside>\n<p class=\"story-body-text story-content\">About every three weeks, therefore, the home care aide who provides 12 hours of city-subsidized weekly assistance accompanies Ms. DeLaPaz outdoors. They walk to the corner and back, perhaps a six-minute expedition. Other outings are largely limited to medical appointments, with an escort from the social service agency <a href=\"http:\/\/www.dorotusa.org\/site\/PageServer?pagename=homepage_DOROT\">Dorot<\/a>.<\/p>\n<p class=\"story-body-text story-content\">Unlike some homebound older people, Ms. DeLaPaz doesn\u2019t feel isolated, she said. Friends and relatives stop by; between a son\u2019s and a grandson\u2019s visits from Texas and California, she stays in touch online and by phone. A hairdresser and a priest make house calls. A volunteer helps with grocery shopping; a pharmacy delivers prescriptions.<\/p>\n<p class=\"story-body-text story-content\">Being homebound in rural areas <a title=\"Journal of the American Geriatrics Society abstract.\" href=\"http:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/j.1532-5415.1996.tb06403.x\/abstract\">can be harder and lonelier<\/a>. Even for Ms. DeLaPaz, however, \u201cbeing inside the house all the time is stifling. I\u2019m confined.\u201d<\/p>\n<p class=\"story-body-text story-content\">Almost two million people over age 65, or nearly 6 percent of those Americans (excluding nursing home residents), <a title=\"JAMA Internal Medicine article abstract.\" href=\"http:\/\/archinte.jamanetwork.com\/article.aspx?articleid=2296016&amp;resultClick=3\">rarely or never leave their homes<\/a>, researchers recently reported in JAMA Internal Medicine. The homebound far outnumber the 1.4 million residents of <a class=\"meta-classifier\" title=\"Recent and archival health news about nursing homes.\" href=\"http:\/\/topics.nytimes.com\/top\/news\/health\/diseasesconditionsandhealthtopics\/nursing_homes\/index.html?inline=nyt-classifier\">nursing homes<\/a>.<\/p>\n<p class=\"story-body-text story-content\">Using data from the 2011 <a href=\"http:\/\/www.nhats.org\/\">National Health and Aging Trends Study<\/a>, the study authors defined as homebound those who in the past month had not left their homes at all or had gone out no more than once a week. The researchers categorized another six million people as \u201csemi-homebound,\u201d able to leave home only with difficulty or with another\u2019s assistance.<\/p>\n<p id=\"story-continues-2\" class=\"story-body-text story-content\">Who are the homebound? Compared with other aging adults, \u201cthey\u2019re older,\u201d said <a title=\"Staff page.\" href=\"http:\/\/www.mountsinai.org\/profiles\/katherine-a-ornstein\">Katherine Ornstein<\/a>, an epidemiologist at the Icahn School of Medicine at Mount Sinai Hospital in New York and the study\u2019s lead author. \u201cThey\u2019re more likely to be female and less likely to be white; they\u2019re lower income. They\u2019re more likely to be non-English speakers and to be <a class=\"meta-classifier\" title=\"Recent and archival health news about Medicaid.\" href=\"http:\/\/topics.nytimes.com\/top\/news\/health\/diseasesconditionsandhealthtopics\/medicaid\/index.html?inline=nyt-classifier\">Medicaid<\/a>beneficiaries.\u201d<\/p>\n<p class=\"story-body-text story-content\">And, she added, \u201cthey\u2019re sicker,\u201d with higher rates of heart and lung disease, <a class=\"meta-classifier\" title=\"In-depth reference and news articles about Arthritis and Rheumatism.\" href=\"http:\/\/health.nytimes.com\/health\/guides\/disease\/arthritis\/overview.html?inline=nyt-classifier\">arthritis<\/a> and <a class=\"meta-classifier\" title=\"In-depth reference and news articles about strokes.\" href=\"http:\/\/health.nytimes.com\/health\/guides\/disease\/stroke\/overview.html?inline=nyt-classifier\">stroke<\/a>. Among the completely homebound, who haven\u2019t left home in the past month, 80 percent have <a class=\"meta-classifier\" title=\"In-depth reference and news articles about Dementia.\" href=\"http:\/\/health.nytimes.com\/health\/guides\/disease\/dementia\/overview.html?inline=nyt-classifier\">dementia<\/a>; so do nearly 60 percent of those semi-homebound older adults who never go out alone.<\/p>\n<p id=\"story-continues-3\" class=\"story-body-text story-content\"><a class=\"meta-classifier\" title=\"In-depth reference and news articles about Depression (Mental).\" href=\"http:\/\/health.nytimes.com\/health\/guides\/symptoms\/depression\/overview.html?inline=nyt-classifier\">Depression<\/a>, too, is widespread, affecting a quarter to a third of the semi-homebound and almost 60 percent of the completely homebound. Researchers don\u2019t yet know whether these people rarely go out because they are depressed or grow depressed because they have become homebound.<\/p>\n<div class=\"ad ad-placeholder nocontent robots-nocontent\">\n<div class=\"accessibility-ad-header visually-hidden\"><\/div>\n<p>But it is clear that while physical and <a class=\"meta-classifier\" title=\"Recent and archival health news about mental health and disorders.\" href=\"http:\/\/topics.nytimes.com\/top\/news\/health\/diseasesconditionsandhealthtopics\/mentalhealthanddisorders\/index.html?inline=nyt-classifier\">mental health<\/a> play key roles, the difference between those stuck at home and those able to participate in life beyond their front doors also depends on their environments and on assistance.<\/div>\n<p class=\"story-body-text story-content\">Dr. Ornstein\u2019s 79-year-old father in Queens, for example, lives alone and after several strokes, walks unsteadily. Jerry Ornstein could easily become homebound. Instead, \u201cmy father has two amazing home care attendants, so he\u2019s out every day\u201d visiting the park, his synagogue and the local library, Dr. Ornstein said. \u201cHe enjoys seeing people, watching the kids in the playground.\u201d<\/p>\n<p class=\"story-body-text story-content\">Edward Sedlacek, on the other hand, hasn\u2019t left home in about three months, he told me. At 87, he has difficulty standing and walking, but the bigger factor may be the 16 steps from his walk-up Manhattan apartment to the street. If he lived in an elevator building and used a motorized wheelchair, he might still be able to join friends for lunch at a nearby senior center.<\/p>\n<p class=\"story-body-text story-content\">\u201cWe really don\u2019t know the extent to which assistive devices \u2014 canes, walkers, wheelchairs \u2014 or environmental modifications like hand rails and ramps can fill this gap,\u201d said Vicki Freedman, an epidemiologist at the University of Michigan\u2019s <a href=\"http:\/\/home.isr.umich.edu\/\">Institute for Social Research<\/a>.<\/p>\n<p class=\"story-body-text story-content\">A study she helped conduct last year, using the same 2011 data to look at older adults\u2019 \u201cunmet needs,\u201d turned up an interesting comparison: When the researchers controlled for demographic characteristics and health and function, people in assisted living facilities actually <a title=\"Journals of Gerontology abstract.\" href=\"http:\/\/psychsocgerontology.oxfordjournals.org\/content\/69\/Suppl_1\/S42.abstract?sid=c6704a8c-ad43-497a-b143-4c4bb3c9b56e\">got outside more often than those in their own homes<\/a>.<\/p>\n<p class=\"story-body-text story-content\">How stuck in their homes older adults became, in other words, depended not only on how ill or frail they were, but on where they were. In assisted living facilities, aides, outings, vans and single-floor designs probably promoted access to a broader world.<\/p>\n<p id=\"story-continues-5\" class=\"story-body-text story-content\">Geography matters, too. Among people over 80, more than three-quarters<a title=\"Joint Center for Housing Studies.\" href=\"http:\/\/www.jchs.harvard.edu\/research\/publications\/housing-americas-older-adults%D1meeting-needs-aging-population\">remain in their own homes<\/a>, the Harvard University Joint <a href=\"http:\/\/www.jchs.harvard.edu\/\">Center for Housing Studies<\/a> has reported, and those homes can reduce or reinforce their limitations.<\/p>\n<aside class=\"marginalia comments-marginalia  selected-comment-marginalia\">In the Northeast, for example, more than 40 percent of homes have stairs and no bedroom and bathroom on the first floor. In the South, more than 80 percent of homes offer single-floor living.<\/aside>\n<p class=\"story-body-text story-content\">Concerned about how the homebound get routine health care, and the costs that <a title=\"Journal of the American Geriatrics Society abstract.\" href=\"http:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jgs.12974\/abstract\">mount when they don\u2019t<\/a>, a small but growing number of geriatrics practices make house calls. In the Mount Sinai study, about 12 percent of those completely homebound received primary care at home.<\/p>\n<p class=\"story-body-text story-content\">But there is more to a satisfying life than seeing doctors. You have to wonder whether older adults\u2019 preference for \u201caging in place\u201d has inadvertently helped imprison them.<\/p>\n<p class=\"story-body-text story-content\">Aging in place, by the definition of the <a href=\"http:\/\/www.cdc.gov\/healthyplaces\/terminology.htm\">Centers for Disease Control and Prevention<\/a>, is \u201cthe ability to live in one\u2019s own home and community safely, independently and comfortably, regardless of age, income or ability level.\u201d<\/p>\n<p class=\"story-body-text story-content\">In practice, however, older adults\u2019 desire for familiar surroundings, and their fear of institutionalization and its financial burdens, have apparently led millions to fight to remain in homes they can rarely leave. Our national celebration of independence as a value may not help.<\/p>\n<div class=\"ad ad-placeholder nocontent robots-nocontent\">\n<div class=\"accessibility-ad-header visually-hidden\">\n<p>\u201cThey don\u2019t have enough care,\u201d Amy Murray of the <a href=\"http:\/\/carterburdencenter.org\/\">Carter Burden Center for the Aging<\/a> in New York said of her homebound clients. \u201cBut when we suggest other situations, they don\u2019t want them.\u201d<\/p>\n<\/div>\n<\/div>\n<p class=\"story-body-text story-content\">As Mr. Sedlacek\u2019s case manager, she has arranged for <a href=\"http:\/\/www.mealsonwheelsamerica.org\/\">Meals on Wheels<\/a> and regular home visits from a <a class=\"meta-classifier\" title=\"Recent and archival health news about nursing and nurses.\" href=\"http:\/\/topics.nytimes.com\/top\/news\/health\/diseasesconditionsandhealthtopics\/nursing_and_nurses\/index.html?inline=nyt-classifier\">nurse practitioner<\/a>. She has suggested, and his nieces have also urged, that he hire home care.<\/p>\n<p id=\"story-continues-8\" class=\"story-body-text story-content\">He could afford help from aides, or a move into assisted living, \u201cbut for some reason, I\u2019m resisting it,\u201d he said. \u201cI can still get around, more or less.\u201d Mostly less.<\/p>\n<p class=\"story-body-text story-content\">To keep older people in their homes, as Medicaid and other programs increasingly try to do, represents a laudable goal but an inadequate one. Aging in place also requires a variety of supportive services; creating or expanding them involves money, time and many moving parts.<\/p>\n<p class=\"story-body-text story-content\">Remaining at home, however difficult or isolating that becomes, gives older people a sense of control that may prove illusory, Ms. Murray said. \u201cThey feel like they have their freedom even though they don\u2019t, really.\u201d<\/p>\n<footer class=\"story-footer story-content\">\n<div class=\"story-meta\">\n<p class=\"story-print-citation\"><em>A version of this article appears in print on June 23, 2015, on page D3 of the New York edition with the headline: Imprisoned by Independence.\u00a0<\/em><\/p>\n<\/div>\n<\/footer>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>At Home, Many Seniors Are Imprisoned by Their Independence JUNE 19, 2015 Photo Solange DeLaPaz, 67, who has chronic obstructive pulmonary disease, needs constant oxygen and struggles to leave her Manhattan apartment. CreditRuth Fremson\/The New York Times &nbsp; What she mourns most, says Solange DeLaPaz, are the mundane pleasures and rituals of her once-active life&#8230;.<\/p>\n<div><a class=\"more\" href=\"https:\/\/uamscaregiving.org\/littlerock\/2015\/07\/01\/at-home-many-seniors-are-imprisoned-by-their-independence\/\">Read more<\/a><\/div>","protected":false},"author":364,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_seopress_robots_primary_cat":"","_seopress_titles_title":"","_seopress_titles_desc":"","_seopress_robots_index":""},"categories":[3],"tags":[],"_links":{"self":[{"href":"https:\/\/uamscaregiving.org\/littlerock\/wp-json\/wp\/v2\/posts\/1066"}],"collection":[{"href":"https:\/\/uamscaregiving.org\/littlerock\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/uamscaregiving.org\/littlerock\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/uamscaregiving.org\/littlerock\/wp-json\/wp\/v2\/users\/364"}],"replies":[{"embeddable":true,"href":"https:\/\/uamscaregiving.org\/littlerock\/wp-json\/wp\/v2\/comments?post=1066"}],"version-history":[{"count":0,"href":"https:\/\/uamscaregiving.org\/littlerock\/wp-json\/wp\/v2\/posts\/1066\/revisions"}],"wp:attachment":[{"href":"https:\/\/uamscaregiving.org\/littlerock\/wp-json\/wp\/v2\/media?parent=1066"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/uamscaregiving.org\/littlerock\/wp-json\/wp\/v2\/categories?post=1066"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/uamscaregiving.org\/littlerock\/wp-json\/wp\/v2\/tags?post=1066"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}