We talk a lot about independence as we age. People say, “I want to stay independent,” “I don’t want to be a burden,” or “I want to stay in my own home.”
But I think what most people really want is control.
We want control over where we live, who helps us, how our money is spent, which healthcare providers we use, and how decisions are made if we can no longer make them ourselves.
That is an important distinction because independence and control are not the same thing. Independence means doing everything yourself. Control means having a say in how things get done.
You can need help getting dressed and still have control over your life. You can stop driving and still decide where you want to go. You can have a caregiver in your home and still determine how you spend your day. You can even move to assisted living and maintain significant control over your choices.
In fact, accepting the right help at the right time can often help you maintain control longer.
The bigger risk is waiting until a crisis forces decisions to be made quickly.
A Crisis Shrinks Your Choices
Consider what happens every day to families.
Mom is living independently at home and everyone thinks she is doing pretty well. Then she falls. There is an ambulance ride, a hospital stay and perhaps a few weeks in rehabilitation. Suddenly, the family is being told that she probably should not return home alone.
Now everyone is scrambling.
Does someone need to stay with her? Can the house accommodate a walker? How much does home care cost? Will insurance pay for it? Should she move? Who has power of attorney? Who can make healthcare decisions? Most importantly, what does Mom actually want?
These are difficult questions under the best circumstances. They become much harder when a hospital or rehabilitation facility is telling you that discharge is happening in the next few days.
Planning does not mean predicting exactly what will happen. It means making enough decisions in advance that a crisis does not get to make all of them for you.
Eight Questions That Help You Stay in Control
You do not need to know exactly what your life will look like at 75, 85 or 95. But you should have a framework for how you want decisions to be made.
Start with these eight questions:
1. Where will I live?
Think beyond simply saying, “I want to stay in my home.”
Ask yourself:
- Is my current home realistic if my mobility changes?
- Could I live primarily on one floor?
- Would I consider downsizing?
- Would I consider independent or assisted living?
- Would I ever move closer to family?
- What circumstances would cause me to reconsider where I live?
You do not need to pick a senior living community today. You should understand your options before you need one.
2. Who will help me?
Most people assume their family will help, but that needs to be more specific.
Who will actually be available? What can they realistically do? What happens if your spouse is your primary support and something happens to them?
There is also a big difference between a daughter picking up groceries once a week and providing hands-on personal care every morning. Families should talk openly about what they can provide and where professional home care or care management may eventually be needed.
3. How will I pay for care?
This is one of the most important conversations to have before care is needed.
Understand what resources could be available, including:
- Personal savings and income
- Long-term care insurance
- Veterans benefits
- Medicaid or other government programs
- Family financial support
- Other insurance or benefits that may help with specific services
You should also have a general idea of what you would be comfortable spending each month on care.
Money should not be the only consideration when making care decisions, but it will be a consideration. Understanding your resources ahead of time gives you more choices.
4. Who makes decisions if I can’t?
Someone may eventually need to speak for you. Who is that person, and do they actually understand what you want?
Review your power of attorney, healthcare surrogate and other legal documents. Make sure they are current and that the people named in them know their roles.
More importantly, talk with them.
A legal document can identify who has authority. It cannot explain everything that matters to you.
5. What happens in a crisis?
You cannot prevent every emergency, but you can decide how your family should respond.
If you fall or are hospitalized:
- Who gets called first?
- Who knows your medications and medical history?
- Who has access to your insurance information?
- Where are your legal documents?
- Who communicates with doctors?
- Who helps coordinate care after discharge?
- What happens if returning home immediately is not safe?
A crisis plan will not eliminate the emergency, but it can eliminate a tremendous amount of confusion.
6. What healthcare resources will I use?
Aging well often requires more than having a good primary care physician.
Think about who will help you navigate the healthcare system if your needs become more complicated. You may eventually encounter specialists, home health, rehabilitation, private home care, care management, palliative care, hospice and other services.
Families should understand what these resources do and when they might be appropriate.
The worst time to learn how the aging and healthcare systems work is when you are already in the middle of a crisis.
7. What changes should I make to my home?
You do not need to turn your house into a hospital. Often, relatively simple changes can make it safer and easier to remain there.
Look at:
- Bathrooms and showers
- Stairs and railings
- Lighting
- Rugs and trip hazards
- Entrances and steps
- Grab bars
- Bedroom location
- Accessibility for a walker or wheelchair
The best time to think about fall prevention and accessibility is before the first serious fall.
8. What is important to me?
This may be the most important question on the list.
What makes your life meaningful?
Maybe it is seeing your grandchildren, playing golf, going to church, having dinner with friends, traveling, keeping your dog, living near the water or simply drinking coffee on your own porch every morning.
Aging wisely should not become an endless exercise in eliminating every possible risk. I write frequently about preventing falls, recognizing cognitive decline, knowing when driving may no longer be safe and putting the right support in place. Those things matter, but there has to be balance.
The goal is not simply to prevent bad things from happening. The goal is to help someone continue living a life that matters to them.
Sometimes that means accepting reasonable risk in exchange for quality of life.
A Care Manager Helps You Gain and Maintain the Control of Choice
You cannot control everything that comes with aging. You cannot guarantee that you will never fall, become sick, need assistance or experience changes in your health.
But you can have a plan.
That is where a professional Care Manager can make such a difference. A Care Manager helps you think through these decisions before the crisis, understand the options available to you, put the right resources in place and adjust the plan as your needs change.
They can help you answer the questions that ultimately determine how much control you maintain:
- Where will I live?
- Who will help me?
- How will I pay for care?
- Who will make decisions if I can’t?
- What happens in a crisis?
- What healthcare resources will I use?
- What changes should I make to my home?
- What is important to me?
And when something does change, you are not starting from scratch. You already have someone who understands your wishes, your family, your resources and your plan.
A Care Manager helps you gain and maintain the control of choice.
Because aging wisely is not about doing everything yourself. It is about making sure that, for as long as possible, the choices about your life remain your choices.
