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Most seniors prefer to age in place but end up moving to senior living because of preventable problems. Here’s how you can help.

Did you know that 66% of seniors who planned on moving to senior living in 2020 were skeptical of moving due to COVID-19? The decisions behind those moves are difficult to predict if you are not directly involved in the process.

In home care, it’s hard to anticipate when your clients might move. Other than when you are informed of their relocation, you generally don’t know they were even looking. When your revenue is at risk, it’s a challenge to shuffle caregivers onto other shifts without interrupting their schedules.

At the end of the day, your job is to help seniors get the type of care that best accommodates their situation. However, the benefits of home care are often overlooked, so it’s important to thoroughly understand the reasons why seniors move so that you can help your clients recognize situations where home care is a better choice.

The reasons and psychology behind seniors’ decisions about where to age have been a focus of research by care providers and academics alike. Let’s take a look at some of the academic research on the topic.

By understanding the decision-making process behind these moves, you can learn how to utilize the services that you offer to your clients’ advantage.

Why do seniors move?

Here are three theories centered around the decision-making process that seniors and their families use. These will help you to better understand the reasons why your clients might reconsider aging in place.

Theory 1: Seniors move an average of three times once they retire. (Litwak and Longino, 1987)

There are three moves that seniors make:

  • At retirement for improved living conditions, but for those that are less able, they move to an area with more physical and/or social supports

  • Upon minor or subtle changes in condition and abilities

  • Upon major condition changes or severe reduction in functional abilities

Litwak and Longino’s approach to their research focused on the reasons behind each move that a person makes after retirement. They also studied the factors behind each move and identified whether it was for leisure, physical, or social reasons.

Your caregivers are going into clients’ houses on a daily basis. They would be the first to identify changes or convey events that are going on in a client’s life, from forgetting their morning meds to a breakdown in family relationships – it’s important to know what to look for.

Stay on top of client observations by training your caregivers on how to recognize and report abnormal observations. Some of those include:

  • Higher or lower than normal vital signs

  • Mental and cognitive status changes

  • Changes in appetite and intake/output

  • Unusual skin color or bruising

  • Relationship and family dynamic changes

You and your caregivers know what normal looks like for each client, and by training them on what information needs to be conveyed to the office, you can identify clients that may need additional support.

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Theory 2: Seniors have seven specific needs to be met, and may move to senior living if one or more of them are not met at home. (Deprés and Lord, 2005)

To the researchers behind this theory, home is an idea (not a place), based on factors like the seven dimensions of health and wellness:

  • Psychological – the satisfaction and perception of residence

  • Emotional – their emotional well-being and ability to process emotions in a healthy way

  • Social – the ability to relate and connect with their family and friends

  • Economic – financial status and material health

  • Environmental – familiarity and attachment to memories and the setting

  • Intellectual – the center of daily life, identity

  • Occupational – their ability to contribute to society and having a meaningful connection to their community

Deprés and Lord focused on the concept of what makes a home – as defined by seniors. If these needs are met, clients would not consider relocating.

Some agencies have been addressing client needs by looking at the social determinants of health (SDH) and whole-person-care. Agencies such as Lifesprk have created programs focused on whole-person care that evaluate and track seniors’ well-being across categories similar to those listed above; this approach is much more likely than traditional approaches at ensuring that all of a senior’s needs are met.

Theory 3: The reasons why seniors move can be sorted into 3 categories of factors: push/pull, unexpected/expected events, and endogenous/exogenous factors. (Wiseman, 1980)

Wiseman’s theory explored the factors involved in a senior’s decision-making process to move or not to move from their homes. Some of the reasons include:

Push or pull factors: Events or things that push a senior out of their home or pull them toward senior living.

Some of the most impactful push factors according to a recent study included:

  • Not wanting to be a burden

  • Barriers to adaptation in the home

  • Care that isn’t tailored to their own needs

  • Lack of engagement/acceptance

Pull factors include fun activity departments and appealing amenities.

Unexpected or expected events: Unexpected events happen without notice or warning, while expected events are anticipated and can be planned out in advance. Some of those include:

  • Unexpected events include serious falls or other medical events

  • Expected events include the desire to work, or to explore retirement/leisure

Endogenous or exogenous factors are changes that come from inside or outside of an individual that may influence their decision-making process to age in place or relocate. Some of these include:

  • Endogenous factors – changes that come from an individual (ex: the desire to age in place)

  • Exogenous factors – changes that come from the environment (ex: inability to afford a move into senior living)

Wiseman concluded that the decision to move results from ties between big life events (medical episode, or spousal death) and personal resources (like money, memories, and keepsakes). Keep these in mind when thinking of your clients. Frequently communicate with your caregivers if they notice any changes in their condition or circumstances.

What has changed since these theories came out?

These theories are not recent; however, they lay the foundation for our understanding of the decision-making processes that lead seniors to choose senior living.

By incorporating these theories into your care, you have an abundance of tools at your disposal to help your clients age in place.

From bed alarms to automatic medication dispensers, and toilet safety frames, there are many adaptations that can be made to keep seniors safe at home.

You can suggest these modifications to clients during a home safety evaluation. This can help to establish trust and position your agency as a helpful resource for families.

Caregiver training has improved over the years as well. Online training itself started in 1989, and home care has followed the trend to have a more blended learning approach: using online and in-house training curriculums. Learn more about our blended learning solutions, the only one available for the home care industry here.

Having trained, reputable, and highly-qualified caregivers can help you hold onto clients that want to stay at home.

What can you do to help your clients stay at home?

Did you know that almost 90 percent of the 50+ age group want to age in place? Too often, seniors put off moving until staying at home is no longer safe or able to fulfill their care needs. During your home safety assessments and client supervisory visits, you can use these as opportunities to gauge and fix safety hazards to promote independence.

By listening to your caregivers about client changes or declines in condition, you can help your clients be more deliberate and confident in their decision-making processes.

The main factors that cause seniors to relocate center around their satisfaction with their current home. If your caregivers can identify what makes your clients happy and satisfied, this will keep them from moving.

Your client’s care needs may increase beyond your scope of care. If that’s the case, then you could make a referral within your network. You can reach out to a home health agency for chronic condition management, or hospice for various clinical and non-clinical therapies.

For example, if one of your clients loses a spouse, it’s important to staff them with a caregiver that is equipped to provide emotional support. Make sure that the client has a team of caregivers that they have built a strong relationship with.

When your agency collects and analyzes care notes from caregivers, double-check that you are up to date on everything that is going on with a client.

  • Did one of their close friends move away?

  • Do they live in an area that has limited access to healthcare and important facilities?

  • Is your client satisfied and happy with their current residence?

  • Are there modifications or devices that you can introduce into the home to prevent falls?

These are just a couple of questions to think about for each of your clients. By knowing the answers, you can identify clients who may be starting the search for senior living options. This presents an opportunity for you and your staff to approach the client about additional services that you can offer to improve their happiness at home.

Knowing what causes your clients to move or stay in their home can help to:

As an agency, it can be easy to let information slip through the cracks or overlook certain things, but it can be rewarding to hold onto this information to keep your clients happy.

Senior living may be best for some of your clients, but that doesn’t mean that your journey with them has to end.

As a home care agency, you want to keep each client on services for as long as possible. Each client situation is different, and for some, their best option for care may take place in a senior living community.

This is an opportunity for you to facilitate an easy transition that sends the client off on a good note. In addition, this could serve as a referral partnership opportunity.

Some clients may elect to keep home care after moving into a community, to maintain the one-on-one attention that home care provides.

You can introduce a meaningful transition program to help the client adjust into their new home by:

  • Asking the family if there’s anything that they need support with

  • Refer them to a moving company that you know

  • Offer to send a caregiver on the moving day to make sure that they acclimate okay

  • Have your nurse or someone from your clinical team sync with the facility staff to exchange notes on the care plan and the client’s condition

  • Put together a care package to help the client feel at home in their new place

If you help the client to the best of your abilities and leave things on a good note, they will surely reach out to you in the future with any care needs if they or someone they know need care.

Client satisfaction and length of service go hand in hand.

According to the Home Care Benchmarking Study, the average length of service for clients has increased by 4 months since 2019. You have the potential to put your agency above the benchmark by preventing clients from moving to senior living options. By being fully aware of your clients’ needs, keeping a strong pulse on their well-being, and educating them on the ways that they can continue to age in place should they choose to do so.

You can place additional emphasis on client satisfaction by using surveys to keep a pulse on how things are going.

With a better understanding of the factors that influence clients to consider relocating, you and your team can create a plan that will address clients’ concerns and increase their satisfaction with their homes.

Quality care is a priority for you; what improvements are you going to make to keep clients with your agency longer?

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