Andy Rooney once observed: “It’s paradoxical that the idea of living a long life appeals to everyone, but the idea of getting old doesn’t appeal to anyone.”
Older adults face a number of changes that challenge the notion of aging well. Declining health, decreased income, death of family members or friends, and loss of mobility and independence can all shadow our older years. Since there is only one undesirable alternative to aging, however, older adults and their families do the best they can to manage the transitions that come with the territory. And in Evanston quite a few people are working to make the lives of older adults better. There are many settings, services, providers and programs that, with a bit of planning, can help make both a long life and getting old more manageable.
“Evanston has tremendous assets for older adults,” notes Susan Cherco, Chairperson of the Age-Friendly Evanston Task Force. “We have a lively, walkable downtown, access to continuing education at Northwestern University, robust health and community services, and diversity.” Ms. Cherco, who has worked in multiple capacities with the aging community and has a degree in gerontology, says her task force’s members are working on several key initiatives to make and keep Evanston friendly for seniors, including business accessibility, better dementia awareness, and affordable housing solutions.
Housing options are as important for Evanston as for the rest of our aging nation. According to the Age-Friendly Evanston Action Plan, by 2020 more than 20% of Evanston residents will be over the age of 65, a statistic that mirrors national population trends. For older adults who are making decisions about where and how to live as they age, a variety of options exist: from independent living at home to dementia-care skilled nursing homes, and from relying on “friendly visitors” to volunteering to become one.
Surveys show that, by a large margin, older adults want to age at home and in a familiar community, says Helen Gagel, Age-Friendly Evanston Task Force member and former executive director of North Shore Village. For some, that may be the home where they raised their families. Others may move to a smaller place when finances change, a home becomes hard to navigate, or living there comes to feel isolating, especially if a person does not have family in the area, or a spouse or partner passes away. As long as finances and independence allow, an older adult can stay in her or his home and take advantage of services provided through city, state, and federal programs, and nonprofit organizations, to manage the transition to their older years.
Two natural stops for many older Evanstonians are the Morton Civic Center and the Levy Senior Center. Another great social outlet is the Foster Senior Club, the oldest senior club in Evanston, which meets every Wednesday at the Fleetwood Jourdain Community Center and boasts an annual fashion show that attracts more than 200 supporters.
The Levy Center provides seniors access to a slate of activities, social groups and fitness resources.
Evanston has a volunteer snow shoveling program and an Evanston Benefit Card that affords subsidies for taxicab rides, wheel taxes, yard waste fees, and handyman services, plus discounts with a number of Evanston merchants. Card benefits are detailed on the city’s website and eligibility is determined by age, income, and disability factors. The Levy Center offers access to a slate of activities, social groups, and fitness resources. The center also provides support to seniors as they research living options, prepare legal documents, and learn about available services.
In addition to city offerings, seniors will find a significant network of resources as they seek help with daily activities and work to stay connected with their community. Audrey Thompson, Evanston’s Long-Term Care Ombudsman, says, “What sets Evanston apart is all our collaborating agencies. We are enmeshed together. Our goal is to keep individuals living independently as long as possible, and then to support them when they can no longer do that.” Technically, Thompson’s role is focused on advocating for residents of 13 licensed care facilities in Evanston, but she fields many inquiries about the myriad options in town. “People call and ask, ‘Where would you place your own mom?‘” she says. While she cannot give a stock answer, she is happy to share checklists and questions that can help identify a good fit for an individual’s situation. The best choice could be a senior rental community like the Merion or a specialized mental health rehabilitation facility like Albany Care or Greenwood Care.
Beyond the idea of facility placement, Ms. Thompson recommends investigating the many resources available to older adults in Evanston, which can be found through a mix of volunteer programs, membership programs and pay-for-service fees, as well as government subsidies for low-income seniors. Tom Giller, Evanston Social Service Manager for North Shore Senior Center, says many older adults who wish to continue living independently can do so, even when income is limited. In Evanston the center provides a range of services, including benefits counseling and administering the state’s Community Care Program. CCP provides non-medical home care services to income-qualified seniors to help them with activities of daily living so they can remain at home.
Low-income seniors may be eligible for subsidized senior housing. Ebenezer Primm Tower and Jacob Blake Manor are subsidized by the U.S. Department of Housing and Urban Development, while the Perlman and Walchirk apartment buildings are funded through the Housing Authority of Cook County. Mitchell Smith, Property Manager for Primm Tower, notes that subsidized housing is a rental agreement, not an arrangement for medical or home care, which may also be subsidized, but must be arranged separately. There is a waiting list of up to two years for Primm Tower, he says, and he recommends applying as soon as it becomes clear this would be a good option. “Successful families,” Mr. Smith says, “are not necessarily financially sound, but they have a plan. It’s an overwhelming responsibility to care for an older adult sometimes. You have to be in your loved one’s life to make sure the people you’ve lined up are accountable.”
Ebenezer Primm Towers offers subsidized housing for low-income seniors.
For seniors who do not qualify as low-income, living independently, staying connected to the community, and finding ways to meet daily needs can be challenging. There are, however, a number of for-profit home care agencies as well as non-profit organizations that can help. SASI (Services for Adults Staying in Their Homes) is an independent, nonprofit agency that helps seniors and their families find caregivers to assist with non-medical activities of daily life. The caregivers are paid by the person receiving services, but SASI tries “to keep rates low enough for people who can’t afford to move into a continuing-care retirement community, but can afford to stay in their home,” says Jeanie Ramsey, SASI’s executive director. SASI recently merged with Senior Connections, a long-time Evanston program that trains and coordinates volunteer friendly visitors for isolated older adults in the community.
“Friendly visiting” is a term that comes up often in interviews with organizations that work with older adults. Evanston’s Long-Term Care Ombudsman, NSCC, SASI’s Senior Connections, and North Shore Village all have friendly visitors who reach out to seniors. This focus reflects their shared belief that social connections are essential to an older person’s quality of life. Often when work and family connections wane and a person’s mobility becomes compromised, she or he becomes more isolated. According to Ms. Gagel, “Research shows that social isolation is a better predictor of death than smoking or obesity. What older adults need is social engagement. Without it you see a rapid downward spiral.” Ms. Ramsey notes that the term “elder orphans” (describing seniors, most often women, who have lost all family members) gives a sense of the deep impact of losing connections to other people.
Working to counteract isolation in aging, North Shore Village (NSV) is a paid membership organization that provides older adults connections to activities, community resources, vendors and volunteer services. Executive Director Marie O’Connor says, “One of the biggest transitions we go through as we age is losing independence and our friends.” She adds that NSV fosters social engagement as an antidote to older adults’ feeling that they are a burden to others. The staff and board of NSV encourage members to both volunteer to help others and to ask for help when they need it. Additionally the organization promotes social engagement before and after the traditional hours when senior centers are open. Board president Jennifer O’Neil says of NSV’s members, “We have always been joiners and boy are we transitioning as a group!… The Village is there as long as you can utilize its support.”
Advocates for seniors in Evanston agree that while a primary goal is to help older adults age in place, there are certain signs that indicate an elderly person should no longer be living independently, even with some amount of assistance. Ms. Thompson advises that if a person needs care 24/7 and does not have that, the situation becomes unsafe. At some point older adults’ inability to make safe decisions could endanger themselves and others. Mr. Giller says warning signs may include self-neglect (poor diet, poor hygiene, extreme clutter or hoarding) or cognitive impairment that puts the person in dangerous situations. And Ms. Ramsey adds, “If a person is not taking care of themselves that should become a red flag.” At that time the person needs to transition to a safe place of care, and “it’s best if family can identify that need early on,” says Mr. Smith.
Most seniors and their families make decisions about moving between independent living, assisted living, and skilled nursing facilities as the need arises, usually in response to illness, injury, cognitive or physical impairment, or general declining health. Licensed assisted living facilities provide meals, housekeeping services, and assistance with activities of daily living, as well as social activities and medication supervision.
The cost of assisted living reflects all of those services, and is generally paid by the individual. Should a person require 24-hour-a-day medical care, services and the corresponding costs increase significantly, and a licensed skilled nursing facility is usually required. Evanston has a number of those: Alden Estates, Aperion Care, Dobson Plaza Nursing Home, Grove of Evanston, Symphony of Evanston, Three Crowns Park, and McGaw Care Center. The layered interaction of levels of care, time horizons, costs, and insurance benefits is beyond the scope of this article, but the Long-Term Care Ombudsman’s office has many resources that lay those out.
For seniors whose resources allow, life plan communities pair independent living with access to a continuum of medical care. Evanston has three well-known organizations that fall into this category: Mather Lifeways, Presbyterian Homes, and Three Crowns Park. Enrollment in these communities’ programs requires a significant up-front investment followed by monthly payments to cover services, and the commitment assures that changing health conditions will be managed with continuity of care. Ms. Thompson says these communities can make transitions easier to manage. Because they require such a significant investment, she suggests seniors and families familiarize themselves fully with the different levels of care as well as the contractual obligations involved. Her advice is to “examine every level of care from independent living to dementia care. Could you imagine yourself living there at the various levels?”
While the task of researching Evanston’s rich network of settings, services, programs for older adults can seem daunting, advocates for older adults encourage seniors and their families to start researching and planning sooner rather than later. Ignoring or denying changing circumstances does not work in an older adult’s favor. “Avoiding the conversation doesn’t make future events go away,” says Ms. Thompson, “Knowing what your options are makes growing old a lot easier than just falling apart.”
Diane Lequar is a community volunteer and writer who lives in Evanston with her family.