Two years ago, isabelle Dourley sold her house in Montreal and bought a bungalow in Toronto, where her two children and grandchildren live. She wanted to be closer to them but still retain some independence.

These days, at age 88, she lives quietly with her dog, surrounded by furniture and memorabilia acquired over the years. There’s no place like home, and Dourley, like many seniors, wants to age in place. “I like to be as independent as possible,” she says.

Dourley’s life is arranged to enable her independence. She doesn’t venture out alone, except onto the back deck. The bathroom is equipped with grab bars and an elevated toilet seat. And she wears a Lifeline bracelet so she can summon help in an emergency.

Her children telephone every day. On Saturdays, daughter Kathy shops for her mother and helps her take a bath. Son Brian does yardwork, light cleaning and takes his mom to his home for Sunday dinner. A cleaning person visits once a month. And every Wednesday, Dourley spends the day at Community Care East York’s adult day program. The $25 fee includes escorted transportation, lunch and socializing with other adults.

In addition to her family’s support, Dourley is taking advantage of some of the devices and services available to help seniors stay in their homes. It all depends on the needs of the senior.

“If the needs are primarily physical, a person may be able to get along at home better than if the needs are social,” says Peter Silin, a social worker and principal of Diamond Geriatrics, a Vancouver-based care-management firm. He suggests the family make a list of their elderly relative’s needs. “Are [these] physical or social?” he asks.

First of all, the senior’s home should be safe. This may mean renovations, such as installing ramps at entrances, widening doorways or remodelling a bathroom to allow wheel-in access. Or it may mean small additions such as bathroom grab bars or minor adjustments such as removing loose rugs and putting dishes and cookware within easy reach.

Technology is enhancing safety. Call-in emergency systems, such as Lifeline (www.lifeline.ca), allow people to call for help, even if they aren’t near a telephone. Lifeline’s “personal help button,” worn as a bracelet or pendant, is waterproof and can be kept on while bathing. Pressing the button alerts the firm’s operators, who will call a family member, a friend or an ambulance, as instructed.

But for these emergency systems to work, the elderly have to be willing to use them, says Barbara Carter, president of Papillon Consulting Services, a Toronto seniors’ housing consultancy. “I’ve come across seniors who were too embarrassed to use them. They’d rather wait to be found.”

There are other products that trigger an alarm without the client’s active involvement, including:

> pressure mats. These can be placed on the floor beside the bed to monitor whether a person has risen from bed that day;

> bed/chair occupancy sensors;

> fall detectors;

> flood detectors, which provide an early warning of flood situations, caused when a tap is left on, for instance.

Businesses that carry these products are listed in the Yellow Pages under “Home health services and supplies.”

Trusted neighbours can enhance home safety. They can be asked to watch for signs of activity in and around the house. Some neighbours arrange signals with one another that all is well. When my mother-in-law was living alone in her home, she turned on a lamp in her front window at nightfall. Her neighbour across the street watched for this light every evening.

“It adds to the senior’s social well-being, feeling part of a community,” Carter says. “We underestimate how lonely living alone can be.”

Community senior services groups across the country are developing adult day programs to address the social needs of seniors living at home. Dourley calls the group she meets with “my club.” She enjoys her Wednesdays so much she’s considering attending twice a week.

Initially, living in a small house or rented accommodation may be less expensive than a seniors’ residence or a nursing home. But as people age, they may need to bring in outside help. Carter notes that nursing care costs about $40 an hour; two hours of nursing care a day would cost up to $2,480 a month. Seniors who develop dementia need 24-hour help. Long-term care insurance would be a godsend in these situations.

@page_break@LTC insurance has two payout formats, says Diana Deverall-Ross, vice president of individual health insurance at Sun Life Financial Inc. in Waterloo, Ont. The “reimbursement” type reimburses the policyholder for eligible expenses, while an “income” product provides a regular income that can be used however the client wishes. “You can even use it to pay a family member to look after you,” she says.

A Sun Life LTC policy can be purchased up to age 80, but, as Deverall-Ross notes, “You have to be healthy to qualify. People often get frail as they age, so advisors should start talking about coverage early on. Our average issue age is 51.”

According to Silin, there are five stages of home care your elderly client may require:

> help with household tasks such as cooking, shopping, banking, laundry and housecleaning;

> help with bathing;

> help with grooming and getting dressed;

> help with eating and the toilet;

> palliative care — 24-hour nursing care for the terminally ill.

These stages are not static. A person who suffers a stroke may initially need round-the-clock nursing care, but may eventually regain the ability to perform most activities of daily living. And, Carter notes, these stages are not necessarily based on age, but on physical and mental abilities. “Just because Mom is 75 doesn’t mean she can’t cook her own meals and clean her house,” she says.

The big hurdle, she says, is convincing seniors that they need help: “You may have to wait for a crisis, such as a fall, to convince Mom that she needs help.”

Once the senior agrees to bring in help, he or she will need assistance finding that help. You can suggest your client’s family start with provincial services, which provide help with bathing and dressing, nursing care and light housekeeping.

Most provinces have single-point entry systems through their regional health authorities, such as Community Care Access Centres in Ontario and Centres Local de Services Communautaires in Quebec. The nearest health authority office can be found by calling the provincial ministry responsible for health listed in the government pages of the telephone book. A representative will assess the senior’s needs.

“You pay according to income,” Silin says. “If you’re living on CPP and OAS benefits, you may not pay anything. But if your income is $50,000 after taxes, you’ll probably pay as much as you would with private care services.”

Private home care includes everything the province covers, as well as home maintenance, errand-running and companionship. Silin says you can find this help in a number of ways, including through geriatric-care managers, who will hire the appropriate services, or home-care agencies, which are listed in the Yellow Pages and which, he says, charge $18-$20 an hour in British Columbia. For housekeeping and companionship, he says, “You can probably hire someone for half that price by running an ad in a newspaper.”

Carter says war veterans’ associations provide members with referrals to services. Community seniors’ organizations may also know people who do this kind of work. And inquiries can be made at colleges that train care aides.

Family members should help the senior interview individuals for these positions, and be clear about what tasks the aides are to perform. If part-time help is required, ask what other work these people do to be sure it won’t conflict with caring for the senior. IE