The background for this book began in the mid-1990s, when I was doing research for my Ph.D. dissertation, Residents in Long-term Care: A Case-controlled Study of Individuals in Nursing Homes and Assisted Living in Washington State. I visited dozens and dozens of nursing homes and assisted living communities1, and interviewed as many as 20 people in each community, resulting in hundreds of interviews. The dissertation was recognized with the 1997 Student Research Award for “Outstanding Research Relevant to Aging and Directly Applicable to Practice” by the American Society on Aging.
With this foundation of knowledge, I found a publisher that was interested in a guide to state-wide retirement communities. The industry was booming, and little was known about specific communities, other than the enthusiastic paid advertising. I published Retirement Options: The Statewide Guide to Independent and Assisted Living Communities. This wordy title took me to 52 cities and towns in Washington State, some with as many as 40 communities (Seattle) or as few as one or two in each of them.
I learned personally that an age-segregated community was not a good fit for me. My spouse and I always had friends and neighbors of all ages. As a professor, I respected the insights and diversity of graduate students in their 20s, 30s, 40s and 50s. We can always learn so much from each other.
And I knew that if at all possible, I did not want to end my days in a nursing home. I paid attention to those who died at home or in a retirement community. There were commonalities, sadly not the least of which was money. So many people find their retirement funding dwindling to the point of limiting options. Most industrialized countries have robust social services and integrated universal health care that encompass home care options and affordable housing. The United States does not.
I know that most other older people also do not want to end up in a nursing home, other than for shortstay rehabilitation. Survey after survey shows statistics that most older people want to age in place. I do too.
When my most recent book came out, To Move or to Stay Put, I did a series of talks at senior centers, libraries, social groups on “Seven Ways to Stay Out of a Nursing Home.” I learned much from the audiences— what they knew and what they didn’t know; what I knew and what I didn’t know.
This book is a result of that process. We want to age intentionally and avoid ending up in a situation we do not like.
1Nursing homes are federally- and state-regulated ‘skilled care’ facilities. Assisted living, in most states, is basically room and board with housekeeping and some activities, plus perhaps transportation.