Planning the Move to a Senior Community Before a Crisis Hits

We’re heard it often, whether from friends, relatives or through-the-grapevine. “I had to move mom into a nursing home after she fell while she was alone at home”, or “I thought everything was OK until we came to visit and grandma had left the gas on the range” or even “We were so worried when dad didn’t come home from the store; the police brought him home 5 hours later”. These are situations that an “outsider” would have picked up on but the family member often can’t see or refuses to admit there’s a problem.

Why do families avoid the situation? It’s hard to admit that something may be happening either physically or mentally with our senior loved ones. We often hear people say “after we lost dad we promised mom she could stay in the house as long as she is able”. Or they think the situation is temporary and their senior relative will “get better”. They see a move as taking away the senior’s independence and their home. What people don’t consider is if they wait, something catastrophic can happen. Rather than the individual moving into an independent or assisted community, they’ll completely lose their independence and have to move into a nursing home.

The reality about pre-planning is that it actually increases the senior’s independence by including them in the planning processing, allowing them to tour the communities to see what amenities and features each to offer, and allowing them to take control of their lives. More often what happens is that something has happened to put the senior into a rehab or skilled nursing facility and a family member takes on the decision making process. If this was the situation you were in which position would you rather be in? The position of being able to make your own choice or depending upon someone else to make the decision while you’re laid up in a hospital room?

Whether you’re a senior or the family of a senior and you’re reading this, ask yourself the questions: is everything you’re doing revolving around taking care of a loved one? If you’re the family member of a senior, have you turned into the caregiver, spending all of your “free” time running errands, making decisions and assisting your senior loved one? And if you are the senior relative, do you want your children to give up everything to take care of you?

You may be surprised to learn that statistics are showing that nearly 75% of people, over the age of 65 with a chronic disability, rely exclusively on family and friends to help with everyday activities. Adult children, especially daughters, are the primary caregivers. Women comprise more than 70% of the family caregivers to their chronically ill elders. The most recent study estimated that the cost of this “informal” caregiving is $196 billion, or more than twice the cost of nursing home placement. Seniors requiring assistance are receiving, on the average, of 60 hours of informal care and 14 hours of professional caregiving per week.

We’ve heard about the “sandwich” generation. The baby boomers are faced with a dilemma of having to care for both their parents and their children. This is the first time in history that grown adults have more living parents than they have children. In fact the average American woman can expect to spend 18 years caring for an older family member compared to 17 years caring for a child.

Unfortunately this has also turned into a problem for the female caregiver. Women do not tend to report the stress in rendering care. Instead they try to “manage” the stress by negotiating their caregiving responsibilities around their jobs and families, giving up their free time, and possibly affecting their income potential. But despite the amount of care they provide, many women caregivers still fell guilty and feel they could be “doing more”.

Are you a caregiver? You are if you are...

• providing emotional support.
• providing instrumental activities such as transportation, meal preparation, shopping and housework.
• providing personal care assistance such as bathing, hair care, feeding and dressing.
• mediating with agencies to obtain services.

Think about how the role of a caregiver is affecting your own life.

• Is it affecting you financially? Have you missed out on career advancements, reduced hours at work, work absenteeism, cost of travel and/or purchases for your senior?
• Is it affecting you personally? Are you starting to develop health problems (headaches, muscle aches, weight gain, digestive problems), are you constantly tired, are you neglecting your own health?
• Is it affecting you emotionally? Are you depressed, anger easily, constantly worried, withdrawn from family and friends, experiencing a strained relationship with your spouse/partner, starting to resent your elder care recipient?

When do you need to start thinking about planning for a move? What are the signs that the elder relative needs to move from their own home into a senior community? The important issues are:

• Safety
  Does your loved one refuse or forget to use safety equipment such as walkers or grab bars?
  Is the home environment becoming difficult to maneuver (stairs, dark hallways, and inaccessible areas)?
  Has your loved one had accidents with the appliances or other household items?
• Personal hygiene
  Is it difficult for your loved one to get to the bathroom when needed?
  Are they unwilling or unable to bathe themselves?
  Are they unwilling or unable to change clothing when needed?
  Are they unwilling or unable to help with personal care tasks?
• Behavior concerns
  Has your loved one ever wandered away from home or been lost?
  Is he/she combative, suspicious, angry or refusing care?
  Has he/she tried to physically harm themselves or others?
• Nutrition
  Does he/she have problems preparing meals or eating independently?
  Is he/she having health problems associated with poor nutrition?
  Has eating or swallowing become difficult?
• Financial concerns
  Have the financial strains of caregiving become difficult on your own budget (buying food, gas, medical supplies)?
  Do you miss work due to caregiving responsibilities?
• Caregiver issues
  At the end of the day do you feel exhausted and like you couldn’t make it through another day?
  Is your health beginning to suffer because of your caregiving responsibilities?
  Is there frequent conflict between you and other family members regarding your caregiver responsibilities?
  When you get a break from caregiving, do you still feel overwhelmed and exhausted?
  Are you beginning to resent the care recipient?

If you’ve answered yes to many of these questions, you may need to begin thinking about alternative care options. These are just some of the factors to consider when making this decision. Individual personalities, other family members and outside support will always be part of your decision.

The point to remember is: plan ahead to prevent making decisions during a crisis. It’s alright to ask for help…you need emotional and physical support. You’re doing the best you can; don’t feel guilty that you’re not able to do more.

So how do you start the process? Change is stressful and challenging. But it can be a positive experience if you do a good job of preparation, approach it with a positive attitude, surround yourself with a support network of friends and family, and maintain patience and understanding.

Developing a plan
Along with your family and senior loved one, develop your plan that will create a smooth transition. Regardless of how guilty, depressed or reluctant you or anyone else feels, continue with the plan.

Discuss the change with your senior loved one
Know and understand what they are feeling. Are they angry, resentful, and confused? Take their emotions into consideration when you start implementing your plan. Make sure you maintain an open dialogue, discuss their feelings, and empathize. As much as possible, have them participate in the process. Take them on tours of communities. Talk about what they like and don’t like. Keep them involved so they don’t think you’re taking away their right to chose.

Where is the rest of the family emotionally?
Try to discuss the plan with all family members who have a stake in the outcome so everyone is aware of why the change is being made. Is the rest of the family in synch with the plan? Are there certain family members who are against the transition and may try to disrupt the plan? You may never have 100% agreement but if the majority of the family is supportive it will be an easier transition.

Suggestions for a smooth transition
Listen as your loved one talks about the change and what they feel they’re leaving behind.
Recognize that moving to a new home is a major change. Many seniors have lived in their homes for the vast majority of their adult lives.
Call and visit often, especially during the first few weeks.
Be positive, be supportive, have patience, be understanding.

Despite your best efforts, you may still run into problems after the move. I often hear “mom’s still angry and keeps saying she wants to go home.” Think about your previous moves and how stressful they have been on you. Add to that the stress she is experiencing from the loss of her independence, her cherished possessions, the strain of being in unfamiliar surroundings, the loss of the closeness of friends and family and you’ll begin to understand how she is feeling. Suffice it to say the first 30 days will be difficult for you and her. Don’t be surprised if the whole family feels guilt and tension.

So how do you cope with the change? Whenever you doubt your decision, remember the reason you made it in the first place. You chose the community based on any number of considerations: safety, nutrition, activities, proximity to friends and family. You hopefully were able to include your senior loved one in the decision making process and this was a decision you both made together based upon what would be best for her.

Geriatricians agree that the best therapy in the world is a visit from a loved one. Successful visiting is like any other social skill – it can be improved with a little bit of work and some practice. The payoff will be more enjoyable visits for both you and your loved one. Consider these tips for visiting.

Plan ahead. You can avoid the “duty” visit by remembering why you used to visit your loved one before the move. Fill your visit with similar activities. If you used to play games, read books or go shopping don’t stop doing it.

Get involved in the activities that the community has to offer. Meet her new friends. Participate in community events.

Don’t fear reminiscing. Talking about your senior’s life is an important part of adjustment. It helps to put their current situation into perspective and deal with conflicts.

Remember that you’re a link to the “outside world”. Keep her informed about family and community news.

Let her vent. Sometimes you’ll just have to let her vent her frustration with her new situation. Don’t tell her she’s wrong and don’t criticize. You can try to turn the discussion around and talk about the great things about the community, her new apartment, the food or whatever else you can identify as a positive.

Get to know the staff. These care providers are part of your “extended family” now who work to improve the conditions of your senior loved one’s life. Fill them in on your family’s stories, events, things your loved one likes and dislikes, and other useful information that can help them understand her personal needs. If you have the time, volunteer in the community.

Bring the kids and grandkids. They are an important part of your senior’s life and her new home should be a place for them to visit. Don’t be concerned about accommodations; the sights and sounds of children in a senior community can be a welcome change, even for those elderly people who don’t have their own. Be sure to visit on days that are special for the children such as Halloween (in costume), the first day of school, important holidays and life events like birthdays. Try to continue or build family traditions.

In the end, just remember that choosing the appropriate community can make all the difference in an individual’s mental, physical and social well-being. You’re not doing this “to them”, you’re doing it “for them” so your senior loved one can live in a community that has individualized care and assistance. Your interest in this information reflects your commitment to making the right decision and easing the transition. Certainly problems may occur along the way, and when they do, open communication among the senior loved one, the staff and other family members will make the problems more manageable. Finally the simple expression of love and concern for the resident will help them through the rough spots and make the good days even better.