In one of those strange confluences of timing, I’ve been corresponding with two friends who both have traumatic difficulties with an elderly parents. One requires solving drug dependency, the other is an issue of frailty and living alone. But the ultimate outcome of both situations will be moving to assisted living.
It struck me that, even though the decision to move to assisted living is tough enough on its own, there’s always a side issue that makes it even harder. Loss of cognitive functioning or increasing frailty aren’t predictable. What you do know is this: at some point you’ll no longer be at ease that your mother can manage safely and well by herself. What you don’t know is this: how do you recognize that point? And if you can’t recognize it, how will you know when it’s the right time for her to move?
The situation my sister and I faced was a perfect case in point. My mother’s decline was noticeable, everyone could agree on that. But no one could say how fast her abilities would fade. What followed were two years of fretting, repeating the questions, “Is this it? Are we there now?” Imagine the two of us, circling like airplanes around the terminal that was our mother, only air traffic control had us in a holding pattern. And, man, was it getting bumpy! We knew we’d have to come in for a landing at some point, but could never figure out where or how rough it would be.
What we did learn was that there’s lots that can be accomplished pending “the big move.” Once we figured that out, we had plenty of work to do, which was its own form of comfort. If we couldn’t control when a move would happen, at least we could control the figuring-things-out stage.
Here are a five tips, drawn from our own experience:
1. Find the assisted living facility that’s best for you and your parents. This takes time and is a great thing to be doing if you know that eventually your parent(s) will move to such a place. You want to get a well-rounded a sense of the offerings in your area. The goal is to have your first choice ready to go when you need it. Visit as many assisted living places as you can, even some that are out of the way. Investigate which ones are close to your preferred hospital, and to activities your parent enjoys. Look at their actual units, both ones that are larger than you think you’d take and those that seem smaller. You’ll be surprised at how different each unit looks in real life than on a printed floor plan. Meet with their Executive Director and their Directors of Nursing and of Activities. Ahead of time is the best time for expressing needs and concerns. Eat a meal at each place, preferably in the company of some residents. You’ll get a different feeling for the facility sitting in the dining room. And this is a great way to sneak a peek at how facility staff actually treat and interact with residents. Inspect their Alzheimer’s or Skilled Nursing units, if they have one. You might eventually need these facilities. Ask around with doctors you know to see if any facility has a better or worse reputation than others. Sniff around, literally. If the facility smells good, that means it’s well-cared-for and clean. Talk to their references. Share this task with siblings so you can compare notes. Find out their wait list policy. Some places will keep you in your wait list priority spot indefinitely and allow you first right of refusal on each new unit that comes up.
2. Get paperwork in order. This may mean putting in place a broad enough power of attorney so that you can move your parent without their say so if the need arises. It also may necessitate a clause that defines by what means your parent is considered no longer competent to manage their affairs. It’s good to have an attorney assist with this.
3. Keep talking with your parent about the issue of moving. There are pros and cons worth airing on both sides. This is a tough decision for everyone. It’s sensible to allow time for the idea and its ramifications to sink in.
4. If memory and dementia are concerns, have a neuropsych evaluation done of your parent cognitive functioning. This should be more extensive and detailed than an internist’s evaluation and may give you a clearer understanding of your parent’s condition and what lies ahead.
5. Visit a few assisted living facilities with your parent. For some parents, the following strategy has worked well: First show them a facility you know they won’t like, perhaps one that’s even a little crummy. The two of you can then agree that place isn’t suitable for them, which puts you on the same footing. Next, take them to the facility you prefer, which will be in direct contrast to the one they just saw. You just may hear “Yes, I could live here!” Is this strategy manipulative? Yes. But it’s done for the greater good. It’ll ease the strain of making a decision and put your parent in a positive frame of mind, both of which ultimately make the move so much easier.
At one point, my sister and I were given an invaluable piece of advice: don’t wait until you have a crisis on your hands. So, my final suggestion is: above all, be willing to take control of the timing of the move. Don’t wait to get a call from neighbors saying your father has fallen and is in the hospital, or that your mother has gotten lost while driving and couldn’t find her way home for two hours. Moving to assisted living will be easier for your parents–and you!– if they are in good health and good spirits.
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