As a geriatric care manager, consultant and freelance writer, I have helped clients and written scores of articles about the transition to assisted living. But nothing prepared me for making that transition for my own parents.
Watching the decline of two people who have always been healthy into their 90s was a shock. And not just physical decline. I can’t help but think that the isolation caused by mandatory lockdowns of senior living during the height of the pandemic has had detrimental effects. Both of my parents lived in independent senior living for three years before moving from independent to assisted living in the same building.
As a family, we couldn't visit, and senior living facilities suspended all activities and congregate meal services. The toll this has taken on seniors and families has been well documented, and I have seen it firsthand. My sister and I live in the same community as my parents, which has been an immeasurable help, but that isn’t the case with many families. I have learned some lessons that I will pass on to you to hopefully prepare yourself for the coming storm when the time comes.
As our father declined, we could see the toll it took on my mom, who is much more mobile. We talked with our dad about hospice which, much to our surprise, he agreed to. But you may not realize that hospice, for all of its benefits, is limited to nurse visits two to three times a week and an aide three times a week to help with bathing.
Convincing my dad to accept additional help in the home was a battle, and he and my mom adamantly refused assisted living. Here are some of my suggestions:
Our dad has always had a healthy anxiety about money. He and my mom have savings and a decent income, but assisted living is expensive. They have also paid tens of thousands of dollars into a long-term care policy that they have never used. Plan with your parents early while they still can make sound decisions.
Chances are, a move to assisted living will involve significant downsizing. This process is very emotional. All of a person’s belongings have personal meaning and carry memories of a better time. We all go through adulthood, growing our families, our careers and our possessions. Over time, an aging adult’s life starts to shrink – fewer friends, less opportunity and smaller spaces to live in. Downsize with care and compassion.
I am one of the luckiest people on the planet because I have a caring and close relationship with my sister, who lives in the same city. We work seamlessly together and divide up all of the tasks involved in taking care of aging parents. Even during the stress of moving, we worked smoothly and efficiently. However, sibling involvement is not always smooth. In fact, it can be contentious and challenging. Next Avenue recently published a personal account of the primary caregiver and refusal of her siblings to help. Here are some suggestions if you have siblings who won't help.
You have to decide how to handle a sibling or siblings who are confronting or questioning your every move. If you have health care power of attorney, you can work with your parents on these decisions. Sadly, I have seen families go to court to argue about care and who should be in charge.
Part of the transition to assisted living involves getting doctor’s assessments, pharmacy information and insurance verification. If you don’t have health care power of attorney, this part of the process will be very challenging. My sister and I have had health care power of attorney for several years, so although this part was time consuming, we had no problems getting all of the information the assisted living required. Advance directives vary depending on where you live, but these are the essential components.
Health care power of attorney
In most cases, a health care power of attorney gives the appointed person access to medical records and the authority to talk to providers. But, making decisions only occurs if your parent is unable to function in that capacity.
Financial power of attorney
A trust will take care of this authority as long as it is set up to give the trustee access immediately if need be. If you don’t want a trust, then meet with an estate planning attorney to set up a financial power of attorney for your state.
An assisted living community will require a living will or POLST form. These documents state your parents’ wishes concerning CPR and other life-saving or life-extending medical interventions. If your parents have not filled these out previously, take the time to sit down with them and discuss them in detail. It can often be helpful to have the assisted living nurse case manager help you with this.
All of those old conflicts you thought were behind you? They may come roaring back. Don’t be surprised if old arguments, disagreements or unresolved conflicts return during a transition to assisted living. Loss of independence, disempowerment, dependence on others and the stress of moving can bring old habits back. Those old coping mechanisms are sometimes the only thing left to rely on.
You can only keep deep and troubling emotions at bay for so long. I think both my sister and I kept things positive, upbeat and efficient for ourselves and our parents. But, feelings of sadness, grief and anxiety are normal. Accept that you will feel strong emotions connected with this transition.
Once the move is complete, you can have a sigh of relief. But it isn't over. Few things are static or stable during aging. Immediately after the move, expect that there will be an unsettled period where your parents can’t find items and don’t completely understand how or when to ask for help. As my sister and I put things away in the new apartment, we expected this to happen.
Also, the care needs of your parents may increase over time. Most assisted living communities will alert you that it is time to move care up another level, or you may request it yourself. The assisted living community where our parents live can provide care similar to end-of-life care with every two-hour checks all day and night.
After moving your parents to assisted living, you will be exhausted. We were. Take some time off if you can, but if not, take care of yourself. Self-care is different for each person, but getting plenty of sleep, eating a nutritious, balanced diet and drinking lots of water is an excellent place to start. If you have some time to engage in a preferred leisure activity, seize the opportunity now before your parents need more of you. Stress is damaging to your health, and the more you can do to manage it, the better.
My parents’ transition to assisted living may have similarities and differences to yours. However, the fundamentals of planning, advance directives and kind and compassionate communication will serve you well. Try to be as flexible as you can during the journey.
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