Deciding on senior living vs. assisted living for a family member

[PeterPan]

Sorry for the not so Christmas-y topic!  If you've dealt with this, how did you decide which they needed? 

[JFSinIL]

We looked at a few places for my Dad (he is still in his house with his long-time lady friend for now) and seems like most places will want to meet with and evaluate the person, find out all they can about their conditions and mental capacity etc., before saying yeah or nay.  We would have loved to have Dad in some of the retirement homes we saw, but reality was that he would have needed more help (and probably resisted entering any "old folks home" - still a problem) and the places would probably either not have accepted Dad after an initial trial stay, or recommended him for their wards for folks with dementia.

 

You should visit seveal places yourself, without your parent, and make appointments to take tours and talk to the folks there.  You will get a good feel what level of care your parent may need, and where to place them then. The social workers etc., who work at the more reputable senior housing places are used to helping people find the most appropriate "fit" for their loved one. Hope this makes sense.

 

Some places are set up to move a resident into more assisted care if/when needed.  My in-laws moved into just such a place, but first my MIl then my FIL passed  before needing to be moved from their two-bedroom apartment into the more "nursing home" type care part of the facility.

Edited December 25, 2015 by JFSinIL

[FriedClams]

We were told the average stay in assisted living in 3 years, so take that into planning. I'd ask the facilities you tour what their span is normally before residents need the next care level. In our case we tried to go as low intervention as possible for as long as possible. That's what my parents wanted, and each care level is a lot more $$$. My mom is now in a memory care facility and dad is in assisted living. It's so hard.

Edited December 25, 2015 by FriedClams

[FriedClams]

We looked at a few places for my Dad (he is still in his house with his long-time lady friend for now) and seems like most places will want to meet with and evaluate the person, find out all they can about their conditions and mental capacity etc., before saying yeah or nay. We would have loved to have Dad in some of the retirement homes we saw, but reality was that he would have needed more help (and probably resisted entering any "old folks home" - still a problem) and the places would probably either not have accepted Dad after an initial trial stay, or recommended him for their wards for folks with dementia.

 

You should visit seveal places yourself, without your parent, and make appointments to take tours and talk to the folks there. You will get a good feel what level of care your parent may need, and where to place them then. The social workers etc., who work at the more reputable senior housing places are used to helping people find the most appropriate "fit" for their loved one. Hope this makes sense.

 

Some places are set up to move a resident into more assisted care if/when needed. My in-laws moved into just such a place, but first my MIl then my FIL passed before needing to be moved from their two-bedroom apartment into the more "nursing home" type care part of the facility.

This was a factor for us, too. The ability to step up care AND keep mom and dad together (at least to visit daily) was important.

 

We toured places without them to start narrowing....we got reputation info from local medical people and friends in similar situations...we evaluated which of us they would live near (with LOTS of input from mom and dad)... affordability... availability of medical care nearby ... transportation... activities... food... social activities... Demographics of residents (would our parents fit in?)... Staff turn over... Management reputation...

 

And loads of prayer.

 

In hind sight, we didn't use the nursing care at their place when mom got really sick. It wasn't a good fit for her. So, have back ups and keep business cards.

 

And, as morbid as this is, have honest discussions and make plans for wills, advance directives, power of attorney, access to all bank records, bill paying, taxes, etc..... We took too long to take care of some of this, and then it was 10x harder. Do it up front. It'll stink, but it'll stink a TON more later.

Edited December 25, 2015 by FriedClams

[Harriet Vane]

Just finished reading Being Mortal, by Atul Gawande.

 

http://www.amazon.com/dp/0805095152/?tag=googhydr-20&hvadid=46300187186&hvpos=1t1&hvexid=&hvnetw=g&hvrand=15571071709270628809&hvpone=&hvptwo=&hvqmt=b&hvdev=c&ref=pd_sl_62trdi1zp8_b

 

Seriously, this is the best. book. ever. 

 

I really think everyone should read this as part of facing decisions for elder care. His research is thorough and he discusses important nuances of the whole process. 

[PeterPan]

Just finished reading Being Mortal, by Atul Gawande.

 

http://www.amazon.com/dp/0805095152/?tag=googhydr-20&hvadid=46300187186&hvpos=1t1&hvexid=&hvnetw=g&hvrand=15571071709270628809&hvpone=&hvptwo=&hvqmt=b&hvdev=c&ref=pd_sl_62trdi1zp8_b

 

Seriously, this is the best. book. ever. 

 

I really think everyone should read this as part of facing decisions for elder care. His research is thorough and he discusses important nuances of the whole process. 

So does he discuss the assisted living issue?  Right now our gut (and the family member's gut) is saying assisted living is the right way to go, and it's hard to put our finger on what it is.  It's not like the family member is *quite* there, but the person is fragile and at that point where any little thing can be a problem.  We would feel better with more oversight and the family member is saying they'd like to make the move.  Then another family member is like wow, overkill, not appropriate.  So then it's really hard to pin down what it is we're seeing, kwim?  

 

But yes, I've been pretty thorough so far.  I've caught on that this is a big business, with major chains owning locations in multiple states.  The fascinating thing (to me) is the spread in philosophies with what they emphasize.  You get some that emphasize food, others the quality of interaction with staff (your family member will "blossom", etc.).  It's also hard for me to tell what the *culture* is like at these places.

 

Honestly, I had not thought about visiting ahead by myself.  That's an interesting idea.  

 

Part of what confuses me is that when I read about some people's experiences with "independent" or senior living, it's like what I'm reading about with assisted living.  In this part of the country, there's a lot more assisted living than there is senior living, so maybe it's a geographical thing, more typical of Florida or something?  And then I think sometimes the pricepoint is the same whether they call it independent or assisted, when you hit that level of service.  But mainly it's that challenge of justifying what you can't put your finger on.

[Guest]

Is diabetes involved? If so there may be issues with assisted living. I'll check back for your answer. No need to type out the long version if it is not an issue.

[Carol in Cal.]

When my FIL started being unable to handle *any* yard work, which was serious for him as his garden and lawn were kind of his pride and joy, I asked around his area for recommendations for a reliable lawn service.  One of the people I talked to strongly suggested that I also start asking around about other things--good in home help, good assisted living places locally, good nursing homes--on the theory that you want to develop a list to increase your chances of finding an opening in one if it suddenly became necessary.  I think that that is good advice.

[Laurie4b]

Is diabetes involved? If so there may be issues with assisted living. I'll check back for your answer. No need to type out the long version if it is not an issue.

 

I'd be interested for our situation.

[Laura Corin]

So does he discuss the assisted living issue?  

 

Yes, he does.  He looks at the whole industry: how it came into being and whose needs it is intended to serve.  A very valuable and readable book.

[JFSinIL]

Visiting places yourself helps you weed out any obviously not suitable for whatever reason,...and may cause less distress for the person needing to be placed. Only take your elderly parent to visit places most likely to be a good fit AFTER you have done all the leg work. It can't be pleasant for them and if like my Dad, can be very upsetting.

[Faithr]

From my family's experience, the best thing is to either have the person move in with a family member or have a family member move in with them.  They have a much happier life at the end there than if they are off at a place.  Of course sometimes that is out of the question, but if it somehow isn't, things are much more in control.  You don't have to advocate as much or go through as many bureaucratic levels to check on what kind of care they are getting.  My dad was at an assisted living place after having so many strokes and he developed situational psychosis.  We moved him home and my sister, her husband and sons moved into his house.  He lived for two more years and died peacefully at home.  It was such a blessing for all of us that my sister could do that.  My sister worked full time as did her husband but the lady who used to houseclean for my parents was the sitter during the day.

 

My aunt who had diabetes and had her leg amputated when she was 78 was in a supposedly wonderful nursing home which was TERRIBLE.  We had to keep going in and advocating for her.  It was so time consuming and disruptive both emotionally and time-wise.  Finally we moved her out and into my house.  We were able to have Visiting Angels come in and help take care of her.  She lived with us for a year.  We loved having her but she had been an independent single woman all her life.  She felt she was a burden to us and she wanted her independence back so she went to live in an assisted living place.  It went well for a year though it is hard living in dorm life (which is what it amounts to!) at that age.  You've got a lot of old cantankerous people who maybe don't have it all together.  People are always dying.  It is depressing.  Then when her health started to fail for the last time, once again it was hugely time consuming to travel to the place and meet with all these people.  She got really paranoid about everything and was afraid of her caretakers.  She was calling us in the middle of night in panic.  It was awful.  At the very end we were going to bring her back home but she passed before we could make arrangements.  

 

So that's my experience.  You want control over the situation and the minute you farm it out, while you might think it makes things easier, in the end for us, it was better to keep them at home as long as possible.  It makes everybody happier and the person's passing is not so traumatic.

[SparklyUnicorn]

You might get a sense by visiting various places (I know already mentioned here).  Places vary in terms of rules/types of residents they will accept.

[Tree Frog]

We just went through this with my MIL. She moved here from CO in late May to a brand new senior living apt, but should have moved straight into assisted living. At the time, though, she would not have moved into AL; the idea offended her, except that just moving around her apartment was difficult for her, she rarely had regular meals, and she didn't socialize because everyone was more active than she was. In Sept, she ended up in the hospital. While she was there, we were scrambling to find someplace for her to live and had arranged with the social worker to go to rehab to give us a little more time. There was never an option for her to go back to her other apartment. She never went to rehab and instead moved in to an AL apt associated with her senior living apt. She has had and will continue to have increasing support for her physical/emotional well being and for a price she can afford this place has stepped up care. So if she needs toileting help, the staff are supposed to help. If she needs laundry done more frequently because of accidents, the staff should help. They give her her meds 4-5 times/day and ensure she has 3 gluten free meals a day, and help her into bed each night. This facility offers a memory care unit if she needs to move (unlikely; she will probably pass away before this summer.)

 

It sounds like an ideal place (and was at first), but I have found I need to watch her meds list to ensure they don't run out (they have twice and don't notify anyone they're out), that they're documenting when they give her the meds (they've told her she took a med she knew she hadn't and the nurse director was able to document she hadn't), that they give the PRN meds when she asks for them, not an hour or two later. I've needed to purchase the gluten free breads/desserts, etc. (They do reimburse her for those.) The biggest problem, though, is the turnover rate. Mom likes the staff (well, most of them anyway), but many of them have left and their replacements have been unwilling to help where ever needed, which means her care has gone downhill because she has to wait for the CNA. I know staff turnover is to be expected, but I think we've had over 50% turnover in 3 month (including the executive director and both nurse directors.) Currently there is no RN on staff; the new one starts Monday and the corporate one left Wed. to return home. Mom has also had a hard time remembering everyone's names because they keep changing and doesn't feel she can trust some of them for good care.

 

I guess the takeaway is that any facility is likely to have problems and the more involved family will benefit the senior. Fro this reason, I would suggest finding someplace close to family who will be involved in the senior's care. When you do your research, if you see a family member at the facility you're looking at, ask what they like/don't like about the facility. I think most will be honest. 

[Tree Frog]

 

I would say, if the person can afford it and likes the place, pick the one with more help available than is currently needed. It's hard on the person to move to a totally new facility while sick and frail.

 

Definitely this! It's much easier to step up care in the same place than it is to move someone who's sick.

[PeterPan]

Is diabetes involved? If so there may be issues with assisted living. I'll check back for your answer. No need to type out the long version if it is not an issue.

Hmm, that's a good question!  I think the family member is borderline, with just the recommendation not to go hogwild with diet.  I don't think the family member needs meds for it and the person is under complete care and compliant, meaning it wouldn't be for lack of getting it done.

[PeterPan]

Yes, he does.  He looks at the whole industry: how it came into being and whose needs it is intended to serve.  A very valuable and readable book.

Ok, then thanks, I'll look into it pronto!  

 

And just to be clear, our situation is a little unique, or different from run of the mill, because the person is alone, needs to remain in a location to continue to receive care at the hospital in that city, *is* living independently, but is not living *satisfactorily* in the current set-up.  Not getting proper meals and needing companionship.  Also there's just sort of the watchful eye thing, like the ability to find the person when the person goes off the grid, to check in on them if they're sick or the weather is inclement.  The person would like to be able to get places without driving and without taking a bus or cab.  The person *can* drive, but sometimes it's not *good* for them to drive (bad weather, doesn't feel well but needs to get to the doctor, etc.).  The person can dress themselves, but they might need some help with buttons.  They might need some love and noticing, because they might forget conventions like showering or brushing hair.  Not that they can't, but just enough companionship that it gets noticed and prompted, kwim?  And the person needs help with cleaning, laundry, etc.  

 

So it's a really different mix of disabilities, in that it's not old age and not *inability* so much as disability.  You don't want to provide more than necessary or provide it in a way that reduces motivation to do for themselves what they *can*, but you want to improve quality of life with food and companionship.  Said person has also said they would prefer to be in the main building of the location, ie. surrounded by people, NOT in the sort of independent cottage/duplex gig some places have.  Some places will have independent and assisted in one facility but have the independent be in detached units from the main building.  And it's really hard to put my finger on what the person is wanting when they ask to be in the main building.  I *think* it's that they want more constant companionship and they want to be noticed, not off the grid and alone in some separate unit with no one noticing.

 

And I'll add, while the average assisted living stay (from what I've read) is 3 years, this person could be at this stage for 10-15.  There's enough money for the care, but another family member is questioning whether a given tier is overkill or wasteful.  It's just that there's something going on here that is hard to put into words.  We just feel like the *alone* thing is not good and that whatever it takes to solve the *alone* thing is worth the money.   We also feel like we're on the cusp of decline, like making the move to solve the alone/food/laundry thing puts the person in a better position to have help with other changes or needs.  

Edited December 26, 2015 by OhElizabeth

[PeterPan]

Visiting places yourself helps you weed out any obviously not suitable for whatever reason,...and may cause less distress for the person needing to be placed. Only take your elderly parent to visit places most likely to be a good fit AFTER you have done all the leg work. It can't be pleasant for them and if like my Dad, can be very upsetting.

What we're actually concerned about is that the person is easily swayed and might be confused if we visit and then we say no.

[Reefgazer]

If the elderly person is of sound mind, then the choice should be theirs to make, after they tour the facilities and discuss the pros and owns of places with whomever is awaiting them in the decision.

Edited December 26, 2015 by reefgazer

[PeterPan]

Faithr, that's an interesting parallel, to say it's like dorm life.  That's what I've been trying to pin down.  I also don't know about the dying all the time thing.  I agree, there's that intangible I've been trying to pin down of what the atmosphere is like, whether it's depressing.  Our family member could have 10-15 years at this stage, easily.  But I'm pressed trying to figure out how to get the person that level of increased companionship, food service, laundry, etc. without assisted living.  I'm not finding a lot of places that call themselves independent living in the midwest.  In florida, tons.  In our area, even if a company has that parameter, only say 2 of their 6 locations in the major city will offer it.  It just seems like *assisted* living is more common than *independent* living.  When you google independent living, assisted living places pop up.  It made me wonder if the one I (think) I like is bridging that, sort of doing both in one building.  They have a lease rate for your unit and then you add on services you need.  They specifically state they have residents living WITHOUT those services.  I really don't know about the die rate.  I agree that wold be depressing.  I think at this particular place they have a high standard for who can be there.  Like I read a review where a gentleman had been very happy there, had an incident with his leg or something that required hospitalization, and they wouldn't let him back.  

 

But you're right, if I get there and everyone is in a wheelchair and creeking around (pseudo nursing home), that isn't appropriate for our situation.

 

It's just very challenging.  You don't want to make a mistake, but you also need to address the concerns.  And no, moving the family member to be with another family is *not* an option.  I've spent HOURS upon HOURS talking with hospitals to see whether I could bring the family member to our state and still have the person receive equivalent care.  I cannot guarantee it, and to move someone who MUST have that continued care (psychiatric), to remove them from their current support structure, to bring them to a new location with new everything, destroy consistence and relationships, it's just just good.  The ONLY situation that works is a location near a place that can give equivalent care, and that place would be 2 hours from me.  And 2 vs. 4, there's no benefit.  To destroy everything good in the person's life to move them only 2 hours closer (and still be 2 hours away) doesn't make sense.  There *will* be a time when we probably do that, but right now it doesn't make sense.

 

I could be wrong about that.  The person is malleable enough that they can't sort it through and are accepting what I say.  If I could have figured that out, that would have been the golden ticket.  But to change SO much about someone's life, when everything else is working, and NOT get them close enough to have it be a benefit, I can't see it.  Sometimes being with family does NOT trump everything.  Maybe it does, I don't know.  I'm just not communicating the level of challenges here.  I know, I had thought to bring the person to within 1/2 hour of us.  That would have been worth it.  But that location can't provide all the services under one roof.  Then it would be like oh you're sick, go to this hospital an hour away, oh you have that, go to that other location.  Right now, it's one location, one roof, and the same providers for 13+ years, excellent care.  Would you REALLY move your family member away from their *very necessary* support structure of 13 years only to get them 2 hours closer?  When before said person was unstable and homeless?  When it's literally THAT BIG an issue?  

 

But trust me, I feel bad that I can't make the family member's life better.  Who doesn't want to??  It sounds laudable, kwim?  Like oh yeah, move them closer.  But when they MUST receive integrated care, MUST have the consistent structure, you only have so many options.  So I feel like if the family member pays $3K+ a month but gets community, healthier food, and someone who CARES, then let's buy the love.  But depressing atmosphere, constant dying, that wouldn't be cool.  

 

I think y'all are right that we need to visit first ourselves.  I think what we're going to do is not *tell* the family member we're visiting there, go do it, then pick up the conversation.  Otherwise, just oh we're here to visit you and not even mention that we went to the place.  Dh agreed to that when I told him y'all's counsel, and we like that idea a lot.  It's definitely safer.  And a die rate, mercy, I don't know if they would disclose that, kwim?  But I think there's sort of a vibrancy or atmosphere to things, like you figure it out.

[PeterPan]

Visiting places yourself helps you weed out any obviously not suitable for whatever reason,...and may cause less distress for the person needing to be placed. Only take your elderly parent to visit places most likely to be a good fit AFTER you have done all the leg work. It can't be pleasant for them and if like my Dad, can be very upsetting.

You know what's wild?  Right now, I can look up places on google maps and tour the INSIDE of the facility!  You can do full 360 tours of them.  It's wild.  

[Joules]

 But I'm pressed trying to figure out how to get the person that level of increased companionship, food service, laundry, etc. without assisted living.  I'm not finding a lot of places that call themselves independent living in the midwest.  In florida, tons.  In our area, even if a company has that parameter, only say 2 of their 6 locations in the major city will offer it.  It just seems like *assisted* living is more common than *independent* living.  When you google independent living, assisted living places pop up. 

 

 

I'm shopping for a place right now and wanted to comment on the above.  I'm finding that I need to ignore the label and ask about the services.  In one place, "independent living" still included every two hour bed checks (even in the villas) and "assisted living" meant a staff member had to be in the apartment during showers (for safety).  In another, "independent living villas" were completely independent except for life alert buttons and bracelet, and "assisted living" at the base level meant they just check if you miss both breakfast and lunch.  There was such a world of difference that I found the labels meant nothing to me.

 

This is a completely frustrating process, particularly when the individual is between levels of care (or asynchronous in needs.)

[PeterPan]

If the elderly person is of sound mind, then the choice should be theirs to make, after they tour the facilities and discuss the pros and owns of places with whomever is awaiting them in the decision.

 

It *is* the person's choice, but the person has significant disabilities (as in 100% disability pay), is easily impressionable and confused, and cannot do a 100 piece puzzle unassisted, let alone negotiate the complexities of this.  I've spent hours on the phone calling each VA hospital in our state to see which ones offer the range of services this person needs.  One offers the category of services but places limits (3 weeks!).  

 

I've spent hours and hours trying to sort this out, weighing which things were important.  If I cannot ensure continuity of care, I CANNOT move the person closer.  I have a location near the person's current location, so the person could have complete continuity of care, have an equivalent drive to go to things at the hospital, maintain relationships, still be close enough to visit family, etc. etc.  I've used the Google maps 360 thing to tour the inside of the facility.  It's so nice *I* would live there!!  And yet another family member is squacking and complaining that it's ASSISTED living, not independent.  But independent living, in that city, is usually at an assisted living facility and they have sort of duplex cottages near the main building.  So then you would walk to the main building to eat, etc.  Family member has visited these places (having friends in them) and family member did NOT think they liked the detached, said they wanted to be in the main.  But also, for some freakish reason, the independent set-ups allowed smoking.  They also encourage roommates.  It's just a different level of functionality.  Family member cannot have a roommate (that's an absolute) and does not need neighbor hassles like that.  Also, some places with assisted living have really odd calendars.  Like this one had drinking parties.  Family member was like REALLY??  I kid you not, champagne and cheese parties to welcome new people!  That's just not his flavor and he's not going to fit in there.

[PeterPan]

I'm shopping for a place right now and wanted to comment on the above.  I'm finding that I need to ignore the label and ask about the services.  In one place, "independent living" still included every two hour bed checks (even in the villas) and "assisted living" meant a staff member had to be in the apartment during showers (for safety).  In another, "independent living villas" were completely independent except for life alert buttons and bracelet, and "assisted living" at the base level meant they just check if you miss both breakfast and lunch.  There was such a world of difference that I found the labels meant nothing to me.

 

This is a completely frustrating process, particularly when the individual is between levels of care (or asynchronous in needs.)

Yes, yes, yes!!!  That's what I  think I'm seeing!!!  The place I'm liking is like that.  They will notice if you aren't eating and check on you.  That's their base level assisted living.  So I guess I can ask my dh, but would you roll with it if the family member says they WANT to be in a main building vs. in the cottage thing?  I mean, family member was really emphatic about that and I asked multiple times.  

 

And it's screwy, but "independent" living at one place that distinguishes them was averaging $3K, basically the same as the base level "assisted" living with no extras (like brushing your teeth or dressing you) that the assisted place has.  So you might be right that they're equivalent.  I might just be letting people rattle me.  To me it's like, well I'm not a cursing woman, but I get frustrated.  I feel like if the military and God and the gov't give you a disability retirement high enough to afford the place you want to live at and receive enough observation that people NOTICE and care that you aren't showering or getting good meals, then how is that wrong???  Why do we have to say oh go lower care and save $1K a month??  Why?  Why does the family member have to be isolated in an independent cottage if the family member WANTS to be in a building with people?  To me, it would be MUCH easier to drop off the grid with the independent cottage thing.  I think that's what the family member is sensing, that family member no longer wants to drop off the grid.

[PeterPan]

Definitely this! It's much easier to step up care in the same place than it is to move someone who's sick.

This is what dh is saying.  He'd rather do assisted living with a base rate that is essentially independent living, and be able to step up.  It's entirely conceivable that within a few years the person *will* need help with medications, simply because the care is complex.  Currently independent, but complex.  And to have that *option* is good.  

[PeterPan]

We just went through this with my MIL. She moved here from CO in late May to a brand new senior living apt, but should have moved straight into assisted living. At the time, though, she would not have moved into AL; the idea offended her, except that just moving around her apartment was difficult for her, she rarely had regular meals, and she didn't socialize because everyone was more active than she was. In Sept, she ended up in the hospital. While she was there, we were scrambling to find someplace for her to live and had arranged with the social worker to go to rehab to give us a little more time. There was never an option for her to go back to her other apartment. She never went to rehab and instead moved in to an AL apt associated with her senior living apt. She has had and will continue to have increasing support for her physical/emotional well being and for a price she can afford this place has stepped up care. So if she needs toileting help, the staff are supposed to help. If she needs laundry done more frequently because of accidents, the staff should help. They give her her meds 4-5 times/day and ensure she has 3 gluten free meals a day, and help her into bed each night. This facility offers a memory care unit if she needs to move (unlikely; she will probably pass away before this summer.)

 

It sounds like an ideal place (and was at first), but I have found I need to watch her meds list to ensure they don't run out (they have twice and don't notify anyone they're out), that they're documenting when they give her the meds (they've told her she took a med she knew she hadn't and the nurse director was able to document she hadn't), that they give the PRN meds when she asks for them, not an hour or two later. I've needed to purchase the gluten free breads/desserts, etc. (They do reimburse her for those.) The biggest problem, though, is the turnover rate. Mom likes the staff (well, most of them anyway), but many of them have left and their replacements have been unwilling to help where ever needed, which means her care has gone downhill because she has to wait for the CNA. I know staff turnover is to be expected, but I think we've had over 50% turnover in 3 month (including the executive director and both nurse directors.) Currently there is no RN on staff; the new one starts Monday and the corporate one left Wed. to return home. Mom has also had a hard time remembering everyone's names because they keep changing and doesn't feel she can trust some of them for good care.

 

I guess the takeaway is that any facility is likely to have problems and the more involved family will benefit the senior. Fro this reason, I would suggest finding someplace close to family who will be involved in the senior's care. When you do your research, if you see a family member at the facility you're looking at, ask what they like/don't like about the facility. I think most will be honest. 

Wow, that was really helpful.  That's terrific advice.  I've seen people mentioning the turnover issue, and I agree that with this family member it could be, well let's just say it's not ideal.  I don't know if I can get closer.  I'm going to need to talk with dh about that.  

 

You know the sad thing?  This Christmas may have burst the family member's bubble on how sweet it would be to be near us.  Ds' autism is increasingly apparent, and even when the family member *tries* to play with him ds can be very unpredictable, erratic, or volatile.  It might be the family member is really GLAD to go home, lol.

[PeterPan]

Our neighbors moved into an assisted living facility that didn't have nursing care. When the guy's health started to fail, the couple's kids needed to find a new place while the dad was still in the hospital following surgery. The assisted living facility wouldn't let the dad come "home" from the hospital. That kinda shocked me.

 

I would say, if the person can afford it and likes the place, pick the one with more help available than is currently needed. It's hard on the person to move to a totally new facility while sick and frail.

If the family member needs nursing home care, I will be bring them close to me.  That's the irony to me that the person would get that move when they're no longer well enough to enjoy it.  Seems cruel.   :(

 

And yes, the place I'm liking is picky like that.  If you go out and need care to return, you don't return.  It seems abrupt to the resident who liked being there, but it may ensure that it's a vital community for those who *are* there...

Edited December 26, 2015 by OhElizabeth

[Lanny]

@OP OhElizabeth:   I think it was in post #22. in the first paragraph, I got the feeling that if you could find someone truly reliable and caring, and pay them to be the live in roomate/caregiver, with an appropriate salary/benefits, that for the time being, this might be a good solution. They would need scheduled time off and someone to take their place, on their days off, sick days, vacation days, holidays, etc.

 

If the person is not in good enough shape for that, I didn't read what you wrote correctly and please forgive me for that.

 

My late mother lived by herself in an apartment building for senior citizens, far too long.  However, she would have screamed and hollered, had I or others tried to get her to move into a facility where some of her basic needs (someone cooking 3 decent meals, cleaning, etc.) would have been taken care of for her.  About 6 months before she passed away, she had to be placed in a situation where she received care. I remember visiting her and she had a private room/bath and that some of her things were there with her.  Her physical/mental situation deteriorated rapidly during those last months.  

 

There are no perfect solutions for the person you are trying to help or for other elderly people, and no easy answers. I applaud you for trying to figure out what is the "best" thing to decide on at this time. It may be the best of the worst possibilities.  .   

[Carol in Cal.]

To the OP:  It sounds to me like what you should look for is a 'continuing care' facility.

Those start with reasonable independence.  People have to be ambulatory, and they have to want to live in community, but they have their own individual apartments.  Common dining is available but the larger apartments have their own kitchens.  There are lots of organized activities.  If someone gets to need more care, 'assisted living' and 'nursing home' and 'memory unit' spots are available, but usually only if people started out independently.  Many of these places guarantee ongoing care to anyone they accept into their independent living spots.

 

Here is an example of one that I am personally familiar with.  It's a nice place.  http://www.sunny-view.org/wp-content/uploads/sites/7/2015/09/SV_brochure_2012.pdf

[Shellydon]

There are many places that have independent apartments, assisted living and nursing home care in one large complex.  At the independent apartment level, there is dining available  if you want to purchase it. 

[Harriet Vane]

Elizabeth--

 

Sorry to take so long to respond. 

 

Yes, the book I recommended covers a full range of placement options. He discusses the mechanics of those options, and more importantly, he discusses the psychology. Knowing how quickly you read and research, I think you would eat this book up. :)

 

Second, I just want to affirm you--your specific gifts and talents. I think you are very, very good at seeing what is really there, clinically, and finding answers. You do this with your kids, and the result has been therapy and intervention to help. Trust your instincts, and trust that you see accurately.

 

When I walked this road with more than one relative, I found that *other* relatives often were very, very obstructive. Some were living in denial. Some had rose-tinted glasses on. Some were unable to differentiate between what was important to them personally versus what the needy person valued and/or needed. 

 

As you interact with the group on this, try to be brutally honest (as I know you are)--

 

--What does the needy person value? What is most important to that person? The answer will lie in what they want every day, in how they would like daily life to look and to feel. It will also lie in what they want the end to look like. Being Mortal talks about this extensively.

 

--Clinically speaking, what does the needy person need? Answer this question from a few different perspectives--the needy person's, your perspective, a doctor's perspective, the perspectives of the others who care. 

 

--THEN--re-filter the clinical perspective back through the answer to the first question--what is important to the needy person? 

 

--What are the motivations of the others who are in on the discussion? Yes, they will all say they care about the needy person. The reality is that motivations are often more complex than that. As an example, when my grandmother was declining, her kids had a pathological need to be in denial. They were motivated by their need to not have to interact with such a difficult person. Their decisions were not based on caring about her, but on their own fears of an emotionally complicated relationship. That's a negative example, but there are lots of nuances in motivation that may or may not be negative. It's best to be brutally honest--privately, with yourself and dh--about the layers underneath the discussion.

 

--Another nuance is to ask how realistic the needy person's wants are. My grandmother's most intimate desire was twofold. Her first desire was to be with her youngest daughter. She was willing to accept any privations for that to happen. Choosing to live with that daughter meant great expense, and it meant leaving the home she loved and had lived in for decades. She was willing, as long as she could be with that daughter. When her daughter became profoundly brain-damaged due to a brain tumor, my grandmother spent her days--virtually all day--with her in her (bleak, state-run) nursing home. When that daughter died, everything changed. If grandma couldn't be with youngest daughter, then she was single-mindedly focused on living in her own home. Not living on her own somewhere (tried that and hated it)--rather, she needed to be in the home she had lived in for decades. She did go back for a short time, but the reality was that her dementia was profound at that point. It was unsafe for her to be there. It wasn't a simple matter of her forgetting things a little--it was really, really unsafe. The only way to care for her was with 24-hour supervision (and she was intense at that stage, not passive), and it was financially impossible to do that. Neither she nor the family had the resources for the amount of care she needed. Her desire at that point was unrealistic.

[*****]

My parents were in independent living, then moved to assisted living because at the time, they needed help with their medication.  Now I hear there is such a thing as the word 'light' added to independent living. This means now some places will dispense meds to those in independent living. That would have been perfect for my parents, if they had offered that. They would not have had to move. I would check on this first. Are your parents still active? A senior living place may be better. Some seniors still get out quite often and are physically able to. 

 

My parents were not able to get out as much on their own. Dad still drove, even when he was in assisted living. Mom had a little dementia, but was still able to get out and about with dad. 

 

If you are looking in to an assisted living place, you might want to consider these things:

 

What we learned (sometimes the hard way), was to check with your parents' physician for recommendations for which facility would be a good fit for your parents. Physicians know your parents' cognitive ability and often have been in the different facilities. They may know which place fits the personality and needs.

 

I had been to over a dozen places. Some had bathtubs only. Can your parent get in and out without falling?  

 

Some places had easy to step in showers. Make sure the bathroom can handle a wheelchair with ease. 

 

Are the sinks and kitchen counter wheelchair accessible? That means, is there a cut out for the wheelchair to fit in? They may need that down the road.  I feel all places for the aged should be ADA approved!  (Not all are!)

 

2 places I went to were beautiful and my mom would have loved them. However, to keep the seniors active, the seniors had to leave their rooms in order to get their meds. My mom did not like the idea of having to take meds in the first place, so I felt this would have been a daily battle, so those were automatically out.

 

Try the food first. Many offer a free meal. Again, some places were tops, until I tried the food!

 

Do the nurses wear stethoscopes? Or are they just paper pushers? 

 

Finally, in Washington state, each place must provide forms called 'Disclosure of services'. Ask for these as you begin you visit. They must provide this form by law, but sometimes they are handed to you as you sign your contract. It is good to have them ahead of time, to read it fully. This will help you to know ahead of time which services are available. This is so important!

 

 Deal with where your parents are at now. It's too difficult to try to prevent every possible scenario down the road. 

 

And yes, prayer.  Best of luck to you and your loved ones!

 

[Carol in Cal.]

PS  When you look at places, ask to see the menus for the last two months.

Some places have a weekly or biweekly menu that gets extremely boring.  

Also try the food.

[Lanny]

This isn't always for "Senior Citizens".  Wednesday afternoon, my wife received a call on her cell phone, telling us that the woman who owned the house we lived in for 9 years, before we bought this lot and built this house, had passed away, the week before. Not unexpected, since she was in her 90's.  She was blessed with a very long life and she was very active physically, in the yard, when we lived there.

 

The sadder news was that one of her 2 daughters is terminal, with Pancreatic Cancer, and is expected to pass away, within the next few weeks. The mother didn't know that her daughter is terminal...   The daughter is at home now, waiting for the inevitable.  Probably she is in her 60s.

 

It is possible that one could be looking for a care situation for someone who is not their parent, and that has another set of issues to add to those mentioned in this thread.

 

There are many many things that come into play in these kinds of situations.  My mother was in CA and she had Kaiser Foundation (very large HMO) for medical coverage. During her last month (?), she was taken in an ambulance to a hospital that was not affiliated with Kaiser.  I am very thankful and appreciative of the doctor(s) in that hospital, who refused to allow her to be transported to another hospital, one that was affiliated with Kaiser, until her medical condition stabilized. That probably cost Kaiser USD $20 to 30 K extra, for those 2 days.

 

Where medical care will be provided and how it will be paid for, if there is an emergency, also plays into the decisions the OP and others in her shoes need to make when faced with this kind of situation. 

[dirty ethel rackham]

I wish I had the room and an appropriate setting to have had my mom move in with me when things got difficult.  However, she wanted no part of that, since I live 20 minutes from where all her friends were.  When she began having some memory issues from some small strokes she was having, we looked into senior living situations that had assisted living and nursing homes all in the same place.  Dad had been gone for nearly a decade by that point so there wasn't any worry about if Dad could be with her.  The place she chose was a senior living campus.  She did have a Life Alert type of system for the campus that she could call when she needed help.  Also, she had to push a button every morning to let them know that she got up that day.  If she didn't push the button, they would go check on her.  To be accepted, she had to be healthy enough to be independent.  However, if she needed more assistance, she could stay in her unit and have help come to her.  She never got to that point.  She did have a couple of stays in the nursing home as rehabilitation from some illnesses.  But, when those came, we knew that things were going downhill fast.  For her, it was a good situation. 

[PeterPan]

Lanny, the idea of live in care had not occurred to me.  I can talk it over with my family.  My initial sense is that it's not a good fit but for reasons I haven't elaborated on here.  The person has enough disabilities that even the assisted living wasn't sure they could handle it.  I'm not sure another person could handle living that intimately with this person, honestly.  No, I'll go farther than that.  I think the issue is that it doesn't set the person up for changes with ability to handle their own medication, etc.  But you're right that there could be in-between options, like hiring housekeeping, hiring someone to cook 3 meals a week, that kind of thing.  There could be some in-between steps like that to make their life better NOW.  That would be a really good thing to pursue.

 

Carol, thank you for that link!  That place is LOVELY, wow!  Hate to think what it costs, lol.  But lovely, absolutely lovely.  

 

HV, you're nailing a lot of the analysis there.  I used your list to talk it through with a family member, and it strikes me that the things the needy person is valuing, though good, aren't necessarily the things the doctor or family is putting an emphasis on in this process.  That's really interesting to ponder.  Not that the person would *object* but that they weren't things getting moved up on the list, things like food, like exercise for arthritis, etc.  And you're VERY correct that the person would sacrifice very important things to get something the person wants, when that wouldn't put them in a good position.  That's why I'm trying to be so careful here, because I don't want to set up a situation like that.  That was definitely interesting though, because now I have it all written out as lists in front of me, so I can see what each person is valuing and not get confused.  

 

My dh feels that we are seeing accurately, as you say, and sort of predictively, that the family member is at a turning point where this kind of change is needed.  But as I've thought about it, I've realized I don't have a plan for what the set-up should be if the person can no longer live in assisted living at some point.  That could come on, as many of you have pointed out, precipitously, and I haven't thought that through at all.  I'm going to try to get some tentative plan there, so I am thinking through this as a plan, not just random changes.  

[PeterPan]

*****, I was wondering about the bathrooms!  As you say, I would have assumed the showers were accessible, but I couldn't tell from the floor plans.  You know, I really hadn't thought through what would trigger us bringing the family member here.  When you put it that way, yes a wheelchair would trigger it.  I don't know, that's nuances I hadn't thought through.  Like if the person was unable to go out and do their activities, then why be so far from us?  If you're not able to go ANYWHERE and interact with anyone, then you should be near us.  But if you can keep up your life (which for this person, could be another 10 years), you might as well be where your life is.  

 

Carol, that's a good point on the menus.  I really wondered!

 

Lanny, that's something I need to talk with the social worker about.  I'm realizing I have some pretty precise questions about who covers what, whether the family needs to save money for later or whether benefits will cover it, etc.

 

Ellen, that's interesting that your mother chose it for herself.  Choice is something I have always emphasized with this family member, because I think it's key to dignity and a sign of respect. 

[Harriet Vane]

Lanny, the idea of live in care had not occurred to me.  I can talk it over with my family.  My initial sense is that it's not a good fit but for reasons I haven't elaborated on here.  The person has enough disabilities that even the assisted living wasn't sure they could handle it.  I'm not sure another person could handle living that intimately with this person, honestly.  No, I'll go farther than that.  I think the issue is that it doesn't set the person up for changes with ability to handle their own medication, etc.  But you're right that there could be in-between options, like hiring housekeeping, hiring someone to cook 3 meals a week, that kind of thing.  There could be some in-between steps like that to make their life better NOW.  That would be a really good thing to pursue.

 

Carol, thank you for that link!  That place is LOVELY, wow!  Hate to think what it costs, lol.  But lovely, absolutely lovely.  

 

HV, you're nailing a lot of the analysis there.  I used your list to talk it through with a family member, and it strikes me that the things the needy person is valuing, though good, aren't necessarily the things the doctor or family is putting an emphasis on in this process.  That's really interesting to ponder.  Not that the person would *object* but that they weren't things getting moved up on the list, things like food, like exercise for arthritis, etc.  And you're VERY correct that the person would sacrifice very important things to get something the person wants, when that wouldn't put them in a good position.  That's why I'm trying to be so careful here, because I don't want to set up a situation like that.  That was definitely interesting though, because now I have it all written out as lists in front of me, so I can see what each person is valuing and not get confused.  

 

My dh feels that we are seeing accurately, as you say, and sort of predictively, that the family member is at a turning point where this kind of change is needed.  But as I've thought about it, I've realized I don't have a plan for what the set-up should be if the person can no longer live in assisted living at some point.  That could come on, as many of you have pointed out, precipitously, and I haven't thought that through at all.  I'm going to try to get some tentative plan there, so I am thinking through this as a plan, not just random changes.  

 

Atul Gawande addresses the highlighted specifically in his book. 

 

If you prioritize the doctor's priorities, where does that leave the needy person in terms of having a quality of life that feels worthwhile to him/her? 

 

If you prioritize the relatives' priorities, where does that leave the needy person in terms of having a quality of life that feels worthwhile to him/her?

 

And it's also fair and valid to ask--if you prioritize the needy person's priorities, where does that leave the family in terms of the amount of work it takes to scaffold/support the needy person to have the lifestyle he/she values?

 

Sometimes safety or medical needs must actually take a backseat to quality-of-life issues for the needy person. In other words, you may have to choose a less-than-ideal physical or medical response so that the needy person does not have to give up something that is intrinsically valuable to him/her. 

 

Other times, what the needy person wants may not be realistic in terms of the scaffolding and support it would require of you. BUT--there may be creative ways to get the needy person the basics of what they value in life. 

[JFSinIL]

If the elderly person is of sound mind, then the choice should be theirs to make, after they tour the facilities and discuss the pros and owns of places with whomever is awaiting them in the decision.

 

but you can still visit a lot pf places ahead of time to weed out the unsuitable, then the elderly person can visit and select from the best options.  I agree, if they are still of sound or fairly sound mind, they should indeed have a lot of input and (finances permitting) the final say.  This won't be the case for my dad eventually (probably some time in 2016)

[JFSinIL]

To the OP:  It sounds to me like what you should look for is a 'continuing care' facility.

Those start with reasonable independence.  People have to be ambulatory, and they have to want to live in community, but they have their own individual apartments.  Common dining is available but the larger apartments have their own kitchens.  There are lots of organized activities.  If someone gets to need more care, 'assisted living' and 'nursing home' and 'memory unit' spots are available, but usually only if people started out independently.  Many of these places guarantee ongoing care to anyone they accept into their independent living spots.

 

Here is an example of one that I am personally familiar with.  It's a nice place.  http://www.sunny-view.org/wp-content/uploads/sites/7/2015/09/SV_brochure_2012.pdf

 

My in-laws were in one of these, their apartment did have a small kitchen BUT besides the fridge/freezer and sink/dishwasher, the only allowed cooking item was a microwave and a toaster, plus a coffeepot.  No stove or oven, lest a forgetful older person burn the place down. 

 

[PeterPan]

Atul Gawande addresses the highlighted specifically in his book. 

 

If you prioritize the doctor's priorities, where does that leave the needy person in terms of having a quality of life that feels worthwhile to him/her? 

 

If you prioritize the relatives' priorities, where does that leave the needy person in terms of having a quality of life that feels worthwhile to him/her?

 

And it's also fair and valid to ask--if you prioritize the needy person's priorities, where does that leave the family in terms of the amount of work it takes to scaffold/support the needy person to have the lifestyle he/she values?

 

Sometimes safety or medical needs must actually take a backseat to quality-of-life issues for the needy person. In other words, you may have to choose a less-than-ideal physical or medical response so that the needy person does not have to give up something that is intrinsically valuable to him/her. 

 

Other times, what the needy person wants may not be realistic in terms of the scaffolding and support it would require of you. BUT--there may be creative ways to get the needy person the basics of what they value in life. 

These are very reasonable questions.  I think if the discussion is about end of life, it's pretty easy.  I could easily get to quality of life over doctor preferences, any day, any time, no questions asked.  But once you say the person ISN'T dying, that the person is going to LIVE, and that their quality of life is intricately connected with complying with doctor recommendations, then it's much harder.  Even the ability to socialize, to be stable, everything is dependent on the medical care and complying.  It's not like we can just disregard the doctor recommendations and end up with quality of life.  If a person is dying and they disregard medical recommendations, often time that just means *shorter* life, where they're choosing quality over quantity.  I think that's totally fair.  But to reduce medical thinking it will give you the option of more quality of life when it really only decreases your ability to have quality of life (without affecting lifespan), THAT is not cool.  And, honestly, the person in question has not chosen that either.  

 

Reality is, we want it ALL and we want to be able to give it ALL to our loved ones.  That's what is so hard, that at some point something gives.  

 

******** (2 hours pass) *********

 

Ok, I'm back and that was amazing!  I sat down and had a talk with the family member and asked them to work through some scenarios that you all suggested (what if you're wheelchair bound but still qualify to live in assisted living, what if you have a precipitous incident and need extended care, etc.).  THAT was amazing.  Must add another value to my list: independence!  This family member immediately, when faced with a wheelchair bound scenario, IMMEDIATELY started talking about how to have independence and continue their quality of life.  Wow!  So to me, this person's ability to self-determine, to continue to do what they enjoy as long as they can, is MORE important than moving close to family!  Like I figured ok, wheelchair bound, time to mope and whine and move near family.  Nope!  

 

So these are hard issues.  And it turns out the person had *not* thought through preferences for where to do extended care when no longer able to be in assisted living.  I really think there's enough relationship that we're good there though, that we'll just make the logical choice.  

 

Well I'm excited to start visiting and get this person some options.  Next thing is to understand lease law.  Unfortunately, this person has another 6 months to their current lease.  I'm just believing it all works out somehow for the best.

 

Thanks ladies for talking it through.  I really hadn't thought through those uglier scenarios (wheelchair bound but still in assisted living, etc.).  When the person is younger, it's sort of an uncomfortable conversation to have.  And yet, when you have it, they are happier for knowing you cared.  And I think the family member finally put into words why they want assisted living (main building) not independent living (cottages).  The family member just feels burnt out, overwhelmed, tired. The family member doesn't have the energy level to suit the independent living, separate building, cottage gig.

 

So we'll see!  We're going to visit places, get options (under both labels) and let it come together.  Thanks!   :)

Edited December 27, 2015 by OhElizabeth

[Harriet Vane]

Just have to say--You're awesome, Elizabeth! As I said in an earlier post, you really can trust your instincts. I am also really impressed with how carefully you are evaluating all the different nuances of this and how carefully you are holding the needy person's desires and needs. 

[PeterPan]

Thanks HV.  It's hard, because when someone is fragile you really have to slow down and let them see things multiple times and really understand all the issues.  Otherwise it's not a choice but just a reaction, maybe an emotional reaction.  And, unfortunately, that means there is some skewing and weighting that goes on with how the options are presented.  But I try, I really try.  Thanks for the encouragement.  :)

[TechWife]

Ok, then thanks, I'll look into it pronto!  

 

And just to be clear, our situation is a little unique, or different from run of the mill, because the person is alone, needs to remain in a location to continue to receive care at the hospital in that city, *is* living independently, but is not living *satisfactorily* in the current set-up.  Not getting proper meals and needing companionship.  Also there's just sort of the watchful eye thing, like the ability to find the person when the person goes off the grid, to check in on them if they're sick or the weather is inclement.  The person would like to be able to get places without driving and without taking a bus or cab.  The person *can* drive, but sometimes it's not *good* for them to drive (bad weather, doesn't feel well but needs to get to the doctor, etc.).  The person can dress themselves, but they might need some help with buttons.  They might need some love and noticing, because they might forget conventions like showering or brushing hair.  Not that they can't, but just enough companionship that it gets noticed and prompted, kwim?  And the person needs help with cleaning, laundry, etc.  

 

So it's a really different mix of disabilities, in that it's not old age and not *inability* so much as disability.  You don't want to provide more than necessary or provide it in a way that reduces motivation to do for themselves what they *can*, but you want to improve quality of life with food and companionship.  Said person has also said they would prefer to be in the main building of the location, ie. surrounded by people, NOT in the sort of independent cottage/duplex gig some places have.  Some places will have independent and assisted in one facility but have the independent be in detached units from the main building.  And it's really hard to put my finger on what the person is wanting when they ask to be in the main building.  I *think* it's that they want more constant companionship and they want to be noticed, not off the grid and alone in some separate unit with no one noticing.

 

And I'll add, while the average assisted living stay (from what I've read) is 3 years, this person could be at this stage for 10-15.  There's enough money for the care, but another family member is questioning whether a given tier is overkill or wasteful.  It's just that there's something going on here that is hard to put into words.  We just feel like the *alone* thing is not good and that whatever it takes to solve the *alone* thing is worth the money.   We also feel like we're on the cusp of decline, like making the move to solve the alone/food/laundry thing puts the person in a better position to have help with other changes or needs.  

 

 

Not knowing details about the disability and the health of this man, I don't know if this is appropriate, but have you looked into a group home for people with similar disabilities and need for services? If he is in the hospital now, the social worker/discharge planner may know of some or be able to refer you to another resource for that information. Other than that, maybe calling a local organization that works with people with these needs would yield some results. A group home would have a house parent and would help with reminders, give him a sense of community and he would possibly have some responsibilities according to his ability. Again, I don't know enough about his situation, nor about the community he is in, to know if this is an appropriate placement or if anything like that is available. 

 

Other than that, it sounds like a need for personal care instead of independent living due to the need for prompts for personal care and the need for companionship. 

 

I wouldn't worry about the average length of stay, it really is just an indication of the health of the people who live there. I had an aunt and uncle who moved into an independent living situation with the ability to move to assisted living and then nursing home care within the same campus. They never did move into assisted living, opting instead to hire a caregiver to stay with them when they began needing help. They had the financial resources to do that, though. They stayed there through my uncles entire life, including hospice care in that apartment. They lived there for over fifteen years. After my uncle died, my aunt declared she never liked living there and bought a house near her daughter, which also happened to be closer to her caregiver's home as well. She moved out and lived on her own for the first time in her life at the age of 88! She lived happily with the assistance of the very same caregiver and her daughter until she died at the age of 92. 

[PeterPan]

TechWife, that's an interesting story!  Now it makes sense to me why we're seeing mention of *2* bedroom units.  That had confused me.  We don't think that would be a good set-up for this particular person, but it's interesting to think about.  I can discuss it with dh.  I think that sense of community you get by being in the main building would be more important.  But, you know, we've lined up some choices for him across those categories, so we're going to go see them and just see.  

 

How do you go about *finding* this type of live in caregiver?  I'm not saying it can work (because I don't think it can, not for this particular scenario), but I'm happy to look into it. 

[TechWife]

 

How do you go about *finding* this type of live in caregiver?  I'm not saying it can work (because I don't think it can, not for this particular scenario), but I'm happy to look into it. 

 

Check around with home health agencies, sometimes they know people who provide this type of care. Also, care.com is a good place to look, from what I have heard. People post ads when they are looking for caregiving jobs. I talked to a few really nice people from there when we were looking for a caregiver for my parents. We ended up going with an agency because we did not want to deal with taxes, nor did we want to have the possibility of her being our employee. The only problem we have run into with the agency is that they seem to have a high turnover rate - they seem to get an new caregiver about every three months. 

[PeterPan]

That pretty much answers it then.  My gut was that that couldn't work.  The situation is just way too complex for that.  I'll even exclude facilities that have that kind of turnover.  I'm looking for the place with the most consistency possible, even if it means a little less swanky food or something.  Consistency is vital here.  

 

Well thanks for explaining that!  :)

[Suzanne in ABQ]

When I was looking for a place for my mom, two web services were very helpful (linked below).  They have articles to help you sort through the questions, and the options, to figure out what is best for your loved one.  Both will speak to you over the phone to find out what your family member's needs are, then give you a list of available facilities in the area you are searching.  They have published rates, services offered, etc, and will put you in touch with the right person at those facilities you want to investigate.  When you go talk to them, you'll probably find that they offer you a deal ("for a limited time").  I was very leary, because the deal they offered seemed to be too good to be true.  But, they were true to their word on every point, and we're all very happy.

 

I also recommend going by yourself at first, to get a feel for the services and atmosphere at several places.  Doing so will allow you to ask questions and share information candidly, without confusing or upsetting your family member.  And, once you've narrowed it down, prioritize them in order of those you think would be the best fit.  My mom loved the place I liked best, so she didn't even want to see any other.  

 

My mom ended up going to a place that has independent living and assisted living.  She is in the independent part of the facility, but she can get additional care on a prorated hourly basis, if/when she needs it.  And, eventually, when she needs assisted living full time, the move will simply be down the hall to the AL wing.  In IL, she has a two bedroom apartment with a fill kitchen.  They have three meals a day available in the Dining Room.  She goes down for lunch and dinner, but makes her own breakfast in her apt.  They check on her if they don't hear from her or see her before 9:30 am, so she'll generally call down to let them know she's okay.  They clean her apartment every other week, and wash her towels and bed linens.  She does her own laundry.  They have lots of music, even dances, so she likes that.  It's a perfect fit for her, and she's very happy she's there.  She was home before that, not eating well, and lonely.  Now, she has good friends all around her whenever she wants.  

 

Anyway, check out Caring.com and APlaceForMom.com

 

 

ETA: I just saw that your family member is thinking of "independent living" as separate cottages.  That isn't necessarily the case, at least not in our city.  Most of the senior living and independent living facilities are enclosed buildings.  My mom's facility (Brookdale Place) is "independent living", but they don't have separate cottages.  It is a three story building, like a hotel, where all the doors open to a hallway.  There is an elevator that goes directly to the dining room.  There is a large, central great room in front, where the residents gather for morning exercise, concerts, etc.  There is a pool for water aerobics, as well as a small gym.  There is a TV room, and a snack room. Most of the residents walk, though several use walkers.  Only a few are in wheelchairs, and most of them come over from the assisted living section.

Edited December 28, 2015 by Suzanne in ABQ

[TranquilMind]

From my family's experience, the best thing is to either have the person move in with a family member or have a family member move in with them.  They have a much happier life at the end there than if they are off at a place.  Of course sometimes that is out of the question, but if it somehow isn't, things are much more in control.  You don't have to advocate as much or go through as many bureaucratic levels to check on what kind of care they are getting.  My dad was at an assisted living place after having so many strokes and he developed situational psychosis.  We moved him home and my sister, her husband and sons moved into his house.  He lived for two more years and died peacefully at home.  It was such a blessing for all of us that my sister could do that.  My sister worked full time as did her husband but the lady who used to houseclean for my parents was the sitter during the day.

 

My aunt who had diabetes and had her leg amputated when she was 78 was in a supposedly wonderful nursing home which was TERRIBLE.  We had to keep going in and advocating for her.  It was so time consuming and disruptive both emotionally and time-wise.  Finally we moved her out and into my house.  We were able to have Visiting Angels come in and help take care of her.  She lived with us for a year.  We loved having her but she had been an independent single woman all her life.  She felt she was a burden to us and she wanted her independence back so she went to live in an assisted living place.  It went well for a year though it is hard living in dorm life (which is what it amounts to!) at that age.  You've got a lot of old cantankerous people who maybe don't have it all together.  People are always dying.  It is depressing.  Then when her health started to fail for the last time, once again it was hugely time consuming to travel to the place and meet with all these people.  She got really paranoid about everything and was afraid of her caretakers.  She was calling us in the middle of night in panic.  It was awful.  At the very end we were going to bring her back home but she passed before we could make arrangements.  

 

So that's my experience.  You want control over the situation and the minute you farm it out, while you might think it makes things easier, in the end for us, it was better to keep them at home as long as possible.  It makes everybody happier and the person's passing is not so traumatic.

This.  It is such a short time in the scheme of things, looking back. 

[PeterPan]

Suzanne, thank you for explaining that!  I had found your mention of Brookdale in the past, but apparently the Brookdale's in the town where I'm looking aren't the same or as nice, sigh.  Anyways, we are going to do some visiting, and that's the VERY thing I've been sweating for the last hour sitting here, how to prioritize visits!!  I'm very afraid of OVERWHELMING the person, turning it into a blur, and having them give up.  I know full and well which one is probably the right fit, because I've researched it pretty heavily.  Google is amazing these days, with the ability to tour inside, see reviews, etc.