In New England, resident elders are usually rugged individualists. This can make conversations about assisted living more of a challenge. Typically, people place more value on maintaining independence here in the Northeast. The reluctance to recognize the need to accept help can be a daunting hurdle.
Several factors may come into play – are there family members or in-home caretakers readily available to visit over time to observe how the elder is doing? What terms are you one with the elder(s) you are concerned about? What stresses are occurring now? Is there any underlying dementia or mood disorder such as anxiety, depression or PTSD?
If any of these complications are present, then you may be well advised to ask a trusted friend or professional to assist – a nurse, physician, a social worker, psychologist, or physical therapist. Trust and patience are the two most critical factors in facilitating a successful conversation – one that opens up possibilities rather than closes options down.
Often, these kinds of conversations are avoided, out of concern for upsetting people. Delay can add more stress, as it collapses the time interval needed to promote clear thinking. Instead of creating a well-planned and executed move, it can become an emergency. It’s not uncommon for family members or caregivers to wait until there is a critical incident – like a fall, illness, or near calamity – before raising the subject. Under duress or the pressure of time is not ideal for reasoning well.
People have pride. Adults don’t want to feel dependent and will do their utmost to appear as if they are functioning better than they actually are. That’s why multiple visits are needed at unexpected times, over a month or more, to ferret out information about how well the elder is managing. And a softer approach may be best so as not to alienate, create a sense of threat, or make them feel they are being treated like a child.
If you can, start a conversation well before the time when a decision is needed and ask: “How will we know when it’s time to consider a move into assisted living?” Let the elder come up with some initial criteria that they would prefer to go by. If you disagree or get into a power struggle, back off. Listen, gently ask more and come back again to talk later. There’s a fine line between guiding a conversation and being authoritative. Family members’ fears and worries can contaminate the conversation, especially if there is a history of conflict, defensiveness or stubbornness. Don’t feel as though you need to resolve things within a week’s time or a single conversation.
Broach the topic as an exploration – ask what their preferences are – to obtain in-home support, if finances allow, to attend adult day care, or to tour the assisted living options ahead of time. Find out whom to consult about their financial picture, to make sure their preferences are financially feasible.
Here are some criteria by which to consider a need to move:
- Losing or gaining 10 pounds in a month
- Inconsistency with medications
- Loss of bowel or bladder control
- Unable to cook/warm up meals
- Unable to keep appointments
- Unable to keep up with minimal cleaning – obvious spills, rotten food in fridge, trash piling up, mail unopened
- Unable to keep up with bills
- Unable to get groceries
- Unable to maintain daily structure – 2-3 meals, getting dressed, bathing, normal sleep patterns, etc.
- Fearfulness/Suspiciousness – avoiding answering the phone or door, accusing others of things that they have not done, etc.
- Social isolation/withdrawal
Things you can check:
- Refill dates on medication bottles – are they expired?
- Are medications organized?
- Evidence that appliances are being used safely
- Evidence of lack of grooming – hair or teeth unbrushed, clothing unwashed, mal-odor
- Evidence of insufficient nutrition – check in the cupboards, fridge and freezer. Ask what they had for dinner the night before?
- Notice whether you see any potential hazards – burners left on, candles burning, piles of things on the floors, etc.
Schedule a tour if possible and find out what activities are offered, what services are available and stress how much easier life will be with these things taken care of – laundry, meals, cleaning, medication administration, appointments in-home, etc. See if you can plan to have a meal there, to allow more time to meet people.
The holidays may be an ideal time to schedule a visit, when there are more festive activities taking place. Article on the best times to visit a facility
People often remark that moving into assisted living is, “where I’ll go to die.” While it’s true that this may become the last place they will live, there is still a lot of living that can be enjoyed, if the decision is made early enough. You could counter this objection with, “Well, when the time is right for you to move there, you’ll be able to liven up the place!”
Make sure you speak with the elder’s health care providers and find out what changes they’ve noticed and how they see this person’s ability to manage, over time. Ask them to alert you about any significant changes, or attend the appointments, if you are permitted.
Here’s a resource for the moving process, once a decision has been made, or clarity reached about when to move: Click here for helpful PFD on making a successful transition to assisted living
When it is time to move, you may want to consider hiring someone to help organize, declutter and physically do the moving and cleaning. One such business based in Portland, Maine is called Bettina & Co. Meet Bettina & Co.
Start the discussion early, be patient, take notes and call on assistance when needed! You’ll set a good example by asking for help.