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Print2010 Retirement living
To stay or to go? That's the question facing many aging parents as they ponder their living arrangements. Here are tips regarding the decision to remain in a home or move into assisted living facilities.
Copyright 2010 Crestock
The parent-child relationship can be a difficult balancing act—a compromise between guiding and letting go. That’s true when we are children, and remains true as we get older until, at some point, the balance shifts and the child becomes the caretaker.
When we were small, we saw our parents as strong, capable figures who met all of our needs and rarely required our care in return. As adults, learning to guide our parents while still respecting their independence can be a tricky act to master, but with a little preparation, it will feel like a natural part of the cycle of life.
In a perfect world, our parents would remain in their own homes, able to drive, care for themselves and maintain active social lives all of their days. In reality, aging robs us of many of the things we take for granted. The role of the adult child many times becomes a support person, helping to assess the situation and offer possible solutions that allow the parents to have all of their physical and emotional needs met.
Staying home
Ideally, all people should have the choice to stay in their homes, because retaining choice means retaining dignity. Kristin Beadle is a doctor of physical therapy who works with Robinson-Brown & Associates Caregiver Connections. RBACC’s mission is to connect individuals with the resources they need to make the choices that matter to them.
Beadle says it’s not the child’s preferences that matter, but the parent’s. She says that fear of being moved to an institution is a huge issue among older adults. Most, if given the choice, would choose to stay home.
“Very often, individuals are afraid to mention that their balance isn’t as good as it used to be, because if someone falls, the first reaction is to talk about putting them into a facility,” she says. “There is a fear of losing their homes and of losing their belongings, and of leaving all the memories behind in the place where they’ve lived for years.”
The reality, Beadle says, is if a person is at risk for falling at home, the risk is still there if that person moves to assisted living. The issue will not change, but the adult children may have more peace of mind.
“You as the child have to make sure you are making these decisions for the right reasons—for your loved one, and not because it is going to be easier for you or because you think you may sleep better at night,” Beadle says.
It’s important to remember that age isn’t necessarily an indicator of increased dependence, and that assessing the issues should be the chief concern.
“There are people in their 90s who are very independent,” Beadle says. Others may encounter problems at a much younger age. To assess potential problems accurately, be aware of what’s going on in your loved one’s life. If housekeeping is falling behind, trash isn’t getting taken out or bills aren’t being paid, there could be an underlying problem. Not taking care of personal hygiene and forgetting to take medications are other signs of potential trouble.
“The individual may be doing these things because of depression, or because he or she is physically unable to do them,” Beadle says.
Watch the way they get around, she says, and look for rigid posture, a loss of balance or reaching out for furniture.
“It’s sort of like the way a person would walk on ice—looking down at the feet and using a shuffling gait,” Beadle says. This indicates that the individual is feeling shaky on his feet and could use some equipment to help get back to his full feeling of competency.
Fortunately, there are a lot of resources that make it perfectly feasible to remain at home, safely and happily, even when issues begin to crop up.
“There are a lot of solutions that we as therapists think of as common sense, but they aren’t,” Beadle says. “If you’re nervous that your mother will forget to turn off the stove, let’s unplug the stove and start using microwave meals. Now she can stay in her home.”
Other solutions require a little more expertise, and this expertise abounds in Central Ohio. RBACC, which specializes in “prevention through intervention,” has several divisions.
The Balance and Mobility Clinic of Columbus utilizes medical technology to assess a person’s risk for falls and helps improve mobility to enhance both safety and quality of life.
Another division, Home Modifications for Independence, helps individuals assess potential hazards in the home that could cause falls, fires or other dangers. Experts then suggest potential fixes for the problems, including adaptive equipment, such as shower benches, elevated legs for furniture or a walker basket. The goal of the modifications is to help individuals continue to care for themselves each day, rather than becoming increasingly dependent on others.
Beadle says most clients pay the caregiver directly, but this isn’t necessary. The costs of in-home care, equipment and other needs can be paid for through insurance. People just don’t know it’s an option, Beadle says. The key is finding a caregiver consultant who has the expertise to locate reputable in-home help, to find low-cost solutions and to get the fees covered by insurance.
She is a proponent of this advocacy, and of people remaining in the home as long as they wish. It benefits everyone involved, she says—emotionally, physically and financially.
“If they are confused or depressed at home, they may become more confused or depressed in a facility,” she says. The costs are much lower, too, when the price of fulltime care is compared to in-home care just a couple hours each day.
Moving out and moving on
On the other hand, some people need close supervision and constant care, and assisted living is a workable solution. In addition, some older adults may look forward to moving into a senior community, seeing it as an opportunity to get out from under a house and all its maintenance issues—and move to a place with scheduled activities, outings and a fitness center, as well as someone else doing the cooking. Others may appreciate the sense of security they get from having someone close by to help, and having the choice to enjoy solitude in their rooms or step just outside their doors for social interaction.
Marsha Glaser, leasing manager at Kensington Place, says that choice makes all the difference.
“Think about people who sit at home all day long with the television,” she says. “Many times, they can’t drive anymore and they are completely dependent on their families and on friends who also may no longer drive.”
Glaser says many older adults begin to feel confined inside their own homes, and being in a community where social interaction is more readily available can boost mental and physical health.
“That stimulation and interaction with peers is important at every age,” she says.
Ohio has more than 500 assisted living facilities, each with its own specialties and advantages. When looking for a facility, begin by finding those in your desired geographical area (see ohioassistedliving.org and the directory at the end of this story). When the list has been narrowed to places, the family should visit each place in person, armed with a checklist of questions. The facility should be homelike, and residents should seem happy and comfortable socializing with one another.
Experts say the staff should be welcoming, greet you by name, be dressed appropriately and interact with clients and with one another in a friendly, professional manner. Staff should also be present and ready to help.
Glaser recommends looking at the personal relationships among the people in a community—both residents and staff. “If you tour a facility and everyone greets everyone else by name, that’s a very good indicator that people get along and are happy,” she says.
The facility should smell clean and fresh, and it should feel safe.
Some experts recommend taking a scheduled tour and then dropping in at different times of the day to get an accurate feeling of what life is really like in the facility. Communities shouldn’t bar people from visiting and asking questions, but neither should they let visitors roam unchecked and unattended.
“All of our visitors sign in and sign out,” Glaser says. That accountability protects the safety and the personal belongings of the residents. She says exterior doors at Kensington Place are locked at 9 pm, although residents may come and go as they please using their swipe cards.
Whatever your own impressions, give ample consideration to your loved one’s opinions of each facility. “Again, find out what is important to them,” says Beadle of RBACC. “For some, it’s the social aspect, and for others it’s all about the food. For some people, looks are everything, and so the aesthetics of the place will be very important.”
Senior facilities can be pleasant and enjoyable places. Most have such scheduled activities as happy hour, bingo, card clubs and performances by visiting musicians and other entertainers. There are fitness opportunities for both the body and the brain, classes, craft rooms and community kitchens where residents can spend time relaxing and doing things they enjoy. Many facilities are employing the Nintendo Wii and holding bowling nights without even having to leave the premises. There are manicurists and salons at a number of facilities, which is just one way the staff helps residents keep their joy for life.
In some communities, the staff and residents make a concerted effort to welcome newcomers. “Many times, people move here from other cities where they may have lived for 50 years,” Glaser says. “They come to be near their children, but maybe they don’t want to live with their children, and they don’t know anyone else in town.” These people are seeking independence, and as a result have to build an entirely new social network. At Kensington, current residents have a sort of welcome wagon organization, inviting new people to join them for dinner or for social activities.
Whatever road a family takes, it’s always important to keep the main goal in mind, Beadle says: “What we all want is the happiness of the person.”
Kristin Campbell is a freelance writer.
