Right at Home: Finding the Right Place for Your Aging Loved One
You may become aware your aging loved one with dementia needs to move after a fall, an illness, increasing signs of dementia, or a combination of these, which is what happened to me. My advice is to pay attention to any signs that they may be struggling at home.
Can they pay the bills and keep their finances straight?
Can they manage their medications?
Are they able to get out to buy groceries and socialize?
Are they withdrawing from activities they used to love?
Are they finding excuses not to invite you inside their home?
If you do get in, are things neat and tidy (if that was "normal") or in disarray?
My Mom wouldn't agree to move until it was almost too late — thankfully I'd already done my homework. Here's how I hit the ground running.
My experience researching independent living communities followed a conversation with my Dad. It was 2018, and my Mom was having issues walking due to her hip?, her circulation?, or as she described it, "because my thighs are stiff from pruning my roses.” (One's thighs do not stay stiff for 5 months after pruning roses, by the way. But I digress.) Dad was concerned about Mom's mobility, and he also expressed concern that his driving ability was declining. "I can tell my peripheral vision is not what it used to be, and I don't want to be one of those old guys driving around with dents in their car — and no idea of how they got there." Ah, I miss my Dad.
So, we made a pact: I would research some communities on the sly and report back to him. And of course, we agreed we would NOT tell my mother. She was a hard "no" on moving, period, and flatly refused to discuss it, which is putting it mildly.
What type of senior living community is right for my loved one?
Before I started my search, I needed to understand what options were available. My Dad had expressed interest in a community where they could "age in place" (a.k.a. a "continuum of care" community) so those were at the top of my list. But choosing a community that is just right for your loved one depends on the state of their physical and mental health.
Things I considered in my own search:
Are they showing signs of dementia or is their mental acuity just fine?
Are they steady on their feet or at risk of falling?
Do they need help managing meds, bathing or cooking?
Are they fully independent or do they need transportation or other support?
There are basically three types of senior living options: Continuum of Care, Senior Living Rental Communities and Continuing Care Retirement Community (CCRC) or Life Plan Communities.
Continuum of Care Community. These offer a full range of senior care that allows your loved one to age in place while getting the care they need. A typical continuum of care community will offer assisted living, memory care, skilled nursing and rehabilitation services.
Senior Living Rental/Lease Community. This is like renting any apartment, but the community is tailored for seniors and often limited to those 55 and older. Some communities may offer senior care or a continuum of care, but it likely won't be part of your rent, and the cost fluctuates based on the level of care the resident needs.
Continuing Care Retirement Community (CCRC) or Life Plan Community. These can be rentals or buy-ins. Both offer independent living plus a continuum of senior care.
I started my search by asking friends if they had loved ones in senior living with a full continuum of care option, which yielded one location to check out. So, I began a deeper dive with googling a resource I'd seen on TV: www.aplaceformom.com. I am not endorsing this site, nor do I know if it will be right for you, but it was a helpful starting place for me. The site allowed me to read overviews of various communities by category, read reviews, and click through to each property's site. I looked at a handful of communities near my parents that looked nice, made a list and a plan visit to a few that were around the town where they lived, and close to their church, which was still a big part of their social life.
What to look for: Visiting independent living, assisted living and long-term care facilities.
I began by contacting each of the top five communities I'd selected, some I emailed, others I just clicked the "request information" form on their website. Either resulted in a phone call from whomever was in charge of admissions, usually a property's marketing person, or facility administrator. After informing them whom I was conducting the search for, and what our timeline was (who knew?), I made an appointment to visit.
Upon your arrival, the greeter will welcome you and show you around the facility. My visits often began with a casual-feeling conversation in the lobby or their office to discuss why I was there — and their opportunity to press me for my parents' names and contact number. I gave first names only and refused to give last names or numbers because this was a clandestine affair and would have been a real hardship for my Dad had they called the house and Mom answered. Once I explained this, they let up. But I found it annoying. I'm sure they had their reasons, but still. After explaining why I was there and any health concerns I thought my parents faced, the tour began.
First things first: The tour is your opportunity to ask questions about things that matter to your loved one, beyond the room features and cleanliness.
I made sure I stayed in control of the tour by keeping the things that I knew mattered to my folks top of mind. This included free transportation to church services, grocery stores, medical appointments, social activities, music programs and dining options. And of course, the more sites I toured, the more overarching things I learned to watch for and ask about. Here are a few takeaways you might find helpful.
6 Things To Look For When Touring a Senior Community.
THE ENTRY: This is usually the most beautiful (or at least nicest) part of the facility, with the dining room a close second. Look around the entry: Does it smell fresh and clean? Are there residents using that area to read, visit, play cards...or is it just for show? This is a great tip-off to the culture there. Remember, this is the community's "first impression”. If it's anything less than pleasant, I'd end the tour right there.
THE DINING ROOM: This is usually the second-most attractive area of the community. After all, it's where residents may enjoy one or even all of their meals each day. Is it bright, clean, and tidy? Do the aromas coming from the kitchen smell appetizing? If they're serving a meal, does it look tasty? Are people looking around for servers or are they plentiful? Is their demeanor toward residents indifferent or endearing? Pay attention and remember, every detail is important. Tip: Many times the person leading your tour will want to treat you to lunch thereafter. Take them up on it so you can see firsthand what your loved ones will be eating and experiencing should they move there.
THE APARTMENTS: This is where your aging loved one will reside after leaving their home of many years. Look around you: would YOU want to live here? Is it bright and airy, or dull and dingy? Are there windows and do they open easily? What's the kitchen like? Is there a stove, or just a microwave and refrigerator only? Many communities omit the stove to encourage residents to eat together and get to know one another while they do it — and to eliminate the danger of forgetting to turn off a burner. If you're looking at long-term or memory care facilities, you'll want to know if each resident can have their own TV and if so, does the facility offer free Wi-Fi for streaming? Some facilities still rely on cable or satellite as streaming can be confusing for some.
THE COMMON AREAS: These are the areas where residents gather for social activities like playing games or cards, listening to music or crafting. Some communities have rooms dedicated to specific activities along with a big TV room for watching sporting events or movies. Give these areas the once-over too: are they clean? Are people using them?
And, this: Does the place pass the smell test? I toured a few facilities that reeked of urine. That means the staff is either not cleaning up quickly after accidents, or not being diligent about their residents' hygiene and care. Either is unacceptable!
THE MEDICAL STAFF: Unless your loved one is in an independent living-only community, there will likely be medical staff on site. Assisted living communities typically employ a licensed nurse and direct care staff, including a medication aide or certified medication technician. Long-term care and memory care facilities typically employ a more robust staff that includes even more caregivers and a director of nursing. If you're touring a center like this, play close attention to the interactions between residents and staff. Is the staff kind and respectful to residents? Are they engaged in their duties or looking at their phones. These are the people who will be looking after your loved ones, so ask the tour giver a few questions like:
How many caregivers are employed here?
What's the ratio of full-time staff to "temps"?
What is the average tenure of your medical staff?
How many nurses are on duty at one time — day and night?
Is a doctor on premises? If not, how often do they visit?
What hospital do you route emergencies to?
LOCATION: Which community your aging loved one moves into is a big decision. But where it is can be just as, if not more, important than much of the criteria I mentioned above. A couple of things to consider:
If your aging loved ones are in good mental and physical health and are actively involved in regular activities, volunteering, hobbies or a local church, temple or mosque, look at communities close to where they live. This ensures that they can remain engaged in the community they’ve built and do the things they enjoy for as long as they can.
If your aging loved one is showing signs of dementia or has health challenges, look at communities that are close to where you, or the person who will be visiting and making daily care decisions, live. This person should also have the Durable Power Of Attorney and Healthcare Power of Attorney for your aging loved one. Having your loved one nearby enables you (or whomever will be the main contact, and let's face it, this usually falls to one person be it a child, spouse, or relative) who will be visiting regularly, making everyday decisions from menu selections to hair appointments, accompanying to doctor's visits, resetting the internet, buying toiletries and clothing as needed, meeting to medical staff about care plans...the list is long. As an only child with both parents in care, having them 10 minutes away made frequent visits — and crisis management — easier to manage. Note I didn't say "easy," because nothing about this journey is easy.
Bottom line: how much does senior living cost?
The short answer: it depends on what you choose. Independent living can be the most affordable option, and usually include meals in the on-site dining room as part of the monthly lease/rent payment. Assisted living communities cost more, because they offer more care. Skilled nursing and memory care are the most expensive options as they offer 24/7 care. In my initial search, I was not even considering if the continuum of care community accepted Medicaid* because my search at that time was focused on independent living and my parents did not qualify at that time. But it is a good question to ask during your search.
Don't wait too long to make your move.
If you have even an inkling that moving your loved ones into a senior living community is in the cards, the time to act is now. Do not dismiss the signs. Lean in, ask, be nosy. Discuss the possibility of moving to a place with new friends, meals prepared for you, transportation anywhere you want to go, and more. If your loved one says no, don't give up. Do your research anyway. Make a plan. Just keep talking...and keep your eyes open. Because more than likely, a move won't be an "if" but a "when."