When the Time Comes How to Ease a Loved One’s Transition to the World of Assisted Living

It’s something no one wants to think about, but should.

“In today’s society, seniors are very willing to talk about what they’re going to do early in retirement, and willing to talk about what they’ll do with their estate after they’re gone, but they’re very reluctant to have a conversation about when they will need care,” said Elena Leon, director of community relations for Orchard Valley at Wilbraham.

“They don’t know what needing care means: is it when they can no longer prepare meals? When they can’t walk so well, hear so well, see so well? When it’s no longer safe to walk out of the tub or shower?”

The fast-growing field of assisted living provides an opportunity for older Americans to enjoy the comforts of a home-like setting, plenty of activities and socialization, along with the help they might need — from bathing and dressing to housecleaning and medication reminders — to get through each day.

Yet, many are so attached to the house they might have called home for decades that leaving it is terrifying, even when diminished faculties, and perhaps the loss of the ability to drive, have left them isolated.

“If you’re sitting looking at the four walls or the TV all day, but your human interactions are lost, you may be staying at home, but what’s the value of that life?” Leon asked. “Are you living life, or just waiting for the end? The thing about assisted-living communities is, there’s a life to be lived, so let’s live it, not just look at the calendar and check off another day.”

Administrators at several area senior-care facilities had similar perspectives on the value of assisted living. But the transition from independent living to a different model can still cause plenty of anxiety for seniors terrified of giving up the familiarity of what they have, and families worried about an aging parent’s safety but confused about the care options available.

Patrick Laskey, administrator of Loomis Village in South Hadley, said the challenges of entering assisted living can vary greatly depending on the circumstances surrounding the transition.

“Some people come in crisis; they’ve been alone and independent, or with their spouse, and then some event happens that brings them to the hospital — some difficulty comes to light — and they suddenly need assisted living,” Laskey said. “That’s often the most difficult for residents and families because they’re the least prepared for it. They’re discharged from the hospital, and it’s, ‘oh my God, what are we going to do?’

“They’re under duress, because they haven’t planned it out,” he added, noting that it’s a good idea for families to begin thinking about such contingencies in advance, in case a loved one suddenly does need additional care.

Leon agreed. “I’m a big advocate of having a plan,” she told HCN. “Otherwise, you’re waiting for a hip fracture, or a wandering incident with dementia, or some other precipitating incident that forces the move, and why put yourself and your loved one through that suffering? The last thing you want is to have this suddenly thrust upon you at the hospital bedside.”

This month, the Healthcare News explores the questions families must grapple with when a loved one needs more care than they can get at home — and why they shouldn’t put those questions off.

When a House Isn’t a Home

Mary Phaneuf, regional marketing director of the Arbors, said it’s natural to want to stay in a house that might have been home for decades, but sometimes an older person needs some prodding to realize it’s no longer an ideal place to be.

“They say, ‘I want to keep that house,’ but when the house doesn’t benefit you anymore, it becomes a prison,” she said. “Assisted living opens up opportunities to keep on living in a quality way.”

What is changing is the public awareness of assisted living, a care model between independent senior housing and nursing homes that has come into prominence in the past 20 years, and will continue to grow as the Baby Boomers head into the retirement years.

“Adult children want to see their parents enjoying things, and they see they’ve lost that in their homes — their eyesight is bad, their hearing is bad, they can’t drive anymore, and when they’re home, they tend to isolate themselves,” Phaneuf said. “But when those opportunities are available to them again, they tend to blossom and enjoy life again.

“We don’t cure diseases, and we don’t prevent people from aging,” she added. “We don’t fix any of those things. But we can allow them to enjoy life to the best of their ability until they’re no longer with us. That’s what our goal is.”

But potential residents and families need to educate themselves first on the benefits of assisted living — and to do it well in advance of actually needing it, said Beth Vettori, administrator of Rockridge Retirement Home in Northampton.

“There’s a trend in society that people generally don’t start thinking about whether they need to move or need services until something happens that forces their hand,” she said. “So one thing assisted-living communities do to help facilitate the transition is to offer a lot of programs and informational sessions for families and potential residents.”

Education has become even more important in recent years, Laskey noted, considering that the trend — perhaps driven by economic strains — seems to be people waiting longer to make the move.

“They feel a need to stay in their houses as long as possible, and they’re presenting themselves with a greater number of challenges, in terms of their own health and support,” he explained. “They may have two, three, four chronic medical conditions, and they’re coming in with what we call a higher acuity level, needing more support than in the past.”

Laskey pointed out that educating families about what assisted living is — and isn’t — helps ease anxieties simply by painting an accurate picture of what to expect. And it’s an important part of the process, since the term ‘assisted living’ has been used in the elder-care community to describe a wide range of models, from home care to skilled nursing care.

For Loomis, “assisted living is residential care; it’s a residential environment, not a health care facility,” he noted. “There’s still a lot of misinformation — some people expect a health care facility, and even people who say ‘I want to be independent’ often have a desire for more medical support.

“So we do a lot of educating,” he continued. “Our approach to assisted living is to assist people with being more independent, not to take care of people. We want you to have the highest level of function, comfort, and safety, but people are still independent, and have rights of privacy, self-determination, and choosing their own providers. That’s our day-to-day philosophy here.”

Jacqueline Marcell, an author, speaker, and advocate for elder care issues, also argues for starting the conversation early — while the potential resident is still in good health — in an essay at www.seniorhousingnet.com.

“Getting them used to the idea beforehand will make it easier when the time comes,” she writes, adding that the senior’s safety is the most important factor, so families should not be deterred by his or her reluctance to discuss the issue.

“If you know that they cannot remain in their home safely, don’t let your emotions override what you know needs to be done,” Marcell adds. “Don’t wait for a broken hip, a car accident, or a crisis call before you step in. Recognize that, when you were a child, your parents would have done everything possible to keep you safe. Now, as hard as it is, you have to be the ‘parent,’ and you have to make the best decisions for their safety.”

Moving Right Along

Even for someone who recognizes the need for assisted living, the move itself can be traumatic, Laskey said, especially if leaving behind a large house, as opposed to an independent-living apartment.

“A major barrier can be how they’re going to downsize,” he told HCN. “That can intimidate a lot of people into avoiding the decision to move — they just have too much stuff.”

To that end, Loomis provides professional organizers to help wade through the downsizing process, which can be daunting, especially for someone who has lived in the same house for many years.

“You can’t fit a 13-room house into a two-room apartment, so you bring the most important things with you,” Leo said, adding that family members can be great helps in whittling down the pile to the most treasured possessions. “You don’t leave your life behind — you take it with you, and look forward.”

She admits it’s not an easy task for many Baby Boomers.

“I’ve moved a dozen times in my adult life, and the next generation [to retire] will probably know how to move, but this current generation, they didn’t move. They didn’t change careers; they purchased or built one home, and that’s still the home they’re in, and they don’t relate to the whole process of relocation. And they can become frozen with fear because it’s too large a concept to think about, and it’s easier to do nothing.”

Vettori stressed the importance of furnishing a unit with the resident’s favorite furniture and decorative items, but just as important is relieving their loved one as much as possible of the burden of the actual, physical move.

“I highly suggest making sure they set up the apartment, cottage, or suite beforehand, so when they person moves in, they’re not faced with that overwhelming sense of, ‘oh my goodness, look at all this stuff boxed up that I have to unpack.’ Instead, they have the ability to walk into a very familiar, very welcoming place.”

Even after the move, many seniors initially struggle with anxiety over this new life, but most adjust well, Vettori said, adding that residents tend to support newcomers with a welcoming committee or buddy system to get them active in their new community.

Laskey said a hospitality committee at Loomis takes new residents under its wing for the first week or so, taking them to dinner and events and basically making the transition as painless as possible.

“We’re not into bringing in people who don’t want to be here and don’t belong here,” he said. “But can be traumatic when a person moves in; they can feel a loss of individuality, and some have trouble adjusting. That’s not abnormal. But most people stay, and, if you talk to them, most of them love it.”

Leon reported similar experiences at Orchard Valley.

Assisted living is “about safety and care, but also about that social element,” she told HCN. “Aging is not kind, but we want to make it the best, most joy-ridden experience we can. We have to learn how to play again and take pleasure, and not just endure.”