....To find the right living situation for an elder, you've got to ask the right questions -- about extra fees, services, comforts and conveniences....
Elizabeth Sturdevant thought she was prepared for everything when she helped her 82-year-old mother, Janet, move into a new assisted-living community. The 46-year-old Los Angeles paralegal had been through the process once before and thought she had asked all the right questions of the new managers.
Then she found out her mother had been stranded outside her doctor's office all day, with none of her phone numbers and no way home.
"She was calling dial-a-ride from a pay phone, but she had no idea where she was." Ultimately, a stranger helped her disoriented mother arrange for a cab ride back to her assisted-living community.
Since then, Sturdevant has had to make sure her mother arranges doctor appointments on days when the assisted-living facility's van can take her. She also has planted her phone numbers, and those of her sisters, in her mother's medicine bag, so she always has someone to call.
Planning for a parent's move into assisted living is more time-consuming and complicated than most people bank on. While many facilities seem like a dormitory with prepared meals, there's a lot more to consider than when you ship your kids off to college.
Memories count, and so do conveniences
Transportation is just one of the issues, Sturdevant found. The others? How and what to pack and how to arrange for care were just a couple. Moreover, she had to figure out how to transfer as much as possible of her mother's old life to her new home.
While Sturdevant drew the line at driving her mother more than 60 miles each week to get her hair done by her old hairdresser, she did arrange for her old newspaper from Lancaster to be mailed to her new community, for an additional fee.
"She was trying to get it delivered to her old home and have people bring it out here," Sturdevant said.
Helping your parents keep as much of their old lifestyle and mementos as possible helps to ease the transition to assisted living, geriatric care experts say.
If you can keep whatever it is in their life that gives it value, then you can minimize a lot of the depression that accompanies a move to assisted living, Johnson said.
Since most places only allow the furniture, appliances and belongings that can fit into their room or apartment, you have to sit down with a parent and choose these items carefully.
Johnson recommends talking about what items have the most memories associated with them. It may surprise you, she said. Rather than a beautiful dresser, your mother may be more sentimental about an antique treadle sewing machine that she used with her own mother.
An experienced eye helps
Likewise, children need to consider a parent's hobbies and lifestyle.
Can Mom take her pet? Many facilities now accept animals under certain conditions, and that can help ease the transition to a new place. Does she have a space to garden or window onto a garden? Is it near her church, trusted doctor or community center she attends? Can she do her own laundry?
"Some adult children come in kind of bossy and parental," Johnson said. "It's better to come in as more of a peer and a friend." Talk to parents about what's important and give them a couple of options, she said.
Moreover, consumer advocates say, it's often better to get a second, professional opinion on your choice.
Geriatric care managers, which can be found through the government elder-care locator number, (800) 677-1116, or at www.caremanager.org, can assess a parent to determine their needs and recommend facilities in your area that might be a good fit.
"They can also help when a family member feels a placement is necessary, but the older person may not," Johnson said.
For a few hours of paid time, these specialists -- typically social workers or registered nurses -- can save you headaches down the road, experts say.
"They can say this facility gives good care, this one has had problems," said Washington D.C.-based estate-planning and elder-law attorney William Fralin. "A lot of the facilities have figured out how to decorate nicely ... but the care manager knows which ones are well run."
There is no federal oversight of assisted-living facilities and only limited state oversight, so this information can be especially helpful, as can advice from an ombudsman affiliated with your area's council on aging.
How much care is enough?
A few years before, Sturdevant's mother had entered an assisted-living facility for which she wasn't capable enough, only to be ejected when she couldn't take care of her apartment. After bouncing from relative to relative, she's back in a facility with greater oversight.
"My mother needs to have a schedule and see other people," she said. In this new community, Sturdevant said, "if she doesn't come down for dinner, they will be calling and checking up on her."
Drop in unannounced to a community, experts say, to see how residents are being treated. Taste the food and see how the place looks and smells. How friendly are people? Do activities happen as planned?
Another thing that Fralin and other care managers recommend is looking at the different levels of care offered by a community. Does it offer several options from independent living to skilled nursing? Does it have a special Alzheimer's unit? While your parent may operate just fine with an apartment and prepared meals today, he or she might not be as capable a year from now.
Being in a community with a continuum of care also is a good insurance policy should your parent's money run out. Most assisted-living facilities give priority for their Medicaid-funded beds to current residents.
Finding another attractive facility that accepts Medicaid, rather than private pay, can be difficult.
"If it does have Medicaid beds, it's probably not as desirable," Fralin said.
Plan for the extra costs
Most facilities are private pay, which means that a house must be sold or pensions used to pay the $3,000 to $6,000 a month that most places charge.
And these facilities often also charge an extra up-front "community fee," says Kathleen Cameron, chair of the Consumer Consortium on Assisted Living, which typically amounts to one month's board.
Cameron said it's important for consumers to know that these fees are negotiable.
Assisted-living centers charge many additional fees, and it's best for people to be familiar with them and plan for them up-front, so they don't come as a surprise with that first bill.
Will your parent need extra nursing, equipment or rehabilitation services? These are often billed separately. There may also be charges for housekeeping or hairdressing. If residents need a meal delivered to their room or apartment, that can cost extra, too.
Likewise, transportation can impose an additional cost. Since most assisted-living residents don't drive, a van is usually provided at least one day a week to take them to a doctor appointment or bank in the surrounding area.
If your parents' doctor isn't in the surrounding area or they have several weekly appointments, you might need to line up other transportation, such as a paid account with a local cab company.
In many cases, prescriptions must also be transferred to a pharmacy that the facility uses, which dispenses the drugs in separately packaged doses, so there is less room for caregiver error. While this is usually more convenient, it's often more expensive, care mangers say. Ask the facility what arrangements they have with a pharmacy and what medication management they offer.
To handle day-to-day expenses, most facilities allow residents to have a small account for petty cash, so they can withdraw money to buy a toy for the grandchild, or buy their favorite cookies or tea at the local grocery store.
"Many communities will keep a certain amount of cash for people, maybe $100, so they don't have to keep going to the bank all the time," said Marybeth Bersani, senior vice president of public policy for the Assisted Living Federation of America.
However, Bersani cautions that residents should leave the expensive jewelry and important documents with a relative, or in a safe-deposit box at the bank. "Although the doors do lock and people have a key to their own room, there's a lot of people coming and going," she said.
Choose comforts carefully
Residents of assisted-living facilities can usually take a television and other appliances, such as a microwave or small dormitory fridge. Some facilities also allow residents to bring in their own bed. And more and more people, she said, are taking a computer along, so they can keep in touch with relatives and friends or entertain themselves.
"Now, they are putting extra phone lines in some rooms," Bersani said.
To save space, many experts suggest taking only a season's worth of your parent's clothes at a time, leaving the rest at your house or in storage. Give Mom and Dad a floor plan to the space and let them show you where they want things to go. Measure the space. If a bed or other furniture won't fit, help them shop for new furniture.
Once it's time for the move, experts say, it's best to get it done quickly. Many caregivers recommend taking your parent out to lunch or to see relatives, then having her room set up with her furniture and other items when she's out.
"Sometimes it's less traumatic," when they don't see movers taking away their belongings, Johnson said.
If your parent is very vocal about wanting to be involved on moving day, let her. Some movers that specialize in seniors will allow residents to show them where to hook up the television and arrange other furniture and dÈcor.
Ease their transition -- and yours
To help her mother stay in touch, Sturdevant programmed her phone number, those of her four siblings and other important numbers into her mother's phone, so she wouldn't lose them. And she takes her mother on regular trips to the local grocery store she likes, and where she knows the layout.
"It's a very big change," said Bersani. "Many people have lived in their home for 50 years."
Don't deny your relative their grief, experts say.
But, at the same time, show them the pluses of living in a community, with greater care, such as not having to bother with preparing meals, or being closer to you and your children, so you can visit more often.
If your parent is moving out of their area, help them find new hair dressers, doctors, churches and other places that they like.
"It's a reason to get out and have a different set of relationships," Johnson said.
And lastly, caregivers say, don't neglect your own needs. Putting a parent in assisted living can bring tremendous grief and guilt to the adult children moving their parents.
"I would recommend a support group," said Gloria Schultz, a systems manager from Philadelphia who moved her mother, Rose, into an assisted-living facility a month ago.
"The first two weeks I went to visit her, I had to walk out of the room crying," she said. "It really stirs up a lot of emotional distress."
If you need assistance with caring for an elderly loved one, are new to elder care or uncomfortable with elder care decision-making, are faced with having to make a sudden decision or major change such as a health crisis or change of residence, or simply want some advice about any aspect of elder care, please don't hesitate to contact us at any time.