By SARA ARTHURS
Deciding when it’s time for an older family member to make a move to assisted living or a skilled nursing facility is never easy, but it’s a conversation families should have together, and ideally earlier rather than later.
Mollie Zinser, community services representative at The Heritage, said the conversation is most difficult when families put it off.
Zinser said skilled nursing facilities — the term used in the field now in place of “nursing homes” — have changed a lot over the years, so “nursing home” doesn’t really fit anymore, and it also has negative connotations.
Bridgett Mundy, administrator at Birchaven Village, agrees that “skilled nursing facilities” is a more accurate term, reflecting that they serve different purposes, such as offering a place for short-term rehabilitation.
And Birchaven’s assistant administrator, Debbie Hatfield, said there is still a stigma around the idea of a “nursing home” as a bad place to go.
All too often, a family is making a decision on where to move an elderly relative in an emergency, such as after a fall. Miranda Young, admissions coordinator at Birchaven, said instead younger seniors in their 60s and 70s may want to consider “preplanning” and looking at their options so if they do need more care when they’re older, they won’t have to make an urgent decision.
“Any decision about senior living, whether it’s a senior thinking about moving, or an adult child considering help for a parent, should include communication with the entire family,” said Charlie Stoner, executive director at Sunrise Senior Living. Sunrise is not a skilled nursing facility but offers assisted living as well as care for people with Alzheimer’s disease.
“Leaving home is always difficult,” Stoner said.
He said that since no two people are alike, there are a variety of options and staff will work to give each person what he or she needs.
“It’s a collaborative decision,” Stoner said. “You really want inclusion of the resident whenever possible.”
Sometimes the senior themself realizes it’s time to make the move. In other cases, the family approaches the senior and the senior may react with “I kind of knew this was coming,” or may take the position that they are absolutely not going to move, Zinser said.
Kate Lindabury, administrator at Fox Run Manor, said usually family members have to first broach the subject, although sometimes the senior will initiate it “when they feel like they’re a burden,” she said.
Lindabury said there are multiple options to consider, including having a home health aide come to the home, or entering adult day care, rather than going into a skilled nursing facility.
One question in determining if it’s time to move is “Do you really feel safe about your mom or your dad when you’re not there?” Lindabury said.
A skilled nursing facility or assisted living offers “24/7 on-site care,” she said.
Once someone is in assisted living, staff can help guide families as to when more care might be needed. Stoner, at Sunrise, and Hatfield, at Birchaven, both said someone who at first lives at one level of care may need to move to another unit later.
Zinser said sometimes people explore assisted living but they are “just not ready yet.” However, they can wait so long that when the time comes, assisted living is no longer appropriate because they need more skilled care.
Marketing Coordinator Khrista Beckmann often represents Birchaven at health fairs in the community. She said people always tell her “I never want to see you.” She responds that she hopes that they do get to live at home for the long term but she advises “knowing your options and being educated ahead of time.”
She points out that, for example, if a senior has a stroke their children may have to quickly make a decision.
A particularly tricky situation is when someone has dementia, a category of illnesses that includes Alzheimer’s disease. Often they can’t make their own decisions so it falls to the children to determine when it’s time to enter a facility.
Marty Williman, education manager with the Alzheimer’s Association’s Northwest Ohio Chapter said when Alzheimer’s is diagnosed early the senior can have some say in the decision-making. He or she might say that a particular home is what they prefer, or that once things get to a certain point that is how the family members will know that it’s time. Sometimes they will even sign a contract saying they will make a particular move at a particular time.
Williman said that often the decision arises as a safety issue, with children telling their parents “It’s no longer safe for you to be here by yourself.”
“No matter how you approach it, it’s tough. … But just being open and honest and having those conversations earlier rather than later (helps),” Williman said.
She said it can help to work the conversations into everyday discussion. Rather than calling a family meeting specifically to discuss the issue, which can make a person feel defensive, it might be better to casually bring up the idea that a transition might be needed well in advance.
“With this disease it’s all about getting to the doctor, talking about the changes that are going on and putting a plan in place,” Williman said.
Someone with memory loss can have “a lot of social isolation,” Hatfield said. She said entering a skilled nursing facility can be good for them not only because it keeps them safe but because they can interact with other residents.
Zinser said even if someone isn’t in favor of moving to skilled nursing care before it happens, once they get there “they just settle in. … This becomes their home. It becomes their world.”
Stoner said the current generation of seniors tends to put a lot of stock in their doctors’ recommendations and are apt to take heed when the doctor says it’s time to make the move.
Professionals urge family members to make multiple visits to different facilities before making a decision.
Williman said it’s important to shop around and noted that an appointment is not needed to visit a facility. The Alzheimer’s Association cannot recommend one facility over another but does offer checklists of what to look for. A checklist is also available online at medicare.gov.
Factors Stoner suggested to consider include staff training, community location, personalized attention, how warm the staff are, whether the place feels homelike, whether the senior likes some of the activities offered and whether caregivers and residents are smiling or enjoying their day, among others. Lindabury suggested looking at the rooms, seeing how staff are interacting with the residents and asking about activities.
Zinser said families really need to find a place they trust and feel good about and should look for “friendliness of staff.”
Another possibility may be staying in assisted living or a skilled nursing facility for a short time to try it out. Stoner said some seniors stayed at Sunrise for 30 days this winter during bad weather in order to stay safe. Sometimes these temporary residents end up moving in full-time and sometimes they don’t.
Beckmann said someone might stay at Birchaven for a couple of months in a “respite stay” to try it out and see how they like it.
Williman said families should also research the cost of facilities, which Medicare often does not cover, and should look at what type of insurance they have.
Mundy said the discussion around entering a skilled nursing facility may come up as someone is looking at their long-term financial planning.
To make the transition as seamless as possible, Zinsler suggests, “really do your homework and know that the move you’re making is the appropriate one.”
She said what is most stressful is if a senior moves into a facility, then realizes it isn’t the best fit and has to move again. This is particularly stressful for those with Alzheimer’s disease, she said.
Making the transition “can be difficult, but it can also be very positive if the community is a good match for the individual,” Stoner said.
One challenge is that many people have been in their home for many years, and may not want to give up some of their things, Zinser said.
“Downsizing is a big struggle,” she said.
Stoner suggested bringing pictures and other keepsakes for the new place as a way to make it feel like home.
And even when someone is living in a skilled nursing facility, family members can take turns bringing them dinner or visiting.
“There’s still a role for you,” Lindabury said.
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