SF/TSG #011

This material has been developed by and is presented by The Sandwich Generation ®

Moving an Elder: Common Vision is Needed
By Carol Abaya, M.A.

Cast of characters:

Bea, 80, a 20-year resident of Florida

Ellen, a resident of New Jersey

Ely, Ellen’s brother, a resident of Florida

Lillian, Ellen’s sister, a resident of New York

Several years ago Bea had a major heart attack and is on a nitrogyclerine patch.  For about a year before that tough decision,  she  wasn’t eating properly, lost 20 pounds and her energy level had deteriorated.  Although she had help for 12 hours each day, one night she put something on the stove, fell asleep, and a fire  resulted.  Staying in her second floor walkup apartment of 20 years wasn’t helping Bea enjoy her last years and presented safety problems.

Ellen had just returned from Florida having helped her mother move into a residential care facility, when she talked with The Sandwich Generation©™.  She, her brother and sister  and  her mother had made the move decision.

Ellen’s story, in her own words:

All the way down on the plane, my stomach was in knots.  I felt guilty that we were going to have to move my mother.   Having to deal with the unknown frightened me.  I didn’t know what her reaction would be to what I had to say.  I didn’t know whether we’d find a place we all liked.

As I went into my mother’s apartment, I looked around.  It was old, and although she had help, it really wasn’t clean.  There was no elevator, and her apartment was on the second floor.  She and my father wanted the second floor 20 years ago because it afforded them more privacy than if they were on the first floor.   But since her heart attack five years ago, she had trouble with the stairs.  By the time she got downstairs, she was tired.  So when she went out, she couldn’t enjoy herself.  She really was a prisoner in her own apartment.

She had been depressed for awhile and had lost a lot of weight.  I said to myself, "My mother is not living.  She is just existing."  This made me feel better, that we were doing the right thing.  

Heart to Heart Discussion

Ellen and her mother were close, and Bea always talked to Ellen about her feelings.  So, as soon as Ellen arrived at her mother’s she sat down with her, to discuss her own feelings as well as those of her brother and sister.  Her conversation follows:

Mom, I would like the opportunity to give you a better life.  If I didn’t love you I wouldn’t be here and want to make things better.  This was once your home.  Now it is a prison because you can’t get out.  You’re confined, and you have no choice.  Just because you’re 80 doesn’t mean you’re dead.  You’re alive, but you’re deteriorating because of where and how you’re living.

I tried to turn the situation around.  You really can’t stay here, I said.  Don’t you want me to be happy?  If I go home and leave you here, I will not be happy.  Seeing you like this is eating me up alive.  It’s always on my mind, and I can’t deal with it as well as with my husband and children.  I am depleting myself of my own energy and money.  (Ellen and her brother were paying $600 a week for 12-hour a day help.)  Let us help you.

You don’t have to make an immediate decision.  We want to give you a new life.  We want you to have the best of everything.  I want to do for you as I would do for myself.  Trust me to do the right thing.  Ely and I will do the leg work.  Then you decide.

I thought she would defy me because she would think of a nursing home.  And she really doesn’t need one.  I was surprised that she agreed so readily.

Her Brother Identified Changing Needs

Ellen, at first, refused to accept her brother’s evaluation of their mother’s deteriorating condition.  It took her awhile to accept the fact that her mother might not be able to stay in her own apartment any longer.  Her reaction follows:

Ely and I have always been very close.  He’s my best friend.  But when he said we should move my mother to a facility, I went on a rampage. I accused him and my sister-in-law of not wanting to look after my mother.  I said some terrible things.  I couldn’t accept the changes in my mother.  But after all, he is down there and sees her every week.  I am in New Jersey.

But then there was the fire.  And I spoke with her doctor.  The doctor said she was deteriorating and that she didn’t have to.  That her depression and her not eating properly was because she needed to get out of the house.  But because she wasn’t eating, she had no inclination to do anything.

Then I realized I needed to take a new look at the situation.  I had the wrong assumption (based on our experience with my mother-in-law) that someone went into a home before they died.  I realized there are alternatives. I accepted the facts of her condition and stopped fighting my brother.

The Search

Lillian had also flown down, so that Bea knew that all her children were in agreement that she should move, that they wanted a better life for her.  A united front.  Ellen continued her story.

Ely and I did the legwork.  Lillian stayed and kept my mother company.  We visited       facilities.  I did most of the interviewing and asked questions.  Ely is more quiet, and he listened and then gave his opinion after we left each place.

I asked a lot of questions.  I purposely started conversations with residents, to determine their mental alertness. We wanted to make sure the people in the facility were as mentally alert as my mother.  I would try to make the person feel comfortable, asking about their children, where they lived, where the resident lived before coming to the facility, what kind of work he or she did, what are his or her hobbies, what activities the person participates in the facility.  I wanted to determine the mental capabilities of the residents and their outlook on life.

I looked at residents to see if they had smiles on their faces when someone came in or were frowning, if their clothes were clean and neat, whether their hair was combed and styled, and whether the temperature inside was appropriate.  If it is too cold in the summer or too hot in winter, people are uncomfortable.

I asked the director if the staff goes out of the way to encourage residents to participate in activities.  I want her to be ‘invited’ to participate, even if she refuses  in the beginning.  I wanted to know if someone checks up on a resident if she doesn’t come down for a meal.  Other questions involved visiting hours, about the ability of the resident to come and go as she pleases, the menu and food  selection.

I asked questions about medicine controls.  In the place we chose, medication is individually bubble packed, so that there is no chance a wrong pill can be given or that it is not clean.

Aside from checking out the track record of the facility and state licensure, I was concerned about the physical environment -- smoke alarms, housekeeping and laundry, whether the decor was inviting or depressing, whether there is space outside so residents aren’t forced to stay inside because of the heat.

The Decision

Ellen and Eli finally located a place where they felt their mother would be happy as well as receive the care she needed.  It is a residential community in which there are independent apartments, with two meals given a day, daily housekeeping, medication controls, and plenty of activities to keep Bea’s mind stimulated.  There are tables and chairs outside in the shade, so that residents can be outside, yet have some quiet space, if they so desire.  And the cost is less than they were paying for home care help.

      The final decision was left to Bea, and she agreed.




Ask  a  Lot  of  Questions

It’s time to move; time to begin a new life; to enjoy the rest of one’s life and be coddled at the same time.  What do you want out of the rest of your or your parent’s life?  What is the best alternative?

An evaluation of the person’s capabilities and handicaps, of financial resources, and of desires has been made.  What next?

Financial resources is the factor which allows for more or fewer options.  Then needs must be matched with financial resources and options.

Today’s options include:

  • staying at long-time owned home or apartment, with appropriate health;
  • retirement community;
  • life care community;
  • moving in with children or having an adult child move in with senior;
  • residential care facility;
  • boarding home;
  • assisted living residence;  or
  • skilled nursing home.

Check List

Regardless of the route one takes or the level of care needed, there are basic elements which should be checked out.

Licensing:  Is the community or facility licensed by the State?  If so, when was the last state inspection, and what were the results?  Were any infractions minor or substantive? 

When was the last local health inspection? Results?

If there are no licensure laws in reference to the facility or type of community are there certain state and/or local standards that must be met.

Is the facility Medicare and Medicaid approved?  If not, why?  Never applied for?  Refused?  If refused, why?

Certification:  Are all members  of the staff directly involved with resident/patient care certified by the State?  What is the staff/patient ratio?  Are various department heads licensed or certified, according to state regulations?

Track record:  How long has the community/facility been in business?  How long has the current owner/management team been involved?  What is the experience and reputation of the owner?  The administrator?  Does the person /group own other projects?  If so, what is the reputation of those projects and the management?

Management credentials and stability:  What are the credentials and experience of key management staff?  Is the administrator, the person handling day to day operations, at the facility every day, or does the administrator come in only periodically?  What is his/her reputation?  How long has the administrator worked at this location?  How many administrators have there been in the past five years?  How many staff members have been there more than two years?  The turnover ratio?

Community reputation:   What is the local reputation of the community or facility?  Are there many ‘accidents’ in which residents or patients are injured?  hospitalized?  Have any complaints been lodged by residents or their families with the local or state Consumer Affairs Bureau, the state elder Ombudsman Office, or the state licensing authority?

Visual inspection:  Are the premises, inside and out, neat and clean?   Well maintained?  Are floors and carpeting clean, with no musty odors?  Are the halls and common area rooms free of urine and disinfective odors?

Is the decor light, warm and welcoming?  Is the lobby and common area furniture clean and comfortable to sit in?  Is the lighting sufficient for older people?

Are bathrooms clean and free of odors?  Are there bugs or cockroaches (open drawers and closets)?

Is the kitchen clean, and are food preparation activities orderly?  Are employees in the kitchen and elsewhere neat and clean?  Be sure to visit.

Are residents/patients neat and clean, with clothes and hair properly taken care of?  Is there a beauty parlor and barbershop on the premises?

Features:  Is security mechanical?  Staffed?  What medical help is available on the premises?  On 24-hour call?  What professional medical and complementary services, such as therapies, are available?  What recreation and social activities are on the premises?  Nearby?  Are residents/patients participating in activities when you visit?

Are rooms individually controlled for heat and air conditioning?  Can residents have their own telephone?  Computer?  Is cable TV hookup available in the rooms?

Do the outside grounds provide safe and secure sitting areas so that residents can go outside at will?  Is there shade?

Management/staff/resident/family interaction:  Do staff members walk around smiling?  Or frowning?  How do they talk to residents?  To family members?  How do they react to and answer questions?  Do they help resolve problems -- or create them?  How do they handle both simple and complex requests?

Comfort Level:  Comfort level is two fold:  that of the person who is going to live in the community or facility, and that of the family, especially when assisted or total care of the resident is needed.

Do you feel at home?  Will you or your family feel comfortable walking into the facility?  Will you feel secure knowing quality care is at hand?  Are the people (both staff and residents) friendly?  Are members of the family of residents friendly or do they walk around looking unhappy?

How much freedom does the resident/patient and his/her family have in coming and going?  Can the resident leave the facility at will with proper attendance?  Are visiting hours narrowly limited or are they every day throughout the day and early evening?

Costs:  If there is a lump sum entrance fee (illegal for skilled nursing homes), what is the refund policy?  Is there any residual to heirs after the resident dies? (Applicable in CCRCs).  What services and amenities does this lump sum payment cover?  What are the extras, and about how much should these be each month?

And with multi-level care facilities, if the resident starts out in one level of care and then needs more care, what is the charge for the next level of care?

What is the track record of the community or facility in relation to increases in monthly charges?  Has the cost over the past several years been stable or have there been substantial increases?

REMEMBER:  Ask a lot of questions and feel comfortable with the answers.  If you’re not comfortable with the answers or the way you have been treated, try another place.

This material is copyrighted by Carol Abaya Associates and cannot be reproduced in any manner, print, or electronically.