Help someone deal with emotions over moving

The decision to move — whether to an independent living community, assisted living community, or nursing home — is only the beginning of what can be a long and challenging journey. Helping someone through this important transition takes research and planning. Here’s a 10-step guide to smoothing her way to her new home and the next phase of her life.

1. Talk to her — and don’t forget to listen.

Even though moving will often improve her quality of life, it’s also likely to stir up all kinds of emotions, and even trigger what Nan Hayes, founder of Moveseniors.com, calls “transition trauma.” Many older adults are filled with anxiety about what a move will mean. They may see moving as a sign of defeat and a harbinger of increasing loss of control and independence.

The listening part should come first — find out as much as you can about her health, needs, fears, and hopes, so you can help her make the best choice possible.

After that, it’s your turn to talk. Help her understand that moving can be “just as freeing as going away to college,” Hayes says. The range of options has broadened tremendously since her parents’ day, and as the human lifespan gets longer and longer, a late-in-life move has come to be a rite of passage just as natural as buying a starter home. If you can help her see a move as a positive transition rather than a defeat, you’ll be off to a good start.

2. To reduce stress, hold off on selling the house if possible.

Moving is hard enough without asking her to live in a home that a realtor is showing to prospective buyers. If she has the assets to finance a move in the short run — or if you can lend her the deposit or entrance fee — move first, sell later is the way to go. If she’s moving to a community where she has to buy an apartment or condominium, a mortgage broker may be able to help her get a “bridge loan” to cover the down payment until she sells her home.

3. Plan on giving her extra support after the move.

A move may be the best thing for her, but it’s also going to be exhausting for her, physically and emotionally. A good assisted living community will offer plenty of support during the transition, but if you’re able to make time for extra visits in the days or weeks after the move, it will help reassure her that the most important things in her life — like family and friends — aren’t going to change.

4. Consider bringing in the pros.

A professional Geriatric Care Manager can assess the level of care an older adult needs, find senior communities in your area, navigate the application process, and prepare for a move. These services can be especially useful if you don’t live in the same state as the person who’s moving and can’t be there to manage the day-to-day aspects of her transition.

5. Help get her finances in order.

This is crucial in order to know what kind of care she can afford and how she plans to pay for it. Also, many continuing care retirement communities and other facilities will ask for thorough documentation of her income and assets in order to be sure she’ll be able to pay for her care over the long haul.

If she doesn’t have an accountant who can help you pull the paperwork together, the Society of Certified Senior Advisors can refer you to a financial planner who specializes in assisting older clients.

6. Get her home appraised.

If she’s planning to sell her home to finance a move, today’s topsy-turvy housing market makes a professional appraisal a must before assessing her financial position.

7. Talk to a doctor.

Deciding what kind of community is best for her is a medical decision as well as a personal one. Her family physician may be able to evaluate her and make a recommendation. If not, ask for a referral to a geriatrician who can do a full evaluation, or go to the American Medical Association’s Doctor Finder and search under “geriatrics” in your area.

8. Shop around.

In most areas of the country, there’s a wide range of options when it comes to eldercare communities. A good place to start is Caring.com’s local services directory, where you can search for nursing homes, continuing care communities, and assisted living facilities in your area. Your local Area Agency on Aging should be able to steer you to local communities. Your local Chamber of Commerce might also be able to help. Once you’ve narrowed down the list, tour several places — with the person in your care — and make sure to take time to talk to residents, eat a meal, and really get the feel of the place before making a decision.

9. Read the fine print.

Yes, those long contracts can be overwhelming, but don’t give in to the temptation to skim documents before signing (or asking her to do so). The contracts and agreements that come with moving into any kind of community may well spell out the parameters of the care she will — or won’t — receive for the rest of her life, so make sure you, and she, understand exactly what you’re agreeing to before putting pen to paper.

If you spot something worrisome or have questions the facility can’t answer to your satisfaction, the National Academy of Elder Law Attorneys can refer you to a lawyer who can go over the paperwork with you.

10. Plan the move logistics carefully.

Downsize and deal with belongings now to avoid moving day chaos. An estate liquidator can often help you with selling what she won’t need, and a senior move manager can help with all the logistics. Bring in a senior move manager who specializes in transition and relocation of older adults.

When making the decision to relocate your parents to an assisted living home, there are various factors to consider, how far away is it from where you live, what are the costs, what are the services offered, what is the environment like, do you and your parents like it or feel comfortable there and many more. There is also the challenge of convincing your parents that this is the best option for them and helping them cope with the stress and misgivings that accompany such a huge life change. This is why assisted living ratings play an important part in helping you choose the right facility for your loved ones to move into.

It is wise to keep in mind that this is not a short-term option; you cannot keep relocating your parents if they do not like the place, or if the services are poor. It is best to do the maximum amount of research before you actually decide on a facility rather than making a hasty decision and having to undo it later.

Assisted Living Ratings can help you make the right decision. For example, the Gannett News Service found that the worst assisted living nursing homes were concentrated in 12 states, and 83% of the violations occurred not in state or government funded homes but in for-profit homes across the country. So it is wise when making a choice to factor in this information as well.

One of the best ways to compare homes in your area is to look at their ratings on the Federal Governments Nursing Home Comparison website. This site allows you to find all the nursing homes within your state or zip code and then compare and view information about each of them.

These ratings evaluate assisted living facilities based on whether they are Medicare or Medicaid certified, the appearance of the residents, the living spaces offered, the staff behavior and background, the condition of the living space of the residents, public area hygiene, menu and quality of food offered, activities offered, and facilities for safety and care. It also takes into account any violations filed against the facility and feedback from residents and their family members.

A good checklist to follow when selecting an assisted living nursing home is:

• Use a checklist like the one above to evaluate the facility
• Keep in mind that state and government funded facilities may actually be better
• Do a Google search to see if the facility has any serious violations against it
• See if information about the facility is listed on any government websites which will provide you with a reliable and accurate rating
• Talk to people in the area and see if anyone has family members living in the centre, what they say about the facilities can also be important.

While it is true that assisted living ratings may not give you the entire picture about a facility and the services it offers, they will however provide you with a more clear and unbiased picture on which to base your decision.

Benjamin Franklin said it best – “nothing in life is certain except death and taxes” but with daily advancements in science, technology and health care, Americans are living longer than ever before*. This blessing however, has created a unique dilemma for modern American families: How to plan for and prepare for one’s retirement years.

Have you taken a road-trip lately? Almost every highway is graced with large bill-boards providing the locations of new planned communities where couples can spend their retirement years dedicated to recreational pursuits. I doubt you will find a local newspaper that doesn’t have at least one ad promoting the amenities found at a local assisted living facility. Try to search for “nursing homes in Virginia” on the Internet and thousands of web pages will appear. Each and every day new facilities offering different programs are being built and marketed across the state.

Is such a facility right for you and your family? If so, which facility? We often hear the terms “retirement community,” “nursing home,” and “assisted living facility” but rarely consider what these terms actually mean. The differences however, are striking and it is imperative to understand these differences when making choices for yourself or your loved ones.

NURSING HOMES

In Virginia, a nursing home means any facility with the primary function of providing long-term nursing care, nursing services and health-related services on a continuing basis, for the treatment and inpatient care of two or more non-related individuals**. Put simply, a nursing home is a facility designed for someone who needs less care than a hospital, but requires daily health care assistance.

The Virginia Department of Health licenses such facilities and has established guidelines regulating various aspects of their operations, programs, and staffing needs, etc***. For example, a nursing home must: (a) have written policies and procedures regarding the treatment of residents and the management of resident care which are available to residents and their families (12VAC5-360-20); (b) provide emergency medical services within 15 minutes, under normal conditions (12VAC5-360-50); (c) be subject to unannounced on-site inspections of the nursing facility by State employees (12VAC5-371-60); (d) have a written agreement with one or more physicians licensed by the Virginia Board of Medicine to serve as medical director (12VAC5-371-230); and (e) each resident shall be under the care of a physician licensed by the Virginia Board of Medicine (12VAC5-371-240).

In addition, residents of nursing homes are also given certain rights as defined by Virginia Code §32.1-138. See http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+32.1-138. Nursing homes are the most regulated and structured residential options for our Seniors requiring some level of daily health care. If the facility provides care through Medicare and Medicaid programs, it is deemed a “Certified nursing facility” (Virginia Code §32.1-123; Virginia Code §32.1-127) and must be in compliance with both federal and state laws.

Of course, the more rules and regulations that define and control the daily operations of a nursing home, the greater the responsibility of the staff. These are the people who will be charged with the daily task of caring for your loved one, and making sure they are in compliance with state and federal laws. No matter how nice and or attractive the facility might be, the staff will make the difference between your loved one being cared for and encouraged, or not.

A nursing home is best suited for someone:

Who requires daily health care – such as assistance getting in and out of bed; taking medicine; or using the restroom.

Who may have dementia or Alzheimer’s and as a result, is unable to eat and or bathe daily without reminder or assistance;

Who is recovering from a fall or accident and is therefore unable to walk, dress and or eat without assistance

ASSISTED LIVING FACILITY

“Assisted living facility” means an adult care residence which has been licensed by the Virginia Department of Social Services to provide a level of service for adults who may have physical or mental impairments and require at least moderate assistance with the activities of daily living. Within assisted living, there are two types: regular assisted living for those seniors (typically) who need assistance with one or more daily activity; and intensive assisted living for someone who may be incapable of performing activities due to mental and/or severe physical impairment (12VAC30-120-450).

The Virginia Department of Social Services licenses assisted living facilities but does not regulate in the way the Department of Health regulates nursing homes. While there are Virginia guidelines regulating aspects of assisted living facilities, they are limited: An assisted living facility must: (a) provide or coordinate personal and health care services; and (b) provide 24-hour supervision.

As reflected in the table below, assisted living facilities have no obligation to provide health care and/or have health care staff available to assist your loved one. In addition, with no obligation to provide such services, there is the question as to whether or not they owe a duty to warn or treat residents with illnesses or diseases that could be transmitted from other residents.

While a nursing home will have many nurses on staff and doctors hired to monitor the residents, assisted living is more analogous to an apartment building or college dorm where laundry and food services are provided and residents are on their own for the rest of the day.

An assisted living Facility is best suited for someone:

Who is basically independent but may not be able or willing to prepare their own food or drive to doctors’ appointments;

Someone who wants to scale back and anticipates needing assistance with laundry, cooking, etc. in the near future.

A couple where one spouse is independent but may need assistance in feeding and or providing for needs of other spouse.

CONTINUING CARE RETIREMENT COMMUNITY

In Virginia you may also see advertisements for a retirement community. They are popping up all around our favorite College Towns and Tourist destinations.

A Continuing Care Retirement Community provides care depending on your current needs. Like an insurance policy, the resident pays an entrance fee and periodic adjustable payments, which in turn gives the resident a package of residential and healthcare services that the CCRC is obligated to provide at the time these residential and health care services are required. For example, if upon entering, all you want is help with your meals, that is the only service which will be provided. If you require intensive physical therapy or God forbid, daily assistance for a Dementia patient, the CCRC has assisted living services or nursing home services available under your contract. Continuing care contracts are regulated by the Virginia Bureau of Insurance of the Virginia State Corporation Commission.

Many CCRCs can have nursing home services available either on-site, or at licensed facilities off-site (12VAC5-360-10). While you may be entering the Retirement Community as a very healthy independent and capable resident, as your needs change, so will your contract with the Community and in turn, the facility’s obligations to you.

A Continuing Care Retirement Community Facility is best suited for someone:

Who is basically independent but anticipates the need for daily health care for themselves or a spouse in the near future;

Someone who is physically disabled and would be unable to care for themselves or a spouse if the disability grew worse.

With at least three very different choices, it is very important to do your research:

To research assisted living facilities in Virginia, go to Department of Social Services website: http://www.dss.state.va.us/facility/search/alf.cgi.

To research nursing homes, go to Medicare’s website: www.medicare.gov.

AND LAST BUT NOT LEAST

It is always best to speak to a family member of a current resident and spend time getting to know the staff, no matter what type of facility you are looking into. If looking and researching is not enough, then consider the chart below – a comparison of the legal duties of a nursing home compared to the legal duties of an assisted living facility in Virginia.

DUTY or REQUIREMENT

NURSING HOME

ASSISTED LIVING

Duty to provide nursing care and or monitor resident’s health?

YES

NO

Doctor required to supervise residents?

YES

NO

Each resident shall be under the care of a physician licensed by the Virginia Board of Medicine?

YES

NO

Must have nurses on staff?

YES

NO

Must offer rehabilitative services?

YES

NO

Must have ongoing consultation from a registered dietitian or dietitian on staff?

YES

NO

24 Hour Supervision required?

YES

YES

Must develop a written plan upon admission of resident?

YES

YES

Staff must undergo criminal background check?

YES

YES

Monitored by Virginia Center for Quality Health Care Services and Consumer Protection

YES

NO

Monitored by Department of Social Services

NO

YES

*Life expectancy increased dramatically during the past century, from 47 years for Americans born in 1900 to 77 years for those born in 2001. These same factors—improved medical care and prevention efforts— that are partly responsible for the dramatic increases in life expectancy have also produced a major shift in the leading causes of death in the United States in the past century, from infectious diseases and acute illnesses to chronic diseases and degenerative illnesses.” The State of Aging and Health in America 2004, published by the Center for Disease Control, available at http://www.cdc.gov/aging/pdf/State_of_Aging_and_Health_in_America_2004.pdf.

**See generally, Virginia Code §32.1-123, as amended and Virginia Administrative Code § 12VAC5-360-10.

***It is a Felony under Virginia law to operate a nursing facility without a license. See generally, 12VAC5-371-30.

Selecting the proper medical care facilities may now be a simpler task, courtesy of a wide variety of services that are available now for the elderly. Some of the assisted living facilities available for retired folk may look like a state or a tiny community of their own. You may also have an in-house care should you want to remain in your own house. Below are some axioms on how it’s possible for you to choose the right one.
First, you will need to help your elderly member of the family into going thru an assessment process. This is an important step to help work out what level of healthcare your loved one may need from the home. If your beloved one is still independent and doesn’t have any repeated or pressing mental or physical problems that may require a more close-knitted care service, then you’ll go together with home care. This permits the one you love to stay in their homes while still getting correct assistance. You are also much safer when you choose to sign up with accredited assisted living facilities. Many people focus on location alone for their selection criteria, but the facility should be visited and investigated to make sure they have all the amenities needed. Today in this world of passionate work style, the elderly, who are medically unfit, also have an opportunity to live a high quality life at their home.
Certain care facilities provide community-based activities such as congregate meal programs, financial support programs and home maker services. This can help boost the output of the aged, and encourage them to contribute to society even at their late age. This service plan is based upon the resident’s individual needs and desires. These individual plans are implemented by a staff of qualified and caring nurses, certified nursing assistants, and aides. .

There really comes a time in our lives when we find it difficult to look after ourselves. The change comes in dramatically like when we have just come from a recent illness or just suffered an accident. Whichever is the case, we are forced to stay home and seek the help of other people. It will be good if we have family and friends whom we can depend and who will extend their assistance. If this is not possible, then there are support social services such as the National Health Service or home care facilities that will provide district nurses to come and visit you. Yet others will be forced to stay either in assisted living facilities or in Florida nursing homes, whichever accommodation would satisfy them and be able to meet their needs.

Florida nursing homes, or if you wouldn’t be comfortable with that, could also called be called Florida convalescent homes, care homes, skilled nursing units, or just a rest home. It is a place where people who need care due to physical deficiencies or who could not sustain the activities of daily living will be attended to. While it may be very popular for the elderly and the seniors who have gone past their retirement age, it can also be a facility for younger adults, specifically 18 years or older, who have physical, mental, and emotional disabilities. Proper treatment and care are given them depending on their needs. There will be physical, speech, or occupational therapists who will focus to all their needs.

Among the services provided in Florida nursing homes are the services of registered nurses, nursing aides, and nursing assistants and a couple of therapists–speech, physical, and occupational. There are also recreational assistants and social workers who will likewise provide any kind of assistance that the residents would need. There are 4 nursing assistants for every 10 residents while 7 to 13 registered nurses for every 100 residents. Room and board for the residents are also among the services in Florida nursing homes. That is why in most nursing homes, care is facilitated and provided by certified nursing assistants but is strictly supervised by their skilled professionals.

As opposed to the concept of nursing homes, assisted living facilities are another option for those considering of senior care. It is another type of residence basically for seniors and elderly who can be independent but will need help in managing some of the basic day-to-day activities. Typical assisted living facilities would resemble an apartment community with each resident living in separate units. The staff would be there each day to check on them and help them with some of their personal chores while a licensed nurse would be on a 24-hour duty to respond to emergencies. Most residents in assisted living facilities would include individuals who still maintain an active lifestyle but for the peace of mind of their family members would admit them in assisted living facilities for constant care and assistance if and when needed. Some assisted living facilities would even provide transportation for their residents when they would go on a medical appointment or when they need to go out for a scheduled outing.

“Are you dedicated, driven, committed, and professional? Do you want to make a difference by caring for others and working with people from all backgrounds and socio-economic levels?”

Yes, this could be an ad aimed at recruiting knowledgeable senior caregivers for openings at an assisted living facility. And, in fact, the many qualified care providers on the staff of a facility work together to make sure each day’s routine runs smoothly. Of course, in order to ensure the highest level of quality and care for your loved one, verifying the facility’s credentials and the staff’s training and on-the-job experience are vital.

Essentially, an assisted living facility provides care for individuals who can no longer live independently but do not necessarily need round-the-clock care. More importantly, however, you must remember that an assisted living facility is not a nursing home nor can it provide the kind of medical care your loved one may require. And while there are many safeguards in place, there are many more caregiving roles at the facility that are not required by law to be provided.

But how do you know what to expect from each caregiver? First and foremost, inquire about the hiring requirements of the senior caregivers – what are their daily tasks? What sort of training have they received? Remember you can never be too careful or too inquisitive, so before your tour, prepare yourself with a look into the care provider structure of an assisted living facility.

RNs/LPNs – Even with an extended staff of experts and senior caregivers on hand, an assisted living facility is not required by law to have registered nurses and licensed practical nurses on staff or even on call.

Nurses are often required to assess the health care needs of residents in coordination with the administrator and the resident’s physician, serving as a sort of liaison between the two parties. They are responsible for developing a comprehensive plan or outline of care for each resident (if necessary) and carry out these tasks on a daily basis. In addition, they train new hires that have an active part in the resident’s health plan.

As RNs and LPNs are licensed medical caregivers, only they can administer and/or distribute medication to residents. While many facilities do have RNs on call, it makes administration and/or distribution of medication to residents harder as they are the only ones able to perform these tasks. If your loved one requires round-the-clock care and supervision from senior caregivers, a skilled nursing facility may be a more practical option.

CNAs/General Caregivers – Certified nursing assistants and general caregivers are hired to bathe, dress, feed, and tend to residents on a daily basis. While CNAs have extensive training, hands-on experience, and a considerable subject knowledge base, general senior caregivers often receive on-the-job training, learning as they go, so to speak.

In addition, some facilities require specialization in key areas such as dementia and Alzheimer’s disease. CNAs and general senior caregivers are the primary point people that interact with residents every day and often provide them with much-needed social and emotional support.

Administrator/Director of Marketing and Sales – Initially, you’ll speak with the administrator and/or the director of marketing and sales, who will guide you through the entire process, conduct a tour of the facility, and answer all of your questions regarding the senior caregivers and staff. The administrator oversees all operations within an assisted living facility, keeping track of the staff, and monitoring residents’ needs and well-being. He or she is responsible for the training of all licensed and unlicensed staff and senior caregivers on the premises.

The director of marketing and sales, on the other hand, promotes the assisted living facility, ensuring the proper advertising messages are relayed regarding the approach to resident care, amenities, and services. He or she will speak with you to discuss the features and benefits of the facility as well as pricing, on-site senior caregivers, and any other perks.

Activity Coordinator – The duties of the activity coordinator are an important part of your loved one’s daily routine at an assisted living facility. These individuals are called on to provide stimulating, mind-challenging, and invigorating games and therapies that help residents get moving and thinking. The activity coordinator keeps aging minds thinking cognitively and aging bodies moving actively with singing, outdoor adventures, movie nights, shopping trips, and other engaging events and games.

During your tour, observe some of the in-house activities to get a feel for what residents do each day. The activity coordinator at an assisted living facility is also responsible for special programs and social events that occur outside of the scope of daily activities.

Dietician/Chef – The makeup of a senior’s diet is much different, and meals require nutritious elements that aid in recuperation, rejuvenation, and weight maintenance. Though a dietician may not always be on staff, if one is, he or she will be able to offer helpful insights into the necessary requirements of a senior diet, including reduced sodium, increased fiber and calcium, and more protein, all while supervising calorie intake.

Besides proper food handling and sanitation requirements, a head chef at an assisted living facility is often required to have line experience, efficient organization and time management skills, and a basic understanding of preparing food for the senior stomach.

The senior caregivers at an assisted living facility promote interaction and prevent isolation but are not capable of caring for a loved one in poor health. Above all, the most important thing to keep in mind when finding the right place for your loved one is that it offers quality assistance from kind senior caregivers and satisfies the requisites for welfare, health, and happiness.