When is it Time to Move Mom or Dad to Assisted Living or Skilled Nursing Care?

“Old age is no place for sissies.” – Bette Davis

We all knew it was time. Dad kept falling and he didn’t understand why. His knees would just give out, he said. The EMTs had to be called numerous times. They knew William by name.

William was relatively lucid. He would read the paper, watch the baseball game, enjoy breakfast at the table. But he was no longer able to fully care for himself and do the things he once enjoyed. He couldn’t manage the stairs any longer that led to the den he loved so much.

Often times he was short of breath. Regular visits to the doctor showed he was on the cusp of being in the danger zone. His oxygen level was hovering at about 88. It should have been in the high 90s. The day came when he didn’t have the energy to get out of bed. Again the EMTs came. They transported him to the hospital, and after a two-day stay he came home with his very own portable oxygen tank. This did not please him. Instead of it offering him freedom, it tethered him.

His zest for life had passed. Once the traveler, he now seldom left his house. His trips to the local library had ceased. He needed help showering and washing his hair. A VNA came twice a week, a home aide once a week, a physical therapist once a week. He needed help with his toenails and fingernails. He couldn’t put on his own socks. Often he bumped his fragile skin against something, the doorframe or a counter, and his thin skin would split and bleed. He was covered in bruises and bandages. He napped several times a day.

Our visits were wonderful. We talked politics, and baseball, and how the kids were progressing in their studies. He was sharp. It was his body that was letting him down. This deflated him, this man who had held himself in high regard as one of the community leaders. He seemed all at once surprised and disappointed in his body. It didn’t align with his brain.

“The great secret that all old people share is that you really haven’t changed in 70 or 80 years. Your body changes, but you don’t change at all.” – Doris Lessing

Although ambulatory with the aid of his walker, his fear of falling kept him homebound. Melissa, his second wife, was still with him cooking meals and caring for him as best she could, but she was aging too, and she had memory issues that kept her from being able to properly relay information to family and caregivers. She was unable to leave him alone, so that left her housebound too. She missed outings with her friends.

“Staying home can be lonely and isolating,” says a nurse at St. Teresa’s Rehabilitation and Nursing Center. “It’s important to keep socialization ongoing.”

First Steps

William’s family saw that the time had come for assisted living, but knew the conversation would not be an easy one. Dad loved his home, the familiarity of it, the comfort it brought to him.

His children worried that a change of housing, a change of routine would be too much for him. But his hospital stays were increasing in regularity, and recently he spent six weeks in a rehabilitation facility after a hospital stay to increase his strength and mobility. It was starting to seem like he spent more time at the hospital and less time at home.

“The time had come, and we all knew it, but no one wanted to be the one to tell him,” Kathy stated. “He was our father after all, the man who told us what to do all of our lives. How would he take this coming from us?”

The children came together and agreed everyone would come home and have “The Talk”.

“The very first thing we did was to determine what was important. We knew we wanted a quality home that offered great care and didn’t feel like an institution. We wanted a library for dad, light music and nice furnishings. We knew we had to have a careful plan. We did our research. We made phone calls to facilities. We received information. Calculated costs. I went to each assisted living facility in advance of our meeting to see if it was the right fit for our father and Melissa.”

The research paid off. Kathy was able to locate a wonderful assisted living home that offered a warm welcoming environment that offered ample space with a living room and small kitchen. They could take meals in the dining hall if they chose to, or cook at home. The facility had all the services William needed, right on site. Best of all, there was a library, computer lab, art center, solarium, barber/beauty salon and a host of activities daily. The grounds were well maintained and blossomed with beautiful flowers in the spring and summer.

The Talk

Kathy and her sisters couldn’t have found a better place. But the conversation was still ahead.

Dad was surprised when we all showed up together. For a minute he thought it was his birthday. After hellos, and catching up and small talk I opened up the conversation.

It started like this: “Dad, there is something we need to talk about. We need to talk about your future, your safety.”

Difficult conversations are never pleasant. And at first he resisted. He said he didn’t need it – didn’t want it. I showed him the brochure and played the video for him on his laptop. I saw a small glimmer in his eye when he saw the grounds. The facility was very pretty.

I explained how it had an emergency button in every room. And help just steps away. No more lying on the floor waiting for help to come. No more worrying. And I reminded him how much easier life would be not only for him, but for Melissa too. She would be moving in with him.

He was quiet for a long time. A very long time. I fought the urge to say anything more. Finally I said, “Just think about it. You don’t have to decide today.”

I saw his face relax. We ate a little lunch, then I trimmed and filed his nails for him. He was ready for his afternoon nap.

“I can’t believe you all are here,” he said. “You must really love me. But I’m not sure if I’m leaving my house.”

We all agreed that it was up to him and Melissa to decide what was best, but that we wanted them to be safe and well cared for. It was a balance of joy and sorrow when we left him with the brochures to review with Melissa on their own time.

Four weeks later we moved Dad and Melissa into their new apartment. It was a nice space, sunny, with a living room and a small kitchen and dining area. He settled into his chair, the one brought from his home that he always read the paper in. His walker was next to him, his oxygen tank at his side. We brought a bird feeder and hung it from the tree just outside the window. We filled the fridge with fresh food.

For the first time in months, Melissa looked relaxed. She had been his caretaker for so long. Now she could relinquish that role and they could enjoy their time together.

It was the beginning of a new chapter for them both, one that allowed them to age gracefully with dignity and respect.

Tips Before the Talk

• Set up conference calls with family to share ideas, thoughts, and updates
• Have a checklist so all can stay on task
• Try to check your emotions, focus on the quality of life for your parent(s)
• Begin the conversation gently
• Leave brochures/videos behind for review
• Acknowledge the elder’s feelings and be sensitive as to how difficult it is
• Have resources ready
• Engage them in planning
• Take a tour of the facility together

Things to look for in a quality assisted living or skilled nursing care facility:

• Is the staff conversational with the residents?
• Does it seem natural or staged?
• How do the residents look? Are they happy?
• Is it a comfortable environment?
• Is it clean? Are there odors?
• Are residents receiving care?
• Does it offer activities and resources that bring pleasure to your loved one?
• Are appropriate safety features in place in every room? (Grab bars in the bath, emergency buttons, etc.)

Remember that you don’t have to be right. You don’t have to win the conversation. You don’t have to force. You only need to bring forth the information showing that you care and love your family member and want what’s best for them. These are difficult conversations, conversations that strengthen families and show your are there through all challenges. These conversations allow for so much beauty. Growth. Dignity. Respect. Unconditional Love. Let it grow in you. Let us honor our loved ones and keep in mind their will, their spirit, their youthful heart. We can offer pathways, but who chooses to walk on it is solely independent.

“To keep the heart unwrinkled, to be hopeful, kindly, cheerful, reverent – that is to triumph over old age.” – Thomas Bailey Aldrich

Suggested Books:

• Checklist Manifesto by Atul Gawande
• Being Mortal by Atul Gawande