The following are a number of questions to be used as a working outline in maneuvering through these scenarios. Each requires input and shared conversation with a guide or mentor to monitor and direct the conversations and the powerful emotions they generate. In order to get answers to these question, you (the person seeking housing and/or the person’s advocate) will have to make arrangements for tours and meetings with key people. A trusted professional or seniors’ organization can help you get a list of possible options to choose from. Keep a log of the answers so when decision time comes, you will have some notes to look back on. The questions are not listed in any rank order of importance, but as they come to our mind as we have worked with older adults and families during these potentially troubling and stressful times. As always, take with you what seems most helpful to your unique situation.
Note: These questions are written for the person who will be moving. Sometimes a trusted family member or advocate (someone who knows the older person very well) can assist through this process.
1. Costs and how they will be paid for
Remember that the highest cost establishments may not be the most rewarding one. Many have entrance fees that may or may not be refundable in some degree if you leave or pass on. All require fees for their services. Ask if there are any move-in incentives. What is included in the costs (i.e., meals, housekeeping, recreation, etc.). Do they have a free or low-cost “trial stay” option? In the United States, some may take Medicare. In Canada, some of the facilities may be government subsidized. Get the facts down right. Higher cost is not always an indicator of better service and dedication to you. You may also want facts about the establishment’s financial health to guarantee their viability.
2. Location, location, location
How far is it from your family and friends? How close or far are familiar places such as services, restaurants, theater, clubs, church or synagogue? Are there plans to establish all these in the retirement community once there, or will your time be split? Remember that connection with important people in your life is a definite component of good quality of life.
3. Values and commitment
Ask the management or representative at the establishment about values and commitment to each person. Get this from the people you talk with, not the brochures they send out. While it is good to talk to folks who are available to talk and share their experiences there, they will probably have you speak with the most satisfied members.. Ask for a list of complaints they have received and dealt with. Seek a place that shares your values about what is important in your life and maintaining a high quality of life: continuity here is also important to your quality of life. Ask what procedures are in place to ensure they uphold their commitment to these core values. Ask how these core values are implemented and evaluated. Are they open to improvements? Is there a “Comment Card” system where the residents/tenants can forward their comments and concerns anonymously? Alternatively, what avenues are in place to motivate, celebrate and encourage outstanding service and achievements by staff?
4. Religious affiliation is only part of the equation
Try not to select by religion alone. You may find the system falls far short of meeting your overall needs. While many families share they receive much comfort if the community is of their religion, this does not guarantee a successful placement.
5. Processes in place to ensure a warm welcome and adjustment
What processes are in place to help you or your loved one transition into their system and become part of their “community”? Who is the “go-to” person if there are questions?
6. Supports to help with the adjustment
How will they assist you or your loved one in coping and adapting to their environment? You or your loved one may find it more complicated and anxiety-provoking to move through the process of adjusting there. Who are the staff and what are their qualifications to do this with you or your loved one?
7. Availability of care and counseling after a major life stressor
Many people and families seek out a place following a serious loss to them, such as death of a loved one; illness; financial problems; or diminished ability to provide activities of daily living (ADLs). Attempting to adjust now can strain an individual’s ability to cope and adapt. How will the community provide care and counseling? Does administration view the need for counseling as necessary for enhanced quality of life for some tenants/residents? Is this included in the overall fee? Is it an add-on expense? If counseling is an additional expense (versus an available built-in service), administration does not view this need as a normative cost to them.
8. Counseling and advocacy for relocation concerns
Most people have some degree of ambivalence and uncertainty about such an important move. Who is there to smooth the way and champion their concerns?
9. Counseling for family members
What family counseling services are available to your family? Not all of us have made our amends with our family, dealt with the issues that cause us strife and worry, and resolved any family guilt or anger between members.
10. Regular assessments to assist with adjustment
Are there regularly scheduled assessments of how you or your loved one is coping and adapting? Who are the people and what are their qualifications?
11. Health services. Your health is crucial
How do they incorporate physicians, nursing, and allied health services into their system?
12. Future care needs
What does the facility offer in terms of long-term care needs? Do they adhere to an “aging in place” concept? Meaning, if your health or condition declines, do they continue to support you in their facility, or do you have to move again? Ask them how long you could stay, and what are the reasons you may be asked to leave (“Exit-criteria” or reasons for “eviction”).
We have listed for you 12 areas of concern we feel are important. There are certainly more and some may be equally as important or more important that any on this list. Think for a moment what they might be for you or your loved one. You may be surprised how these questions and concerns bring other ones to the surface. For example, is there a pet involved? Is the pet welcomed?
Reconsidering a Move
What if you began to rethink about your loved one remaining in their home? What services would they need? What services would they accept? Where would the funds come from? Is this just a temporary measure, and if so, would it give everyone time to breathe easier and simply let the person remain in his/her home for a little while longer? Would this be reasonable for a family with many different opinions? Would it be reasonable for an older person who may perceive these service providers as strangers intruding their home further solidifying their sense and awareness of growing frailty and needs?
Seek Professional Consultation
Consider a consultation by a specialist during this challenging time. Seek out someone who has the experience and expertise to guide you and your family with and through this process. Meeting with this person can illuminate a path that you may not have thought of, and provide guidance to see you through.
Many older adults and their families find selecting appropriate seniors’ housing and the accompanying transition somewhat stress-free. Many do not. If your loved one or family is finding this transition difficult, there is help available. There are many fine people in the community to serve you. Start by discussing with your loved one’s mental health professional or doctor. Start by making an appointment.
We wish you and your family well.
This article first appeared on angelaggentile.com.
Written in collaboration with Alan S. Wolkenstein
Clinical Professor of Family Medicine (Ret.)
University of Wisconsin School of Medicine and Public Health
Wolkenstein and Associates, LLC
Mequon, Wisconsin, 53092