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makingthe move
makingthe move
TABLE OF CONTENTS
Introduction 1
Is It Time To Move? 2
Dealing With Your Emotions 3
Brothers and Sisters: Where Do They Fit In? 5
It’s Time To Talk To Mom Or Dad 5
A Parent Who Is Slowing Down Physically, Not Mentally 6
A Parent With Cognitive Impairment 7
Time To Relocate 8
After The Move 9
Conclusion 9
How Can We Help? 10
Devon Oaks 11
Jennings Place 12
Glossary 13
Additional Information 15
Web Sites 17
Books 17
Cost Comparison Worksheet 18
Visit Checklist 19
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makingthe move
NTRODUCTION
Aging is a natural part of life, and with advances in medicine
and technology, we are living longer than ever. As a concerned
family member, you may see changes your family member is
experiencing as he or she ages. Watching activity levels decline and memory-
related issues increase can be heart breaking. Finding help can be even more
frustrating when you don’t know where to turn.
You are not alone. Many families feel the stress and anxiety of trying to
help a parent* decide the next step in their lives. You may not know how to
approach the topic of assisted living with your parent, your siblings or other
people involved in the decision-making process.
This booklet is designed to provide insight about the emotions you may
experiencewhenchoosingandwhattoexpectaftermakingthedecisionabout
which assisted living facility best meets your parent’s needs. At the end of
this booklet is a glossary of assisted living terms you may hear as you begin
tolookforafacility,checklistsforcomparingthecostsofstayingathomeversus
moving into an assisted living facility, and a list of resources you can use to
gather for more information about assisted living and the moving process.
We also address some of the emotions you may experience throughout
the searching process. Your parents, siblings and other family members
may have strong, and sometimes opposing, opinions about the choices
available. Addressing these emotions and concerns is crucial to everyone’s
peace of mind.
I
*We realize that sometimes it is not a parent, but an aunt, uncle or grandparent. For the
purposes of this booklet, we use “parent” to refer to the older adult in question.
IS IT TIME TO MOVE?
Physical and Cognitive Changes
Moving is a major event at any time in a person’s life. However, with age, it
becomesevenmoredifficulttoadjusttothechangesthataccompanyamove.
How do you know when it’s time to approach the subject of moving into
an assisted living facility? Is it after your parent has a major medical problem
or hospitalization that requires a home health professional? Or, is it when you
notice that he or she can no longer go up or down the stairs at home or do
simple chores such as washing dishes?
Decreased activity level is the most obvious sign that living at home has
becomeaproblemforyourparent.Astheirlevelofphysicalmobilitydecreases,
otherproblemsmayarise.Personalhygienemaybemoredifficulttomaintain,
and the lack of proper nutrition becomes a serious concern. The inability to
cookreducesanolderadult’schoicestopre-packagedfoodsthatarenotlikely
to provide all the nutrients required for a healthy, balanced diet. When your
parent needs more help with daily activities such as bathing, cleaning and
getting around town, it may be time to look at other housing options.
Sometimes the issue is not that your parent has slowed down physically,
but that she is beginning to experience forgetfulness and signs of dementia.
Early signs of memory loss may become increasingly evident. For example,
forgetting to take medication regularly or eat, even when meals are delivered,
may suggest that your parent is no longer capable of living alone.
One option to consider is a personal caregiver—either full-time, or in
combination with family members. This option has many benefits, but once
you find a good reliable caregiver you are still left with the chance that the
caregiver may become ill, miss work or seek other employment. Even more
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makingthe move
stressful is starting the process over again in the event you need to find a new
caregiver. If your family chooses to provide care-giving services, you must
recognizethedramaticinfluenceitmayhaveonyourlivesandyourrelationships.
The next section explores the emotional issues connected to moving
your parent to an assisted living facility. Family dynamics can influence many
of your decisions and the way you approach the subject with your parent.
In the end, this may be one of the toughest things you do, but it can open
up a new world for your parent—one that maximizes his dignity and maintains
his independence.
DEALING WITH YOUR EMOTIONS
You may not be prepared for the emotional impact moving your parent can
have on you. Whether the decision to move your parent is sudden, because
of an illness, or is a decision made over time, you may experience many
emotions, including guilt, anger, stress and anxiety.
Most adult children suffer from guilt because they do not want to move
their parent away from the familiarity of her home. The idea of not being able
to take care of the parent who took care of you is upsetting. Balancing all of
the other responsibilities in your life—children, a career, a spouse—can
leave you feeling overwhelmed by the additional responsibility of caring for
a frail parent. Your parent has done a great deal for you, and you want to
return that love and kindness. Feeling guilty is a very normal response to this
stressful situation.
We don’t pretend to have a solution for the feelings you are experiencing,
but we know that providing an environment where your parent can flourish
with the daily support she needs, with new friends, and social activities that
3
makingthe move
prevent isolation and loneliness might help alleviate some of the worry. We
also understand that older adults often believe that they are a “burden” to
theirchildren.Inneedingtorelyonyoumore,yourparentmaybeexperiencing
as much guilt and discomfort as you.
You may be able to manage your guilt by recognizing you are not alone.
We see many adult children each year who struggle with these decisions.
Taking an interest in your parent’s life as soon as you notice changes in her
physical, mental and emotional health means that you are a responsible and
loving adult child.
As strange as it may seem, anger is another strong emotion that many
adult children experience, especially if their parent’s mental capacity has
diminished and she cannot help make the decision or see the need to move.
Like guilt, anger is a very natural emotion and a common response to this
difficult new reality. At a time in your life when your children are growing up
and are, perhaps, off on their own, it is difficult to cope with the idea that
you may be “becoming a parent” all over again.
Anxiety about choosing the facility that best meets your and your parent’s
needs may begin to surface. Obtaining as much information as possible,
visiting different facilities alone, and with your parent, and asking for help are
crucial to your own health and well being, as well as your parent’s.
Guilt, anger and many other emotions are quite normal, and you should
let yourself “off the hook” for experiencing these feelings. Making informed
choices at this point in your parent’s life is vital. Acknowledging your emotions
will go a long way toward making responsible choices with a clear conscience.
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makingthe move
BROTHERS AND SISTERS: WHERE DO
THEY FIT IN?
It is important to discuss your parent’s situation with your siblings as early as
possible.Youwillallneedtodependoneachotherasyoumakeyourdecision,
and throughout the moving and settling-in process. One good way to divide
the workload for researching housing options is to assign tasks according to
your areas of expertise. For example, if your sister is a financial whiz, let her
focus on gathering your parent’s financial information, while you focus on
visiting the assisted living facilities that make sense for your family.
If possible, you and your siblings should investigate and visit each facility
separately and as a group. Each of you will have different experiences and
collectively will be able to pool your impressions during tours of the facility.
Your candid discussions about the facility, the staff and your opinions will help
you make a choice that works for everyone.
Discussing legal and financial matters are crucial to ensuring your parent
is able to live comfortably in her new home. Arranging your parent’s important
documents,suchasPowersofAttorneyforhealthcareandfinanceisimportant
at this time. Managing these tasks puts you on the road to the toughest job
of all…talking to your parent about moving.
IT’S TIME TO TALK TO MOM OR DAD
Thereisnoeasywaytotalktoyourparentaboutneedingmorehelpormoving
from his home. At the heart of the matter is the fact that your roles have
reversed and you are now taking a parental role for someone who has done
this for you over the years. People of all ages have a difficult time being “told”
whattodo.Imaginehowmuchmoredifficultitmustbetotakeadvice,however
wise, from your children—your babies of just 45 or 50 years ago!
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makingthe move
A Parent Who Is Slowing Down Physically, Not Mentally
Your parent is likely to cling to her home, or car—things she views as symbols
of independence— no matter how logically you explain that her arthritis
makes descending the basement stairs to do laundry dangerous or that she
really can’t see well enough to continue to drive.
Acknowledging these changes can help ease the conversation about
moving to an assisted living. At the same time, you can let her know that
you are concerned as she navigates stairs or drives around the neighborhood.
Pointoutthatatanassistedlivingfacility,shewillhavethebestofbothworlds—
with her own apartment and furniture without the responsibilities of house
maintenance. Talk about the advantages of no longer having to cook and the
opportunity to spend time with other people with similar interests. While she
may not agree with all of your points, chances are she has already thought of
the problems and costs surrounding the continuing use of the car or staying
in the house.
In this case, if your parent is not suffering from a memory-related disorder,
you have an advantage because she can become part of the decision-making
process. She will still have control over many of the decisions, and hearing
and valuing her opinion will make the decision a little easier.
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makingthe move
A Parent With Cognitive Impairment
A parent who has early signs of Alzheimer’s disease or other related dementia
presents an entirely different scenario. In this case, Dad may have no trouble
going up and down the stairs, but cannot remember to take his heart
medication or seems frighteningly more confused and isolated each day. The
decision to move him will likely be made by you and your siblings, but you
may not be able to use logic to convince him about moving. Many adult
children find it useful to ease into such a move with respite care.
Respite care is an option to introduce your parent to life at an assisted
living facility by staying for a short visit – from a weekend to a month. During
this time, he can get to know the staff and engage in the different programs
and amenities offered at the facility. It also gives you a chance to see if the
facility lives up to its reputation and meets your parent’s growing needs.
After he has had a chance to experience life at the facility, discussing the
move should be revisited. It allows your parent the chance to express any
concerns he had during the respite stay. Discussing his concerns with the
assisted living staff also gives you the opportunity to see how well the staff
handlesproblems.Thisprocesscanhelpyoudecideifthesearchforanassisted
living facility is complete or if you need to keep looking.
Sometimes adult children have an even tougher issue to face: coping with
one parent who has Alzheimer’s disease and one who does not. Finding a
facility that will meet your father’s Alzheimer’s needs and allow your mother
to stay with him can be difficult. You and your family members should visit
the facility as a group and individually to ask questions and get a general
feel of the facility and its staff to see if it meets both your parents’ needs. Taking
your parents to visit can be especially helpful as they will be able to see first
hand if the facility is a good fit for them.
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makingthe move
TIME TO RELOCATE
Once you, your siblings, and your parent decide on an assisted living facility,
it is time to prepare for the move.
Because Medicare and Medicaid do not currently cover assisted living
services, most facilities require financial and medical information and a fee
to reserve your parent’s apartment. Having your parent’s bank statements,
tax returns, powers of attorney, advance directives and other legal documents
in place is essential. This is also the time to talk with your parent’s primary care
physicianregardinganymedicalissuesyourparentisexperiencing.Discussing
your parent’s move with her primary physician provides an opportunity to
facilitate care between the physician and the assisted living facility’s staff.
Lookingatwhatyourparenthasaccumulatedovertheyearsanddeciding
what will and will not go to her new home is a difficult task. Based on the layout
of your parent’s new residence, you will need to decide what is necessary for
comfort and what will be sold, donated or divided among siblings.
The first step is to talk to your parent and learn what she cannot part
with emotionally. The next step is to actually see what is needed and what
your parent will use. From there, decide what will fit in the new space. Allowing
your parent to participate in making the decision will reassure her that her
treasured items will remain in the family for another generation.
Insomecases,usinganoutsideprofessional,suchasamovingcoordinator,
to decide what is appropriate for your parent’s new home is the best decision.
Lack of emotional attachment allows an outside professional to see the
situation from a different perspective. He or she will not have the same
emotional attachment you or your family members may have and will be
able to determine what will work in the assisted living apartment space. They
may also be able to elicit what is of true emotional value to your parent, and
what can be left behind. Moving coordinators will also be able to locate other
8
makingthe move
professionals who can help with any remaining items in your parent’s home.
The assisted living facility’s marketing coordinator should have a list of names
of such professionals to recommend.
AFTER THE MOVE
Just after the move is likely to be a stressful time for your parent. Visit regularly
to let her know she is still an important part of your life. The transition from
home to assisted living will be easier for your parent when she sees that you
will continue to visit even after she has moved from her home. At this time,
it is best to set up a visiting schedule that you can handle. Knowing she can
expect to see you every Tuesday will help the transition from home to the
assisted living facility a little easier.
Take time to get to know the staff. Working as a team ensures your parent
willreceivethebestpossiblecare.Whenfamilymemberstaketimetoworkwith
staff, changes in health can be communicated effectively. Taking part in some
of the activities at your parent’s new home not only brightens her day, but also
allows you the chance to see how she is adjusting.
CONCLUSION
We hope this booklet has addressed some of your major concerns about
moving your parent to an assisted living facility. The process can be difficult,
especiallywhensiblingsandotherfamilymembersareinvolvedinthedecision-
makingprocess.Livinginanassistedlivingfacilitycanhelpincreaseyourparent’s
quality of life and independence level more than he may have imagined.
Remember, addressing your emotions and talking openly throughout the
processwillhelpmakethedecision-makingeasier,andwill helpyoudealwith
your feelings and can reduce your anxiety.
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makingthe move
HOW CAN WE HELP?
The Eliza Jennings Senior Care Network is the leader in long-term care and
retirement services on Cleveland’s Westside. The organization originated with
the founding of The Eliza Jennings Home in 1888 as a home for women in
need of a secure and peaceful place to live. A century later, Eliza Jennings
Senior Care Network now includes two nursing communities: Eliza Jennings,
located on Cleveland’s Westside and The Health Center at The Renaissance
in Olmsted Township. Our two assisted living communities are Jennings Place,
across from Eliza Jennings in Cleveland, and Devon Oaks in Westlake.
The Eliza Jennings Senior Care Network provides a continuum of care and
services to its residents. If your parent needs higher levels of care, as a resident
oftheElizaJenningsSeniorCareNetwork,shecanreceiveskillednursingcareat
either Eliza Jennings or The Health Center at The Renaissance.
ElizaJenningsvaluestherightofeveryindividualtoattainhisorherhighest
quality of life. In keeping with our mission, we have developed two programs,
SIGNAL© and Magnolia©, each designed to help older adults play an active
part in their health and wellness.
SIGNAL,ourholisticassessmentprogram,workswithyourparent’sprimary
physician to assess common geriatric concerns. Our experienced,
interdisciplinary team performs an assessment at our Wellness Clinic at The
Renaissance. It includes a complete medical history and exam, medication
review and may include a home safety evaluation. The team then meets with
you and your parent to discuss a plan of care, including the most appropriate
living arrangements, to help your parent achieve his maximum independence
level. Your parent’s primary physician will also receive a written copy of the
plan of care.
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makingthe move
Magnolia© is our in-house memory support program designed for
residents with Alzheimer’s disease and other memory-related disorders. The
program promotes wellness through an environment that emphasizes each
resident’s strengths and abilities, while working around weaknesses. The
program offers assistance with activities of daily living, and entertaining and
therapeutic activities by a staff specifically trained in the Magnolia© method.
An individualized plan of care is created for every resident.
We also offer respite care at Jennings Place and Devon Oaks for short-
term stays. Respite care is available overnight or for up to several months. We
provide a comfortable and secure “home-away-from-home” when family
members are out of town or temporarily unable to provide care. More
importantly, each community has a number of people with whom you can
discusstheseconcerns.Belowaredescriptionsofeachandcontactinformation
to discuss the services available at the community.
DEVON OAKS
Devon Oaks is our assisted living community in Westlake where your parent
canreceivetheamountofassistanceheneeds.Ourprogramsareindividualized
to your parent’s needs to help maintain his maximum level of independence.
Apartments can be furnished with items from your parent’s home and
comewithakitchenette.Eachprivatebathisequippedwithasit-downshower.
Devon Oaks has common areas where your parent can meet with other
residents. The Great Room is equipped with a fireplace and library alcove
for reading. We also have covered porches and walking paths.
The Magnolia© program, a special program for individuals with memory
loss, is also a part of Devon Oaks. We develop a personalized plan for your
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makingthe move
parent based on an assessment completed by our Wellness Staff. Staff
members receive your parent’s complete care plan to help them achieve
the highest quality of life.
For more information about Devon Oaks and the services available,
call 440-250-2300.
JENNINGS PLACE
TheatmosphereatJenningsPlace,ourassistedlivingcommunityonCleveland’s
Westside, is smaller and more home-like than many other assisted living
facilities. As a result, we are able to create an intimate atmosphere for your
parent and provide an environment similar to home.
Jennings Place offers a residential environment for individuals with
Alzheimer’s disease, related disorders and other specialized needs. The
community also enhances residents’ lives through the Magnolia© program.
The staff provides individualized services in a comfortable, cozy environment.
Jennings Place has lovely community rooms for your parent to enjoy, including
an inviting living room with a fireplace, a beautifully landscaped, enclosed
courtyard and covered front porch.
At Jennings Place, your parent can still enjoy her independence. Each
apartment is equipped with a kitchenette and the private bath is equipped
with a sit-down shower. Residents furnish their apartments with furniture and
collectiblesfromhome.Providingfurnishingsfromyourparent’shomehelpsher
adjust to life at Jennings Place. Your parent will also enjoy a wide range of social,
culturalandrecreationalactivitiesplannedbytheactivitiesstaffandvolunteers.
For more information about Jennings Place and how we can help your
parent who is living with a memory-related disorder, call 216-228-7100.
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makingthe move
GLOSSARY
Activities of Daily Living (ADL)
A term used to define areas of assistance. ADL’s include bathing, dressing
and feeding.
Assisted Living Facility
A licensed, residential care facility that provides personal care and support
services to older adults who need help with daily activities.
Caregiver
Someone who takes care of another person.
Cognitive Impairment
The loss of intellectual functioning which can include confusion, poor
judgment,failuretorecognizepeople,placesandthings,personalitychanges
and emotional disturbances.
Continuum of Care
A broad range of services that provide care based on an individual’s level
of need, from independent living to skilled nursing services.
Durable Power of Attorney
A legal document permitting an individual to designate another person
to act on his or her behalf.
Durable Power of Attorney for Healthcare
A legal document that allows one person to designate another to make
health care decisions in the event he or she becomes incapacitated.
13
makingthe move
Durable Power of Attorney for Finance
A legal document that allows one person to designate another to make
financial decisions in the event he or she becomes incapacitated.
Living Will
A document which governs the withholding or withdrawal of life-sustaining
treatment from a person in the event that the person has an incurable or
irreversible condition that will cause death in a relatively short time. This
document comes into use when the person is no longer able to make
decisions regarding their medical treatment.
Long-term Care
Any type of support and care a person may need over an extended period
of time.
Medicaid
A joint federal and state program that subsidizes medical costs for some
people with low incomes and limited resources. Medicaid programs vary
from state to state. In Ohio, Medicaid does not cover assisted living care.
Medicare
Federal health insurance program for people 65 years of age or older,
certain younger people with disabilities, and people with End-Stage Renal
Disease (permanent kidney failure with dialysis or a transplant, sometimes
called ESRD).
Respite
Short term, temporary care provided to people with disabilities in order that
their families can take a break from the daily routine of care giving.
14
makingthe move
makingthe move
15
Cleveland Department of Aging
City Hall
601 Lakeside Avenue
Cleveland, Ohio 44114
216-664-2833
Assists older adults with issues such
as home repairs, outreach, and
health issues.
Ohio Department of Aging
50 West Broad Street
9th Floor
Columbus, Ohio 43215-3363
614-466-5500
Cuyahoga County Department
of Senior and Adult Services
1701 East 12th Street
Lower Level
Cleveland, Ohio 44114
216-420-6750
Provides a broad range of services
to improve the quality of life for
older adults.
Western Reserve Area Agency
on Aging
925 Euclid Avenue
Cleveland, Ohio 44115
216-621-8010
Responsible for planning,
coordinating and administering
state and federally funded
programs and services for
older adults.
ADDITIONAL INFORMATION
You are not alone during this process. Listed below are organizations,
books and Web sites that provide information about assisted living options.
Agencies and Programs
makingthe move
16
Cleveland Area
Alzheimer’s Association
12200 Fairhill Road
Cleveland, Ohio 44120
216-721-8457
The Alzheimer’s Association works
to advance research and insure that
people with Alzheimer’s disease
have the information, care, and
support needed to live life as fully as
possible with the disease.
SIGNAL
The Wellness Center at
The Renaissance
26376 John Road
Olmsted Township, Ohio
440-235-2511
Outpatient geriatric assessment
program provided by the Eliza
Jennings Senior Care Network.
State of Ohio Long-Term Care
Ombudsman/Elder Rights
Hotline
1-800-282-1206
Advocates for individuals and
groups of residents providing
information to residents and their
families about the long-term care
system, and works to effect system
changes on a local, state and
national level.
makingthe move
17
WEB SITES
A Place For Mom
www.aplaceformom.com
A free elder-care referral service for
housing options across the nation.
TLChoices
www.tlchoices.com
Matches older adults’ needs with
the best living choices.
Homestore
www.homestore.com
Search engine listing housing
options for seniors throughout the
country.
Assisted Living Federation
of America
www.alfa.org
Organization formed to advance
the assisted living industry and
enhance the quality of life for older
adults.
Carecheck
www.carecheck.com
A company that provides
information and guidance about
senior living choices.
BOOKS
Bathauer, Ruth M.; Parent Care: a
Guide to Help Adult Children
Provide Care and Support for
Their Aging Parents. Venture, CA:
Regal Books, 1990
Greenberg, Vivian E.; Your Best Is
Good Enough: Aging Parents
and Your Emotions. Lexington,
MA: Lexington Books, 1989
Jacobsen, Jamia Jasper; Help! I’m
Parenting My Parents.
Indianapolis, IN: Benchmark Press,
1988
Mancini, Jay A.; Aging Parents
and Adult Children. Lexington,
MA: Lexington Books, 1989
Morse, Sarah and Robbins, Donna
Quinn; Moving Mom and Dad!
Berkeley, CA: Lanier Publishing
International, Ltd., 1998
makingthe move
COST COMPARISON WORKSHEET
Rent/Mortgage
Medical costs
Property insurance
Property taxes
Utilities
Home maintenance
Security system
Gardening
Housecleaning
Food
Entertainment
Household supplies
Transportation
Car payments,
up-keep, insurance
18
Parents’ Monthly Monthly Monthly
Home Costs Costs at: Costs at:
VISITOR CHECKLIST
Facility
Address
Telephone
Contact name and title
Date visited Year built
Lowest Highest Quality
Building rating 1 2 3 4 5 6 7 8 9 1 0
Service rating 1 2 3 4 5 6 7 8 9 1 0
Total rating 1 2 3 4 5 6 7 8 9 1 0
Approximate Costs
Entry fee or deposit Refundable ❏ Yes ❏ No
Monthly rental fee Additional charges
Respite fee
Housing Demographics
Number of apartments/rooms Number of residents
Average age Waiting List? ❏ Yes ❏ No
19
makingthe move
Sponsorship/Reimbursement
❏ For profit ❏ Not-for-profit ❏ SSI Participant ❏ Medicare
Accreditation
Available programs match parent’s interests? ❏ Yes ❏ No
Overall impression of facility: 1 2 3 4 5 6 7 8 9 10
NOTES ON FACILITY:
20
makingthe move
Devon Oaks
2345 Crocker Road | Westlake, OH 44145 | 440-250-2300
www.devonoaks.org
Jennings Place
10426 Detroit Ave. | Cleveland, OH 44102 | 216-228-7100
www.jenningsplace.com

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Hale, Deauna - Sample 1 (Making the Move)

  • 1. a s s i s t e d l i v i n g makingthe move
  • 2. makingthe move TABLE OF CONTENTS Introduction 1 Is It Time To Move? 2 Dealing With Your Emotions 3 Brothers and Sisters: Where Do They Fit In? 5 It’s Time To Talk To Mom Or Dad 5 A Parent Who Is Slowing Down Physically, Not Mentally 6 A Parent With Cognitive Impairment 7 Time To Relocate 8 After The Move 9 Conclusion 9 How Can We Help? 10 Devon Oaks 11 Jennings Place 12 Glossary 13 Additional Information 15 Web Sites 17 Books 17 Cost Comparison Worksheet 18 Visit Checklist 19
  • 3. 1 makingthe move NTRODUCTION Aging is a natural part of life, and with advances in medicine and technology, we are living longer than ever. As a concerned family member, you may see changes your family member is experiencing as he or she ages. Watching activity levels decline and memory- related issues increase can be heart breaking. Finding help can be even more frustrating when you don’t know where to turn. You are not alone. Many families feel the stress and anxiety of trying to help a parent* decide the next step in their lives. You may not know how to approach the topic of assisted living with your parent, your siblings or other people involved in the decision-making process. This booklet is designed to provide insight about the emotions you may experiencewhenchoosingandwhattoexpectaftermakingthedecisionabout which assisted living facility best meets your parent’s needs. At the end of this booklet is a glossary of assisted living terms you may hear as you begin tolookforafacility,checklistsforcomparingthecostsofstayingathomeversus moving into an assisted living facility, and a list of resources you can use to gather for more information about assisted living and the moving process. We also address some of the emotions you may experience throughout the searching process. Your parents, siblings and other family members may have strong, and sometimes opposing, opinions about the choices available. Addressing these emotions and concerns is crucial to everyone’s peace of mind. I *We realize that sometimes it is not a parent, but an aunt, uncle or grandparent. For the purposes of this booklet, we use “parent” to refer to the older adult in question.
  • 4. IS IT TIME TO MOVE? Physical and Cognitive Changes Moving is a major event at any time in a person’s life. However, with age, it becomesevenmoredifficulttoadjusttothechangesthataccompanyamove. How do you know when it’s time to approach the subject of moving into an assisted living facility? Is it after your parent has a major medical problem or hospitalization that requires a home health professional? Or, is it when you notice that he or she can no longer go up or down the stairs at home or do simple chores such as washing dishes? Decreased activity level is the most obvious sign that living at home has becomeaproblemforyourparent.Astheirlevelofphysicalmobilitydecreases, otherproblemsmayarise.Personalhygienemaybemoredifficulttomaintain, and the lack of proper nutrition becomes a serious concern. The inability to cookreducesanolderadult’schoicestopre-packagedfoodsthatarenotlikely to provide all the nutrients required for a healthy, balanced diet. When your parent needs more help with daily activities such as bathing, cleaning and getting around town, it may be time to look at other housing options. Sometimes the issue is not that your parent has slowed down physically, but that she is beginning to experience forgetfulness and signs of dementia. Early signs of memory loss may become increasingly evident. For example, forgetting to take medication regularly or eat, even when meals are delivered, may suggest that your parent is no longer capable of living alone. One option to consider is a personal caregiver—either full-time, or in combination with family members. This option has many benefits, but once you find a good reliable caregiver you are still left with the chance that the caregiver may become ill, miss work or seek other employment. Even more 2 makingthe move
  • 5. stressful is starting the process over again in the event you need to find a new caregiver. If your family chooses to provide care-giving services, you must recognizethedramaticinfluenceitmayhaveonyourlivesandyourrelationships. The next section explores the emotional issues connected to moving your parent to an assisted living facility. Family dynamics can influence many of your decisions and the way you approach the subject with your parent. In the end, this may be one of the toughest things you do, but it can open up a new world for your parent—one that maximizes his dignity and maintains his independence. DEALING WITH YOUR EMOTIONS You may not be prepared for the emotional impact moving your parent can have on you. Whether the decision to move your parent is sudden, because of an illness, or is a decision made over time, you may experience many emotions, including guilt, anger, stress and anxiety. Most adult children suffer from guilt because they do not want to move their parent away from the familiarity of her home. The idea of not being able to take care of the parent who took care of you is upsetting. Balancing all of the other responsibilities in your life—children, a career, a spouse—can leave you feeling overwhelmed by the additional responsibility of caring for a frail parent. Your parent has done a great deal for you, and you want to return that love and kindness. Feeling guilty is a very normal response to this stressful situation. We don’t pretend to have a solution for the feelings you are experiencing, but we know that providing an environment where your parent can flourish with the daily support she needs, with new friends, and social activities that 3 makingthe move
  • 6. prevent isolation and loneliness might help alleviate some of the worry. We also understand that older adults often believe that they are a “burden” to theirchildren.Inneedingtorelyonyoumore,yourparentmaybeexperiencing as much guilt and discomfort as you. You may be able to manage your guilt by recognizing you are not alone. We see many adult children each year who struggle with these decisions. Taking an interest in your parent’s life as soon as you notice changes in her physical, mental and emotional health means that you are a responsible and loving adult child. As strange as it may seem, anger is another strong emotion that many adult children experience, especially if their parent’s mental capacity has diminished and she cannot help make the decision or see the need to move. Like guilt, anger is a very natural emotion and a common response to this difficult new reality. At a time in your life when your children are growing up and are, perhaps, off on their own, it is difficult to cope with the idea that you may be “becoming a parent” all over again. Anxiety about choosing the facility that best meets your and your parent’s needs may begin to surface. Obtaining as much information as possible, visiting different facilities alone, and with your parent, and asking for help are crucial to your own health and well being, as well as your parent’s. Guilt, anger and many other emotions are quite normal, and you should let yourself “off the hook” for experiencing these feelings. Making informed choices at this point in your parent’s life is vital. Acknowledging your emotions will go a long way toward making responsible choices with a clear conscience. 4 makingthe move
  • 7. BROTHERS AND SISTERS: WHERE DO THEY FIT IN? It is important to discuss your parent’s situation with your siblings as early as possible.Youwillallneedtodependoneachotherasyoumakeyourdecision, and throughout the moving and settling-in process. One good way to divide the workload for researching housing options is to assign tasks according to your areas of expertise. For example, if your sister is a financial whiz, let her focus on gathering your parent’s financial information, while you focus on visiting the assisted living facilities that make sense for your family. If possible, you and your siblings should investigate and visit each facility separately and as a group. Each of you will have different experiences and collectively will be able to pool your impressions during tours of the facility. Your candid discussions about the facility, the staff and your opinions will help you make a choice that works for everyone. Discussing legal and financial matters are crucial to ensuring your parent is able to live comfortably in her new home. Arranging your parent’s important documents,suchasPowersofAttorneyforhealthcareandfinanceisimportant at this time. Managing these tasks puts you on the road to the toughest job of all…talking to your parent about moving. IT’S TIME TO TALK TO MOM OR DAD Thereisnoeasywaytotalktoyourparentaboutneedingmorehelpormoving from his home. At the heart of the matter is the fact that your roles have reversed and you are now taking a parental role for someone who has done this for you over the years. People of all ages have a difficult time being “told” whattodo.Imaginehowmuchmoredifficultitmustbetotakeadvice,however wise, from your children—your babies of just 45 or 50 years ago! 5 makingthe move
  • 8. A Parent Who Is Slowing Down Physically, Not Mentally Your parent is likely to cling to her home, or car—things she views as symbols of independence— no matter how logically you explain that her arthritis makes descending the basement stairs to do laundry dangerous or that she really can’t see well enough to continue to drive. Acknowledging these changes can help ease the conversation about moving to an assisted living. At the same time, you can let her know that you are concerned as she navigates stairs or drives around the neighborhood. Pointoutthatatanassistedlivingfacility,shewillhavethebestofbothworlds— with her own apartment and furniture without the responsibilities of house maintenance. Talk about the advantages of no longer having to cook and the opportunity to spend time with other people with similar interests. While she may not agree with all of your points, chances are she has already thought of the problems and costs surrounding the continuing use of the car or staying in the house. In this case, if your parent is not suffering from a memory-related disorder, you have an advantage because she can become part of the decision-making process. She will still have control over many of the decisions, and hearing and valuing her opinion will make the decision a little easier. 6 makingthe move
  • 9. A Parent With Cognitive Impairment A parent who has early signs of Alzheimer’s disease or other related dementia presents an entirely different scenario. In this case, Dad may have no trouble going up and down the stairs, but cannot remember to take his heart medication or seems frighteningly more confused and isolated each day. The decision to move him will likely be made by you and your siblings, but you may not be able to use logic to convince him about moving. Many adult children find it useful to ease into such a move with respite care. Respite care is an option to introduce your parent to life at an assisted living facility by staying for a short visit – from a weekend to a month. During this time, he can get to know the staff and engage in the different programs and amenities offered at the facility. It also gives you a chance to see if the facility lives up to its reputation and meets your parent’s growing needs. After he has had a chance to experience life at the facility, discussing the move should be revisited. It allows your parent the chance to express any concerns he had during the respite stay. Discussing his concerns with the assisted living staff also gives you the opportunity to see how well the staff handlesproblems.Thisprocesscanhelpyoudecideifthesearchforanassisted living facility is complete or if you need to keep looking. Sometimes adult children have an even tougher issue to face: coping with one parent who has Alzheimer’s disease and one who does not. Finding a facility that will meet your father’s Alzheimer’s needs and allow your mother to stay with him can be difficult. You and your family members should visit the facility as a group and individually to ask questions and get a general feel of the facility and its staff to see if it meets both your parents’ needs. Taking your parents to visit can be especially helpful as they will be able to see first hand if the facility is a good fit for them. 7 makingthe move
  • 10. TIME TO RELOCATE Once you, your siblings, and your parent decide on an assisted living facility, it is time to prepare for the move. Because Medicare and Medicaid do not currently cover assisted living services, most facilities require financial and medical information and a fee to reserve your parent’s apartment. Having your parent’s bank statements, tax returns, powers of attorney, advance directives and other legal documents in place is essential. This is also the time to talk with your parent’s primary care physicianregardinganymedicalissuesyourparentisexperiencing.Discussing your parent’s move with her primary physician provides an opportunity to facilitate care between the physician and the assisted living facility’s staff. Lookingatwhatyourparenthasaccumulatedovertheyearsanddeciding what will and will not go to her new home is a difficult task. Based on the layout of your parent’s new residence, you will need to decide what is necessary for comfort and what will be sold, donated or divided among siblings. The first step is to talk to your parent and learn what she cannot part with emotionally. The next step is to actually see what is needed and what your parent will use. From there, decide what will fit in the new space. Allowing your parent to participate in making the decision will reassure her that her treasured items will remain in the family for another generation. Insomecases,usinganoutsideprofessional,suchasamovingcoordinator, to decide what is appropriate for your parent’s new home is the best decision. Lack of emotional attachment allows an outside professional to see the situation from a different perspective. He or she will not have the same emotional attachment you or your family members may have and will be able to determine what will work in the assisted living apartment space. They may also be able to elicit what is of true emotional value to your parent, and what can be left behind. Moving coordinators will also be able to locate other 8 makingthe move
  • 11. professionals who can help with any remaining items in your parent’s home. The assisted living facility’s marketing coordinator should have a list of names of such professionals to recommend. AFTER THE MOVE Just after the move is likely to be a stressful time for your parent. Visit regularly to let her know she is still an important part of your life. The transition from home to assisted living will be easier for your parent when she sees that you will continue to visit even after she has moved from her home. At this time, it is best to set up a visiting schedule that you can handle. Knowing she can expect to see you every Tuesday will help the transition from home to the assisted living facility a little easier. Take time to get to know the staff. Working as a team ensures your parent willreceivethebestpossiblecare.Whenfamilymemberstaketimetoworkwith staff, changes in health can be communicated effectively. Taking part in some of the activities at your parent’s new home not only brightens her day, but also allows you the chance to see how she is adjusting. CONCLUSION We hope this booklet has addressed some of your major concerns about moving your parent to an assisted living facility. The process can be difficult, especiallywhensiblingsandotherfamilymembersareinvolvedinthedecision- makingprocess.Livinginanassistedlivingfacilitycanhelpincreaseyourparent’s quality of life and independence level more than he may have imagined. Remember, addressing your emotions and talking openly throughout the processwillhelpmakethedecision-makingeasier,andwill helpyoudealwith your feelings and can reduce your anxiety. 9 makingthe move
  • 12. HOW CAN WE HELP? The Eliza Jennings Senior Care Network is the leader in long-term care and retirement services on Cleveland’s Westside. The organization originated with the founding of The Eliza Jennings Home in 1888 as a home for women in need of a secure and peaceful place to live. A century later, Eliza Jennings Senior Care Network now includes two nursing communities: Eliza Jennings, located on Cleveland’s Westside and The Health Center at The Renaissance in Olmsted Township. Our two assisted living communities are Jennings Place, across from Eliza Jennings in Cleveland, and Devon Oaks in Westlake. The Eliza Jennings Senior Care Network provides a continuum of care and services to its residents. If your parent needs higher levels of care, as a resident oftheElizaJenningsSeniorCareNetwork,shecanreceiveskillednursingcareat either Eliza Jennings or The Health Center at The Renaissance. ElizaJenningsvaluestherightofeveryindividualtoattainhisorherhighest quality of life. In keeping with our mission, we have developed two programs, SIGNAL© and Magnolia©, each designed to help older adults play an active part in their health and wellness. SIGNAL,ourholisticassessmentprogram,workswithyourparent’sprimary physician to assess common geriatric concerns. Our experienced, interdisciplinary team performs an assessment at our Wellness Clinic at The Renaissance. It includes a complete medical history and exam, medication review and may include a home safety evaluation. The team then meets with you and your parent to discuss a plan of care, including the most appropriate living arrangements, to help your parent achieve his maximum independence level. Your parent’s primary physician will also receive a written copy of the plan of care. 10 makingthe move
  • 13. Magnolia© is our in-house memory support program designed for residents with Alzheimer’s disease and other memory-related disorders. The program promotes wellness through an environment that emphasizes each resident’s strengths and abilities, while working around weaknesses. The program offers assistance with activities of daily living, and entertaining and therapeutic activities by a staff specifically trained in the Magnolia© method. An individualized plan of care is created for every resident. We also offer respite care at Jennings Place and Devon Oaks for short- term stays. Respite care is available overnight or for up to several months. We provide a comfortable and secure “home-away-from-home” when family members are out of town or temporarily unable to provide care. More importantly, each community has a number of people with whom you can discusstheseconcerns.Belowaredescriptionsofeachandcontactinformation to discuss the services available at the community. DEVON OAKS Devon Oaks is our assisted living community in Westlake where your parent canreceivetheamountofassistanceheneeds.Ourprogramsareindividualized to your parent’s needs to help maintain his maximum level of independence. Apartments can be furnished with items from your parent’s home and comewithakitchenette.Eachprivatebathisequippedwithasit-downshower. Devon Oaks has common areas where your parent can meet with other residents. The Great Room is equipped with a fireplace and library alcove for reading. We also have covered porches and walking paths. The Magnolia© program, a special program for individuals with memory loss, is also a part of Devon Oaks. We develop a personalized plan for your 11 makingthe move
  • 14. parent based on an assessment completed by our Wellness Staff. Staff members receive your parent’s complete care plan to help them achieve the highest quality of life. For more information about Devon Oaks and the services available, call 440-250-2300. JENNINGS PLACE TheatmosphereatJenningsPlace,ourassistedlivingcommunityonCleveland’s Westside, is smaller and more home-like than many other assisted living facilities. As a result, we are able to create an intimate atmosphere for your parent and provide an environment similar to home. Jennings Place offers a residential environment for individuals with Alzheimer’s disease, related disorders and other specialized needs. The community also enhances residents’ lives through the Magnolia© program. The staff provides individualized services in a comfortable, cozy environment. Jennings Place has lovely community rooms for your parent to enjoy, including an inviting living room with a fireplace, a beautifully landscaped, enclosed courtyard and covered front porch. At Jennings Place, your parent can still enjoy her independence. Each apartment is equipped with a kitchenette and the private bath is equipped with a sit-down shower. Residents furnish their apartments with furniture and collectiblesfromhome.Providingfurnishingsfromyourparent’shomehelpsher adjust to life at Jennings Place. Your parent will also enjoy a wide range of social, culturalandrecreationalactivitiesplannedbytheactivitiesstaffandvolunteers. For more information about Jennings Place and how we can help your parent who is living with a memory-related disorder, call 216-228-7100. 12 makingthe move
  • 15. GLOSSARY Activities of Daily Living (ADL) A term used to define areas of assistance. ADL’s include bathing, dressing and feeding. Assisted Living Facility A licensed, residential care facility that provides personal care and support services to older adults who need help with daily activities. Caregiver Someone who takes care of another person. Cognitive Impairment The loss of intellectual functioning which can include confusion, poor judgment,failuretorecognizepeople,placesandthings,personalitychanges and emotional disturbances. Continuum of Care A broad range of services that provide care based on an individual’s level of need, from independent living to skilled nursing services. Durable Power of Attorney A legal document permitting an individual to designate another person to act on his or her behalf. Durable Power of Attorney for Healthcare A legal document that allows one person to designate another to make health care decisions in the event he or she becomes incapacitated. 13 makingthe move
  • 16. Durable Power of Attorney for Finance A legal document that allows one person to designate another to make financial decisions in the event he or she becomes incapacitated. Living Will A document which governs the withholding or withdrawal of life-sustaining treatment from a person in the event that the person has an incurable or irreversible condition that will cause death in a relatively short time. This document comes into use when the person is no longer able to make decisions regarding their medical treatment. Long-term Care Any type of support and care a person may need over an extended period of time. Medicaid A joint federal and state program that subsidizes medical costs for some people with low incomes and limited resources. Medicaid programs vary from state to state. In Ohio, Medicaid does not cover assisted living care. Medicare Federal health insurance program for people 65 years of age or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure with dialysis or a transplant, sometimes called ESRD). Respite Short term, temporary care provided to people with disabilities in order that their families can take a break from the daily routine of care giving. 14 makingthe move
  • 17. makingthe move 15 Cleveland Department of Aging City Hall 601 Lakeside Avenue Cleveland, Ohio 44114 216-664-2833 Assists older adults with issues such as home repairs, outreach, and health issues. Ohio Department of Aging 50 West Broad Street 9th Floor Columbus, Ohio 43215-3363 614-466-5500 Cuyahoga County Department of Senior and Adult Services 1701 East 12th Street Lower Level Cleveland, Ohio 44114 216-420-6750 Provides a broad range of services to improve the quality of life for older adults. Western Reserve Area Agency on Aging 925 Euclid Avenue Cleveland, Ohio 44115 216-621-8010 Responsible for planning, coordinating and administering state and federally funded programs and services for older adults. ADDITIONAL INFORMATION You are not alone during this process. Listed below are organizations, books and Web sites that provide information about assisted living options. Agencies and Programs
  • 18. makingthe move 16 Cleveland Area Alzheimer’s Association 12200 Fairhill Road Cleveland, Ohio 44120 216-721-8457 The Alzheimer’s Association works to advance research and insure that people with Alzheimer’s disease have the information, care, and support needed to live life as fully as possible with the disease. SIGNAL The Wellness Center at The Renaissance 26376 John Road Olmsted Township, Ohio 440-235-2511 Outpatient geriatric assessment program provided by the Eliza Jennings Senior Care Network. State of Ohio Long-Term Care Ombudsman/Elder Rights Hotline 1-800-282-1206 Advocates for individuals and groups of residents providing information to residents and their families about the long-term care system, and works to effect system changes on a local, state and national level.
  • 19. makingthe move 17 WEB SITES A Place For Mom www.aplaceformom.com A free elder-care referral service for housing options across the nation. TLChoices www.tlchoices.com Matches older adults’ needs with the best living choices. Homestore www.homestore.com Search engine listing housing options for seniors throughout the country. Assisted Living Federation of America www.alfa.org Organization formed to advance the assisted living industry and enhance the quality of life for older adults. Carecheck www.carecheck.com A company that provides information and guidance about senior living choices. BOOKS Bathauer, Ruth M.; Parent Care: a Guide to Help Adult Children Provide Care and Support for Their Aging Parents. Venture, CA: Regal Books, 1990 Greenberg, Vivian E.; Your Best Is Good Enough: Aging Parents and Your Emotions. Lexington, MA: Lexington Books, 1989 Jacobsen, Jamia Jasper; Help! I’m Parenting My Parents. Indianapolis, IN: Benchmark Press, 1988 Mancini, Jay A.; Aging Parents and Adult Children. Lexington, MA: Lexington Books, 1989 Morse, Sarah and Robbins, Donna Quinn; Moving Mom and Dad! Berkeley, CA: Lanier Publishing International, Ltd., 1998
  • 20. makingthe move COST COMPARISON WORKSHEET Rent/Mortgage Medical costs Property insurance Property taxes Utilities Home maintenance Security system Gardening Housecleaning Food Entertainment Household supplies Transportation Car payments, up-keep, insurance 18 Parents’ Monthly Monthly Monthly Home Costs Costs at: Costs at:
  • 21. VISITOR CHECKLIST Facility Address Telephone Contact name and title Date visited Year built Lowest Highest Quality Building rating 1 2 3 4 5 6 7 8 9 1 0 Service rating 1 2 3 4 5 6 7 8 9 1 0 Total rating 1 2 3 4 5 6 7 8 9 1 0 Approximate Costs Entry fee or deposit Refundable ❏ Yes ❏ No Monthly rental fee Additional charges Respite fee Housing Demographics Number of apartments/rooms Number of residents Average age Waiting List? ❏ Yes ❏ No 19 makingthe move
  • 22. Sponsorship/Reimbursement ❏ For profit ❏ Not-for-profit ❏ SSI Participant ❏ Medicare Accreditation Available programs match parent’s interests? ❏ Yes ❏ No Overall impression of facility: 1 2 3 4 5 6 7 8 9 10 NOTES ON FACILITY: 20 makingthe move
  • 23. Devon Oaks 2345 Crocker Road | Westlake, OH 44145 | 440-250-2300 www.devonoaks.org Jennings Place 10426 Detroit Ave. | Cleveland, OH 44102 | 216-228-7100 www.jenningsplace.com