How to know it's the right time to move someone to assisted living

by Stephanie Kanowitz

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Monday, June 3, 2019 12:00 pm EDT


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My mom wanted nothing more than to live out her days in the home she had owned for almost 40 years. But dementia and her failing body didn’t let that happen. After a bilateral pulmonary embolism and a series of small strokes in July 2016 left her unable to walk or care for herself, I had no choice but to move her from her beloved townhome in Florida to an assisted living community a mile from my home in Northern Virginia.

Despite the absolute necessity, I felt guilty about moving her. And the severe emotional trauma she experienced during her transition to her new home did little to assuage that guilt. She spent many days and nights literally screaming for help, disrupting other residents and leaving employees at a loss for how to calm her. The director suggested she move into the memory care unit, which has a higher* staff-to-resident ratio (*this has been edited to reflect the author's intent). Three years later, my mom still screams at night but she is far more content during the day. The situation still breaks my heart, but it also reinforces that I made the right decision.

To get a broader understanding about how others might approach this decision and how to handle the emotions that go along with such a difficult decision, I interviewed Rita Altman, senior vice president of memory care and program services at McLean, Va.-based Sunrise Senior Living, which operates my mother’s community. Our email interview has been lightly edited for clarity and length.

MemoryWell: How do you know when a loved one may need to move to a senior living community for assisted living or memory care?

Altman: Every family dynamic is different and the decision to move into a senior living community is a highly personal one. The first step is really just to observe and keep an eye out for changes in a loved one’s personality or habits. For instance, a senior may consider assisted living if they need help with everyday activities like showering or bathing, keeping their house and yard maintained, or if they can no longer drive. For those who are showing signs of memory loss, family members may notice that bills are going unpaid or that their loved one is skipping meals, having personality changes or increasingly isolating themselves from others. A physician’s visit is advised to rule out a medical condition and screen for dementia. A move to assisted living is often made because of physical limitations, whereas a move to memory care is often made due to cognitive concerns.

MemoryWell: What should you look for in a community?

Altman: Not all communities are created equal. So, do your homework. Talk to friends and family. Take tours. Ask questions and listen carefully to the language that is used by the staff. For instance, many families make the decision to move their loved one into a “secured” memory care area when they become very forgetful or begin to unsafely leave their home. When you hear phrases like “locked unit,” it may be an indication that creating a homelike environment is not valued.

MemoryWell: What are your tips for preparing someone to move to a facility?

Altman: First and foremost, you can ease the transition by involving your loved one in the decision-making process. Keeping them in the dark takes away their voice and sense of control. Invite them to tour the community with you so that they can give you their feedback. Encourage them to have a meal there or join in an activity before they move in. They might even meet some potential friends, which can make the move and new environment feel more comfortable and familiar.

Validate their feelings about the move. Our natural instinct may be to tell them how wonderful and positive everything is going to be, and jump to reassurance when they express fear or nervousness. But it’s best to let them openly express their feelings so they feel respected and heard. And remember to be honest about where or why they are moving. For instance, don’t tell your loved one something like, “You’re staying here while we make repairs to your home.”

MemoryWell: How can loved ones prepare themselves for a move and relieve that inevitable guilt?

Altman: Even if you’re confident that moving your parent into assisted living or memory care will allow them to live their best life, it’s normal to feel guilty or like you let them down in some way. In reality, this is one of the most loving and respectful choices you can make.

When doubt and guilt creep in, force yourself to do something positive and productive. Do what usually helps you to cope when you are upset. Perhaps it is taking a walk, listening to music, or talking to a close friend. Replace guilt and fear with something positive, like participation in an online caregiver support group. The Family Caregiver Alliance’s website is a good place to find an online support group.  You can also consider getting involved in your loved one’s community. Think about what interests and talents you have and volunteer to share them with residents.

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