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Wednesday, March 2. 2016
Mrs. BD and I have been moving her parents into an "Independent Living Senior Community" over the past month. (Ros Chast calls these places The Place, but I call them Old Folk's Homes.) Their new place is a one-bedroom apartment in a Senior complex in a suburban area less than a half-hour from us. The apartment is small, but they get the run of the place with its dining rooms (with 2 fireplaces), library (with fireplace), theater, patios, gym, meeting rooms, outdoor walking paths, etc. Their apartment has a small kitchen, large fancy bath, and a terrace to outdoors. You get three good meals, weekly cleaning and laundry, 24-hr handiman and 24-hr RN on duty. There are music concerts, movies, and good lectures all the time, religious services, plus of course Bingo and Mah Jong and all that. You can keep your car there, or they will drive you anywhere within 15 miles - included. That's all - no personal help unless you hire it on your own (which some residents do). These places are costly, but not necessarily a lot more costly that the cost of running and maintaining one's own home.
The next step, if needed, is Assisted Living. Assisted Living places often have specialized Dementia sections.
And then there are nursing homes, aka Skilled Nursing Facilities. Nobody ever wants to need those except temporarily to recover from something.
Posted by Bird Dog in The Culture, "Culture," Pop Culture and Recreation at 14:59 | Comments (11) | Trackbacks (0)
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Our experience observing our parents is that assisted living can be quite pleasant, even more enjoyable than home if you can talk them into it. SNF's, nursing homes, are hard to make pleasant, though places do try.
We are so-o-o much more fortunate here in Canada.
Our enlightened legislators are even now in the process of introducing "physician-assisted death" to our medical care. Soon, with the deft application of pharmaceuticals from a caring vet, er, doctor, we'll all be put out of our misery.
To heck with assisted living! So much easier to put down the old farts when they become a costly inconvenience and drain on the health system!
For those facing this kind of situation with parents, it would be worth it to talk to a Geriatric Care Manager in your area. A GCM is an independent practitioners who can help you through the maze of facility selection and government red tape. They also can help with Dr.s visits for a parent in another city and also help in getting a better deal for you and better service from the facilities. My wife had such a practice outside of Boston in the recent past. She is a Nurse Practitioner by training and this was a nice role for her and her clients.
My wife's grandfather was a proud Canadian (very proud, wouldn't stop talking about Canada). Some years back he was diagnosed with a serious heart disease and needed a quadruple bypass. He was 82 at that time. He was not weak or meek or out of shape he looked like he could have plowed the fields in his farm all day everyday. But Canada health care in their wisdom told him although they predicted he had two years to live they would not spend the money from their limited budget that could be spent to save younger people. He had money having recently sold their farm and he knew he could drive five hours over the border to American and have the life saving operation within a week of showing up at the specialists office. But he would not do that (did I mention he was a proud Canadian) and to reinforce that he brought his four adult children together and gave them each a check for their share of his cash assets. I saw this and I saw his lovely wife almost in tears but unwilling to speak. At this time none of hic children knew of his diagnoses and if they had they wouldn't have taken the money and would have argued with him to get the operation. Two years later almost on queue he passed away from a massive heart attack. I saw the family often during this time and he was still the outgoing, happy and proud man he always had been but never again bragged about Canadian health care.
I miss him and his wife who passed away five years after he did.
I saw many extended family in my grandparents generation either choose to stay at home as long as possible, or choose to go into "independent living" when they were still capable and active.
The ones who ditched the responsibility of home ownership early in retirement had fantastic experience of the lifestyle, new friends, and activities. They had smooth segue from independent to assisted to skilled at the end, but generally long lives and short declines at the end.
The ones who stubbornly put it off until they really couldn't cope on their own often ended up confused and unhappy.
I can see either my wife or myself becoming a person who kept putting off moving until it was psychologically impossible, then being miserable and making others miserable my last few years.
If you wait until your spouse dies before you move, then you have to go to an empty place with no memories. If you move earlier to something all-on-one-level that is convenient to something important - stores, church, relatives - you can go a lot longer.
Have watched many situations over time. The best seem to be couples making decisions to "retire" from basic housekeeping and meals, and moving to nice residences - though this costs. Have seen single seniors make the same move, albeit more reluctantly, and often find themselves much healthier and happier because 1) eating three squares a day and 2) more social life. Had a friend whose Mum had to go into a home but who improved so much that was almost ready and able to return to old home. Didn't happen, but such a move can be beneficial.
My own mother moved to be near us after Dad died and her eyesight deteriorated to the point she could no longer live in the home Dad had bought for her almost forty years earlier. Was not easy, but she worked through the pain and sorrow, and had many good years. Unfortunately, as time went on, she retreated into her condo (had a lot of furniture from home and was very comfortable) like a snail in its shell. Years earlier, she had said she hoped she would be smart enough to know when the time had come to move into assisted living of some type. Unfortunately, this did not happen and - after a disastrous several months when carers were supposed to be looking after her but reality was I had to be no more than 15 minutes away at all times - a fall finally landed her in a nursing home. Not the best situation, but I was given no help as to the possibility of better places (and was constrained by sibling insistence on the cheapest possible option), so Mum want to a home near us. We all visited regularly and kept a close eye on how she was being looked after. However, I have regretted that I did not explore more options - and to hell with the expectations of sibling anticipation of the settling of her estate and distribution of same.
My parents never moved out of their home until they died, but at the end had trouble getting to the Farm.
Their biggest problems were shopping, and cooking enough food. They really needed more help in the house, but resisted it. They were competent adults.
Both died of complications of hip replacements after falls, in their late 80s. Of course, that can happen anywhere.
The Old Folks Home you describe, while excellent for the seniors who live there, sounds like what the New Urbanists would force upon Americans of all ages. A small zone of privacy and a large zone of shared space and services.
My observations, fwiw:
1) An independent living senior community is a good but expensive option, if only for medical emergencies and the segue from independent > assisted > dementia units
2) Stay in your home as long as possible, but not longer
3) To do that, you need to precommit
a) you need a 5 year lead time
b) communicate clearly and ahead of time with ALL children
c) talk at age 70, act by 75 (timing obv. depends on health)
d) make a down payment on a waiting list
4) Physical and cognitive breakpoint seems to be around age 85, so that's the very latest you should hold out before entry
5) Life in the senior communities is like re-entering high school, what with social cliques, etc.
6) Initially, claustrophobia and loss of previous routine can make for a jarring adjustment.
7) If physically able, cannot emphasize enough the importance of getting out and walking around (new routine).
8) Also vital for the senior to find a new purpose or project.
9) Look for a place that at least offers some equity after death. Kendal at Hanover, for example, is top of the line but the buy-in is exorbitant and the monthly fees high. You get nothing back. Other places will let you sell back the unit at 70-80% of original price or fair market value.
10) Scrutinize the contractual agreement carefully. For example, management may promise assisted living and dementia care, but when the time comes there may not be enough beds -- what then? (I am about to find out with my in-laws.)
11) There is an inescapable agent-principal problem at these facilities regardless of the competence and/or compassion of individual staff. Management is out to maximize profits and has a captive market. It's a sad fact that management knows it will simply out last and out wait its customers. There are no checks and balances. For example, there is a lot of featherbedding in the allocation of costs. As your proud and intelligent parents or loved ones revert to child-like status, they are given the illusion of making meaningful choices in operational matters. ("Would you like broccoli or brussel sprouts with that, sonny?") Meanwhile, the second generation is too busy with daily life to know or care.
12) Read "Watership Down"
Some dementias are reversible. My husband began exhibiting symptoms of cognitive decline about 3 years ago. We were on our way to a declaration of incompetence when his gp noticed elevated blood calcium. Further tests showed high levels of parathyroid hormone. Both the elevated calcium and the elevated pth can cause dementia. Surgery to remove the parathyroid gland affected by a benign tumor provides a cure in most cases. Hyperparathyroidism only produces symptoms of dementia in the elderly. In younger patients, other symptoms appear. Every elderly person exhibiting symptoms of dementia should be tested for this - elevated blood calcium is often dismissed by gps as due to other causes. Many elderly take a diuretic for hbp and that can drive blood calcium levels up too.