Elder Care : When is the right time to move?

There was an interesting comment yesterday on my post Learning to Speak Up. It broached the quandary many of us experience in determining when it's the right time to move an aging parent from their home to assisted living. On the one hand, you have a parent who is clearly still able to manage their life pretty much on their own. On the other hand, that same parent is showing signs of cognitive loss which you expect will eventually increase. You know at some point you'll no longer be at ease that they can still manage safely and well by themselves.

The question is: As their caregiver or care manager, how do you know when it's the right time for them to move?

Loss of cognitive functioning isn't predictable in its pace. You know it's happening, but no one can say how fast a parent's abilities will fade or fail. The not knowing makes it difficult to plan in concrete when a move should be done. What you can see is that your parent is doing OK right now. And you expect that they'll be able to continue doing OK for awhile. But you don't know how long "awhile" will be, and you don't know what part of your parent's cognitive functioning will fade next. You feel like you're in a holding pattern. You know you're going to come in for a rough landing at some point, but in the meantime, you're hanging around circling. What can you do to be proactive?


In a separate post in August, Making the Big Move, I addressed specific issues related to moving one's parents from their own home to assisted living, so I won't repeat that here. There's lots that can be accomplished pending "the big move" which will give you a great feeling of comfort and control. Here are some suggestions:
1. Find the assisted living facility that's best for you and your parents. This takes time and is a great thing to be doing if you know that eventually your parent(s) will have to move to such a place. You want to get as well-rounded a sense of the offerings in your area as possible and end up with your first choice ready to go when you need it.

• Visit as many assisted living places as you can, even some that are out of the way.
• Investigate which ones are close to your preferred hospital, and to activities your parent may enjoy.
• Look at their actual units, both ones that are larger than you think you'd take and those that seem smaller. You'll be surprised at how different each unit looks in real life than on a printed floor plan.
• Meet with their Executive Director and their Directors of Nursing and of Activities.
• Eat a meal at each place, preferrably in the company of some residents.
• Inspect their Alzheimer's or Skilled Nursing units, if they have one.
• Ask around with doctors you know to see if any facility has a better or worse reputation than others.
• Talk to their references.
• Find out their wait list policy. Some places will keep you in your wait list priority spot indefinitely and allow you first right of refusal on each new unit that comes up.

2. Get paper work in order. This may mean putting in place a broad enough power of attorney so that you can move your parent without their say so if the need arises. It also may necessitate a clause that defines by what means your parent is considered to no longer be competent to manage their affairs. It's good to have an attorney assist with this.
3. Keep talking with your parent about the issue of moving. There are pros and cons worth airing on both sides. This is a tough decision for everyone. It's sensible to allow time for the idea and its ramifications to sink in.
4. If possible, have a neuropsych evaluation done of your parent cognitive functioning. This should be more extensive and detailed than an internist's evaluation and may give you a clearer understanding of your parent's condition.
5. If possible, bring your parent to visit a small selection of the assisted living facilities you've found. For some parents, the following strategy has worked well: First show them a facilityyou know they won't like, perhaps one that's even a little crummy. The two of you can then agree that that place isn't suitable for them, which puts you on the same footing. Next, take them to the facility you prefer, which will be in direct contrast to the one they just saw. You just may hear "Yes, I could live here!"

Is this strategy manipulative? Yes. But it's done to ease the strain of making a decision and to put your parent in a positive frame of mind, both of which ultimately make the move so much easier.

Last year, when my sister and I were struggling with a similar situation, I was given an invaluable piece of advice: don't wait until you have a crisis on your hands. So, my final suggestion is be willing to take control of the timing of the move. Don't wait to get a call from neighbors saying your father has fallen and is in the hospital, or that your mother has gotten lost while driving and couldn't find her way home for two hours. Moving your parent to assisted living actually will go far better for them if they are in good health, reasonable spirits and still able to learn new routines.