Moving seniors is never as simple as we’d like. You may think your job is done once the move date for your loved one is set. But your involvement will only continue, as she or he transitions to a new home and adjusts to the new surroundings. Whether nearby or at a distance, you are still one of the primary caregivers, regardless of the living arrangement. I’d like to offer some suggestions and guidelines that can significantly smooth the transition and promote harmonious living in a retirement or long-term care community.
Planning the Move and Setting up the New Environment
Most parents benefit more when you provide the actual physical assistance in packing and unpacking rather than your dos and don’ts about what to take and what to leave. Creating a new home can be a highly personal and potentially emotional process, and ensuring choices rather than issuing mandates about possessions is one method that may foster a better sense of identity and comfort for mom or dad in the new location.
It may be helpful to encourage a meaningful farewell from whatever place mom or dad is leaving. Whether it is the family home of many decades or a hasty move from assisted living to a higher level of care, your parent has established relationships with people and some sense of continuity of place in the familiar setting.
My friend Elaine M.1, a Seattle grief counselor in practice for many years, created her own ceremony when she moved. She held a dinner party in her house with family and a few close friends, and then they visited each room by candlelight, remembering special events, commenting on the changes over time, and saying goodbye. For her, this helped start a better beginning in the new community.
Establishing a Familiar Environment
When in doubt about what to take, it may be good to err on the side of hanging on to “stuff” a bit longer, even if space is tight, as it often is in a new setting. Possessions can be discarded later, after thoughtful contemplation. Don’t rush these decisions when moving seniors, especially if they seem difficult. I remember one retired university professor, Henry L., who ruthlessly culled his books, donating many valuable volumes to a library. He later lamented his decision and mourned his missing books. Even though he knew he may never have opened some of them again, they were long-time companions and he missed them profoundly.
When moving seniors, establishing a familiar environment, rather than buying the perfect new couch or carpet, can ease the adjustment. When my father moved to assisted living, I helped him arrange his bedroom so that when he awoke, his gaze met the same bookshelves, books, souvenirs, and family photos he had first seen when he awakened in the family home of 20 years. The living room was set up with the same old recliner, TV, pictures, and ornaments. He felt immediately at home, and it especially helped keep him oriented in the difficult process of mid-stage Alzheimer’s.
Working with Staff
Often, what’s your job, what’s their job, and what’s somewhere in between is unclear. You and your parent may have carefully reviewed a lengthy contractual document full of legalese, yet are uncertain as to the difference between a nurse, an aide, and a resident assistant, for example. Most of you who are moving seniors are dealing with a retirement community or long-term care community for the first time and it is not intuitively obvious what a social worker does or what the duties of an activities director are.
Primary Point Person
Ask your initial contact, often a marketing director, who your primary liaison person will be. I’ve visited almost 300 different retirement and long-term care communities, and personnel in all of them vary considerably, depending on number of employees and number of residents, style of elder care services, budget, and acreage.
You probably don’t want to stop the first person you see in the hall to take care of a housekeeping issue or to fix a leaky faucet. Find out who the main “point person” is. In many communities, the general manager or second in command to the top administrator will be that person. He or she can explain to you who to talk to in various circumstances. It might even be helpful to ask for an organization chart and even job descriptions, if available.
Conversely, it is important that the office staff knows who the primary “point person” within your family is. You want to be clear about whom to contact in case of emergency and who would be the backup to that family member, in case the primary family contact cannot be reached or lives at a distance.
Medication Management
In some communities, elder care services such as obtaining emergency medications are handled by staff. In other situations this may be up to a family member. Assisted living can be defined quite differently from state to state, and sometimes quite differently within the same city.
Try not to get a reputation for being “the difficult daughter” if you can possibly help it. I remember my dear friend Mary who was working hard to help her mother settle in comfortably to an assisted living community. The third day there she complained to one of the housekeeping staff that some soiled linens had not yet been removed from the bathroom. However, many communities provide fresh linens only on a weekly basis. Find out what the norm is for their elder care services.
Ask staff what you can do to help them do their jobs well. For example, taking my father out to lunch on the day they cleaned his room helped housekeeping to discharge their duties more quickly and efficiently. Then, if an unexpected mess occurred on a different day, they would have more time and good will to deal with it.
In a nursing home with round-the-clock staff, elder care services are not usually provided 24/7. The people on graveyard shift are there for emergencies and for routine care that must be provided in the middle of the night-for example, repositioning a resident in bed to prevent or to help heal bed sores. It’s usually unrealistic to expect staff to provide room service if mom wants a midnight snack. Find out what can be expected and what is considered above and beyond the call of duty.
Some residents in long-term care communities might benefit from an advocate, especially if you live at a distance and cannot be there on a regular basis. The national long-term care ombudsman program provides trained volunteers in every county who visit every facility on a regular basis (see http://www.ltcombudsman.org).
Your family member might desire a paid companion who has the time and motivation to make certain that your mom or dad has the best possible quality of life. I was visiting my mother-in-law once in a Florida nursing home with exceptionally high standards of care. But during my visit I heard a woman, undoubtedly with one of the dementias, calling out, “Help me-please help me!” I went in and held her hand, asking how I could help. She immediately became calmer and soon fell peacefully asleep. This was a busy skilled care facility and the staff simply did not have the time to just sit and hold someone’s hand. I did.
Get to know the staff who work directly with a family member-often the CNAs (certified nursing assistants), aides, and resident assistants or caregivers-and learn their names and what they do, both officially and unofficially. Thank them for a job well done at every opportunity. Written thank you notes are especially appreciated. When someone does an excellent job, I have sent that staff person a letter and a copy to their supervisor and sometimes nominated them for a caregiver award. The local Alzheimer’s Associations, State Pioneer Networks (see http://www.pioneernetwork.org/) and organizations such as the associations for homes for the aging (see http://www.aahsa.org/) for your state usually have recognition events, which are important because they help to improve care for everyone.
Most senior housing communities forbid or discourage tipping for their elder care services. Usually there is a scholarship or Christmas fund to which you can contribute. I have also bought holiday or birthday gifts for the people I felt were doing the most.
Every family is as different as a fingerprint and what works well for one might not work well in yours. Some families need additional help. If you find yourself needing guidance with the process of moving your loved one, there is a profession dedicated to assisting older adults and their families with the emotional and physical aspects of relocation. Senior Move Managers® have significant expertise in resources and approaches, personalizing their services to meet a loved one’s needs and preferences. You can find one in your area here.
Most importantly, planning ahead when moving elderly parents and seniors and understanding the environment will always help families enjoy the community and maintain happy family ties.
By Jeannette Franks, PhD
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