Monday, October 12, 2015
When a family with an elder (s) or an elder themselves begins to think about and have conversations with family about moving to a retirement community, these conversations may become uncomfortable and anxiety provoking because they consist of making major changes in home, relationships, and even in family dynamics. We already know that everyone seems to have a slightly different opinion, for those involved directly the stakes are very high, and previous attempts to have such conversations may have not turned out very well. People can feel unsure of themselves and the elders may experience that their own wishes may be disregarded by their children who push for changes to insure a more safe and healthy environment.
This may be the first time adult children have seen their parent (s) unsure of themselves, possibly afraid of the future, and even angry or refusing to participate in these talks. It seems that no matter what is decided, many feelings may be hurt and someone will feel disregarded and not appreciated for their wishes.
Many situations like I have described simply do not occur. An elder wants to move on or a family comes together with a unified plan that seems positive and helpful to the whole family. Then the issue is where to look, how to assess, and when to choose a place. For many others, the situation is confusing and there seems to be no way to satisfy all, and in the end, no one feels or experiences satisfaction. If an elder moves into a retirement community following this scenario, the likelihood of a successful adjustment is deeply compromised. Both situations seem to require some professional intervention. The first to assist a family in choosing a place, and secondly, to help the family sort through the levels of conflict and mentor the family to a better path to choose for themselves.
I have listed a number of questions to be used as a working outline in maneuvering through both scenarios. Each requires input and shared conversation with a guide or mentor to monitor and direct the conversations and the powerful emotions they generate.They are not listed in any rank order of importance, but as they come to my mind as I have worked with elders and families during these potentially troubling and stressful times. A always, take with you what seems most helpful to your special situation…..
1. Costs and how they will be paid for. Remember that the highest cost establishments may not be the most rewarding one for you or your family. Many have entrance fees that may or may not be refundable in some degree if you leave or pass on. All require fees for their services and some take medicare: get the facts down right. But higher cost is not always indicative of better service and dedication to you. You will also need facts about their financial health to guarantee their viability.
2. Location, location, location. How far is it from your family and friends? Can you get back to your established places for services, restaurants, theater, clubs, church, synagogue? Are you planning on establishing all these in your retirement community once there, or will you split your time? Remember than connection with important persons in your life is a definite component of good Quality of life.
3. Ask about their values and commitment to each person. Get this from the people you talk with, not the brochures they send out. While it is good to talk to folks who are available to talk and share their experiences there, the system will probably have you speak with the most satisfied members. Ask for a list of complaints they have received and dealt with. Seek a place that shares your values about what is important in your life and maintaining a high quality of life: continuity here is also important in your quality of life.
4. Now ask how what are their consistent strategies for these core core values and how are they implemented?
5. What are their practices to incorporate you or your loved into the their system and the group of other people in the community?
6. How will they assist you or your loved one in coping and adapting to their environment. You or your loved one may find it more complicated and anxiety provoking to move through the process of adjusting there. Who are the staff and what are their qualifications to do this with you or your loved one?
7. Are there regularly scheduled assessments of how you or your loved one is coping and adapting? Who are the people and what are their qualifications?
8. Many people and families seek out a place following a serious loss to them: death of a loved one, illness, financial problems, diminished ability to provide activities of daily living (ADL’S). Attempting to adjust now can strain an individuals ability to cope and adapt. How will the community provide care and counseling?
9. Most people have some degree of ambivalence and uncertainty about such an important move. Who is there to smooth the way and champion their concerns?
10. What family counseling services are available to your family? Not all of us have made our amends with our family, dealt with the issues that cause us strife and worry, and resolved any family guilt or anger between members.
10. Try not to select by religion alone. You may find the system falls far short of meeting your needs. While many families share they receive much comfort if the community is of their religion, it is not a guaranteed successful placement by itself.
11. Do not let them confuse a busy schedule and keeping you or your loved one busy with the possible need for in-house counseling that is part of the regular costs. If it is an additional expense, then it seems to me that it is not a built in need that the administration is viewing as a normative cost to them and necessary for enhanced quality of life for some members.
12. Your health is crucial. How do they incorporate physicians,nursing, and allied health services into their system?
I have listed for you 12 questions and concerns that are important. There are certainly more and some may be equally as important or more important that any on this list. Think for a moment what they might be for you or your loved one. You may be surprised how these questions and concerns bring new ones to the surface that you may have not thought of.
What if you began to re-think about you or your loved one remaining in their home? What services would they need and accept to accomplish this? Where would the funds come from? Is this just a stop gap measure, and if so, may this stop gap measure give all the family the time to breath easier and simply be as it is. Would this be reasonable for family with many different opinions and for elders that may perceive this as an intrusion into their home by strangers which solidifies their sense and awareness of growing frailty and needs?
Consider a consultation by a specialist during this challenging time. Someone who has the experience and expertise to guide you and your family with and through this process….sitting down with this person can illuminate a path that you may not have thought of, and provide guidance to see you through….
Lastly, many families come through this family life cycle event easily, many do not. It is not unusual for the latter and I want to try to reassure you that help is available for you and your family. There are many fine people in the community to serve you. Take the chance and the opportunity and call for an appointment.
I wish you and your family well.
Alan S. Wolkenstein, MSW
Clinical Professor of Family Medicine (Ret.)
University of Wisconsin School of Medicine and Public Health
Wolkenstein and Associates, LLC
Mequon, Wisconsin, 53092
[email protected]