The Choice Between In Home Care vs Out of Home Care

ageormoveI recently attended a session hosted at my Mom’s Continuing Care Retirement Community (CCRC). My parents made this choice more than 15 years ago, however, it’s not like you don’t wonder what it would have been like if they had opted to age-in-place.

“Aging-in-place” is a hot topic now, and in reality there are many “aging” options. In addition to a CCRC, there are local adult care options, many offered by local government and non-profits; in-home care and group home care. As a society, we seemed to have moved away from living with children, but I’m feeling a little guilt about that now. My Mom seems terribly lonely, but I know the move would be difficult on her cognitively.

Had my parent’s opted to “age in place”, we would most likely have had to take my parents to court to gain guardianship. Because they both moved into dementia together, they really didn’t recognize how much difficulty they were having managing on a day-to-day basisI’m thankful we never had to pursue this option. My parents would have recognized and been very hurt by this process.

This session I attended was focused on caring for a loved with dementia. The speaker shared that those that have a loved one in a CCRC feel guilt while those that care for a parent in their home are exhausted.

I know I’m lucky my parent’s made this choice and can afford it. The support of my parents over the past two years has been overwhelming at times. Now, it’s comforting to know that I’m not responsible for my mother’s care 24/7.

It has me wondering how my husband and I will manage this decision. Nothing is perfect, but given the wave of aging loved ones that is going to build in the coming years, I want to start having this conversation now. Discussed.

Please share with me what you are planning to do

The Benefit of a Continuing Care Retirement Community (CCRC)

lovehateIn the past year, I’ve had a love-hate relationship with the retirement community my parents selected.

At first, when I learned how much they paid to enter and then were paying monthly to live in an apartment with just meal and cleaning services (its referred to as Independent Living), I wondered why my parents selected this choice.  The numbers were big and they never explained what it meant to buy into this community.

My mom always told me I would never have to worry about them, but as you may have noticed by reading this blog … I’ve spent many years worried for my parents safety and well-being.

As my parents started to exhibit odd public behavior, the retirement community staff noticed. They would visit my parents but did not share that information with us. They were interested in respecting my parents privacy. At one point they suggested I petition the courts for guardianship and conservatorship. My siblings and I weren’t interested in heading down this painful, expensive and very public path.

Eventually, when things got bad enough, the retirement community terminated my parents Independent Living contract and moved them into Assisted Living. It was horrible and difficult but the staff worked with us to manage the transition and now my parents are the happiest I have seen them in years.

As my parents are aging, I am thankful they made this choice. My siblings and I will still be involved and vigilant, but the fact that I could leave for a week and not worry about my parents safety or well-being makes me realize the true value of the CCRC. Appreciated.

AARP’s Summary of a CCRC

Don’t lock the door

lockfrontdoorWhen my dad and I return from our trip to the grocery, we find that the bulk of the items have been moved. The new place is just a bedroom, living room and small kitchen area, so the movers got the bulk of the big furniture moved in a few hours, despite my mom’s interference.

Apparently while I was off with my dad, my mom went to speak to the Assistant Executive Director that she has known for more than a decade. She was very agitated by the moving and in order to placate her, he tells her they can visit their old apartment anytime they want. Oh no!

Maintaining access to the old apartment in Independent Living was not part of the game plan. Our goal was to move everything they needed and close down the old apartment. Given our parents inability to give up their town house and move into the retirement community full-time (even after the stroke and broken hip), we wanted this transition to be a clean break. We had their apartment in Independent Living rekeyed so we could ensure our parent’s would not be able to return.

By late afternoon, we are in the apartment working to pack up final items like pajama’s and toiletries. My brothers invite my parents to dinner so they could get them out of the apartment. We believe it’s critical that our parents stay in their new apartment tonight. My mom has said she plans on sleeping on the guest bed in their old apartment tonight. Before my parents and my brothers walk out the door, my dad instructs them: “don’t lock the door.”

My sister and I work a little longer and take the last of the boxes to the new apartment. As we leave, we diligently lock the door behind us. Closed 

It takes all four of us to manage the move

fourkids (2)The past year has made me regret not having more than two children. Since I grew up with four kids in my family, I always believed I would have four children myself. That was until I had the first one! He was a tough baby, or possibly, I was an ill-prepared mom.

I started late, having my first at 33, so that by the time I was ready and actually did get pregnant, my second arrived to a 38-year-old mother. Given all the high-risk discussions and the additional needs just a second child brought, my husband and I felt for us, it was too late to have more. I am lucky to have two healthy kids.

On the day of the move with my parent’s, we can barely manage my mom between the four of us. Our game plan was that two of us would give our parents a specific task to keep them busy while the other two would manage the move and movers. My mom always behaved nicer when there were two children in front of her — she would often bully you if you showed up alone.

When the movers arrived we have them start with the bedroom. While they are loading up the furniture, we task our parents to decide which sofa set they want in the new apartment. My sister and I invite my dad to go to the new apartment.  My mom is furiously trying to redirect the movers. My dad invites my mom along and she comes with us to the new apartment. Our job is to kill time so the movers can move.

After we linger in the apartment, we suggest getting lunch. On our way to the dining room, my mom sees their furniture being moved down the hall and takes off for their old apartment. My dad decides to follow me into the lunch room. My sister takes off to the old apartment after my mom.

My dad and I order lunch and try to find a topic to discuss. It’s only been two hours since breakfast so I’m unable to really eat anything. I know if I don’t eat, my dad won’t eat so I try to at least fill up my plate with a salad and some fruit and move it around on my plate.

My dad is ready for this move and does not want to fight it. My mom is making him very uncomfortable. I ask if he will come with me to the grocery store and we can pick up some of his favorites snacks for the new apartment. He agrees.

My mom and sister make their way to lunch and we tell them of our plans. We invite my mom along with us. She is not interested.

We all go back to the apartment and my mom is very upset. She keeps trying to tell the movers to put the furniture back and runs to the office of the Executive Director. I leave my mom to my siblings to manage and take my dad out to shop. Wandered.

The sale of the town house is really awful timing

splitheartMy parents have just been told they are being moved into Assisted Living in two days. No one said a word as we walked back from the meeting, but as soon as we walk into my parent’s apartment in Independent Living, my mom erupts. “We are moving out. Let’s get our bags and go now.” My dad tells her “No, I’m not going to fight it.”

My parents disagree. Only a few times in my life have my parents disagreed in front of me. I should say, has my dad disagreed or contradicted my mom.

On the way back to the apartment, I texted my brothers and told them to please come as soon as possible. My brothers shortly arrive and my mom tries to tell them what’s happened. She hands them the letter.  “The sale of the town house is really awful timing,” my mom laments. She decides that she will just move into a hotel for now until they find a new place.  E, the brother who just spent the last week with them, tells them why he agrees with the move. This just makes my mom angrier and the conversation escalates into the illogical zone.

She’s unhappy with the fact that the three of her children support the decision made by the retirement community. She makes a variety of statements and demands about the situation. My siblings and I are wondering how we are going to make it to move day – and it’s only two days away.

I turn to my dad and ask him what he wants to do. He says he will be moving into Assisted Living in two days. Divided.

We are moving you into Assisted Living

moveThe Executive Director (ED) of the retirement community requested a meeting with my parents. I know she will be informing them they are being transitioned from Independent into Assisted Living. We arrive and are sent back into the conference room. My mom is chattering away, she is nervous. She has no recollection of this meeting room although we have been in here together at least twice before in the past two months. The ED and Manager of Independent Living join us. The ED explains why she called the meeting and informs my parents that in two days, they will be helping them move into their new apartment in Assisted Living. She hands them a copy of the letter detailing this change and the move date.

My mom tells the ED she won’t be moving and challenges her to provide specific incidents as to why this change is being made. The ED agrees to deliver a time line of events later in the day but does detail several recent incidents. My mom refutes each one. Deftly, the ED suggests we go look at the new apartment.

My dad agrees and asks if I will come along. I tell him I will. My mom refuses to go. As we are walking out, I ask my mom if she will join us. She has decided to stop and get some tea instead. The Manager of Independent Living says she will walk down with her once her tea is ready. My dad and I leave with the ED.

We arrive and I can’t bear to watch my dad. It’s a bedroom, living room and kitchenette with one bathroom. It’s the largest of the Assisted Living suites. My parents are both very mobile, which isn’t always the case for those moving in, which is why most Assisted Living units are so small. My parents are having to move from their 3 bedroom, 3 bathroom expansive apartment to this 400 square foot apartment.

My mom arrives and complains about the size, the carpet, the kitchen … the ED does a great job of selling the benefits and the positives.

The walk back to their apartment is quiet. My mom is holding the letter in her hand and no one talks. I am worried about what will happen when we get behind closed doors.

I text my brothers “911” so they know to get to the apartment immediately. I’m going to need some reinforcements. Revealed.

Preface: The forced transition into Assisted Living

timebombSo many things have happened since I got the call that my parents were being terminated from the retirement community. I wanted to write, but was afraid of putting out a series of Tarantino-esque blog posts that did not convey what was happening, make sense or share what we have been learning from this experience.

Before I got the call from the retirement community Executive Director(ED) notifying me that they were going to require that my parents move into Assisted Living, many warning shots were fired. Two months prior the ED and Manager of the Independent Living community requested a meeting with my parents. I also attended. They provided my parents with a list of concerns and suggested that they consider hiring a personal assistant to help them – particularly in the afternoons and early evenings. My parents refused.

After this meeting, enough events had happened that the retirement community made a report to Adult Protective Services (APS).  APS visited several times and did follow-up calls with both myself and brother. APS closed the case since they did not see an immediate danger to my parents or others.

We chose not to pursue guardianship. We were not willing to initiate this court proceeding of which our parents would understand we were declaring them incompetent only to move them into Assisted Living.

There were several events where my parents were disruptive or a concern was raised that they could harm others. My parent’s behavior was getting bizarre in late afternoon. The Independent Living community was not the right fit for my parents any longer.

Their dinner companions, their life-long friends, the retirement community staff and several doctors have all suggested my parents consider getting an aide or moving into Assisted Living. My parents refused or were unable to accept the need to make changes.

The retirement community invoked their right to move my parents into the next level of care. Over the next few weeks, I hope to share what we went through and what we learned. Explained.