Transition Planning
Like many people my age, I have parents in their early 90’s who are no longer able to live independently. Although it feels to them like an abrupt transition brought on by my mother’s stroke nearly three months ago, in fact the situation has been developing gradually. For many years, their four children have been concerned about their ability to continue living by themselves in the lovely two-story home we grew up in. We’ve suggested hiring help for cooking, cleaning and yardwork, which they are well able to afford. However, they are children of the 1930’s, prefer doing work themselves and don’t like spending money unnecessarily. Eventually my parents agreed to allow us to hire them some help, but within one or two visits they would be displeased with the work and fire the handymen we’d found to assist them. We’d end up back where we started.
The last few years have been especially frustrating as my father has developed some short-term memory loss and a balance disorder that’s led to many dangerous falls. When Mom was unable to help him up, they relied on generous neighbors. Those neighbors very reasonably suggested to us that we needed to do something. We wanted to do something, but any changes would require our parents’ agreement. Since they were still competent to make their own decisions, we learned that we had very few options. Their doctor wouldn’t discuss the situation with us because of HIPAA rules. Although my brother and I are successor trustees, we had no current authority to act on their behalf. We’ve been concerned enough to consult experts for advice. One of our most trusted colleagues told us that there’s really not much that even well-meaning, caring kids can do in such situations except be open to future opportunities for change.
My mother’s stroke on March 20th created an urgent need for change. After a week in the hospital and three weeks in rehab, my Mom came home where I served as her caregiver until we could find a suitable assisted living situation. My brother also came from Washington state to facilitate the search and move. By then we’d each had many long talks with our father, who had been ready to move for some time. He was exhausted by the work the house requires, and told me poignantly “This is a wonderful place, but it’s not the right place for us anymore.”
This started us down a path that nearly all families negotiate at some point, but there seems to be no road map to navigate it successfully. Over the course of a few weeks we found a place, arranged for medical evaluations, finances, address changes etc., and moved them with their little cat to an assisted living community a mile from the house we grew up in, along the same creek. It’s not a bad place, but the transition has not been easy. To our parents, it sometimes seems like they were abruptly taken from their home of 54 years and became virtual prisoners in a strange community. We’re working on making that better.
I’ve learned from this experience that we all need to plan for transitions that come with aging. It’s important to have and to regularly review a good estate plan, but it’s not enough. If we’re so fortunate as to live into our mid-80’s, we need to ask ourselves some hard questions:
-Is my home suitable for aging in place? If not, consider a move.
-Is in-home care available and affordable? Do I have family members who can help?
-If I move to assisted living, should it be in my own town, or nearer my children?
-Am I still a safe driver? California Department of Aging offers resources to evaluate and train older drivers: https://aging.ca.gov/How_Do_I/Learn_More_About_Safe_Senior_Driving/
Also consider who will be available to assist you with moving. I’m extremely fortunate to have flexible work I can do from anywhere, and a great business partner to take care of the day-to-day operations, allowing me to be more hands-on with my parents when they needed help at home. If your family members have a more regimented work schedule, you may need to hire assistance with moving and administrative details. Many assisted living communities have a concierge service that can help you with such services for an hourly fee.
Consider visiting some assisted living or Continuing Care Retirement Communities (CCRC’s). Time your visit for lunch so you can see if you like the food. Learn about the credentials and priorities of the executive director, activities director, and medical team. Visit the memory care unit. Each community has its own programs, outings, cost structure and culture. Find one that can feel like home, and also fits your budget. Have your financial advisor run a plan to model care costs.
My brother and I have visited 14 assisted living communities in searching for a place closer to my home. We’ve found three that we think could work for my parents. It’s worth an exhaustive search to find the best place, the right place for our loved ones, but it takes time. If a change in circumstances happens abruptly, like a stroke, you can find a place for respite care temporarily while you continue to search for a permanent home.
We’ve learned that there are many wonderful care models available. There’s so much more out there than the nursing home where I remember visiting my grandmother. Many of these places are lively and buzzing with activities and fun. We met some lovely residents who are very happy with their community. I hear often from my mother how hard it is to give up your autonomy, and yet I also see people who are grateful for the care they receive and the friends they have made in their new home. It's a hard thing to give up your home and some of your independence, but with advance planning and some thoughtful effort, this transition can be a positive one.
