PLACES TO LIVE

There comes a time in many senior's lives when they have to move to more supervised residential accommodations. A number of choices are available. This article summarizes levels of care available with short descriptions of the benefits of each. Systems of classification and regulation vary from state to state. 

Levels of Senior Care:
  • Skilled Nursing (SNF): Constant skilled nursing care and help with many if not all activities of daily living are provided. Nursing staff is on site 24/7. 
  • Assisted Living: Residents receive assistance with activities of daily living like managing medication while being able to do most things on their own. Staff consists primarily of qualified nursing assistants. Nurses or doctors available on call.
  • Memory Care: Specialized for people with memory loss, it falls into the Assisted Living category. Residential care can include assistance with most activities of life. Most memory care communities have a nurse only part time.
  • Independent Living: No medical personnel on staff. Meals and minor assistance with daily life tasks are provided along with activities including on site exercise classes.
  • Recreational Care (RCFE): Maximum of 6 residents. No medical personnel on staff. Medicine management is provided along with meals and personal assistance with bathing and bathroom. Ultimately full care is provided for a continuum of care till passing.
  • Adult Day Care: Day programs for seniors who require some assistance. These are often held for those with memory impairment. Transportation, mid day meal and activities provided. No health care.
  • Senior Centers: Excellent source for social and learning activities.
  • Continuous Care Retirement Community (CCRC): Continuum of care provided from senior apartment through skilled nursing care. Often one building will have separate wings for independent living, assisted living, memory care and hospital like skilled nursing accommodations. The resident moves from one to another as life progresses.
  • Acute Care: Similar to Skilled Nursing but primarily for those requiring short term critical care after hospitalization.
  • Home care: Living with a relative and being cared for by family or remaining in your home with hired caregivers.

Some opinions:

I have taught exercise for those older in almost all these living circumstances beginning with thousands of classes at skilled nursing facilities through a program sponsored by our local junior college. I have also taught extensively in assisted living and memory care homes, senior centers and continuous care communities. And I have had some experience with senior care in the home. Here are some of the opinions that I have developed over 25 years:
  • In general, quality of care in our area is excellent. In the thousands of visits I have made to nursing homes for example, only on one or two occasions have I observed lack of cleanliness. 
  • Almost all of these facilities are regulated by state and Federal authorities although there is much variation of level of oversight across states. An activities staff member once told me that she spent as much time filling out paperwork as being with the residents at activities. California state reporting is particularly onerous.
  • Most assisted living, memory care and skilled nursing are corporate owned. As of several years ago, Brookdale owned more than 95% of assisted living facilities nationwide. Profits are a primary motive. I recall a number of years ago, staff at a beautiful and expensive assisted living home were simply told one month that their activities program budget was suddenly and permanently cut in half. Resident care is certainly impacted.
  • Cost is oriented toward level of care as well as opulence of lifestyle provided. Reports comparing costs and showing any past or current complaints, penalties or fines are available in most states.
  • Some facilities are quite luxurious and others rather basic. Cost of residence does not necessarily provide excellence. I suggest extensively checking recommendations, ownership and history before selecting. My own guidelines would include finding out how many classes are provided weekly and more specifically how many exercise classes. I would suggest rejecting any facility that provides less than 3 exercise classes per week.
  • My personal choice of the above options is definitely the small residential care facility. The cost is so much less and in my opinion the care far better and more personal. They are extensively regulated here in California. Difference between individual residences is determined by each's management and ownership. Make sure to investigate that before making your choice. Our family's experience has been excellent with this solution but the owner is a wonderful person with a great supportive family and that makes all the difference. A major advantage of an RCFE is that the resident doesn't have to move as they require more intensive care.
  • The biggest disadvantage of an RCFE in my opinion is that activity programs are rare. There are no classes taught in house and activities seem to revolve around holidays instead of ongoing entertainment or education. Emphasis is entirely on the care of the residents, most of whom require assistance with activities of daily living.

Being cared for in your own home or with family is thought of as the very best outcome. But it is important to understand the risks involved.

There are some huge challenges that may end up making this a more difficult choice. Elders will probably be far more isolated living at home than they would be in a group residence. Help is also more limited, especially medical care. Caring for others at home is very intense and can become overwhelming to your own life. I have found that the pivotal challenge in home care for everyone is bathroom care. Be prepared. Make sure you have a support structure in place including getting time off to do whatever your heart desires without judgment. It will help greatly to involve as many as possible and the larger your family the better.

Some ideas that will help to make a successful transition:

  1. Try to adopt a positive attitude: Complaining about your situation nor being depressed about it does not help you. The situation will probably not change and you will just end up being miserable. Ultimately everyone else around you will be also and the attention you receive from staff and other residents will reflect that.
  2. Take advantage of the activities offered at your new residence. Go to all of them whether you are interested or not, at least in the beginning. Then find the ones that really help you and add to that any classes that emphasize exercise, balance or any kind of movement. Attend classes religiously. Among other things, it is a wonderful way to meet new people and create new relationships.
  3. Be friendly with other residents: If you see someone sitting in the lobby looking forlorn then go up to them and introduce yourself. Do not rely on others taking care of you. They will but it is so much more enjoyable and satisfying to take the initiative yourself.
  4. Learn a new language: It is wonderful for the mind and if you choose the language that many of the caregivers in your region speak then you can talk with them and form marvelous relationships with people whose help you rely on.
  5. Remain interested in the world outside your own. Learn about computers. Follow the news. Read or access audible books. Take up new hobbies.
  6. Record your autobiography: Many senior residences offer classes in creating a record of your own personal history. If that is not offered then entice one of your relatives to visit equipped with a recorder and speak about the parts of your life that are meaningful to you. Brag. Let everyone know your successes and about all the wonderful people you have known. Plus the challenges you have faced and the solutions you found.
  7. In general, the more you are involved with the happier you will be. 
  8. Attend classes with your relative if they are the ones moving until they find their way. Do everything you can to support your relative remaining as active as possible.

Some examples of successful life in senior retirement living:

  • One of my students celebrated her 100th birthday by continuing her daily walks up the hill and around the parking lot, all with her walker. She takes every class offered, cheerfully. Her life is lovely and it is primarily because she has insisted upon remaining active without complaint.
  • Grace under adverse circumstances goes a long way to helping. 25 years ago, I knew a beautiful resident in a nursing home who was in great pain most of the time. The grace she displayed while she was in pain was one of the most beautiful things I have ever seen. Just being with her made an impact on me.
  • One delightful 102 year old insisted on doing abdominals along with the rest of us. Everything she did, she did with charm and warmth. She made you feel loved just by being in the same room with her.
  • My wonderful student whose arthritis was so intense that every movement hurt terribly. Yet she persevered and did all the exercises anyway. Her courage influenced me profoundly.