Home is such an integral part of our lives that making the decision to move your parent from their home can be emotional and overwhelming. How can you, as the adult child or close relative, be sure that the time is right to make the move to senior housing, retirement homes, assisted living communities, or even nursing homes?  Though changes can sometimes be subtle, there are signs you can look for. If you note any of the signs listed below, then special care and planning are needed to help your parent or older relative make the decision that will be best for him or her.

• Be aware of any changes in appearance or grooming. Take special note if your once meticulous mother is no longer wearing make-up or going to the hairdresser. Or, if your father is wearing the same outfit each time you visit. Try to check the clothing hamper or laundry room for signs that clothes are being laundered regularly.

• When you visit, take a look at the different rooms in the house, especially the kitchen, bedroom, or living room. Are these areas clean? Do they look like they are being used regularly? Answers to these questions will give you an idea of how much time, if any, your parent or relative is spending in these areas and if he or she is keeping them clean and tidy.

• Take special note of the yard and outside of the house. Does it appear that your parent is still able to provide regular maintenance? If not, this could be a sign that your parent may not be physically able or may not want to continue to do these tasks.

• Plants and pets can give you clues as well. Your parent or relative’s ability to care for other living things may offer you insight into the ability to manage his or her own care.

• When you have the opportunity, inquire about old friends or social activities. If your parent is no longer active with friends and activities, then isolation could be an issue. Lack of companionship can leave older adults more vulnerable to health issues. Moving to a place with other people and a variety of social opportunities can decrease isolation and possibly improve health.

• Another consideration is how often a parent leaves the house, especially in inclement weather. If he or she is spending days in the house due to fear of driving or fear of forgetting the route, then finding a place that offers regular outings and companionship can keep a parent more active and mobile.

• Finally, consider your own health and stress level. While the decision to move is not primarily about you, as a caregiver, your stress level can be an indicator of your parent’s decline in ability to care for themselves. If this is the case, then it may be a sign to start looking at other options.

If you note any of these signs in your parent or older relative, it may be time for you to do some investigating into housing options. The communities of Retirement Unlimited, Inc. provide a variety of care options to consider. Take a look through the website and review each of our gracious and well-appointed communities. We offer something for everyone!

People age 65 and over take more prescription medications and over-the-counter drugs than any other age group. In retirement & assisted living communities, on average, residents have ten medications administered to them. One reason for this increased number of medicines is that many people in this age group have long term chronic illnesses such as diabetes, arthritis, high blood pressure, and heart disease. Another factor is that these diagnoses are usually made by multiple physicians who may be unaware of other medications that a person is taking. For all of these reasons, it is important that seniors be sure to take their medications safely. The National Institute on Aging has recommended these suggestions for being safe with prescription and over-the-counter drugs:

•    Make a list of all the medicines you take. Show this list to all your health care providers including physical therapists and dentists. One copy of this list should be in your medicine cabinet. You should make additional copies for your wallet or pocketbook and for your spouse or family member. The list should include:

o    The name of each medicine
o    The doctor who prescribed the medicine
o    The reason it was prescribed
o    The amount you take
o    The times you take the medicine

•    Read and save all written information that comes with the medicine.

•    Take your medicine in the exact amount and at the time your doctor prescribes.

•    Call your doctor if you have any problems with your medicine. Your doctor will decide whether to change your medicine to another that may work better.

•    Use a memory aid to take your medicines on time. Some people use meals or bedtime as reminders. Other people use charts, calendars, and weekly pill boxes to remind them.

•    Do not skip doses or take half doses to save money. Instead, talk to your doctor or pharmacist if you can’t afford the prescribed medicine. They may know of less costly choices or special programs to help with the cost.

•    Avoid mixing alcohol and medicine.

•    Take your medicine until it’s finished or until your doctor says it’s okay to stop.

•    Don’t take medicines prescribed for another person or give yours to someone else.

•    Don’t take medicine in the dark to avoid taking the wrong pills.

•    Check the expiration dates on your medicine bottles and throw away any outdated medicines.

•    Don’t leave your medicine on a kitchen table or counter where someone else may get to it.

For more information about medication safety, contact the National Institute on Aging Information Center by calling 800-222-2225 or by logging on to www.nia.nih.gov.

At some point, many seniors need additional help to take medications safely. Since the medications are prescribed to treat illnesses, the impact of not taking medications correctly can be serious. When you do need help, many retirement and assisted living communities can provide assistance with medication administration. In coordination with your doctor, these facilities can ensure that you maintain your health.

In a 2009 Cost of Care Survey released in April by Genworth Financial, Inc. of Richmond, Virginia, the national median monthly rate for an assisted living apartment was $2,825. This rate can fluctuate dramatically depending on whether the retirement or assisted living community is located in an urban or a suburban or rural area. Additionally, the cost for assisted living has been rising an average of 4.7% annually over the past five years. As these figures demonstrate, paying for your retirement will require some preparation and planning. In the first part of this article about paying for retirement, we’ll provide information about private payment sources, real estate options, and long-term care insurance.

Private Payment – For the most part, the assisted living industry is a private pay business. To pay for retirement in these communities, you would be using funds from your own resources including pensions, retirement accounts, savings accounts, annuities, or investment accounts. You might also use the proceeds from the sale of real estate or private property.

Real Estate Equity Options – The real estate market has been hit hardest by the downturn in the economy. If you were planning to use the monies from the sale of your house or other property to fund your retirement, you may be delaying the sale to await the inevitable upturn in the market. However, when you need the services provided in a retirement or assisted living community, the need is immediate, and you may not be able to wait for the sale of your property. In this case, you do have a few options that you can discuss with a real estate professional or a financial advisor. You may consider a home equity loan, reverse mortgage or a bridge loan. With a home equity loan, you can borrow against the equity you’ve accrued over the years. A reverse mortgage is available to homeowners 60 years or older. It allows you to convert some of the equity in your home into cash. A bridge loan can be obtained if you are awaiting the sale of your house, but need immediate funds for assisted living or retirement costs. A bridge loan is an interest only loan that can help pay these costs until your house sells. Any loan comes with both risks and benefits. It is extremely important that you speak with a professional that you trust before entering into any of these types of loans. You can also check with your state’s Commissioner of Revenue to find out if you might be eligible for any type of tax credit with respect to real estate or property.

Long-Term Care Insurance – According to the American Health Care Association and the National Center for Assisted Living, long-term care insurance can “protect personal assets and inheritance for the family and provide for financial security.” The insurance policy premiums are based on age, health, length of deductible period, amount paid, and duration of the benefits. The premiums can increase with additional options such as higher daily benefits, inflation protection, and non-forfeiture benefits. According to the Health Insurance Association of America, the annual low option premium for long term care insurance for a person aged 50 is about $850; at age 65, the policy would cost $1,800 and at age 79, it would rise to approximately $5,500. Of course, these costs vary by insurance providers. So, it is imperative to speak with a financial advisor or contact your state insurance commissioner’s office for a list of insurance companies who can sell long-term care insurance in your state. In Virginia, the commissioner’s office is located in Richmond. The phone number is (804) 371-9694. Also, if you live in Virginia, you may deduct long-term care health insurance premiums from your state taxes. This deduction can be taken provided that these premiums have not been deducted for Federal taxes. Please consult a tax advisor for full details.

In the next part of Paying For Your Retirement, we’ll discuss the government benefits that may be used toward the cost of assisted living. These benefits include: Veterans Administration Aid and Attendance, Medicare, and Medicaid.

With the many options out there for your retirement, it can be confusing knowing what choice to make. Many senior housing communities have assisted living options. Some nursing homes have an “assisted living wing.” Some assisted living communities offer independent living. It’s enough to make you want to build a raft and spend your retirement on a small deserted island! We want to provide you with some helpful definitions to navigate through these choices. We can also recommend some deserted islands and really good sunscreen, if you choose that option as well.

Independent Living
When do you want “Independent Living?” You are making this choice usually because you want to and are able to live without any help, but you no longer want (or need) the burden of maintaining your current home. You would prefer to live with other people of the same age and similar interests. You may desire social activities or interesting day trips. You might want to cook some meals, but you also may want the option of dining out without having to drive anywhere. You definitely want someone else to mow the lawn, shovel the snow, weed the garden and water the grass (or at least you don’t want to do so much of it any more)

Where can you find “Independent Living?” One option is found in the retirement housing subdivisions. These can be sprawling campuses with many amenities. With this option, you can buy or rent an apartment/condo/or small “cottage” Many times, these communities require total independence with regard to your health. However, you can also find the option of “independent” living within an assisted living community. In these communities, while you live independently, you also have the option of adding health services as you need them.

Assisted Living
When do you want “Assisted Living?” You make this choice when medical, memory, or aging issues reduce your ability to safely stay in your own home. You may still want the personal privacy and autonomy, but you may need a little assistance. And, honestly, you may also be tired of cleaning, cooking, laundry, and home repairs. Many assisted living communities offer services for personal care. They also may provide housekeeping, laundry, transportation, dining options, and 24 hour supervision. In addition, these communities may have other amenities such as exercise rooms, outdoor gardens, libraries, chapels, or internet access. Assisted living communities frequently base their costs by offering levels of care based on the amount of assistance that you need. Some assisted living communities will allow you to “age in place” meaning that you can remain there even as your health deteriorates. Sometimes, you may find a nursing home that has a dedicated area for assisted living. You should consider this option based on your medical needs, but also on your privacy and autonomy wants.

Nursing Home
When do you want a “Nursing Home?” You make this choice when your health needs require skilled medical professionals (like doctors and nurses) providing services and care on a daily basis. The emphasis in a nursing home is on medical care. Frequently, nursing homes also provide rehabilitation services, allowing for a short term or a long-term stay.

Other Options
There is a really lovely chain of islands throughout the Caribbean that are uninhabited. Choose one with a good coastline and lots of trees for shelter. For long term retirement, we strongly recommend a UVA/UVB full spectrum sunscreen in an SPF 30 or higher. Just a thought: learn to fish and gather before you go. Oh, and bring LOTS of your favorite beverage.

Adapted from the publication, Choosing An Assisted Living Facility: Considerations for Making the Right Decision, by the Consumer Consortium on Assisted Living. Visit the website for more information at www.ccal.org.

1.    Identify the facilities in your area and plan to visit as many as you can. Use search engines on the internet to identify facilities. Visit the facility’s website and take a virtual tour to narrow your choices. Remember that the closer the facility to your home, the more likely you are to make frequent visits. Be sure to tour the facility and ask the questions that are most important for your physical, financial and lifestyle needs.

2.    Choose your top 2 or 3 choices and return to those facilities to ask more questions. It is important while at those facilities to talk with staff and residents. Ask how long staff and management have worked at the facility.  Ask residents about their experiences living at the facility. If possible, have a meal. Compare the answers to your questions from the different facilities that you visit.

3.    Ask to review the Resident Agreement (facility contract). This document should provide information about services, rates, additional fees, facility and resident responsibilities, admission and discharge criteria, and conditions of termination of the contract.

4.    Review the licensing or certification inspection reports and contact the Long Term Care Ombudsman for complaints about the facility. These reports may be available online. Complaints alone do not indicate the quality of the community. It is important to ask how the complaints were resolved or corrected.

5.    Make an unannounced visit to the facility. You can learn a lot about a community by visiting during meals, in the evenings or on weekends. For resident safety and privacy reasons, you may not be able to tour the community at these times unless accompanied by a staff member. However, observations in the lobby or common areas can be invaluable in your decision.

Use these tips to choose the community that best fits your needs.

Armed with a few more pieces of information, you can be more prepared to decide whether your parents should move from their home to assisted care.

The routine that your parents have and their overall health will be important precursors to what level of assisted care they might need and how well they will make the transition. It is important to take an in-depth look at how they accomplish all the tasks required in a day: everything from cooking, to laundry, to driving, to paying bills. Your parents may be able to accomplish the automatic tasks that will reasonably get them through the day; it just might take them longer. However, there may be other signs that suggest that living independently at home might not be possible. Some families discover delinquent bills nestled in sock drawers while check books are in another part of the house. Some begin to notice that their parents clothe themselves in the same outfits each time they visit, yet the laundry detergent goes unopened. Some have even found pots and pans in the washing machine. The extent of the disruption of a regular routine can suggest the need for assisted living versus independent living. It can even suggest the onset of memory impairments that might require some additional assisted living needs.

Now, what about your parents’ health? When was the last time they saw their physician and for what condition? You might not be able to obtain this information from the physician due to privacy laws, but you can certainly get an overall sense of their health by exploring the medicine cabinet. How many medications are in there? What are they for? When are the expiration dates? Can your parents tell you what the medicine is, why they take it, how often, and what they do if they have a reaction to it? You can learn a lot by how specific (or not) the answers are to those questions. The determination of your parents’ health will give you the information to ask better questions about medication administration when visiting an assisted living community.

Finally, consider the type of support system that your parents’ currently have. Do they have friends with whom they visit or who regularly visit them? Are they active in their church? Do they have hobbies or activities that they enjoy? The answers to these questions will give you information to ask about activities, transportation, and social networks in an assisted living community.

So, you now have a wealth of information to begin your quest for an assisted living community that will match your parents’ needs. Now all you have to do is find it! HOW??? That comes next…

You’ve come to the realization that Mom or Dad (or both) are going to need more help – maybe sooner rather than later. Now, it is time for you to become Inspector Clouseau (minus the hat and silly mustache) and determine, objectively, what Mom or Dad can do for themselves. Once you have this information, you can better negotiate the labyrinth of assisted living.

It is as important for your sense of well-being as it is for your parents’ future to focus on what your parents can do, NOT what you think, remember, or wish they could do. So, if you can’t be completely objective, then ask a spouse or a trusted friend to help you. I would recommend looking at four main areas: their environment, their routine, their health, and their support system. These four areas cover the most typical services that you can expect in an assisted living residence.

Let’s start with the environment: the home in which they currently live. Remember to observe everything from the street to the curb, to the driveway, to the stoop, to the entryway, to the floor plan on each level. You should be noting all potential fall or tripping hazards. Find out how many steps it is from the curb to the front door? Are there railings and what condition are they in? Is there a welcome mat, and how thick is it? How many stairs are in the house – especially note the number of stairs, railings, or turns from the master bedroom and the bathroom? How many area rugs are scattered throughout the house (include each bathroom) – As an aside, my mother loved to place what I referred to as “toilet sweaters” in each bathroom. You know what I’m talking about: those chenille or cotton “U” shaped bath mats around the toilet. All of these things, which you and never think about, could be potential risks for your parents. Now, watch your parents as they navigate all of these areas. How steady are they walking? Are they using a cane or walker, and if so, is it helping or hindering their maneuvering? Do they avoid certain entryways because they have difficulty? My father would pull into the garage and enter our house by going up only one step. He said it was more convenient, and it probably was, but the other “truth” was that he was no longer able to climb the porch stairs (there were 5 of them) because he would be out of breath by the time he made it into the hallway. See what I mean, parents are sneaky.