Almost every elderly person wants to be in their own home for as long as possible. Their home holds special life achievements and represents an independence that no one wants to give up. But, is living at home the best option for an aging person? With aging also come concerns about safety, nutrition, health, and socialization. The impact of these concerns can be the difference between healthy independent living and the need for assistive services. If you are a family member of an elderly person living at home, consider how these concerns may impact you and your loved one.

Safety

The most common medical conditions affecting the elderly are hypertension (high blood pressure), Diabetes, and Heart Disease. These conditions lead to decreased physical strength and stamina and affect balance; and along with age-related vision and hearing problems can increase the risk for falls. Even in the absence of one or two of these problems, elderly persons may continue to complete daily chores using less than safe methods.

Nutrition

Anyone who lives alone knows how boring it is to cook for one (or two) people. The elderly are no different. But, for them, boredom may not be the only factor in lack of meal preparation. Mobility problems, memory impairment, inability to get to the grocery store for food items and even arthritis can influence meal preparation and impact nutrition. Poor nutrition can compound or even create health issues. Very often elderly will snack throughout the day rather than prepare nutritious meals, especially if they are eating alone. A nutritiously prepared meal combined with social interaction makes a meal more enjoyable and increases the likelihood that more food will be consumed.

Declining Health

Any person living alone, but especially the elderly, may not recognize both subtle and obvious changes in health and seek appropriate medical care. Many diseases like Parkinson’s, renal failure, or cancer require almost around the clock attention and care that many spouses, friends or family just cannot provide. Of additional concern is the failure to take medications at the right time or in the right dosage. These errors can occur even when a “medication system” is put in place by a spouse or family member. Sometimes even forgetting to bathe or groom on a regular basis can place an elderly person at risk to develop medical issues like urinary tract infections.

Socialization, Isolation, & Depression

Living alone at home, or even living with a spouse or occasional hired care giver does not provide enough mental and social stimulation. Study after study has shown that social isolation can be as detrimental to a person as smoking or obesity. Prolonged isolation can also lead to other problems like memory impairment or depression. These problems can greatly impact declining health, nutrition, and safety.

Many elderly today are adamant about living in their own homes despite their needs for certain services. These folks may need a great deal of support from family and friends to keep the disadvantages to a minimum. Even with intervention, the disadvantages may not be completely overcome and the emotional and financial burden on the family can be enormous. If you are a family member concerned about the care and well-being of a parent or other loved one living alone, you will need to consider the commitment it will take to maintain their “independent lifestyle.” The burden of care for your loved one can deplete your personal finances, disrupt your family life and increase stress for everyone involved. Before this becomes the situation, consider the option of placing your relative in a reputable retirement and assisted living community. These communities have professionals onsite who will monitor and respond to safety, nutrition, and health needs. They also provide many opportunities for recreation and socialization thereby reducing the likelihood of isolation, depression and declining health.

Of course, it is important to understand the costs involved in assisted living. The majority of assisted living communities are private pay meaning that the resident is fully responsible for the cost. While Medicare and Medicaid do not usually cover the cost of assisted living services, long term care insurance does. Veterans and their spouses should also ask about VA Aid and Attendance.

Ask, up front, about how costs are paid at the assisted living you or a loved one are considering. Look beyond the glossy brochures and ask specific questions about the cost of living there. A reputable community will always have a written contract, so ask to see one. Be sure that they clearly differentiate between the cost of the apartment and the cost of any services provided.

It may be a good idea to have a calculator with you when you tour so that you can have a running total of the costs. Find out if services are bundled or itemized, when provided. Ask for a listing of any other fees that might be assessed. Assisted living communities vary greatly with regard to the amount of the security deposit, “buy-in” fee, endowment fee, or move-in fee that might be assessed. Also, there can be variance in the timing of rent and fee charges. So, be sure to ask about each of these cost items.

Leaving the home you have been in for years is difficult. However, if an assisted living facility provides a variety of services and amenities, it can significantly help the transition to a new environment. The key is to match your loved one’s current personality and interests to the services that would be most beneficial. For example, an assisted living community offering a pool, tennis courts, or a community center will only benefit you or your loved one if you actually swim, play tennis, or throw parties.

Conversely, if you or your loved one no longer drive, then an assisted living community with transportation to medical appointments, shopping, and excursions would be very useful. So, with respect to services and amenties, consider a wide array of possibilities including activities, opportunities for socialization, visiting hours and policies, dining options, housekeeping and maintenance services, transportation, safety, and “special touches.”

• Ask for a copy of the assisted living’s activity calendar.
• Find out how often the activities change or how the community incorporates resident suggestions into the activities.
• Does the community offer both onsite and offsite activities?
• Do the activities address your social, emotional, physical, and spiritual needs?
• Do volunteers or family members get involved in running some activities?
• What are the policies regarding visitors?
• Can you have guests in your apartment and for what length of stay?
• Can you and your guests use the common areas in addition to your apartment to socialize?
• What times of day or night can you receive visitors?
• Does the assisted living facility have a process for checking visitors who come and go a the community?

Quality can be determined by a number of factors. Having information about each can give you a picture of the total quality that a community provides. Therefore, find out about licensure, length of stay, complaint resolution, and support services. Every state has different regulations governing assisted living communities.

In Virginia, all assisted living communities are licensed by the Department of Social Services. One determinant of quality care is the type or length of the license, but quality extends much further beyond.

You should also find out how long an average resident stays at the community and why. Short term stays can be indicative of a community that accepts more frail residents who move on quickly to higher levels of care. Or, a short stay may mean that the facility accommodates residents who only need services temporarily until they are strong enough to go back home.

Complaints are inevitable any time a group of diverse people are living together. The key to a quality assisted living community is their ability to resolve disputes. Ask for a copy of a grievance procedure or inquire specifically about how complaints are resolved.

Finally, high quality assisted living communities have access to support services such as rehabilitation, specialized medical services, and multi-denominational clergy, to name a few. Find out which services the assisted living you are considering provides.

When considering a tour of an assisted living community, its ambiance should be more than a feeling. It should encompass the staff interaction, apartment choices, and accessibility of home-like amenities. As you enter the community, the vibe should be warm and welcoming. The entire place should look, feel, sound, and smell inviting.

Take note of staff members’ interaction with you and with each other. If staff members are calling residents by name and interacting in a friendly manner with them, then you’ll have a critical clue about the quality of care.

Ask to see all the apartment styles available. Be sure to view both furnished and unfurnished apartments. Note the amenities within the apartment – does it have a full kitchen or a kitchenette? Is the bathroom handicap accessible? Is there storage? What type of view is there from the windows? Is it well lighted? Are the carpeting and window treatments clean? Most importantly, picture you or your loved one and his/her belongings in this space – would it suit them?

Finally, a part of the ambiance of a community is the resident’s accessibility to common areas. Ask about the use of common living rooms, libraries, computer rooms, dining rooms, patios, and porches. Do you see any residents using these amenities during your tour? Observing residents actually using amenities can tell you about how comfortable and functional these rooms can be to residents.

The old adage of “location, location, location” definitely applies to assisted living. In this instance, “location” considerations should include both distance and surroundings. If you are looking for assisted living for a loved one then, maintaining your relationship with them and developing a good relationship with the assisted living community, will require the ability for frequent visits. So carefully consider the driving time and distance to the community.

Also, consider the distance of the assisted living community from both your home and work. Are you most likely to visit during the week, on the weekend, or both? What happens when you are contacted in the event of an emergency? How quickly would you be able to get to the community? If you are looking for a place for yourself, you will want the place you choose to be near friends, family, and quality medical services.

In addition to the driving distance, also consider the surrounding neighborhood in which the community is located. Is it in a rural, urban, or suburban location and what would fit your needs? What are the traffic patterns like? Will there be any new building construction? Is the community well landscaped and well maintained? Is there adequate parking? Determine how all of these factors compliment your personality and needs or those of your loved one.

The choice to remain in your home throughout your retirement years involves careful thought and tough decisions. Before making your final decision, you should consider three factors: fit, friends & family, and finances.

First, determine whether your home is still the best fit for your retirement. You have spent the majority of your life in your home, raising your family, making memories. Now, consider whether the layout of your home is the most convenient and safe for you now. How easy is it to traverse the stairs to your bedroom or the laundry room? How many rooms are you actually using and how many have furniture or items that you haven’t used in years? Can you continue the upkeep on your lawn and landscaping? How has the neighborhood changed over the years? How convenient would it be to shop or visit the doctor during inclement weather or if you were not able to drive your car? The answers to these questions are important not just for your immediate future. These are factors to consider if your current good health declines.

The next factor to consider when deciding to age in place at home is your access to friends and family. No matter your age, health or ability, we all need help from time to time. You will need to know that a neighbor or family member can help. Be sure you have a good friend to assist you or to check on you periodically, especially if your children are no longer in the area. Also, have a discussion with your children who may live near you to determine their ability to help. Finally, consider who you might contact for other tasks you may not be able to do such as mowing the lawn, shoveling snow, or doing household repairs.

You should also take a critical look at your finances to determine if you really can afford to remain in your home. While the Washington Metro area has a plethora of in-home services available the costs can add up. The average cost for a companion or home care assistant can run upwards of $20/hour. Most companies will require a minimum number of hours. If you include other costs such as grocery or medication delivery, home maintenance, meal delivery, gasoline and car repairs, lawn maintenance, and utilities, you may find that the total costs far exceeds your budget.

If your home’s fit, your friends and family, and your finances do not support your decision to remain in your home either now or in the future, you should consider other options. The communities of Retirement Unlimited, Inc. have independent, assisted living, and dementia care services to keep you safe and well cared for throughout your retirement years. Contact a community in your area for more information or stop by for a tour.

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!

Recently, the Washington Post published an article about the potential pitfalls of buying into a Continuing Care Retirement Community (CCRC). In addition, a sidebar article by David Hilzenrath suggested scrutinizing the fine print of a contract prior to moving into this type of Retirement Community. However, a Continuing Care Retirement Community with its many amenities in not the only option for retirement or assisted living care. The Washington Post articles did raise some important issues that need to be addressed prior to moving in to ANY retirement or assisted living facility. You need answers regarding how the facility handles changing level of care, additional fees, move out decision making, and financial security. Additionally, the financial viability of the retirement or assisted living community is important to learn. Publicly owned companies make decisions about operations differently than privately owned retirement companies; and for-profit companies have different operating structures than no-for-profit companies.

Clearly, there are some major issues to resolve prior to moving into a retirement or assisted living community. The following is a list of questions you should consider asking any potential retirement or assisted living community. The questions are based on the concerns raised in the Washington Post articles.

• How does the community determine when a resident needs another level of care different than the level required when he or she originally moved in?
• Does the community notify the resident or family about the change in care and if so, how much notice is given?
• What are ALL the costs associated with a change in level of care?
• If a resident needs more care is he or she required to physically move to another apartment?
• What is specifically provided under another level of care? Can the family provide any aspect of the care or must the care be provided by the community?
• How long can the resident remain at the new level of care before another change is required?
• At what point will the community no longer be able to care for the resident?
• What type of training is given to the staff that provides the care to the resident?
• How often is the rent or additional fees changed or raised?
• What kind of notice is required to break the lease agreement and are there penalties associated with breaking the lease?
• What is the resident responsible for doing prior to moving out and are there additional charges associated with the move out?
• Does any security deposit placed accrue interest and how is the resident refunded this deposit after moving out?
• What happens if the resident outlives his or her finances? Does the community make any provision for this occurrence?
• Is there an entrance fee? If so, is it refundable?
• How is a resident’s financial viability determined by the community?
• Who can I contact if any part of the care is NOT provided?
• Who is responsible for the on-site management of the community and what is that person’s tenure with the company?
• What type of company manages the community? Is it public or private, for profit or not-for-profit?
• How are financial decisions made by the company that may impact the retirement or assisted living community?

The answers that you obtain when asking these questions will provide insight about how well a community is able to care for you or your loved one. It can give you a better foundation for feeling secure about the retirement or assisted living community you choose.

During the process of normal or “healthy” aging, there are natural changes that take place if one is free of any disease. Dr. Adam Gazzaley, MD of the University of California Memory and Aging Center has stated that some changes in the ability to think are considered a normal part of the aging process. Dementia, on the other hand, is not a normal outcome of aging. Being able to recognize the difference between normal aging and dementia in you or a loved one can assist you in determining when additional help or evaluation is needed. When the time comes for the help you need, turn to the retirement and assisted living communities of Retirement Unlimited, Inc for the right care at the right time.

Normal Aging
In normal aging, you can expect a number of skills and abilities to be intact or only slightly different. You will continue to be independent in what are considered daily activities, such as bathing, dressing, driving, and working. You may notice memory loss, but you will be able to give details about those incidents of forgetfulness; and you will be more concerned about this type of memory loss than your close family members. Despite these occasional lapses of forgetfulness, your memory for recent events and conversations will not be a problem. You may notice occasional difficulty with finding the right word that you want to use, but your vocabulary will remain rich. Also, a part of the aging process will be the annoying problem of getting lost in a familiar place. You may have to give yourself a few moments to remember your way (but you WILL remember). As you age, you may still be able to operate your common household appliances, even if you may be unwilling to learn how to use new devices.

Dementia
Now, contrast the abilities and skills of normal aging stated above with what you can expect with dementia. A person with dementia depends on others for those daily activities that will keep them independent. He or she will not be able to recall incidents of memory loss and may only complain about memory problems if specifically asked. These occasions of memory loss will become more of a concern for close family members than for the person. In addition, there may be a noticeable decline in memory for recent events or the ability to maintain a conversation. A person with dementia has considerable difficulty finding and using the right word. The person may use close substitutions for the word he/she wants or may use a description instead of the actual word. The ability to find the right word continues to decline in dementia. The person may lose his/her way in what was very familiar territory and sometimes may take hours to find their way back. Also, a person who has even early dementia will not be able to use common appliances and will be unable to learn how to operate even simple new devices.

Factors to Consider in Normal Aging vs. Dementia
Dr. Adam Gazzaley identifies a number of risk factors for decline that can lead to dementia. He also points to additional factors that can contribute to healthy aging. The risk factors are:
•    High blood pressure, diabetes, poor nutrition and social isolation
•    Heart disease
•    Family history of dementia
•    Stress and depression which negatively affect the healthy aging process
The important factors that will promote healthy aging include:
•    Don’t smoke and limit alcohol consumption
•    Maintain physical activity through exercise that promotes flexibility, strength, and mood
•    Keep up with routine medical care to maintain good health
•    Keep your heart healthy; as the doctor says “What’s good for the heart is good for the brain!”
•    Maintain your social contacts with friends and associates
Retirement and assisted living communities can provide healthy meals, fitness and wellness programs, and social opportunities for seniors.

Some information in this article was adapted from the “Normal Aging” article by Dr. Gazzaley’s. For more research on the normal aging brain, visit http://memory.ucsf.edu/Education/Topics/normalaging.html.