Proactive Planning: When is it Time to Think About Assisted Living?

How Get a Head Start and Investigate All Your Options - Before Your Health Declines 

How do you know when the time has come to choose an assisted living facility? Learn factors to consider and how to proactively make a good choice for the future. https://bit.ly/4iKzbvx

In this Episode:

• 02:30 - Illinois Road Trip and Recipe of the Week: Ann Sather's Famous Cinnamon Rolls
• 04:39 - Ten Rather Undignified Deaths
• 09:14 - Assisted Living: How Do You Know the Time is Right?
• 10:55 - What Factors Go Into the Decision to Go Into Assisted Living?
• 13:35 - Making a Selection: Quality, Cost and Location
• 21:25 - How to Talk with Aging Parents about Moving to Assisted (Senior) Living
• 24:03 - Outro

We go in depth into factors to consider, such as current functional status, current housing features, social networks, what retirement communities offer, and financial considerations. 

We have the choice to be proactive in a move, and if we do, we have primary control over what happens.

#seniorcare #assistedliving #eldercare #elders #aging #agingparents #podcasthon #everyonedies #everydayisagift #palliativecare #hospice #agingwithdignity  

We are very happy to participate in this 3rd edition of Podcasthon! For one week, more than a thousand podcasts will highlight a charity of their choice. As you know, Everyone Dies is a registered nonprofit organization and in celebration of this year’s Podcasthon we would be most pleased to receive your donation. You can support us by purchasing a piece of mourning jewelry, a brick for our virtual memorial wall, or by credit card. Donate Here

Chapters

• 0:00 Intro
• 2:30 Illinois Road Trip and Recipe of the Week: Ann Sather's Famous Cinnamon Rolls
• 4:39 Ten Rather Undignified Deaths
• 9:14 Assisted Living: How Do You Know the Time is Right?
• 10:55 What Factors Go Into the Decision to Go Into Assisted Living?
• 13:35 Making a Selection: Quality, Cost and Location
• 21:25 How to Talk with Aging Parents about Moving to Senior Living
• 24:03 Outro

Transcript

Hello and welcome to Everyone Dies, the podcast where we talk about serious illness, dying, death, and bereavement. I'm Marianne Matzo, a nurse practitioner, and I use my experience from working as a nurse for 46 years, yes, 46 years, to help answer your questions about what happens at the end of life. And I'm Charlie Navarette, an actor in New York City, and here to offer an every-person viewpoint to our podcast.

We are both here because we believe that the more you know, the better prepared you are to make difficult decisions before a crisis hits. We would also like to remind you that this podcast does not provide medical nor legal advice. Please listen to the complete disclosure at the end of the recording.

We are very happy to participate in the third edition of Podcastthon. For one week, more than a thousand podcasts will highlight a charity of their choice. As you know, Everyone Dies is a registered non-profit organization, and in celebration of this year's Podcastthon, we would be most pleased to receive your donation.

You can support us by purchasing a piece of mourning jewelry, a brick for our virtual memorial wall, or by credit card. Please go to www.everyonedies.org, that's www.everyonedies.org, and share the love. Welcome to this week's show.

Please relax, put your feet up, and thank you for spending the next hour with Charlie and me as we talk about the things to consider when thinking about moving to assisted living. Like the BBC, we see our shows offering entertainment, enlightenment, and education, and divide that into three halves to address each of these goals. Our main topic is in the second half, so feel free to fast forward to that flight of chatter-free zone.

In the first half, Charlie has our recipe of the week and tells us about some deaths that may not be considered a dignified one. In the second half, I'm going to give you some things to think about when making the decision about moving to assisted living. And in the third half, Charlie has some suggestions to consider when talking to a loved one about moving to assisted living.

I do? Hi, Charlie. I mean, yes, I do. Hi, Marianne.

Because you know all about that stuff. Yes, I do. Yeah.

Yeah. You're the man. I'm the man.

I be the man. Yes. For our first half, as we continue our gastronomic tour of these United States, we are in Illinois.

Ah, Illinois. The home of Abraham Lincoln and Superman, deep dish pizza, and Twinkies, and the first McDonald's restaurant. Illinois, or Illinois's, which is a mispronunciation, so don't say it.

Illinois is Illinois is 80 percent farmland, and the largest city is Chicago, known as the Windy City. Do you know how it got that name? As for Chicago, you might think it is because of the winds coming off Lake Michigan, but the locals will tell you that it was coined in reference to Chicago's bloviating residents and politicians, who were said to be full of hot air. Etymologist Barry Popkik, a longtime researcher of the Windy City question, uncovered evidence that the name was already well established in print by the 1870s.

Popkik found references showing that it functioned as both a literal reference to Chicago's windy weather and the metaphorical jab at a supposedly boastful citizenry. In the 1940s, a vivacious career woman named Anne Sather decided that what she really wanted to do was own and run a restaurant. So, in 1945, when the Swedish owners of a restaurant located on Belmont decided to retire, Anne quit her job of 22 years, pooled her life savings, and bought herself a diner, known today as Anne Sather Restaurant.

She ran the diner for 35 years, and her wholesome, made-from-scratch food, low prices, friendly service, and hard work became legendary in the Lakeview neighborhood and beyond. A trip to Chicago would not be complete without eating a few of Anne's famous cinnamon rolls. And we have her recipe for you to make and bring to your next funeral lunch.

Bon Appetit! And now for something completely different. A list of 10 deaths some would consider lacking in dignity. In 4056 BC, Aeschylus, the father of Greek tragedy, dies when an eagle drops a tortoise on his head.

In 1649, Sir Arthur Aston, the royalist commander during the English Civil War, is beaten to death with his own wooden leg by Cromwell's men during the Siege of Drogheda. In 1687, Jean-Baptiste Lully, the French composer, accidentally stabs himself in the foot with his baton and dies of gangrene. In 1737, Queen Caroline, wife of King George II, shows remarkable composure during a badly bungled attempt to cure her neglected, strangulated hernia.

But as she lies in bed surrounded by courtiers, her bowels burst, showering a torrent of excrement over the bed and on the floor. Upon her death soon afterward, the poet Alexander Pope is moved to write, Here lies wrapped in 40,000 towels the only proof that Caroline had bowels. I like that one.

1845, at President Andrew Jackson's funeral, his pet parrot, Hole, has to be ejected from the proceedings when it swears repeatedly. 1927, Isadora Duncan, the American dancer, having just taken delivery of her brand new Bugatti racing car, steps into it for the first time, waves gaily to her friends and speeds away. As she does so, her long red scarf becomes entangled in the spokes of her left rear wheel, snapping her neck and killing her instantly.

1975, Claude Francois, the French Elvis Presley and co-writer of one of the most successful songs of all time, My Way, dies attempting to change a light bulb while standing at a water-filled bath, age 39. 1995, an Italian stripper, Gina Lallapolla, is found suffocated inside a cake she was supposed to leap out of at a bachelor party in Cosenza. Her body had lain inside the sealed wooden cake for more than an hour before her death was discovered.

1998, the family of the late Russell U. Schell files a wrongful death suit against the Other Side nightclub in Fitchburg, Massachusetts, after Schell chokes to death on a miniature plastic penis in his cocktail. 2005, Reverend Kyle Lake, 33, reaches for a standing in a pool, used for a Sunday morning baptism in Waco, Texas, and is electrocuted. Pastor Ben Dudley tells the press, at first there was definitely confusion just because everyone was trying to figure out what was going on, but then everyone just immediately started praying.

Please go to our webpage for this week's recipe for Ann's Famous Buns, uh, sorry, cinnamon rolls, and additional resources for this program. Everyone Dies is offered at no cost, but is not free to produce. Please contribute what you can.

Your tax-deductible gift will go directly to supporting our non-profit journalism so that we can remain accessible to everyone. You can also donate at www.everyonedies.org, that's every, the number one, dies.org, or at our site on Patreon, www.patreon.com, and search for Everyone Dies. Marianne? Thanks, Charlie.

Have you seen A Man on the Inside with Ted Danson on Netflix? Uh, not the, not all of it, Marianne. I saw the first episode and I haven't seen anything else. Oh, well, I thought it was, I thought it was good.

I mean, you know, it was not must-see TV, but I thought it was good. So Danson goes into an assisted living facility in San Francisco to solve a case of missing jewelry. What this show does do is a great job of showing a beautiful environment and realistic friendships between the residents.

It kind of leaves you with the feeling that it would really be nice to not have to think about maintaining the structure of your home and not having to grocery shop and hang out, play cards with people. So assisted living started more than 80 years ago, evolving in response to the adult's needs for supportive care, but not ongoing nursing care, and to states for nursing homes and older models of congregate care. In the United States, they range in size from four to 581 beds, with the average being about 35.

How do you know when a time has come to consider leaving the work of home ownership and choosing a change to assisted living? Caro, now this was interesting to me and probably not to anybody else, but when I was doing this research, I found this study by Frank Caro, who was my dissertation chair at the University of Massachusetts. So I was nostalgic to see his name. So Caro and colleagues conducted a study looking at the factors that go into the decision of moving to assisted living and documented that functional status, features of the current housing, social networks, amenities of the retirement communities themselves, and financial considerations were the variables that affect decisions to relocate to a retirement community.

They also noticed that functional status of the person who was moving had the greatest impact, where financial considerations were the least, and adult children were more likely to recommend moves than were the older people themselves. So you can think about the decisions or the reasons to decide to move as either pushing or pulling factors. Pushing factors include your own or your spouse's failing health, wanting to get rid of responsibilities, or not having the help that you need, and loneliness.

Pulling factors are the location of where your family is and they may be far from where you are, familiarity and reputation of the facility you are considering, security of where you are living now, and wanting to join friends in a community where they live. Of course there can be both pushing and pulling factors which overlap and constitute the reason for moving. Some specific factors to look at might not be apparent to the elder themselves, such as poor personal hygiene, either because of forgetting to shower, not being able to get in and out of the shower, forgetting to change clothes, not brushing hair and teeth.

These may be signs that help is needed. Or not taking care of the home, not cleaning or emptying the fridge can be signs that there's an issue with nutrition. Memory loss, having difficulty keeping track of paying bills, not make it to the bathroom on time tells you that there could be something wrong medically.

So we have a choice to be proactive in a move and if we do, we have primary control over what happens. We can always wait until our situation becomes so dire that we are either compliant or passive resistant in the move. These last two are more difficult because we have less control and ownership over the process.

The decision to move involves weighing and balancing gains and losses to go to where the help is. When you decide it's time to move and you set out to select your new home, the most influential factors for both elders and their family members are quality, cost and location. When you think about quality, there are a variety of factors to consider including the quality of the care, the quality of the life you're going to have, the physical environment and residential rights.

This place will be your new home, so you have to ask yourself what you want and need from a home. We put a table in the show notes to help you consider the various dimensions of home, which include factors like personal control, financial investment, familiar setting, a center for daily life, housing type, privacy and refuge. Money is also a consideration.

Assisted living is expensive. The only source of insurance covering assisted living is long-term care insurance, but the proportion of older Americans covered by such insurance remains small. Virtually all states cover some nursing home care service costs through Medicaid, but access is often limited due to waiting lists and insufficient funds.

How much the state pays ranges from less than two thousand dollars in North Dakota to more than a hundred thousand in Pennsylvania. Investors and operators have largely focused on the senior market at the upper end of the income distribution, so if that's where you are, you're going to have a lot of choices. But the fastest segment of the population that needs these services are middle-income seniors whose financial resources are projected to be below expected annual assisted living costs, so their choices are very limited.

When you find one you like, ask yourself if you can afford it. Many places focus on older adults with at least 62,000 in annual income, and at times they will include children's agreed financial support, which is needed to afford assisted living and health-related expenses. Different places offer different services.

Make sure you know what services are offered and if they're the ones that you need. Look at the staffing ratio and does it fit with the care that you need? Find out under what conditions you're asked to leave. Is it because if you lose your money or you move to a different level of care? What about increased health needs? Is the facility part of a chain or privately owned? And this has issues related to staffing and quality.

You have to visit. Look at the rooms available. How does it smell? Do you like the decor? Is it cleaned and well-maintained? Have a meal or participate in activity.

This will be your new home, just like buying a house. So ask yourself, how does it feel? Can you see yourself living there with the people and staff around you? It's also better to start early so you have time to visit multiple facilities. Ask questions and look at your finances.

It's suggested that you go to at least six facilities so you have a range of choices. If you wait for a decline in your health, it may be harder to get around to visits or feel like you have to take just what's available. Some may have long waiting lists, so if you find one you like but aren't exactly ready to move, being on the list is a really good start.

One of the hardest things is making the decision to take the step. Then it's what to do with all the stuff you have. The sooner you start your search, the better your outcome will be.

If you're forced to make a rushed decision, you won't have time to ask as many questions and compare multiple properties. If you want to compare multiple facilities before selecting one, that can be difficult to accomplish when there's urgency around making the move because of a rapid decline in health. Charlie, thoughts? I hate these conversations.

Only because, I mean, the thought of getting older and needing a place like this doesn't appeal to me. That being said, no, because, well, I mean, I've thought about it for myself, but I mean, I live in New York now. I don't see myself dying in New York.

I'll leave at some point. And you'd leave and go where? Like back to with your sister? Well, that's the thing. I'm not sure.

Yeah, maybe go back where my siblings live. Maybe California. I don't know.

I don't know. You know, it's good though. It's good to maybe dedicate some time when you're walking or something to envision what you might want and how you might know when it's time to do that.

Well, are you going to still be able to get around New York? Are you still going to be able to get up and down the stairs to go on the subway? Oh, I see what you're saying. It might be, that's the time that you might need in a situation to move. Yeah, stuff like that, I'm not, I see what you're saying now.

Stuff like that, I don't worry about. I got that figured out. But just, yeah, long term, yeah, I need to start thinking about that.

Yeah, I don't know. I don't know if I will stay here. I mean, there are different places to where I put my name on, as you said, like on waiting lists.

But as you can imagine, this being New York, those waiting lists are really, really long. Well, and the thing with the waiting list with these kinds of things is that they'll start going through the list. Let's say they get a room and the first five people say, no, I'm not ready for that.

And then number six has already moved someplace. You can, sometimes you can fly through that list and suddenly your name gets called and it's like, geez, I thought there were 300 people ahead of me, but for whatever reason, there's not. And now you're being asked to say, you know, they'll say, well, we'll hold it for 24 hours or 10 minutes, depending on what they're doing, you know? Yeah, I've, yeah.

Just plant in the seed, Charles. No, no, that's fine. Yeah, when it, yeah, but everything is about preparation.

But it's just that, it is inevitable. I mean, I'm sure at some point, for example, I might just fall. Yeah, especially in New York where, yeah.

Many of them are, are, are uneven, are uneven. And while I'm careful, you know, who knows? Stuff happens. Okay, more fun.

Stuff to be looking forward to. In our third half, starting the conversation, in our third half, starting the conversation about moving to get additional support with your aging parents can be emotional and uncomfortable. But here are some suggestions that may make things go a little easier.

One, if you have brothers and sisters, be sure to talk with them first to see if you all agree that it's time to have the senior care discussion. Settle any differences of opinion among yourselves before you speak to your loved one. Presenting a united viewpoint is important before having this conversation.

You don't need the family dynamics of one sibling disagreeing with you as you discuss a sensitive issue with your parents. Two, when you or your siblings meet with your parents, you can start by saying you've noticed that they seem to be having a harder time taking care of things and that you want to help. Ask them how they see themselves needing help.

Work with them to determine exactly what kind of help they want and which type of setting would best meet their needs. Three, know what options are available in the area. There is information in the show notes about the different types of places that are available and what they offer.

Four, don't wait for a medical or other emergency to force you to address the issue. It's much harder to make good decisions in a moment of crisis. Stalling is not helpful because you never know when an aging loved one may need help and you don't want to have to take a less desirable option because the facility they really want is full.

Five, accentuate the positives of moving into senior living. For example, not having to mow the grass or clean the gutters, grocery shop and cook, the opportunity to socialize with other people and participate in activities if they want to or read a book alone in their room. Six, if your loved one isn't ready to face the need for more care, don't push it.

Suggest that you revisit the topic another time. Suggest that you check back in on the subject in a few months to see if their needs and wishes have changed. Often this is not a one and done type of conversation.

Be gentle and respectful of what they want. They may need time to consider the reality that their needs are changing and need to know that you are willing to help them find a workable solution. And with that, please stay tuned to the continuing saga of Everyone Dies.

And thank you for listening. This is Charlie Navarrete and from Evelyn on the television series Two and a Half Men, I think God gives us children so death will come as such a disappointment. And I'm Marianne Matzo and we'll see you next week.

Remember, every day is a gift. And that wraps up this special episode as part of Podcastthon. Feel free to visit www.podcastthon.org to discover hundreds of other associations through the voices and talents of amazing podcasters.

This podcast does not provide medical advice. All discussion on this podcast, such as treatments, dosages, outcomes, charts, patient profiles, advice, messages, and any other discussion are for informational purposes only and are not a substitute for professional medical advice or treatment. Always seek the advice of your primary care practitioner or other qualified health providers with any questions that you may have regarding your health.

Never disregard professional medical advice or delay in seeking it because of something you have heard from this podcast. If you think you may have a medical emergency, call your doctor or 911 immediately. Everyone Dies does not recommend or endorse any specific tests, practitioners, products, procedures, opinions, or other information that may be mentioned in this podcast.

Reliance on any information provided in this podcast by persons appearing on this podcast at the invitation of Everyone Dies or by other members is solely at your own risk.