Expert Spotlight: Dr. Jim McCabe on How to Plan Senior Housing for Aging Parents

One of the most difficult decisions for families as a parent ages is the question of staying at home versus a more structured institutional environment. For the senior, the goal is to age in place on one’s own terms in a place that is familiar – that is “home”. For an adult child, often the focus is on safety and managing care needs. This situation sets up a conflict between the ingrained “wants” of the senior and the perceived “needs” of the concerned child.

In most cases the dilemma presents itself suddenly. A fall at home, competency concerns, or as a result of a family get together where relatives realize that “things just aren’t right”.

Understanding the Process
For many families this is foreign ground. While everyone has awareness that aging presents it owns challenges, acknowledging things in a frank and open discussion rarely happens. In my experience, the key to addressing concerns of home safety and aging in place involves three steps: starting the conversation, getting to some consensus about what the “its” are, and developing an awareness of the options that are available.

Managing the Conversation
Family history has a lot to do with how this stage goes. If this is a new exercise for a family, it will be difficult and oftentimes end in conflict. Seniors becomes defensive and distant as a result of the perception that their child is attempting to take over and make decisions for them. At the same time, the adult child is frustrated and angry because they “are just trying to help and dad is being uncooperative”.

In these cases, a third party might be useful (see resources at the end of this article). An objective third party may be able to dispel the emotion of the situation and get the conversation started in a way that both parties feel heard and create the potential for some degree of consensus and compromise.

Understanding the “its”
The irony of elder care giving is the conflicting behaviors that are embedded in the experience. The elder parent is struggling to maintain control of his life and environment at the very time when a personal or health care issue requires outside help. And the more help that is needed the more he resists. For the adult child, it is this very resistance that creates a resentment that oftentimes boils over and leaves them both at an impasse.

In an ideal situation, a conversation has been started in the past where the adult child has posed this question to a parent, “If a health issue came up for you and you needed help, what would you want done?”
This question is a great entry into the discussion about choices and options when the current situation is not ideal. And in many cases this offers the senior and the adult child the opportunity to understand one another’s “wants” and “needs” that are at the heart of most situations.

Senior Housing Options
The senior housing options in this country are numerous and varied. Choice is often driven by four factors: level of care need, cost, location, and desire for amenities. It is important to know up front that very few of these options are covered by Medicare or private insurance so cost can be an issue when considering options for care.

Independent living options include: senior apartments, continuing care retirement settings and retirement communities like the Sun Cities model in various parts of the country. The continuing care retirement settings combine all levels of care onto one campus. An entry fee is often required but all levels of care are available when the need arises which eliminates the need for relocation if and when a person health begins to fail.

Assisted living and residential care are environments where personalized supportive services are available for individuals needing assistance with some activities of daily living. Nursing and rehabilitation care are environments designed to provide care for complex and serious medical problems.

The non-institutional home-based options include adult day care, custodial home care, private duty nursing, and hospice care for individuals with a terminal illness.

Resources
Understanding the options for senior housing can be time consuming and frustrating. Many family members will call me and say “Jim, I don’t even know what questions to ask!” And, as is often the case, in a situation where a crisis has occurred, time can be of the essence.

There are a number or valuable resources to consider for helping you in your planning.

Geriatric Care Managers – Individuals who work extensively with families to manage the challenges of eldercare. These folks have a good sense of resources in the community and can assist you in understanding what your options are. www.caremanager.org

Placement Specialists – Professionals who work specifically in the area of assisting families to identify and evaluate living options for seniors

Senior Move Managers – Specialists who assist seniors in the process of downsizing and relocating to that next living situation www.nasmm.com

New Lifestyles – An excellent publication that lists housing options for seniors in locations all over the country www.NewLifestyles.com

Dr. Jim McCabe is the President of Eldercare Resources, a planning firm that specializes in working with elderly clients and their families in managing health and long-term care issues. He has offices in Scottsdale, AZ and Los Altos, CA. He can be reached at 800-588-6088 or jmeldercare@yahoo.com. His web site is www.EldercareResources.biz.