Having the conversation about a move to assisted living before a health emergency occurs can afford you and your loved one the opportunity to methodically discuss plans to tackle a host of issues, like downsizing and getting rid of extra possessions, figuring out finances and gathering medical records.
A family crisis set the stage for Melissa Bovenkamp’s conversation with her elderly mother about the idea of moving into an assisted living facility.
Neal Tunison, Bovenkamp’s father, had been experiencing problems with his balance for months when he underwent successful back surgery in March 2005. Following the procedure, Neal, then in his late 70s, went into a series of rehabilitation centers. Something went wrong at one of the facilities, a snafu that undid the successful procedure, Bovenkamp says. Rather than recuperating and regaining his balance, Neal ended up confined to a wheelchair, unable to walk. Returning to the condominium where Neal had lived with his wife, Pauline, for 10 years wasn’t an option; the condo would’ve needed thousands of dollars worth of modifications to make it wheelchair accessible. Besides, Neal needed full-time skilled nursing care.
Bovenkamp got her father into the skilled nursing facility at Providence Mount St. Vincent in Seattle, where she and her parents lived. She was confident about the care her father would receive there, but she worried how her mother would fare without her longtime spouse. For more than five decades, Pauline had relied on Neal to drive her when she needed to run an errand, and he was also in charge of the household finances. Bovenkamp helped her mom as much as she could, but she couldn’t be with her all the time. It was time, Bovenkamp decided, to talk to her mom about the idea of moving out of her condo and into an assisted living community.
She knew the discussion would be emotional. Bovenkamp worried about how her mom, who was still mentally sharp, would react to the idea of losing a measure of independence. But the situation was dire, so she went with the direct approach. “I just had to be very realistic with her about her situation,” she says. “She doesn’t drive. I asked her, ‘Who would take you to the grocery store? To get your hair done? To see him?'” Bovenkamp says. “At that point, [assisted living] was kind of the only option.”
Fortunately for Bovenkamp, Providence Mount St. Vincent — also known as “The Mount” — also has an assisted living facility. It includes apartments of various sizes, a cafeteria and programs that encourage residents to socialize through different activities, like playing bingo and group exercise classes. If she moved into The Mount’s assisted living center, Bovenkamp explained to her mother, she couldn’t live with her husband again, but they could see each other every day. She could also socialize as much, or as little, as she wanted with people her own age. Pauline agreed to the move. Before Neal died in 2010, he and Pauline would meet daily in The Mount’s chapel. Neal would spend the day in Pauline’s apartment and share meals with her until it was time for him to go back to skilled nursing in the evening, Bovenkamp says. Though she was initially anxious about moving into assisted living, Pauline eventually adjusted, and today, at age 91, The Mount is her home and she enjoys being part of its community, Bovenkamp says.
Bovenkamp says her father’s presence at The Mount made it easier for her to talk to her mom about moving into an assisted living facility. Most people who face the prospect of talking to an aging parent or other loved one about the idea, of course, won’t be in those specific circumstances. Some will be grappling with chronic conditions like depression, diabetes or heart disease. Some must maintain a regimen of prescription medication. “There isn’t a ‘one-size-fits-all’ approach to starting the conversation of moving into assisted living,” says Jennifer DiOrio, assisted living director at Glenmere at Cloverwood Senior Living, an assisted living facility in Rochester, New York. Glenmere is part of Friendly Senior Living, which has five facilities in New York state that offer a variety of senior community living options. Glenmere also offers enhanced assisted living, respite care and memory care. Cloverwood Senior Living, a separate independent living facility, is located in Pittsford, New York. “We are essentially asking people to live their private life in a public space. For someone who may have lived in their home for more than 60 years, this can be a very scary prospect. The best way to approach this conversation is with empathy, validation and love.”
While there’s no playbook for how to talk to a loved one about the idea of moving into an assisted living facility, experts recommend these five strategies:
Have the discussion as early as possible, preferably before a health crisis strikes. Having the conversation before a health emergency occurs can afford you and your loved one the opportunity to methodically discuss plans to tackle a host of issues, like downsizing and getting rid of extra possessions, figuring out finances and gathering medical records, says Rani E. Snyder, program director at The John A. Hartford Foundation. The foundation disburses grants to groups that work in the areas of supporting family caregiving and age-friendly health systems and that provide assistance for people facing serious illness and end-of-life issues. “Your loved one’s wishes will be respected if you have a plan in place,” Snyder says. If a medical emergency arises, whether it’s from a fall or from complications related to a chronic health problem, you or another family member may have to make a series of important medical and financial decisions. If those decisions are made relatively quickly in the middle of a crisis, they may or may not align with your loved one’s wishes.
Look for an organic window of opportunity. Rather than bringing up the idea of transitioning to assisted living seemingly out of nowhere, look for a natural opportunity to raise the idea, says Mark Friedman, owner of Senior Helpers Boston & South Shore, a senior home care agency in the Boston area. For example, say your mother falls and sustains minor to moderate injuries that don’t require hospitalization. This situation would be a good time to explain that you can’t respond to such events every time, particularly if you don’t live nearby and have kids of your own, Friedman says. “Speaking to a loved one about their need for assisted living doesn’t have to be a difficult conversation,” Friedman says. “Especially if you’re sparking the conversation after a minor event like a non-major fall or time when you were unable to provide the immediate support your loved one needed. I tell our Senior Helpers clients, who often are the children of baby boomers, [that] this conversation is about reconciling expectations. Your parent’s needs have to be reliably met. If you live far away or work full-time, explain why a change like an assisted living community should at least be considered and looked at together.”
Listen carefully to your loved one’s concerns. Don’t try to minimize your loved one’s anxieties about the prospect of making the transition from being on his or her own to moving into an assisted living facility. “It’s very important to acknowledge and offer understanding that your loved one is fearful about the life change of moving into an assisted living community, and to offer understanding about [his or her] trepidation,” DiOrio says. Rather than putting forth a sales pitch, listen and ask lots of questions, advises Teri Dreher, president of NShore Patient Advocates, LLC in Chicago. This approach makes it clear that you want to follow your loved one’s wishes.
Don’t issue orders. Keep in mind, unless he or she is mentally incapacitated, your loved one gets to decide where and how to live. Issuing orders or ultimatums attacks your loved one’s sense of agency and could make him or her feel dishonored and defensive. “Legally and ethically, it’s their life and they get to choose,” Dreher says. “You should deal with your family in a loving way, and that’s not a loving thing to do.”
Let your loved one see what assisted living looks like. Ask if he or she is willing to tour assisted living facilities, DiOrio says. “Use the [assisted living] staff as a resource to help families with these difficult conversations,” she says. “We should be a partner in the process and help foster a sense of ‘connectedness.'” Visiting an assisted living community could ease some of your loved one’s anxieties.
Keep in mind the discussion may be a process, not an event. Your loved one may need multiple conversations to reach a decision, and that’s OK, given the stakes, Snyder says. “Most people prefer to age in place,” she says. “However, we can [and] should try to ease their transitions [from home to assisted living]. That may mean a series of conversations, not a single talk.”