July/August 2010 Issue
What to Consider Before the Move
The woman calling was in a panic. She had moved her father into her home but, after two weeks, had become completely frazzled about his behavior and personal needs. He stayed up all night, slept all day, and continually insisted that she take him home. I could tell from the tone in her voice and what she was telling me that taking him home was precisely what she’d like to do—if she could. She eventually shared that the reason her dad was living with her was that his neighbors at his former home several hundred miles away had called her when her father was found outside in the middle of the night, unable to find the house where he’d lived for more than 40 years.
The daughter had received similar calls during the previous several months. She knew it was time to do something about the situation. She promptly flew to her father’s aid, packed up his belongings, put the house on the market, and moved him into her own home. It took only two days for her to realize his needs were way beyond her understanding. It took another 10 days to call for help.
As adults age, they do so with a variety of aches, pains, and chronic diseases. They adapt their routines to accommodate their disabilities. For instance, when night vision becomes a problem, they stop driving at night and run their errands during the day. As the need arises, they hire help to clean the gutters, carry in the groceries, and take care of other physical activities that have become too difficult. Sometimes the adult children are unaware that the help is in place. Other times, it is the adult child who arranges the help after visiting a parent and realizing the challenges that numerous tasks present.
However, when the issue with an elder is memory related, the problem and the solution are not as readily apparent. A short phone conversation or even a quick drop-in visit may be inadequate to alert the family that a problem exists. Often, if the discussion of memory occurs at all, an older adult may admit to being forgetful and then remind the family member of his or her age. “I’m entitled to be a little forgetful, don’t you think?” an elder will ask, leaving a family member feeling guilty for even suggesting there may be a problem. So it’s no surprise that this daughter, who lived a distance from her father and visited only once or twice each year, was caught off guard and felt the need to act immediately.
Of course hindsight is always crystal clear, particularly when you realize you’ve made a mistake. In this woman’s case, she recognized the problem, was able to articulate her concerns, and recognized that she was unable to reach a solution without some help. It would have been better had she contacted a geriatric care manager (GCM) before she moved her father out of his home, but unfortunately she did not. After I spoke with her for some time on that first phone call, she felt great relief that there was a possible solution and someone to help her and her father sort out the situation—even if it was after the fact.
There are numerous issues your patients and clients need to discuss when considering moving an older adult.
Before the Move
It’s equally important to determine whether the older adult seeks or will accept a move. The degree of success in an older adult’s transition depends on his or her willingness to leave home. It’s even advisable to arrange a trial run to determine the suitability of a potential setting on a long-term basis. If the individual and the family agree on the move, the elder should visit the home or the area to which he or she is relocating for one month. It’s one thing to visit for a weekend; it’s another to stay for a month.
Another important consideration is a careful and compassionate exploration of what the older adult will be leaving behind. Are there friends, neighbors, and a church community that have been part of his or her life for many years? Are there other family members who will no longer be able to visit as often? Does the older adult have a special relationship with his or her doctor? Will a pet be left behind? A garden? Are there special pieces of furniture, pictures, memorabilia, or a car that he or she cannot bring?
Taking the proper steps to ensure an elder’s placement in an appropriate living arrangement is essential. Has there been an evaluation of the individual’s current and future needs to determine whether the new setting addresses those needs? For instance, are there stairs involved in a case where an elder can no longer climb steps?
If a crisis prompts the move, are long-term considerations being examined? Can the older adult afford the housing? If an elder is moving in with a family member, can the family take care of the elder’s continuing needs? Will there be ongoing support for the caregiver(s)?
An older adult’s major move or complete change in living arrangements may pose an ideal opportunity to examine appropriate legal concerns. Are there legal issues requiring resolution (eg, durable power of attorney and durable power of attorney for healthcare)? When an elder moves, will legal documents need to be reviewed and changed due to different family member responsibilities or changes in state laws?
After the Move
• It’s critical to realistically evaluate Dad’s day-to-day needs. Does the daughter know at this point what her father can do for himself? She may want to consider utilizing the professional skills of a GCM to complete a psychosocial assessment to determine his abilities, needs, fall risk, and memory deficits.
• Is making a move a short-term patch or a long-term solution? Is the daughter (or the family) in this for the long term, or is the arrangement in place only until another housing option, such as an assisted living facility, can be found? Short-term placements can be difficult particularly when there are memory deficits.
• If the dad and the daughter are both miserable, what are the best options? It all depends on what Dad’s needs are, what he left behind—is returning home with help an option? Does he require a great deal of supervision and/or care? Can the family help? Can Dad stay in his daughter’s home with help so that he’s safe, receives the necessary care, and his daughter has some respite, too?
What’s the first step the family should take? It’s advisable to contact a GCM in the daughter’s geographical area who can help sort out immediate needs vs. long-term planning. Paying for a family meeting will be well worth the family’s time and money to enlist help in determining the best solution. Part of the meeting will be used to discuss the ongoing family role, including siblings who are available to take on portions of the care responsibilities. Following the initial meeting, the family may decide to have the care manager complete a full assessment of the client’s needs to help in planning further.
The GCM can assess numerous issues related to the situation. In helping a family decide on care options, the care manager will evaluate the client’s needs; the finances available to assist with care; the support system, including both his or her previous and current environments, healthcare issues, current health insurance coverage, the client’s wishes and those of the family; and long-term goals for the older adult. The care manager will also review community resources and additional entitlements available for the elder.
Occasionally legal issues need to be addressed with respect to competency. When competency is an issue, the client’s durable power of attorney should be present at the meeting or be available by conference call. When formal placement is at issue, the client has to agree to the placement or the person with durable power of attorney must be present to sign the contract agreement.
Are you wondering what happened with this distraught daughter and her father? The daughter did indeed call a care manager who set up an initial home visit and met her dad. In talking with him in his daughter’s presence, he admitted he was glad to be closer to his daughter but expressed a desire to have more of his belongings from his old home. Although he definitely had memory issues, he was angry that she hadn’t brought his old jacket that was still hanging by the kitchen door. The GCM asked the daughter to make a list of items important to her father, and she returned to his house to retrieve them. In the meantime, the care manager was able to connect the daughter to some community resources, including home care, to help with her father’s day-to-day care. It also involved showing him around his new community, including a tour of the railroad museum.
Finally, the care manager encouraged the daughter to talk with her siblings who had encouraged the move to schedule regular phone calls to their dad and some respite time for the daughter. It would certainly have been easier if the planning had occurred first, but it didn’t. It can be more of a challenge to go in and help pick up the pieces, but it can be done to everyone’s satisfaction.
— Carol S. Heape, MSW, CMC, is a certified geriatric care manager and the executive director of Elder Options, Inc, which serves the Sacramento, CA, region.