Assisted Living, Part II

(This is a continuation of a previous post, Assisted Living Part I).

If your parent is going IN to assisted living right now/today/really really soon

1. Take a copy of your parents living will and any instruction they gave you about how they want things to be. Take your power of attorney with you. You’re going to need it. let the facility scan it, or make a copy of it, but keep the original.
2. You’re going to sit down with an intake nurse and probably another specialist – one for the business end, and one for the medical end. Watch what they write like a hawk. Remember that “no feeding tubes” story? Yeah that’s a thing.
3. Be super-clear on expectations:
   1. If they’re doing your parents laundry, make sure everything is labeled, and inventoried.
   2. If you’re doing it, make sure it is clear where dirty laundry goes (it helps to provide the hamper if you can) and how often you’ll be coming to get it, as well as where the clean laundry goes.
   3. If your parent has instructions that they only want to eat dessert if that’s what they ask for, make sure the nurse (and the kitchen) is clear on that. (Mom pretty much ate just egg salad sandwiches and then just dessert and then opted out.)
   4. If your parent has instructions that if they don’t want to do PT they don’t have to, make sure that the nurse (and the PT) is clear on that.
   5. If your parent has instructions that hygiene is important to them, make sure that the nurse (and the bather) is clear on that.
4. If your parent has any cajoling tricks you can use with them if they are reticent, like TV time, or getting to use their own conditioner, etc. etc. , let the right folks know! The “right folks” are the head nurse, the person who cleans the rooms, the person who delivers the food, the person who bathes your parent, etc. — in short, *everybody*.
5. If folks with long hair have specific rules (e.g., please use lots of de-tangler/conditioner, please braid, do not use elastics) let those folks know and make sure it’s written down.
6. Bring lots of familiar stuff:
   1. Their own toiletries (including any electric conveniences like shavers, toothbrushes, etc. that the home will let you).
   2. Their own blankets, clothing, linens, etc.
   3. Paintings, pictures, albums, alarm clocks (if they’re the punctual type), puzzles, craft/hobby things
   4. Knitting needles and sewing scissors may get taken away from folks if they’re in memory care.
   5. If they are technologically savvy, a e-reader or an tablet is a great thing, too. You can load it up with books, pics, etc., and you can facetime.
      1. Most places are really good about security, but I’d also get it labeled.
   6. Some places will let them bring their credit cards and ID, but maybe quietly cancel them – or replace with a dollar-affixed debit card or pre-paid card if those are actually usable in the facility (e.g., vending machines).
   7. My mom’s window had birdfeeders outside it, so whenever I visited I filled them with birdseed.
7. Ask if you can bring outside food – bringing in a special treat on admitting day can help relieve all the newness.
8. Re-define/nail down the visiting hours, when you get to meet with the doctor, and what the next few days look like. Use the whiteboard or posting board in the room to write down the date and time you plan to visit next if you know that.

When your parent is in assisted living

1. When you visit, sneak in Starbucks gift cards for the folks who do the heavy lifting – bathers, laundry folks, food deliveries – they aren’t supposed to accept them but they will and your parent will benefit. YES, they’ll be awesome to your parent even if you don’t or they don’t accept them – but the gesture goes a long way. And you’re going to feel helpless so that can help you feel like you’re doing something. Alternatively, bring in a bakery tray or something for the nurse’s station. Or a box of candy.
2. Bring food, if your parent is eating, that they like – treats, chocolates, snacks, soda.
3. Bring things to read (if they are readers, magazines are good because new content) and share news (focus on the positive if you can). Unless they’re the type that loves good drama in which case, share the drama. 😃
4. Eyeball their care—is their bathroom clean? If they are incontinent does it smell like they need to be changed or does their room smell fresh? Ask what they got to have for dinner last night/breakfast that day, and if they liked it.
5. If your parent has doctors appointments outside of the care facility, the care facility usually sets up all of the transportation to/from the appointment, as well as the appointment itself – so if mom or dad has an optometrist, or an oncologist, or a cardiologist, etc., make sure they all know where mom or dad is going/has gone, and that they can coordinate with the care facility.

If your parent is having any major medical procedures as part of this process (surgeries)

1. Many assisted living facilities do NOT have staff on hand to support things like wound care (which you need if you’re recovering from surgery). So your parent may have to go to a different facility to recuperate. That will be one of the more expensive ones, but good news! Medicare covers 20 days of the recuperation part (including room and board) for 100% (or near enough), and then the next 80 days at 80% (near enough).
2. You should know that the medical community wants to make everyone better, either because they are that way by nature or because most medical care is for-profit by nature. But telling your parents’ doctor to knock it off, that mom or dad doesn’t need another surgery when they’re already going downhill, is hard. You need to evaluate if the thing the doctors want to do will prolong the life and what kind of life it will prolong. If your parent has written any decisions about THAT in their living will, take heed of that.
3. My mom was on hospice – which is what happens when you have six months or left to live, and offers all kinds of palliative care benefits (that are covered by Medicare, by the way) – and her doctors were insisting that with just one more surgery they could Do a Thing. We had to tell them it didn’t make sense to put her through that risk, and that pain, for dubious benefit. We asked them to honor her hospice care and keep her as comfortable as possible. “Hospice” is not a specific facility, but rather a layer of care on wherever the patient is (even if the patient is at home).

Last but not least – this whole process will be frustrating, abstruse, process-laden, and generally a pain in the ass.  Find a friend who has bandwidth and use them to vent, do NOT vent at the healthcare professionals as it won’t help you (or them).