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The transition toward living with assistance -- beginning the process

By Arlene Klernow
This article originally appeared in Elder Caregiving: An Exploration, a special edition of New Jersey Jewish News.

For older adults and their adult children, the process of transitioning the older adult from an independent living to a more assisted-living situation can be difficult, to say the least. It is often physically, emotionally and financially overwhelming.

When is the right time to make the change? What is the right setting? What supports are necessary, and where do you find them? How much does it cost? How can we begin to talk about such things?

Whether the decision is for extra support in the home or moving the older adult to a whole new environment, the entire process is most successfully navigated with four key elements -- communication, readiness of the older adult, thorough research and outside professional support.

It is never too early to begin talking about, and planning for, a transition from independent to a form of assisted living. Communication between all the individuals involved -- the older adult, his or her spouse and the adult children -- makes the entire process less threatening and easier to accept.

Knowing what the older adult would want well before a crisis situation arises makes for a smoother, easier decision-making process down the road. Talking about "where would you want to go if..." and "how would you want to handle it when..." ensures that decisions can be made with the older adult's true intentions and desires in mind.

When the communication process is begun early, there is adequate time to research all the options and to accept the idea of change and the necessity of support.

Key steps can be taken to ensure that the transition process reflects the wishes of the older adult. Documents such as a power of attorney and a living will should be drawn up. Financial planning should be done. Long-term health insurance should be investigated and decisions about the size and location of the home should be made. It is important to discuss details such as stairs in the home and the distance from family members, as well as other possible living arrangements.

But what if that communication and planning process was never begun? What if there has been little, if any, discussion about the topic? How does one know when it is the right time to step in and begin making changes?

The most obvious indicators for change are related to safety. If the older adult is falling, leaving the gas burner on, not eating well, looking haggard and unable to care for himself or herself because of poor sight, lack of mobility or desire, it is important to make changes in the living situation.

When the older adult is expending all of his or her time and energy in order to just do the basics and life has become drudgery, it may also be time to make changes in the living situation. When the current level or quality of outside support is no longer enough, it is time to act.

Informed, intelligent, appropriate decisions can only be made after thorough research has been conducted. Depending upon the needs of the individual, it may be necessary to research the following:

Types of equipment that are available for use in the home;
Support and assistance that can be provided by medical and non-medical aids;
Day programs for older adults through the community;
The variety of residential facilities and the different levels of service they provide;
The costs of each of these services and the entitlement programs available.

One of the simplest ways to begin the research process is to call the Department of Aging. Every county has such an office. It serves as a clearinghouse for elder care services. One phone call to the New Jersey EASE Program will also put a family in contact with a caseworker who can give you general information about entitlement programs.

If a medical condition necessitates a transition, the individual's physician and the medical institutions involved can also provide information about available services. Discharge planners and hospital social workers can give referrals for a wide variety of home?health services.

Local nonprofit organizations, such as Jewish Family Service of MetroWest and Jewish Family Service of Central New Jersey, can also provide the expertise and support systems to walk a family through the entire transition process. Social workers can assess the home environment, determine the older adult's needs, and assist all the family members in making the necessary changes.

And last, word of mouth can be a very valuable research tool in determining which facilities, organizations, and individuals have enabled other families to work through the transition process with the greatest ease.

The conflicts or relationship difficulties a family typically experiences are sure to be exacerbated by the challenges of the transition process. Throughout the process, the issues of boundaries and relationships continue to come up. Emotions can run high, and the transition process can most certainly be a traumatic one. Issues of loss and coming to grips with the aging process not only affect the older adult but also the adult child. Without support and sometimes the proper medication, bereavement over the many losses involved can turn into depression.

Often the professional support of an expert in older adult services can be a crucial key to easing an entire family through the difficult transition from independent living to assisted living for the older adult.

Arlene Klemow is a public relations consultant for Jewish Family Service of MetroWest.

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