Although frequent visits are very important, you must also have continuous involvement. One way to stay involved is to join the facility’s family council, if there is one in place. If not, you might suggest forming one.

Family councils normally meet once a month in the facility to discuss issues of interest and concern. Council meetings provide an opportunity for family members to raise questions related to care with facility management. Family councils may also organize special events for residents, or generally work together to improve communications between staff and family with the ultimate goal of enhancing resident quality of life.

Also, the family council is allowed to organize letter-writing campaigns to legislators when there is a bill of concern to nursing facility residents before Congress or state legislatures.

Many can take for granted the fact that they live by themselves, whether the person is older or not. Many people move out of their parents’ house and move into an ―independent lifestyle‖ at some point in their lives. To most seniors, ―independently‖, means living in one’s own home, whether it is with or without financial support. Most of the time seniors will receive financial assistance from the children or others and there may even be an arrangement for a child or hired aid to help 2-3 days a week for 4 hours a day with chores, etc. In some cases, a live-in child or aid is necessary to assist with daily living activities. Regardless, the senior is given a feeling of control by living in his or her home, whether the home is a house in a retirement community, or any other home. They do not live in a room in the children’s home or in a community where the senior is expected to follow rules that affect basic choices, such as decisions about food, pets, transportation, relationships, and conjugal visits.

An assisted living facility can be defined as ―a form of housing arrangement that provides some assistance with activities of daily living.‖ In a broader sense it would be a group housing community with additional services, or more specifically, a facility that provides housing, and some level of personal care. The major difference is that the help with activities of daily living (ADL) occurs at the ―facility,‖ which can cause any senior to be scared. The term facility signifies a controlled environment. The Assisted Living Federation of America, a facility can cover a wide range of settings, care offerings, and residences. It could be anything from convenient high-rise apartments to converted Victorian homes, to campus communities with all the charms of a small town. The size of a residence can range form 25 to 120 units and can differ in size from a single room to a full apartment. All assisted living facilities are the same in that the resident is sacrificing his or her ―independent‖ living and some independence, in exchange for readily accessible assistance with daily activities. Even though this can help friends and family to be more comfortable with the senior’s location and well-being, it can be devastating for an elder.

In comparison to the fairly recent advent of assisted living facilities, nursing homes have existed in the United States from the early 1900’s when most states sent their impoverished citizens to poor farms or almshouses. Therefore, it is not out of the ordinary for a senior to view the idea of being put into a nursing home as negative.

Living arrangements are available that will combine parts of independent living, assisted living and nursing homes. Continuing care retirement communities represent a structure that offers varying levels of support, which can range from a senior living in his or her own room or apartment and making most daily decisions; to assisted living where the resident receives help with daily activities; to a nursing home that provides complete assistance. The most similar characteristic of these communities is that a resident can transition across the varying levels of care without leaving the community.

Alternative housing raise different financial concerns, such as the decision to own or rent, the entrance fees and recurring monthly, quarterly, or annual fees are also of concern. The resident needs to know things like what is included in the costs charged by a facility or community, if there is a possibility for exposure to increases in costs, the role of Medicare and Medicaid and long-term care insurance and how it will benefit them, etc. Along with many more, these are some of the more important financial questions.

Medicare is a national insurance program for Social Security recipients who are at least 65 or disabled. Medicare pays for 20 days of nursing home care in full and will continue to pay a portion of the cost for the next 80 days. The resident is responsible for a copayment, which is currently at about $128.00 per day for days 21 through 100 each benefit period. On the other hand, there is Medicaid, which is a joint federal and state program and is the only public program available to pay for long-term nursing home care.

When trying to decide if to move a senior into alternative housing, all costs should be considered and can vary significantly. Covering these costs can be difficult and may need to be generated from various sources. Eligibility for Medicaid is a difficult question and it is recommended that one consult with professionals experienced in Medicaid law. Individuals have the option of looking into personal assets such as their home, which can be sold or rented out. They may also consider securing a home equity loan or reverse mortgage. Long-term care insurance, if owned, could be a major source of funding. Life insurance can provide funds by the owner cancelling a policy with cash surrender value, borrowing against the insurance policy, tapping into accelerated death benefits, or selling the policy. Deferred annuities that may be owned might be accessible early with no penalty. A disability insurance policy may be exchangeable for a long-term care insurance policy.

When discussing alternative housing arrangements, it is important to consider how capable the senior is of performing daily activities. Activities that should be considered usually include bathing, dressing, moving and feeding oneself. Most of the time, it is obvious when a person is fully capable and totally incapable of taking care of themselves, however, what becomes questionable is the area between being completely capable or incapable. The best person to make this call may be a physician, occupational therapist or social worker, and, they may make the decision individually or in conjunction with each other. However, even their evaluation may be challenged, especially by the individual being judged.

While attempting to determine if a senior is able to perform daily activities, some good evaluation tools are the Dependency Scale and the Barthel Activities of Daily Living Index (Barthel Index) (Refer to rating scales in following pages). The Barthel Activities of Daily Living Index is highly recommended; however there have been some uncertainties about the reliability when it is used on the elderly. The Barthel Index addresses ten items – eating, bathing, grooming, dressing, bowels, bladder, toilet use, transfers from the bed to the chair and back, mobility, on level surfaces and stairs. There is a score that goes with each response and there are ranges set based on those scores to determine the independence of each person. For example, 80-100 is the independence range for men.

There are some objective guidelines to assist physicians and others in making a decision; however, there is also a lot of subjectivity and professional judgment involved. In addition to evaluating a senior’s ability to perform daily activities, judgment has to be used to assess a senior’s cognitive impairment or other mental issues. Something to consider is if children are able to determine a parent’s ability to perform activities of daily living. A major concern is the senior’s assessment, assuming that they are of sound mind to do so, which is another judgment that needs to be made. A common question is how to determine if a senior is of sound mind. Many turn to lawyers and judges, but who is to say that they are able to determine how much assistance is needed.

Falls can drastically change many people’s lives. It is usually a time when change is inevitable. The senior can go living independently and performing daily activities alone or with the limited assistance, to needing a walker and not being able to dress themselves, etc.

Accepting one’s limitations as you get older is a very difficult thing to accept, and in many cases can cause people to go through the often talked about, stages of grieving. Those stages include denial, anger, bargaining, depression, and acceptance. It is not unlikely that these stages apply, especially the denial, depression, and anger stages, and mourning the loss of control and independence brought on by age, etc.

A son/daughter assisting in the making of decisions is not an uncommon, and can tend to be a very difficult process. It is especially difficult when the child has the power of attorney to make a choice. At this point, it is their responsibility to make a decision in the best interest of the parent and to select an arrangement that will provide the safest and most comfortable setting for the parent. The same attitude is usually used when they do not have the legal right to make a decision and the problem becomes convincing the senior to make the same choice, which especially difficult when the senior may be the only one legally empowered to make that choice.

It is for all parties, especially the children, to be supportive and acknowledge the issues that the parent may be experiencing. The parent may be angry, depressed, and may even be having suicidal thoughts. The child should consider recruiting trusted professionals, including the senior’s physicians, occupational and physical therapists, social workers, and psychologists who can meet with the senior individually and/or jointly. Family members and friends could play a role by presenting a consistent stream of recommendations that basically conclude that the time has come for the senior to consider alternatives to the type of independent living that he or she has grown accustomed to, then there is a strong likelihood that change will be easier to make and it will ultimately be the senior’s decision. It is important to focus on the advantages of a continuing care retirement community, assisted living or a nursing home. Provide the senior with options, such as a temporary arrangement where the senior is able to try a community or facility or home before making an official commitment.