My Mother’s  sixteen month stay at an Assisted Living facility has been tremendously impacted by staff turnover.  Every time a “new” Assisted Living Director starts we schedule a care conference to ensure that the plans for my mother are well understood and will be implemented.  However, we have found that it is not that simple… for things don’t seem to go as planned.  A recent change in Assisted Living Directors has resulted in a scarce nursing staff, laundry that does not get done, lunch that doesn’t get delivered and dishes that remain in the sink. 

The bottom line is that my Mother suffers each time staff turns over.  Caregivers suffer too, as they are concerned about lapses in care and frustrated by dealing with the same issues over and over.  It doesn’t  seem that it should be that difficult to get the laundry done….esp. when the facility is charging $5K a month. 

Turnover is a problem for everyone.   Number one – it impacts care.  Number two – it is time consuming to constantly readdress the same issues.  Number three – it can’t help but influence staff morale which can affect actions and attitudes during daily resident interactions.

Based on our experience, I would definitely ask questions about management and staff turnover when touring  Assisted Living Facilities or other senior residences.  If the number seems high, think seriously about how this will affect your parent’s care and well-being.  The most beautiful building in the world won’t make up for a breakdown in staff communication, training and service delivery.

"Caring for an older adult can be rewarding and fulfilling but can also place great physical, emotional and financial demands on those who take care of them. In fact, a recent issue of the Journal of Immunology compared Alzheimer’s caregivers to non-caregivers, finding that caregivers aged between four and eight years faster than non-caregivers. In light of these statistics, and in recognition of November as both National Alzheimer's Disease Awareness Month and National Family Caregivers Month, the American Occupational Therapy Association (AOTA) is offering tips for caring for the adult caregiver.

Research recently published in the American Journal of Geriatric Psychiatry tested an occupational therapy home intervention, the Tailored Activity Program (TAP), that systematically evaluates and tailors activities to individual capabilities and trains families in setting up and using activities in daily care. TAP reduced behaviors that trigger nursing home placement and the amount of time families spent supervising and providing care.

“Our research shows that occupational therapists play a critical role in the care of individuals with dementia and their family caregivers,” said Laura N. Gitlin, Ph.D., director of the Jefferson Center for Applied Research on Aging and Health and professor in the Department of Occupational Therapy at Thomas Jefferson University. “Occupational therapy practitioners are uniquely qualified to evaluate individual capabilities, engage individuals with dementia in activities, help families learn specific communication, task and environmental simplification strategies and to take care of themselves.”

Laurel Cargill Radley, MS, OTR, associate director of professional affairs at AOTA, adds, “Occupational therapists can help individuals and their families promote or maximize independence, safety and function.”

Occupational therapy practitioners recommend adult caregivers:

1. Join a therapy or discussion group for caregivers of older adults.
2. Share the responsibility of caring for an older adult.
3. Ask others for help.
4. Develop a schedule that distributes caregiving responsibility.
5. Consider adult daycare or home health aides to provide occasional breaks to full-time caregivers.
6. Create moments of joy throughout the day by participating in pleasurable activities.

Additional caregiver resources can be found on the Centers for Medicare&Medicaid Services’ (CMS) new Web site, http://www.medicare.gov/caregivers/.

Founded in 1917, the American Occupational Therapy Association (AOTA) represents the interests and concerns of more than 36,000 occupational therapists, assistants and students nationwide. The Association educates the public and advances the profession of occupational therapy by providing resources, setting standards including accreditations and serving as an advocate to improve health care. Based in Bethesda, Md., AOTA’s major programs and activities are directed toward promoting the professional development of its members and assuring consumer access to quality services so patients can maximize their individual potential. For more information, go to http://www.aota.org/."
This article was originally published by the American Occupational Therapy Association.

In addition to caregivers having to shoulder the work load of the growing senior population, they are also naturally more engaged in caring for aging parents than health providers for most time their parents face the challenges of aging.  

If you create a "smoothed" picture of the health challenges faced by older adults, you get a continuum like the one shown below.

Each of the "humps" corresponds to major health incidents or living circumstance changes.  In the early part of the continuum, the senior is aging at home and later may require assistive care at a retirement, assisted living, or long term care community.

The health care providers only intersect with the caregiving need at the green arrows for acute or assistive care.  The vast majority of the continuum is addressed by family caregivers who are typically not trained health professionals.  These caregivers need support tools and services to provide the best quality of life for their parents and themselves.

I have the privilege of speaking tomorrow (October 10, 2008) at the Indiana Geriatrics Society Fall Conference. My topic is:

Vision for the Future: Impact of Informatics on the Continuum of Caregiving

At the core of the material I'll be covering I want to share ideas about how technology can improve the lives of seniors and the caregivers around them. 

This in not only a desirable thing; it is a necessary thing.  By 2030 the population of seniors in the United States will be 71.5 million, more than doubling in just 30 years according the Department of Health and Human Services, Administration on Aging, (2006). 

The truth is that there are not enough senior health care professionals, continuous care retirement communities, or even professional geriatric care managers to provide complete and meaningful support for all these seniors.  Caregivers dealing with aging parents or other loved ones must have tools that do not rely exclusively on the individual people from provider community.

After the conference tomorrow, I'll share more on these ideas. 

For a complete program on the IGS Fall Conference follow this link http://iucar.iu.edu/igsfall2008.pdf

**The following post is from my guest blogger, Natalie Langley, MSW.  She is a Geriatric Care Research Analyst for SCANS (for more on SCANS, please see Eric Tinsley's blog by clicking here).**

In today’s society, we value independence… and part of that is being able to jump in our car and go where we need to go.  A major challenge for older adults who are unable to drive is feeling that they have lost some of their independence.  As times are changing, older adults’ schedules are becoming busier than before.  Whether it is picking up the grandkids, going to the doctor, beauty shop, or senior center to play cards, etc. older adults are not just sitting at home anymore.  However, older adults who are living independently and are unable to drive can still get to where they want/need to be in their community.  There are resources in our communities that do just that.  The following are some good resources that will help connect older adults to local transportation resources while still living at home.  Happy traveling! 

Area Agency on Aging office – Search by state and find the closest office nearby and contact the Area Agency on Aging to learn about transportation resources locally. (http://www.n4a.org/about-n4a/?fa=aaa-title-VI)

AARP:  State-by-State Guide to Transportation Assistance
(http://bulletin.aarp.org/yourworld/gettingaround/articles/state-by-state_guide.html)

More and more aging adults are moving in with their children or other family members, according to the U.S. Census Bureau.  Between 2000-2007, the percentage of parents moving in with their children rose 67% or 3.6 million.  There are many reasons why this might be occuring:
1.  Higher housing costs and the nation's current economic status
2.  Families are closer now than in the past
3.  Intergenerational households are increasing each year

The number of parents under the age of 65 that moved in with family grew 75%.  I recently read an article that stated 60 is the new 40.  Becoming a grandparent at a younger age is growing.  Some parents are moving in with their children to help raise and care for the grandchildren.  This concept gives the grandparent a "job" and responsibility while contributing to the family and takes away the cost of daycare.  Combining family resources is helping families and their expenses while also providing assistance, a stronger family bond, and preserving memories.

So pull out the sofa bed, clean out the guest room, or build on a small apartment cause mom may be moving in!  ECHO Housing is becoming more popular, Elder Cottage Housing Opportunity, sometimes coined "granny flats" or "mother-in-law suites".  This refers to a housing opportunity for seniors to share a separate living space on the same property or attached to a family member's home.  This concept brings parents closer to their families while also maintaining a sense of independence.  Zoning regulations do apply, so check with your local county or city zoning board.  For more information, check out ECHO Housing.

For the past year, I have been doing my Mother’s laundry.  In the beginning I did everything – sheets, towels and personal laundry.  Soon that became too much – and I made arrangements for the Assisted Living facility to wash the sheets and towels.  But, I still did my Mother’s personal laundry because she did not want other people “touching” her things.

This plan worked at first, but proved to be very time consuming.  It seemed that I was always behind on laundry. I tried putting loads in before work and drying them when I got home at night.  I tried doing multiple loads on a Saturday AM.  I tried picking it up from my Mother more frequently and doing smaller loads at a time.  I tried multi-tasking by doing laundry and paying bills in the same evening.  But the laundry was ever present and the pile seemed to grow each day, despite my best efforts to take control of a seemingly easy task.  My frustration piled up too. 

I finally accepted the fact that “doing the laundry” was a task that could easily be done by someone else.  All I had to do was convince my Mother that someone else could do it too.  First, I talked with the administrator at the Assisted Living facility.  I learned that they could do the laundry and that they did each resident’s laundry separately.   They also used the detergent provided by the family, so that the laundry did not come out with an industrial smell and feel.  Finally, I had a frank discussion with my Mother and told her that I was having a difficult time finding the time to do her laundry and tote it back and forth.  I suggested that we “try” having her clothes washed on site.

Thankfully, she agreed and so far so good.  I have been “laundry-free” for two weeks.  I cannot begin to describe how getting rid of this chore has improved my caregiving outlook.  My Mother has adjusted very well to the new arrangement.

My advice to all caregivers is to evaluate the many tasks on your plate and try to find ones that can be done by others.  Whether it is laundry, grocery shopping or driving a parent to a weekly physical therapy appointment – enlist or hire someone else to assist with these tasks.  You will be so glad you did.  You will be better able to face the next caregiving challenge because your reserve of time and patience has not been depleted by routine tasks.

According to a recent study, more than 1/2 of those providing care to an aging adult experience some form of stress and strain.  This amount of stress can negatively affect your physical health, your emotional health and well-being, and your ability to provide care.  Taking care of yourself, taking breaks when needed, and utilizing the help of others is very important!  Some caregivers have been taking care of "mom" for years and oftentimes other family members forget how hard the caregiver is working, because it just becomes second-nature that you take care of mom.  I would like to take the time to say THANK YOU and shower all caregivers with applause and praise for their tremendous hardwork for being a caregiver of another person while still maintaining their own lives, jobs, children, etc. 

I love greeting cards, and I tend to spend quite a bit of time finding that right card for that right person.  A friend recently found a Caregiver Support greeting card, made by Carlton Cards...but only 1 card in a store full of every other kind of greeting cards, doesn't seem quite right.  However, the card reads, "The dedication and strength it takes to care the way you do is truly amazing.  It's hard giving so much of yourself, and yet you do so generously and lovingly.  You have a beautiful, caring heart - and you're doing a truly incredible job.  Hope you know what a difference you're making.  Hope you know how wonderful you are."
THANK YOU FOR BEING A CAREGIVER!

We are constantly hearing certain buzz words in eldercare: aging in place, healthy aging, senior healthcare, wellness, and senior well-being.  How do we truly age in place and take care of our senior health needs in our current healthcare system?  One should become aware of the truths about aging versus the myths that are out there.  One should also help health care providers to promote wellness and independent function by asking them questions and having periodic overall health assessments. 

Do you know – Is this TRUE or a MYTH?

Most older adults are sick. 

MYTH!  Most older adults (78% of 65+) are healthy and engaged in normal activities.


If you are old, you are sick. 

MYTH!  Only 23% of older adults claim to have a disability.  85% of the debilitating diseases are from cancer, coronary artery disease, stroke, diabetes, kidney failure, obstructive lung disease, pneumonia, and flu. Remember  -- Chronic illness does not translate into functional inability.


Older adults have more chronic diseases than younger persons, but fewer acute illnesses.  

TRUE!  Older adults have more chronic diseases than younger persons, but fewer acute illnesses.  There are 102 acute illnesses reported per 100 people over 65 and 230 acute illness per 100 people under the age of 65.   85% of the debilitating diseases are from cancer, coronary artery disease, stroke, diabetes, kidney failure, obstructive lung disease, pneumonia, and flu.


Your body systems are affected by age.

MYTH!  Body systems such as your heart and lungs are minimally affected by age but PROFOUNDLY influenced by lifestyle behaviors such as cigarette smoking, physical activity,  what you eat, and sometimes if you have enough resources to access the care you need.

What should the older adult expect?  The older adult can expect to lose 2 inches of height by age 80, which can lead to changes in posture and our feet - which could affect our balance and create a potential fall risk.  Another fact is that the body cannot regulate its temperature as it did when one was younger, so an older adult needs to be aware of exposure both cold and heat.  If the temperature outside is high, the older adult is at risk for heat stroke.  

The most important item for an older adult to remember?  A health assessment promoting wellness and independent function is a must.  Remember that health care needs to be individualized… and that the body can remain healthy as one ages. Although our organs may gradually lose some function, a senior may not even notice these changes except during periods of great exertion or stress.
Today, there are more than 4 million Americans 85 and older. That number is expected to grow almost 5 times by the year 2050.  By the year 2030, it is estimated that the “oldest-old” (85 years and older), will grow to 10 million people. 

Views on aging are changing  

TRUE!  Aging is no longer synonymous with physical decline and illness. 


Future Blogs will continue to address the issues of senior health care and healthy aging.

Resources:
• Luggen, A.,S Meiner,S. E. (Eds.). (2001) National gerontological nursing association: Core curriculum for gerontological nursing. St. Lois:  Mosby.
• Mezey, M, Fulmer,T, Mariano, C, (Eds.). (2005) Best nursing practices in care of older adult. Curriculum Guide. ( 3rd ed.) New York:  The John A. Hartford Foundation: Institute for Geriatric Nursing.

For the last several months, we have been discussing safety concerns for the older adult.  We all know that medication management and fall risk prevention are instrumental to healthy aging, but a holistic picture is what is most important to assist in aging in place and maintaining good “health”.  As the boomers age, we will see more and more written on wellness, well-being, and just overall aging tips. 

But what is key to a healthy life style?

According to American Geriatrics Society it is

1. Not smoking
2. Drinking alcohol in moderation
3. Exercising
4. Getting adequate rest
5. Eating a diet high in fruits and vegetables
6. Coping with stress and
7. Having a positive outlook.  

These are important, but I feel that whether you are elderly or young, you need to understand your overall health issues, have social connections, be at peace with where you are in life, have a purpose, live in a safe environment that supports your needs, and keep your brain functioning. 

Good Morning America does a segment that highlights individuals celebrating their 100th or older Birthday.  Today a man was 107! I am always amazed at the life history of those over 100...  The majority have remained both physically and intellectually active and have remained connected with society.  Amazing, they never reference how many fruits and vegetables they have eaten!!   So stay connected… and do your brainteaser and always learn something new each day. 

How would you want to spend your golden years?  I have lots of different ideas...I'd like to travel more, spend time with family and friends, be healthy, enjoy life!  I love visiting and learning from my grandmothers (and my grandfather).  It's interesting to ask them questions about their life as children, young adults, how they met my grandfathers, jobs they worked, etc.  My one grandmother has a great sense of humor and is always on the go.  She works one day a week, spends lots of times with friends and family, travels, and likes to learn new things.  My other grandmother is just a "sweet old lady" that grew up on farm, who has a green thumb, loves animals, and is a bird watcher.  Both are relatively healthy and live independently.  Some people fear getting older, but today's world offers many services and perks to seniors, such as, travel deals, wellness programs, lavish retirement communities, etc.  The seniors that have a zest for life in their golden years are an inspiration and should be applauded!

In most practices, doctors are busy, the front offices are short staffed and the nurses are swamped.  Is it any wonder that calls don’t get returned promptly or orders don’t get faxed in a timely manner?  While there is an easy explanation for these delays, it can be frustrating to a family that is anxiously awaiting test results or a prescription change for their parent. 

I hear it all the time from everyone I know. “I can’t get through to a nurse…I left a message on voicemail and haven’t heard back from anyone…I am tired of pressing 1 for this and 3 for that and never getting any real information or a live person.”

These experiences are especially troublesome when you are worried about your parent and want information as soon as possible.  It can also be difficult to find times to talk privately during the work day, except for a lunch hour or during a short break, so waiting for a call can be very hard to manage.

So what do you do? 

• Make sure the medical provider knows to call your cell phone.  There is nothing more frustrating than to wait for a call and find out when you arrive home at 6:00 PM that the Dr. left a message on your home voice mail at 10:00 AM.
• Make a list of your questions and have it available when you receive the call from the Dr’s office.  Getting back in touch with the same person quickly may be difficult, so try to minimize the need to call back with additional questions.
• Be respectful of office protocols and policies, but be persistent.  If you don’t receive a return call in a reasonable period of time – call back and try to reach a “live” person.  Restate your concerns and/or questions and tell them you are willing to stay on the line while they find someone to help you.
• Send a fax addressed to the appropriate party.  It might get routed more quickly than a phone message.  Also, it lets the Dr’s office know that you are really serious about your need for information.
• Always remain polite and respectful. Becoming angry or obnoxious certainly won’t help your case and could brand you forever as “difficult.” 

These suggestions are based on my own personal experience and I hope you find them helpful.  They are meant to help facilitate communication between a physician’s office and a senior’s family when a voicemail culture seems to be impeding communication.

If your loved one lives in an assisted living facility or a nursing home, it is important for caregivers to know their rights as family members - and the rights of their loved one living there.  The federal government has many rules and regulations that these facilities must follow.  Each state then has additional rules and regulations that these facilities must follow.  This information is made public through the state department of health.  These facilities are also required to provide the residents/families a copy of the Resident Rights document, which is a list of your rights and can also be accessed through the state department of health. 

The social worker at the assisted living facility or nursing home is the liaison between the facility and the residents/families.  They are also to be an advocate for resident rights.  It is important for family members to educate themselves on the rules and regulations of these facilities.  If you feel the facility personnel is not working with you properly, outside assistance can be helpful.  Each community has an ombudsman, who is an advocate for people living in the residential facility.  They are employed by the state and usually work out of the Area Agency on Aging office.  To find your local ombudsman, contact your local Area Agency on Aging. 

A professional health care manager is also a good resource to utilize as an advocate and 3rd party when working with a residential facility.  Education and advocacy is a powerful asset for family members and seniors.

I've had several people ask me how SCANS (our Senior Care Navigation System) will develop over the life of the Indiana 21st Century Research and Technology Fund grant and beyond.

Version 1.0 of SCANS has just gone live, as active blog readers will know.  Training was completed yesterday and the system is already in the hands of Health Care Managers to improve geriatric care.

Over the next few months we are developing and deploying a series of "point" releases to and features and functionality of the system.  V1.1, for example, will improve the search capabilities of the application to provide easier access to solutions and tools for specific senior health care issues  (e.g. dementia information, well-being concerns, depression, and so on).  The plan includes the following releases:

SCANS    V1.0    Knowledge Repository 
               V1.1    Expanded Search
               V1.2    Enhanced Navigator Integration 
               V1.3    Localization and Enhanced Branding Support

Next, there are a series of major releases planned.  These provide dramatic advances in application capability and can even result in fundamental changes in the geriatric care profession.  The release plan is as follows:

SCANS  V2.0  Reasoning Engine 
SCANS  V3.0  Automated Knowledge Collection  
SCANS  V4.0  Outcomes Validation

Great news for families caring for aging parents!

My colleague Jennifer brought another in home communication device/service to my attention recently.  It's called Celery. 

You may remember a previous blog (click here) on the Presto Printer; a great way to communicate with parents living independently at home of in a retirement community. 
Celery is a service which combines FAX and Email capability.  It allows a caregiver or remote family member to send an email to a FAX machine in their loved one's home.  This can include a text message and even pictures.  The FAX is hooked up to a standard phone line so you don't have to obtain Internet service or have a computer.  The exciting part is that the receiver can hand write a reply and FAX it back to a special Email service that will match it to a preset list of authorized email accounts and send the message on as an image.  This makes the communication two-way.  For more on Celery see their web site http://www.mycelery.com/. 

This could be used to reduce social isolation, provide reminders about heath care, improve medication management, and just keep in touch with distant and busy family members.

There are multiple products and tools on the market today to assist in dementia care and to help provide a sense of independence for the person with dementia.  Those products range from memory games to household items, like door knobs and safety devices.  But which products really work?  Mark Warner, a gerontologist, and his wife did a webcast on August 13th discussing the pros and cons of these products and how to find them.  To listen to the webcast, click on the link HealthTalk.

In several of my past blogs, I discussed safety concerns and the older adult.  One the main concern is medication safety. Not just the management of medications but how many are actually taken.

It is often reported in the news about a medical error made and the impact it has on individual lives.  Those articles are frequently about hospitals errors.  But have you ever thought about the older adult and how they manage at home...?  The impact our current health system has on managing medications...?  How chronic illnesses such as congestive heart failure, diabetes, and arthritis impact the older adult and his/her caregivers...?  Different providers – prescribing different medication – generic versus brand names.  multiple medications with multiple doses all affect the medication management and the safety of the older adult.

Let’s look at the key safety issue: polypharmacy (multiple medications).  
A caregiver may ask what defines polypharmacy or how many pills or too many?  The answer would have to be that different entities in the current health care system define Polypharmacy differently.  I have seen it defined as low as two or more medications, but in general it deals with using more than three to five medications or herbal supplements for longer than 90 days in a given year.  In my career I have witnessed shoe boxes filled with medications that have numbered over 20 different medications- especially when dealing with multiple chronic diseases, over the counter medications, herbs, and vitamins.

Where should the caregiver and/or older adult start in trying to deal with their medications?
First, realize that the main problem with polypharmacy is that it increases the clients’ risk for drug interactions.  Drug interactions occur when one medication or herbal supplement reacts negatively with another medication when they are taken together. It is important to report any side effects to your physician.
 
The following are some steps you can take to prevent drug interactions:

• Provide a complete list of your medications and herbal supplements to your physician and/or pharmacist
• Discuss how each medication/herbal supplement works inside the body.
• Verify with your physician that you are receiving the recommended dose of each medication/herbal supplement.
• Verify with your physician that you are receiving the recommended form of each medication/herbal supplement you are taking (pill, liquid, tea, extract).
• Determine how many times a day your medications/herbal supplements should be taken.
• Discuss any side effects that might be experienced.
• Discuss the common prescription medication interactions.
• Discuss the common herbal supplement interactions.

If you can not complete a list of medications, take them all into your physician or pharmacist and have a list made for you. 

The National Institute on Aging is a great resource for learning more about medication managements, herbs, vitamins and safety concerns - learn more by clicking here.

SCANS (Senior Care Navigation System) goes live today with the first Health Care Manager training session.  A second session will be held this Thursday.  Our Training Manager, Katie Eller, has put together an exceptional train module for the introduction of this exciting new product.

In just a few short days all of My Health Care Manager's and our Affiliates' geriatric care managers will be using this knowledge base to provide eldercare services.

The system is directly integrated with our case management system called Navigator.  Navigator has been in use for well over two years.  The two systems together provide a comprehensive package for Health Care Managers to help with aging parents.

Technology is helping seniors with their health, safety, and overall well-being.

More than 50 million people provide care to a chronically ill, disabled, or aged family member or friend.  While caring for our loved ones is an important job, we often forget to take care of ourselves.  Statistics show that caregivers have a high risk for stress (physical and mental tension), heart problems/heart attack, sleep problems, and depression.  Caregivers also have a higher mortality rate than non-caregivers.  So, what can we do?  Take a break for a few hours or a few days...relax, have fun, take time for yourself and other family members, etc.
There are several community resources available that provide respite care.  Respite care is temporary relief or a temporary break from caregiving.  The local Area Agency on Aging offers home companions and volunteers who can come to your home to sit with your loved one while you run errands, go to lunch, take a break, etc.  To find your local area agency on aging, click on the link provided.  Adult day programs are offered in most communities and provide group programs for seniors during the day.  The provide social activities, meals/snacks, recreational outings, and assistance with care.  Most adult day programs allow you to drop your loved one off for a couple of hours up to a whole day.  Most are open Monday-Friday and are very helpful to those caregivers who work during the day.  To find an adult day program, click on the link provided.  If you would like to take a couple days off for a vacation or just a much needed break from caregiving, some nursing homes and assisted living facilities offer respite care.  This is a great option where your loved one could stay in there temporarily while receiving 24/7 medical and social care.  Most nursing homes and assisted living facilities offer respite care for up to 30 days.  Some communities also offer respite care homes or units, which allow up to 10 people to stay on a short-term basis.  Check your local nursing home, assisted living facility, Area Agency on Aging, or Alzheimer's Association for respite care information and resources.

**The following post is authored by Natalie Langley, MSW.  She is working on SCANS (for more on SCANS, please see Eric's blog by clicking here) and will be a 'guest blogger' from time to time.**

Moving older adults from their homes to assisted living can often be a challenging move and an adjustment; after all, any move is an adjustment for all of us and can create feelings of stress.  Assisted Living Facilities are designed for those who need extra help in their day to day lives, but do not require 24 hour skilled nursing care.  The older adults moving to an assisted living facility may feel they are losing their independence as they move to a place that will help them with their care or with household chores.   However, there are several things families can do to ensure their loved ones have a smooth move.   After determining the services they may need assistance with (dressing, bathing, housekeeping chores, etc), obtain a list of assisted living facilities nearby.  This list can be found at www.alfa.org or in a local phone book.  Include the older adult in this decision making process.  This will help to empower them and allow them to know they are a part of their health care decisions.  Next, schedule a time to view the assisted living home and take a tour.  Talk with the staff and the residents to see how they enjoy being there.  Pay attention to what is going on; do they have activities going on the main gathering room?  Do they ever go on outings or go shopping?  If so, how often?  Are the residents out and about or is it quiet in the building and many are in their rooms?  Ask to get a menu; what foods are served?  Do they have substitutes if there is something on the menu residents do not like?  For a complete checklist on things to ask and consider when visiting an assisted living facility, please go to the National Center for Assisted Living website at http://www.longtermcareliving.com/assess/al/assisted8.cfm. 

Once a place has been decided on, families can be involved in many ways to help make this a smooth transition for their loved one.  First, help with sorting, packing up boxes, labeling which room the box goes in, etc.  This will help reduce stress when moving day comes.  Listen to how they would like for you to help.  Stay positive and smile.  This will help ease the stress for the older adult.  If they sense you are nervous and stressed, they will pick up on that and may begin to feel that way if they are not already.  It is important to remember that these feelings usually will lessen after the move is complete and they begin to settle in.  Give them time to adjust.  Offer to help hang up pictures, etc. around their room to help make it “home-ier”.   Participate in activities with your loved one while there or eat dinner with them one evening.   Try to keep the routine consistent; if you always visited them on Sundays and Wednesdays when they lived at home, keep that schedule.  Remember, the person has not changed… only their address has.   For more information on assisted living facilities, please visit www.alfa.org.