Long-term Care Conversation

Having a conversation about long-term care with an aging loved one can be difficult. Initiating a conversation can be awkward or uncomfortable for family members or caregivers. Although it is impossible to know what the future will bring, here are some hints and checklist that may help to begin a conversation about housing options with your loved one.

1. Determine if it’s time to think about long term care facilities.

Reasons to seek long-term care vary from person to person. In addition to potentially offering a more comfortable and safer environment for the aging loved one, long-term care may be necessary for the mental and physical health of the caregiver.

To ensure your loved one is able to contribute to his/her future, introduce alternate housing options as early as possible, even before necessary. Ask your loved one questions about lifestyle or health-related challenges. Continue the conversation over time by sharing your observations and concerns, including any of the following physical and mental symptoms:
Physical Symptoms

  • Are they able to move around easily given the physical layout of the home? For example, are stairs, carpet, bath/shower or door handles obstacles for mobility? Is the heating and lighting adequate for any sensory impairment including hearing, sight and circulation problems?
  • Are they experiencing balance issues, especially when changing positions? Are you concerned about them falling?
  • If they fell, are you confident he or she would be able to call for help? Is there a reliable source to respond to a call at all times?
  • Is your loved one repeatedly complaining of physical aches and pains?
  • Are they experiencing frequent incontinence? Can they attend to the problem when this happens or is help needed?
  • Do they have difficulty dressing, bathing or with personal hygiene such as hair and foot care?
  • Is your loved one experiencing frequent, significant sleep disturbances?
  • Are they capable of cooking or preparing healthy meals?
  • Have operating gadgets or appliances such as the can opener, stove or telephone become difficult?
  • Have household chores become a burden? Is vacuuming, sweeping, taking out the garbage, cleaning the dishes or bathroom being done in timely ways?
  • Are finances such as bill payment, deposits, and investments being handled in a timely manner?
  • Is your loved one still driving? If so, are you concerned about his/her and others wellbeing? Is public transportation a safe and viable option?
  • Are prescribed medications obtained and taken as indicated consistently?

Mental Symptoms:

  • Is your loved one demonstrating personality changes, including but not limited to:
    • Frequent irritability?
    • Insensitivity to others?
    • Disoriented to place and time?
    • Aggressive behaviors?
    • Repetitive behaviors?
    • Communicating with inappropriate language?
    • Is your loved one socially withdrawn and not able or not wanting to get together with friends or family? Are there signs of depression?
    • Do they express negative comments about him or herself?
    • Are they demonstrating an inability to make decisions or making poor decisions?
    • Is your loved one able to understand communication or instructions from others?

   Schedule a family meeting.

A family meeting can move the topic of long-term care to a more focused discussion that can lead to a plan. Here is a checklist for planning your family meeting:

  • Determine the family members that should be involved directly or indirectly in decision making. This may include extended family members, close friends or paid caregivers. Always include the person if he/she is capable of taking part in any decision making.
  • Consider including an independent third party to play the role of mediator. This could be a minister or other member of the clergy, a social worker or case manager.
  • If necessary, find a neutral place to hold the meeting.
  • Prepare an agenda to help you stay focused. It may include:
    • A medical update
    • Sharing of feelings about the illness and caregiving
    • Daily caregiving needs
    • Financial concerns
    • Who will make decisions
    • What support role each person will play
    • What support the primary caregiver needs
    • Next steps moving forward

 Continue to involve family.

The move to a long-term care facility is an immense transition for any family, so it’s important to involve everyone relevant to the person:

  • Reach out to siblings to secure their input and support. For example, share online information about long-term care facilities to secure greater involvement and participation.
  • Is there is an unequal financial or time burden to one family member? If so, acknowledge the distribution of resources and discuss a strategy for achieving a balance that appeals to everyone.

4. Continue to engage your parent or loved one.

  • Have ongoing conversations at times when your loved one is feeling best and there are few distractions.
  • Introduce the idea of an overnight visit to a long-term care facility or an extended afternoon visit to get a feel for the various available options.

5. Begin researching long-term care options in your area.

  • Go to the Nursing Home Compare website to access a nationwide Nursing Home database or go to http://www.alfa.org to access a nationwide Assisted Living database.
  • Enter your city, state, zip, county or address and begin researching options by.
  • View the listing details or contact the facility to ask questions and schedule a site visit.
  • Ask the facility you visit for a copy of their last annual licensing survey report.
  • Contact your local senior ombudsman to get perspective from a local trusted resource.
  • Check references from existing or prior residents or families.
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