FAQs - PREPARING for Long-Term Care

Coping with the Transition to Nursing Facility Life

For the person who is about to enter a nursing facility, and for caring family and friends, the days just before and during the move can be traumatic. Anticipation, fear and guilt -- often combined with illness or the recent loss of a loved one -- mean that the individual faces the future with fear and doubt.

This is not unusual. With love, understanding, help and planning, the uncertainty of entering and adjusting to life in a nursing facility can be greatly minimized.

Planning Ahead

Though not always possible, the involvement of the resident in selecting a nursing facility can make a critical difference in the final adjustment. If able, the resident should have input into choosing a nursing facility that fits the resident's personal style of living.

The resident also should have the opportunity to speak with the admissions director or administrator. The resident may have questions regarding care that family members may not be able to answer.

As far in advance as you can, begin planning for the move. To the extent possible, plan the move with the help and participation of the resident. Remember, the professionally trained staff understands your concerns and is eager to help you make this period as calm and positive as possible.

Tell The Facility About The Resident

Your family physician can provide the nursing facility with much of this information. The more they know, the better they can help the resident adjust to daily life in the facility. Provide them with written details about individual habits and practices. Include information about:

Diet

• Is the resident a good eater?

• Does the resident have any dietary restrictions: religious, medical or allergy-related?

• At what times is the resident used to eating, and how much does he or she eat?

• What about likes and dislikes?

Mobility

• To what extent can the resident get around independently?

• Does the resident need help because of poor eyesight?

• Will he or she accept help from a staff person or resent it?

Personal Care

• To how much privacy is the resident accustomed?

• What types of activities can the resident perform independently?

• Can the resident manage personal bathing and grooming?

• Up to now, has the resident preferred a bath or a shower?

Living Conditions

• What was it like where the resident used to live?

• Did the resident share a room or bathroom?

• Has the resident always prepared his or her own meals?

• Does the resident like eating with others?

• Is the resident concerned about having a roommate?

• What, if any, habits should we know about that might help in finding a compatible roommate?

Mental State

• Does the resident become fearful in strange surroundings or at night?

• Is the resident always aware of who he or she is, where he or she is, or what day it is?

Religion

• Is religion an important part of the resident's life?

• Does the resident usually attend religious services?

• Does the resident want to continue attending religious services?

• Will a particular clergy member come to visit?

• Would the resident welcome or be hesitant of a visit by a new clergy member?

Habits and Practices

• Does the resident smoke or drink?

• Does the resident have a set routine that involves activities that are enjoyed and anticipated, such as watching a particular television show, going for a walk after breakfast or reading a particular newspaper?

Special Interests

• How does the resident currently keep busy?

• Does the resident have any hobbies?

• Does the resident enjoy membership in clubs and social groups?

• Does the resident have a special interest in sports, music, arts and crafts or gardening?

While some changes in lifestyle are going to be necessary, facility staff will do their best to help the resident to maintain a particular custom, practice or reassuring habit.

Handle the Paperwork

It's a good idea to get a head start on paperwork and financial details. Before admission day arrives, fill out the forms to the best of your ability, making note of any questions you and the resident may have. Provide a complete medical and personal history for the resident. Check on Medicare and Medicaid eligibility requirements.

Finances are often the most confusing and misunderstood part of the entire admission process. Be sure you, the resident and the appropriate staff member openly discuss all costs. Know what's included and what's extra. Know the requirements and how long Medicare, Medicaid and insurance coverage lasts and talk about what happens next. Review your understanding of payment, money management and other details. Don't hesitate to ask questions.

Personal Belongings

Think about personal belongings. Items from home are very important to someone moving away from familiar surroundings. A small piece of furniture, pictures, books, a radio or TV, a lamp, a clock -- these familiar items may help eliminate a feeling of loneliness and displacement. Discuss with staff what's appropriate to bring.

If some of the personal belongings have monetary value, make arrangements with the staff for safe storage and use.

Talk about clothing needs and laundry facilities. Be sure the resident has enough of what is needed, and that the clothes are comfortable and easy to manage. Label items with the resident's name.

Talk About Everything

Many issues may be awkward or embarrassing; some are sensitive and emotional. Instead of avoiding uncomfortable topics, talk about them openly, with dignity and patience. These uncomfortable subjects are probably very much on the resident's mind.

Some of the most common questions asked by new residents are:

Other Residents

• Who are they?

• What are they like?

• Where are they from?

Roommate

• With whom will I live?

• What if we don't get along?

• How will our differences be accommodated?

Personal Possessions

• What can I take with me?

• What will the staff do for me?

• What will I be able or have to do for myself?

• Can I take my own medicine?

Food

• What's it like?

• What if I don't like it?

• Can I have something special fixed for me?

• If I'm hungry at night, do I have to wait until morning?

• Can my family join me at some of my meals?

Visiting

• How often can relatives and friends visit?

• How often will they visit?

• Can I leave to visit friends and relatives?

• What about mail?

• What about going out of the facility?

Staff

• Who are they?

• To whom should I speak if I have a problem?

• Are they qualified?

• Do they know about me?

• What should I tell them?

• Can I trust them?

• Should I tip anyone on the staff?

Finances

• Can we afford this?

• What happens if money runs out?

• Do I have insurance?

• Will I have spending money?

• How much money should I keep with me?

• How can I ensure that my money is safe?

• What if I need money in a hurry?

Privacy

• How much privacy will I have?

• Can I be alone if I want to?

• Can I visit in private with relatives and friends?

• May I make private phone calls?

• Will my personal things be kept private?

• Will my problems and financial matters be common knowledge among facility staff?

Decision-making

It is the resident's right to make decisions. Family input is welcome, but ultimately the resident has the final say. Should the resident be incapable of making key decisions, the legally designated responsible party makes decisions. It is this individual's responsibility to communicate information to other family members.

Regarding treatment decisions, some residents may choose to prepare an advance directive — a legal document designed to express the resident's wishes for treatment should the resident be unable to communicate his or her desires.

If you have questions about handling the decision-making process, or deeper questions about advance directives, guardianship, or powers of attorney, contact the nursing facility administrator or your family attorney.

What Am I Doing?

The resident and his or her family are certain to question their actions as they get close to the day of the move. Second thoughts are common and are to be expected. To deal with doubts and possible feelings of guilt, review the reasons for the decision. Remember, you already have carefully considered other options, decided on the best facility, talked with the staff, discussed finances, and applied for and been granted admission. You've done a lot of debating, and you've made the right decision.

With openness and honesty, stress the positive reasons for the move: security, comfort, companionship, professional care and a concerned staff.

Admission Day

On the day of admission, family and close friends should plan to spend several hours in the facility helping the new resident set up the room, learn his or her way around, and meet some of the staff and residents. Family and friends might also plan to attend the first meal or a planned activity.

When family members depart from the facility, they may be faced with an emotional reaction from the resident. Assure the resident that family will call and visit often and soon. Remember that when you make plans, you should make every effort to keep them.

Also, remind friends and relatives in other cities and states that the resident has just entered a nursing facility. Urge them to send letters and cards, especially in the beginning of the stay.

Initial Reaction

Like any new living arrangement, life in a nursing facility may seem strange at first. The new resident may sense a loss of control over the daily routines of his or her life, and this may result in anger and depression. Some residents may be a bit reclusive initially. Other residents will ease into life in the facility without a problem.

Fortunately, facility staff are quite familiar with the wide range of reactions and make every effort to involve all new residents in activities and at meals. Often the nursing facility has a resident welcoming committee whose purpose is to introduce the resident to others and help him or her become accustomed to the new facility.

Keep in mind that nursing facilities have social workers on staff who monitor residents emotional and psychological progress. Social workers can offer counseling to residents as well as advice to families who hope to aid in the adjustment process.

A person with a major sensory loss who is either deaf or blind may have a more difficult period of adjustment. But the real key to adjustment is time. Adjustment can be helped along by frequent visits from family and friends and by invitations to join in family gatherings outside the facility whenever possible. The new resident needs to feel that although living arrangements have changed, your relationship is as vital and warm as ever.

Getting Involved

Although frequent visits are critical, your continued involvement also is very important. 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 generally meet once a month in the facility to address issues of interest and concern. Council meetings provide an opportunity for family members to raise questions related to care with facility management. Family councils also may 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.

In addition, family councils can organize letter-writing campaigns to legislators when there is a bill of concern to nursing facility residents before Congress or state legislatures.

Moving Into An Assisted Living Residence: A Guide for New Residents & Families

You have made the decision to move into an assisted living residence. Yet you still have many questions. Do I really need the help? Will I make new friends? Will I receive help when I need it? Will I continue to see my family and friends?

While all these questions are common, the answer to all of them is the same— Yes! You can make new friends, you can receive the personal assistance you need, and you can continue to see your family and friends.

Change can be challenging. The time it takes to transition is different for everyone. The keys to success are preparation, a positive attitude, a supportive network of family and friends, along with patience and understanding—all will prepare you for a smooth transition.

Privacy Concerns

One of the biggest differences between living in your own home and assisted living is the number of people under one roof. You will have the opportunity to be around your contemporaries and make new friends. However, that doesn’t mean you will lose your privacy. Your apartment is your space. Friends and family can visit you, but you determine when. You may want to request a key to your apartment for added privacy and security.

What To Bring To Your New Home

Soon after selecting a facility, residents say to begin planning for your move, including deciding which personal items such as furniture, keepsakes, and photographs to move.

Based upon their personal experiences, many residents suggest you see the actual apartment or unit that you will move into and take measurements. Ask the administrator or director what furniture, if any, the residence will provide. Some residences may provide minimal furniture, such as a bed or chair upon request; other residences encourage you to bring whatever furnishings will make you feel comfortable in your new home. Experience indicates that making choices about personal possessions is difficult at the time; however, one resident said, "It’s not as bad as you think . . . Try to remain positive and have family and friends help you."

Residents suggest that you might want to leave large pieces of furniture at home, since your apartment will probably be smaller than your current home. They also suggest that you bring smaller prized possessions to create that "at-home" feeling in your new assisted living apartment. And, for those possessions that you can’t part with but aren’t sure that you want to bring with you, consider putting those items in a storage unit or asking family to temporarily store the items for you. This way you will have time to determine which items are important to have with you at your new home.

You should start packing well in advance of the actual move. Sort through your clothes and decide what you will need and how much your new closets will hold. Residents advise to be sure to look at available closet and storage space to avoid bringing more than the closets can hold. Avoid bringing too many of one thing such as coats.

Moving Day Helpers

When moving day arrives and you are ready to set up your new home, ask family and friends to help arrange and organize your apartment. Many assisted living residences have staff members who can help move your furniture and other heavy pieces into your new apartment. You will want to find out what assistance the residence offers before you arrive on moving day. Although staff, family members, and friends are there to help you, it is important that you decide how your apartment is arranged. Remember, arranging your apartment to suit your preferences will make your adjustment easier.

Making the Emotional Transition

Moving is hard. It can make anyone feel overwhelmed and stressed. However, these feelings are generally temporary and disappear after you establish your own routine. "Give it time and you will adjust," said one resident. In talking with other residents, you will find many of them felt the same way. Some residents found comfort in talking with clergy. Others found comfort in talking to a neighbor or close friend.

Residents say the best strategy is to stay busy, introduce yourself to other residents, and participate in the activities. It is normal to have a tendency to stay in your apartment at first. Yet, getting out and meeting other residents as well as participating in activities were repeatedly identified as the quickest ways to become comfortable with your new surroundings.

Everyone is different. Some people embrace the move with open arms, while for others it may not be as easy. Whatever your feelings, current residents say these feelings are normal. Give yourself time to adjust. If you feel you are taking longer to adjust than what you consider normal, then you might benefit from discussing your concerns and feelings with the administrator or director of the residence.

More Advice For New Residents

• Read all the materials about the assisted living residence before you move in.

• Try and meet the administrator or director and staff before moving day.

• Review the paperwork and contract before you move in so that your questions can be answered in advance.

• Pack wisely. Don’t bring everything.

• Obtain a list from the residence of suggested items to bring.

• Obtain a list of residence policies and familiarize yourself with them.

• Label your clothing if the residence is helping you with laundry.

• Read the activity schedule and choose two or three programs to attend early on to meet your neighbors and other residents.

Advice for Friends and Family Members

Current residents advise friends and family members to be involved before, during, and after the move. Your loved one does not want to be seen or treated differently now that they live in an assisted living residence. Remember, your family member or friend hasn’t changed; it’s only their home address that has changed.

Be aware. Family members and close friends often experience the same emotions as a new resident. These emotions are natural and to be expected.

Suggested DO’s for Friends and Relatives

• If requested, help with the sorting, packing, and moving.

• Listen as your loved one talks about what they left behind.

• Be helpful even if you do not agree with the decision to move.

• Recognize that moving to a new home represents a major change.

• Call and visit often during the first few weeks.

• Be positive. A smile, support, patience, and understanding are required.

Suggested DON’Ts for Friends and Relatives

• Make all the decisions or take over the sorting, packing, and moving process.

• Focus only on yourselves. This is about the resident moving, not you!

• Criticize the decision to move into assisted living.

• Make light of the transition.

• Immediately talk about selling the resident’s house.

• Make promises that you cannot keep.

• Be negative.

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