Transitions

As he aged, Ben removed the burden of decisions and care from his adult children and moved into a nonprofit senior community’s apartment. He selected a community with options for continually changing needs. Hiking trails, library, woodshop with tools that rivaled his own collection and people for interesting conversations all kept him active and happy.

After Ben recovered from an illness, his daughter noticed small differences. He showed tiny lapses in memory. The dryer’s lint screen was fuzzy, no longer routinely cleaned. She worried whether the stove would get turned off. Already part of the community, Ben moved quickly and easily into a personal care room, which provided assistance, including culinary team-cooked meals.

Over time he needed a wheelchair and transitioned to a skilled nursing floor. He still had some independence — heading to the sink when he wanted to brush his teeth. He zoomed around the campus to attend activities and see friends.

At the same time, people looked out for Ben. Because he had resided in the same community for years, staff members knew and loved him. The same medical team could identify what was a permanent change or temporary quirk. Transitions from independent living to personal care to skilled care were easier on Ben and his family because they weren’t big, sweeping changes made in emergency situations.

Safety: Guiding the Decision to Move

Sometimes a sudden traumatic event — respiratory or heart challenge, debilitating fall, surgery or sudden illness — necessitates a move to skilled senior-care. For other people, a continual progression that leads to increased dependency or calls for services from a registered nurse signals that a loved one needs skilled care.

That’s the view of Michelle Loucks, executive director of Ware Presbyterian Village. Some self-aware seniors at Ware recognize that they can’t remain at home or return home from the hospital or rehab.

Helping with Grief

When social workers meet individuals and families facing a move to skilled care, they often encounter and help people who feel confused or a bit down during that transition. Whether families are acting on a senior’s previous written instructions or making decisions for a senior who cannot communicate their wishes — and even when seniors themselves know that aging in place is no longer possible — they may grapple with grief.

A senior may have lost a spouse or pet, or are separated from a spouse who needs a different level of care. They are dealing with losing their independence, the inability to keep up with a home or have full mind or body capacity for activities of daily living.

These seniors in transition are moving, meeting new people and eating at a table with strangers instead of someone they ate with for perhaps 50 years. The social workers on staff talk with the individual about grief and validate their decisions — a vital part of managing a transition.

Family members, too, experience grief and receive help. Seeing a parent walking and talking yesterday, then experiencing a trauma that changes circumstances overnight cause sadness and frustration.

In short, it takes a village. Many communities do things like hold meetings with a team — nursing, dietary, therapy and other staff members — to create care plans. Those plans are shared to give seniors and family members an overall picture. Additional one-on-one sessions allow tears, hard conversations and vented emotions to help make sure they feel someone’s there for them and will become another family.”

Making the Move

Riddle Village’s move coordinator assists with resources and is present on moving day to direct movers. By partnering with LivNow — a relocation company that connects new residents with fully vetted movers, packers and organizers — seniors and their families experience moves that are smoother.

Whether your roots are at a longtime homestead or another area of a Life Plan Community (formerly referred to as a CCRC — Continuing Care Retirement Community), a transition is complex, according to Michele Berardi, senior director of communications and PR at Kendal-Crosslands Communities. People on their waiting list receive invitations for a Move Expo to learn about vendors. Others have already chosen Kendal-Crosslands life plan options, so moving from independent or personal care living to skilled care doesn’t require learning a new campus or floor plan.

Rooms with Different Views

Different communities offer different options, philosophies and habitats for skilled care.

At Barclay Friends, skilled care areas are organized in spaces referred to as neighborhoods. Each neighborhood has a nurses’ station, living room, cozy dining room and outdoor garden patio. Bedrooms have private bathrooms.

Depending on residents’ needs, many skilled care rooms may look like hospital rooms or a homey mini-apartment — shared or private — with a recliner and family photos.

Crosslands’ skilled care spaces were designed to look like homes, rather than like nursing homes of the past. With the household model, each resident has a separate room that’s part of a larger yet intimate household. Each household has a big kitchen with space for all to gather for breakfast and a dining room by the kitchen. Staff members cook breakfast there or make cookies that fill the area with wonderful aromas.

Currently under construction, Kendal at Longwood is reimagining and rebuilding their skilled care health center. Wings will have smaller numbers of people and inclusive communal areas where people can eat together. Each room has a bird feeder outside the window for views of other types of wings.

Other amenities can make a new home in skilled care more comfortable or fun. At Luther Acres a rehabilitation gym is adjacent to skilled care rooms.

Thrive at Every Stage

The right care plan and services can help with the transition. New activities can create new life stories.

Here are tips to make a transition to skilled care smoother:

• Take a tour. Families and prospective residents feel better when they meet friendly faces and know what new surroundings will look like, says Marnie Keenan, admissions coordinator at Riddle Village.
• Meet residents “where they are.” Make it possible for them to continue what they love. Bibliophiles enjoy two resident-run libraries — currently getting a redo — with 10,000 books and periodicals at Kendal at Longwood. If walking isn’t possible, friends take them by wheelchair. For tired eyes, every Wednesday a former professor reads to any group that’s gathered.
• Familiarity is important. When moving to skilled care, take personal furniture and belongings so the new room looks homey, suggests Kendal-Crosslands’ Berardi. Visits from familiar faces are reassuring during changes.
• Enlist help. Families can’t do everything! Allow professionals to shoulder packing and moving so there’s more time and energy to spend with loved ones. If depression or struggles continue with a transition, some communities provide behavioral health staff.
• Sustain meaningful connections. Many communities have chaplains on staff or on call 24/7. St. Martha Villa, a CCRC in Downingtown, offers senior living in a Catholic faith-centered environment. White Horse Village offers pastoral care, and other centers also offer many choices for religious, spiritual and emotional support.
• Turn up the music. Discover the power of music. The Big Bopper, a musical entertainer who sings Frank Sinatra songs at Kendal at Longwood, is a star. Sometimes he inspires folks to dance — good for the body and soul.
• Get educated. Seniors are reminded that the process of change has different timing, stages and emotions for each individual. Transitions can’t be rushed but need to be taken step-by-step. Their new community will walk alongside them and celebrate their milestones.

The Senior at the Center

Through a concept called person-centered living, life in skilled care can still be as independent as possible, as well as joyous and fulfilling. Person-centered living takes into account each person’s unique needs, values and capabilities and involves them in as much of their decision-making and activities as they wish and are able. Dignity is at the heart of care and support.

Loucks said that at Ware, a resident in skilled care can retain their preferred schedule for showering or visiting medical professionals. Many activities are accessible, often brought to the community rather than off-site. A recent event brought the farm to Ware. Local alpacas, a dining team member’s goats and a nurse’s lamb delighted folks throughout the village.

Loucks also recounted the story of what’s possible when listening to community members’ desires. When a resident receiving skilled care wanted a new tattoo, staff went to work. They ensured there was a ramp at the tattoo parlor, lined up transportation and set all in motion. Mission accomplished.

There’s always an opening for fresh ink! There are more stories to live. And there’s always more to love about life.