Fearing the "Assisted-Living-F-Word"
The official terms for a senior community that provides housing plus help with daily activities is "assisted living facility" and "residential care facility for the elderly." But for many people, "facility" is another "F word."
Many of my clients first call me after they become concerned about their parent's safety, when the parent lives alone in a cluttered, multi-story, long-time family home. I then research, recommend and help them evaluate the appropriate senior-living communities, which they subsequently, hopefully, describe to their parent, and try to suggest a visit.
Typical response: "I'm not going to any nursing home! You'll take me out of here in a box before you'll get me to move to one of those places."
Fact: "those places" don't exist any more -- at least not here in the San Francisco Bay Area, where senior-living providers have shed the "old-age facility" heritage. People born between the 1920s-1940s hold a perception of "nursing homes" that is inexorably linked to the mid-20th-century, for-profit "retirement" or "convalescent" facility, which was not regulated or attached to decent medical services, and typically was a deplorable environment. "In response, in the 1950s, what had been a housing and welfare approach...shifted to a medical approach," Beth Baker writes in Old Age in a New Age. "Nonprofit nursing homes followed the hospital model -- a well-intentioned measure, but one that led to a poor quality of life for those destined to spend years in such places."
Tips for dealing with preconceptions about "old-age homes"
Naturally our parents resist the notion of moving someplace like that. We can help folks understand that old approach is history. But it won't work to tell them that a cluttered house is a broken hip waiting to happen.
The way you approach the topic will set the tone and the direction that your talk will take, and more importantly, how your parents react to the concept.
Suggested approaches for planning how to talk with loved ones about assisted living:
1. Download and follow the SCAN Foundation's easy-to-use guide, “10 Conversations to Plan for Aging with Dignity and Independence.”
2. Make an appointment for you and your loved one(s) with their family doctor. Describe your observations and ask the doctor if Mom/Dad is safe to remain at home without help.
3. Website advertising platforms for senior-living companies (a place for mom, caring dot-com, etc.) offer good, basic, common-sense advice for “having the talk.” But I recommend the more detailed, substantive approach from "Talk Early, Talk Often," by wise clergywoman Rev. Dale Susan Edmonds.
Another solid resource is the MarketWatch video conversation between Maria Shriver and Rob "West Wing" Lowe, about how to talk with the folks about "future" long-term care needs. Even your parents might watch that one, especially if they enjoy political TV celebrities.
4. Do not criticize their living conditions. Try to avoid the argument that moving would help you and/or siblings and/or grandchildren. Focus on your parent's concerns and hopes. Remember, their fear of unknown facilities is based on the dismal reality of 20th-century "warehouses for the elderly." It's nearly impossible to change those preconceptions. But you can tell them that those old-school, old-age "home" facilities are history.
Feeling the Sandwich Generation Pinch?
For support, guidance, and proof that assisted-living has evolved, call me at 510-926-0699.
*My mom, who had moved from NYC to Las Vegas after retiring, did wind up moving to an assisted living community in Vegas -- but only after I told her that a certain celebrity visitor had signed his name in the front-desk guest book. Thank you, Wayne Newton.