My aging parents need to move. But where?

Transcript of Interview: “My aging parents need to move. But where?”

Mike Barnes:

This is something that we’ve already been through—figuring out where Mom and Dad should live as far as independent living, assisted living, or memory care. It’s hard to decide, and as we’ve gone through it ourselves, we realize, wow, it helps when you can understand even just the terminology because it can get pretty confusing. 

Kim Barnes:

Today, we’re bringing in Debi Douglass of Oasis Senior Advisors Austin Central Texas. Thanks so much for being with us, Debi.

Debi Douglass:

Glad to be here.

Kim Barnes:

As we mentioned, it is sometimes just confusing because we don’t understand what all the terms mean. Assisted living, memory care, skilled nursing, rehab—whatever you know, all of them get really confusing. So let’s break down the different types of care that our parents might need. This is assuming they’re not living at home, right?

Debi Douglass:

Right. This is assuming that they’re going to live somewhere other than at home or with you.

Kim Barnes:

With at home, and the first option is independent living, which is kind of like living in an apartment except there are meals provided, right?

Debi Douglass:

So, I think when we think of independent living, we’re thinking of a 55-plus apartment. But independent living really does mean more of a supportive environment. So, you have an apartment of your own, but there are meals, housekeeping, activities, transportation, and utilities included. It’s just a more supportive environment—no maintenance, no cleaning, no cooking. You’ve got activities right in the building, so when the weather is bad or you’re making friends, you have people to eat with. It’s independent; you come and go as you please. A lot of people still drive, but it is a more supportive environment.

Mike Barnes:

I kind of like to think of it similar to a dorm. I mean, you have more than just the room when you’re in independent living, but kind of that environment where you’re going to have your own space but also have the support of that community.

Debi Douglass:

Absolutely. And just because you mentioned the 55 and over, let’s just nail down what that is. That is more going to be a 55 and older apartment complex, which is truly more just an apartment complex that caters to people who are 55 and older.

Kim Barnes:

Yes, the amenities they have are like community rooms, usually a pool, things like that, and sometimes the utilities are included. But yes, there’s no meals, no housekeeping, no staff. There’s leasing staff, but there’s not an activities director, not all the other support there.

Mike Barnes:

Okay, so just to kind of know that, if that’s like the basic, I guess you start with the 55-plus community if they really just want to get out of a big house, perhaps, and downsize a little bit or want to just have less responsibility of the upkeep of a house. And then next would be a little bit more care, if you will, is the independent living.

Kim Barnes:

With independent living, I think a lot of people are scared to take that step. They don’t want to leave their house that they’ve owned for years. I know my dad was a little bit hesitant because he pictured the nursing home that my grandfather had to live in the last few years of his life. What do we need to do to try to help them see that oftentimes it’s a better place for them?

Debi Douglass:

Really, it’s like living on a cruise ship. It is very much like a hotel or a cruise ship atmosphere. I think a few things are important for people to think about. One is the socialization. When we think of independence, we often think of living at home, but we can be a lot more independent longer if we have those support systems. If we are not up on a ladder trying to fix something or putting in a new light bulb, if we’re not trying to cook meals when we’re tired and not feeling great, if we have people to eat with, talk to, play cards with without going out into the weather—all of those things actually keep us healthier and keep us more independent. So, I think it’s changing the view of independence.

Mike Barnes:

Interesting, right. Because I know in our situation with my mom, she was in her home, not driving anymore, and so often she was there without much to do. It was difficult to go places; it was very lonely. She liked activities and couldn’t get to them very easily. Frankly, one of the biggest selling points was not having to cook anymore.

Kim Barnes:

That was a big selling point; it would be for me right now.

Mike Barnes:

Absolutely. So, if you’re not able to be completely independent because I think in independent living, you have to be able to get down the stairs in case of an emergency or there are certain criteria or evaluations that are done. The next step would be if you need some care, that would be assisted living.

Debi Douglass:

So, assisted living is ideal for people who need caregivers in the building 24/7. The care needs might not be heavy yet, but they still have a need. In independent living, you could hire somebody to come in for four hours a couple of days a week, for example, to help you get in and out of the shower, go to an appointment, or fill your med box. But if you need help some mornings and evenings getting to meals, you need assisted living because that assistance is there 24/7. You push a button, and somebody can come and help you. If you don’t know exactly when you need help, then you would be in independent living with 24/7 extra care.

Mike Barnes:

Which does not financially make sense.

Debi Douglass:

For most people, assisted living, once you need more than a few hours a day at home or a few hours a week in independent living, starts to make more sense. There’s something reassuring about being able to press that button and knowing that there’s a caregiver in the building.

Kim Barnes:

I think it’s hard for a lot of us, the adult children, to decide where Mom or Dad should go. Do they need assisted living? Sometimes it’s hard for us to admit that they need assisted living. So, in that respect, what do we do?

Debi Douglass:

I think you really look at their everyday life and what you’re concerned about. Are you concerned about meals and housekeeping, or are you concerned that they’re not taking their meds properly? Are you concerned about their mobility, or that they can’t get dressed by themselves and fall often? You have to look at their everyday life and say, what am I really concerned about?

Kim Barnes:

Sometimes we don’t realize because we see them for an hour or two. Going and spending a night with your parents makes a world of difference because then they can’t hide it all that well.

Mike Barnes:

I think instead of seeing it again as a negative, we as the children should help them see it as a positive to have that help. There are two levels of assisted living, but that gets complicated, right? So just know that there are two different levels of assisted living, with one providing more care than the other.

Debi Douglass:

Exactly. Always ask what care is provided. When I’m working with someone, I get all the care in order so that I know. Another thing to remember is that we always want to put someone in the least restrictive place because that’s what we’re comfortable with and makes us feel better. But the truth is, if your parent is 90 years old and having health issues, putting them in light assisted living or independent living is probably not a good answer because you’ll likely have to move them soon. So, I help people look at all those things. Look at their age, health, and physical mobility now because you don’t want to have to move them if you can avoid it.

Mike Barnes:

That’s something that adult children often don’t know about—there are people like you, senior advisors, who can give a better perspective about where Mom and Dad should live.

Debi Douglass:

Absolutely. Find someone local to the area who knows the communities and has been doing it for a long time. They can give you the information you need. There are a lot of behind-the-scenes things, and advisors have done it with their own families and with many clients, so they offer valuable insights.

Kim Barnes:

When you are in assisted living, how does memory care fit into that? Memory care is technically a type of assisted living, right?

Debi Douglass:

Yes, memory care is an assisted living license but specializes in people who have moderate and above memory loss and confusion. A lot of people don’t realize that with dementia and Alzheimer’s, confusion is a big part of it. You have to look at your parent—if they can’t remember to press the call button, then assisted living may not be enough. Residential care homes, which are smaller, can also do a great job with memory care because they design their place similar to memory care facilities. Memory care buildings are set up with trained staff, activities designed for people with memory loss, and meals catered to their needs. They need more supervision and interaction, which assisted living may not always provide. There’s also the issue of wandering and door locks in memory care facilities.

Mike Barnes:

Memory care is usually a secure facility with alarms on the doors, so when someone opens a door, staff go running.

Debi Douglass:

Yes. Residential care homes can be anywhere from three to sixteen people. Some of them are well done with great staffing, but not all are created equal. If they only have three people, they aren’t governed by the same agencies as bigger places, so you need to do your homework. It’s not right for everyone, but it’s perfect for some. Even some people in memory care don’t want to be in a bigger place.

Kim Barnes:

It can be overwhelming for us, the adult children, trying to figure out where Mom or Dad should go. There are so many options, and people start saying, “maybe you need a SNF, rehab, or long-term care.” It can get overwhelming because some are short-term, and some are long-term.

Debi Douglass:

People don’t realize that a nursing home is really designed for more medical care. People assume that if you need a walker, help getting out of bed, or help eating, you must need a nursing home, which is not true. Many assisted livings and memory cares have Hoyer lifts and can handle catheters and other needs. Always look at all the options because there are more than just the go-to choices. Even after a hip surgery, doctors might say, “go to rehab,” but a 95-year-old can’t always handle 21 hours of PT a week. They might be able to go back to their assisted living or memory care and get therapy there.

Kim Barnes:

Typically, a skilled nursing facility or rehab is a temporary option unless someone has no money, qualifies for Medicaid, and needs it.

Debi Douglass:

Yes, more skilled nursing facilities take Medicaid than any other entity.

Mike Barnes:

To me, the biggest thing is to have your eyes open to look at everything and not be afraid to ask for help. That’s what senior advisors like you can do.

Debi Douglass:

Absolutely. Ask for help, ask questions, call, and email. We don’t mind answering questions all day long. You don’t have to be ready to move. I love people who look early. I want you to know what’s out there, what the costs are, and budget accordingly. If your budget is tight, we can help you see that you can live in independent living with a few hours of help a week, or your family can come over and help a couple of times a week to save money. We want you to see all the nuances so that you can make informed choices because a lot of people are in a gray area.

Mike Barnes:

The cost is always a concern. Is it fair to say that independent living, assisted living, and memory care are mostly private pay?

Debi Douglass:

Yes, unless you have long-term care insurance or can get help through veterans’ aid and attendance. Most of it is private pay. There are a few facilities in Central Texas that take Medicaid. Other parts of the country or state might have different options, but in our area of Texas, there isn’t much that takes Medicaid.

Kim Barnes:

Again, another reason to ask questions.

Debi Douglass:

Yes, exactly.

Mike Barnes:

Debi, thank you so much for all the help you give and for the ideas you’ve given us today.

Debi Douglass:

Happy to do it.

Kim Barnes:

It’s a good reminder that it can get really confusing really fast, but hopefully through this interview, you at least know the terminology and the questions to ask to get the answers you need and find the right fit for your parents.

Mike Barnes:

Yes, the right fit helps tremendously. We found the right fit for your mom, my mom, and my dad. It helps a lot. Good luck to everyone. If you have any topics you’d like us to discuss, please let us know at Parenting Aging Parents.

*This transcript is auto-generated. Please excuse any typos or mistakes.