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Care Transitions and Social Services

Robyn Golden addresses the challenges of caring for a loved one at home or in an assisted living facility

Q: My elderly mother has dementia and was moved to an assisted living facility. We feel she can no longer manage on her own. She is adamant that she is fine. How can we have a conversation with her to help her understand that the facility she is in provides the best options for her? Should all three adult children be present when we have this discussion, or will it seem like we're ganging up on her?

A: So much depends on the relationship your mother has with each child. Think about whether she will feel supported with her three children there or more threatened. If you end up deciding that just one of you should talk with her, it should be the child who feels closest to her.

Ask the Caregiving Expert, Caregiving Questions Answered: Care Transitions and Social Services

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Get assisted living facility staff to weigh in on your caregiving decisions.

Usually when someone is in an assisted living facility, the staff knows when the situation isn't working. If that's the case, you may want to involve the staff person in the conversation with your mom so the family members don't look like the bad guys. Once in a facility, it is not unusual for someone to need a higher level of care or even to move to a different place. It might be useful to get the staff to weigh in on the decision. Your mom won't likely feel ganged up on if you try to understand where she is coming from and what she wants.

This is probably not just one conversation. These are hard discussions to have, so they might happen over time.

Q: An earlier AARP The Magazine article suggested getting a social worker to evaluate a family's needs before caregiving reaches a critical point. In my county, it seems the family has to be in trouble and in a hospital before getting advice from a social worker. Where can a family find and pay for social services advice?

A: Often, the family waits too long to ask for help. It's good that you are looking ahead. A nearby area agency on aging can suggest a social service agency or private provider to help. For those without the means, there are social workers available through the National Aging Network to help plan for an older adult's future. Family service agencies often have social workers who specialize in aging and can help people walk through the process as well. For those who can afford to pay, there are private geriatric care managers available by the hour to help. The Alzheimer's Association has caregiving consultants available over the phone (800-272-3900).

Q: My Dad has Alzheimer's disease, and my mom says that she can't physically care for him anymore. They both are in independent living. We agreed to move him to assisted living. On the bad days, he wants to go back and live with my mom. He appears to be very lonely. I felt he was doing better when he attended an outpatient Alzheimer's facility three days a week. Should we give him more time to settle in? Should we not visit him as much to allow him to adjust?

A: I would never suggest not visiting. That's not the answer — particularly if he is feeling lonely, he needs you more than ever. He clearly is missing your mom. As hard as it is to sit through his sadness, it is a loss. People need time to grieve and process. We can't make them feel differently with a magic wand, but we can help by listening.

Give your dad some time to settle in. Also, talk with the staff about getting your dad to connect with other people so he feels less isolated. Get him engaged in programs. There might be activities in assisted living that are similar to what he did at the outpatient facility and can help with the transition.

Sometimes when people are in assisted living, they can still go to adult day care. Don't rule that out. Maybe there is a way he can get back into the program.

Robyn Golden, LCSW, is director of health and aging for Rush University Medical Center in Chicago; she is also a member of the AARP Caregiving Advisory Panel.

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