I began writing about long-term care in the early eighties. In that time care facilities have evolved and expanded their care from facilities that offered what we now call critical care for people who were either bed ridden or very close to that condition. Nothing much was available for those who were still mobile but unable to care for themselves in some areas such as dressing, bathing, or food preparation. Over time the concept of a full continuum of care developed and facilities began to offer care from retirement, to assisted living, to various degrees of nursing care, and then critical care as needed.  

This expands the care dramatically and makes it possible for people to find and pay for just the amount of care they need at any time along the way. The results can be a much more positive transition to the need for care. I urge families to make the transition while the loved one is able to participate in the facilities programs. Socialization is vitally important and it is one of the things we loose as we gradually become bound to our homes. If the transition is delayed until critical care is required, there is very little chance for any socialization to develop. 

Because of the expanded care, it becomes necessary for the family to seek out the levels of care available and find a facility that can provide that level. Care that is not needed is both expensive and can become a source of irritation to the loved one. An evaluation of the loved one by a competent professional is highly recommended to help families find the correct match to meet whatever the care needs happen to be. In the U.S. each county or parish has an Area Agency On Aging who can connect families with qualified people to evaluate and guide families.  I hope our readers in other countries will inform us about what kinds of help is available for them.

In future blogs we will offer several articles on what to look for when making a decision on a facility. The list if far too long for one blog. However, there is one wrinkle that I found to be important and led me to believe that the location of the various kinds of care matters.

My mother moved into a retirement center that also had a nursing home wing attached. This was before the concept of assisted living became widely known. She moved in on her own volition and was finding a great deal of socialization there. I began to notice a sense of fear and dread not only in my mother but in several of her fellow residents. I began listening to the conversations during mealtimes and made a startling discovery. The facility had no buffer of care between retirement and nursing home. The rule was that if you were not mobile enough to come to the table for meals without help and without using a wheel chair, then you had to move to the nursing home wing. This wing was right down a hall very visible from the dinning room. It hung like a sword over the residents every time they ate. When a resident had to make the transition, they became the talk of the room and the object of pity and tears.  

I talked to mother and she agreed that the nursing home was something they all dreaded almost more than death. I explained that we needed a place that had assisted living as an intermediate step and we needed a place where the nursing wing was not located in a way that made them face it at every meal.  

Mother said the residents were so in dread of that hall they would not go down there to visit their friends after they made the move. The nursing wing was a well run clean place with a very good staff, but it had become a dungeon in the minds of those staring down the hall three times a day and dreading the day when it would be their time.

Mother moved to an assisted living facility in a city at least forty-five miles away. It made our visits much more difficult, but her spirits picked up and she seemed so relieved and much less in dread. She died suddenly while still a resident there. Since this was assisted living only, at some point we would have had to move her to a critical care facility somewhere else, but I think it would have been worth the trouble. 

If I were making the decision today, I would certainly consider a facility that offered the whole continuum of care, but I would want to be sure that the location of the critical care wing was not placed so my loved one had to see and dread the move at every meal. I also would not automatically choose a full-care facility. There are a growing number of new assisted living only facilities in the area were I live. Granted, they do not give the care for the rest of a life and a move might become necessary, but moving a loved one from one place to another is not a major thing at that time of their lives. In my case a move was much more desirable than the other alternative. This was caused by this one facility and may not fit any other places, but my point remains. We need to look at the location and arrangement of the place as well as the kind of care they offer.