Today’s elders are more concerned than ever about the quality of care in nursing homes. Health Canada studies show that more than 80 percent of elders consider the availability of chronic, extended care, or nursing home beds for those who need them to be “very important.” Unfortunately, many people are forced to make the decision to move to a nursing home when they are in a crisis or are sick and cannot bear to cope any longer in their present setting. At times like these, moving becomes imperative, and a decision made quickly may be uninformed.

      About This Book

      Making the Right Move is designed to help you make good, informed choices about your health and the places where you will live. It will encourage and empower you to consider your options before you are in a crisis so that you are aware of all the factors that can affect this important decision.

      Choosing a nursing home for yourself or a loved one is a major life decision. After all, you have decided to move after a lifetime of independent living where you have managed to cope on your own — often with increasing physical and mental chronic conditions. You now realize that you need some help with your day-to-day activities.

      But having to leave your family home does not mean that you have not successfully aged. All it means is that you now need a little help. Part One of this book discusses how to cope with the physical, mental, and spiritual aspects of aging. It then explains how the health care system works in the United States and Canada and helps you determine what level of care you may need. Part One also introduces you to the many housing options that are available to elders, from congregate living to 24-hour specialized nursing care. Remember, a nursing home is only one example of supportive housing available to you.

      Part Two is designed to help you choose a facility that will provide you with quality care suitable to your needs. Using questionnaires that allow you to assess and compare facilities, this section of the book examines the components of quality care and considers what to do when you feel you are not receiving the appropriate level of care.

      As you visit potential facilities and work through the questionnaires, keep in mind that the place you choose will be your new home — and it should feel that way. You should feel comfortable both with the level of care you are receiving and with your surroundings. Choosing a new home can be stressful. You may feel pressures from your children, your friends, even the staff of the facilities you are visiting. Take your time and choose the solution that is best for you.

      Who This Book Is For

      Making the Right Move is written for the elder who is considering his or her own future care. However, in many cases, children, spouses, or other relatives either assist in making this choice or are forced to make an independent decision themselves, usually because of a crisis. This book will provide assistance and guidance to both families and elders, giving them specific questions to probe their health care system and helping them to make the best choice to everyone’s satisfaction.

      Many elders who have partners are concerned about what will happen when one of them requires additional care. Although most nursing homes have accommodation for at least one couple, usually each elder in the couple has very different needs. For example, one spouse may need special nursing care at odd times of the day and night, and that may disturb his or her roommate. Unfortunately, nursing homes are not very adaptable to this kind of situation in their physical environment or in providing the different levels of care, although they are improving.

      More and more multilevel homes are being built that allow couples to be housed in the same complex, if not in the same room or building. The most frequent scenario for couples is that one spouse will enter a nursing home while the other visits daily for long periods. The visiting spouse, or caregiver, still plays an important role as he or she does the extra little things that make life more comfortable for his or her spouse. One of the downsides to this arrangement, however, is that when couples are living as a pair, their pension may be adequate. But when separated, the pension does not cover two places of accommodation. This problem can motivate couples into incredible coping arrangements.

      By 2010, 60 percent of people over age 50 will have a surviving parent, compared with only 16 percent in 1960. One of the fears of many elders is that their children will abandon them forever, placing them in a nursing home to die alone and uncared for. This fear along with failing health can make some elders cantankerous. They use all their resources, mental whiles, and emotional blackmail to try to persuade their families that they can live independently.

      This emotional turmoil and underlying fear translates into guilt for their families. The process of deciding to place a family member in a nursing home is not easy, especially for the chief caregiver. The caregivers may feel a sense of failure and guilt that they cannot cope any longer. They may also experience a sense of loss because, in many cases, caring for that person has given their lives purpose and meaning. This is especially true of spouses. Many spouses will exhaust themselves to the point of illness rather than enlist formal help.

      While families generally share the care of their beloved elders, the majority of the care giving usually falls on one person, most often the daughter or the daughter-in-law. The chief caregiver is the one who will bear the brunt of the emotional warfare that goes on before the decision is made to change housing arrangements.

      To ease that tension, try to find out what the elder in your life wants in terms of living arrangements. If his or her expectations are not practical or realistic, then you may need to explain as gently as possible how difficult it is to spend quality time with him or her when you are also having to act as caregiver. Health care professionals advocate the concept of aging in place (see later in this chapter), but it is not possible if the family cannot accommodate the elder. The best plans work when an elder makes a decision in concert with his or her family.

      By using this book as a reference to ensure you have made the best choice, you can help allay some of the guilt and frustration of placing someone you love in a nursing home, knowing you have done your best in their best interests.

      Underlying Principles

      This book is the result of my 25 years of practical experience in the field of elder care. As a gerontologist and previous director of care of a nursing home, I have worked with countless people to help them choose nursing homes and other supportive housing for themselves, their spouses, or their parents.

      I have based my discussion on four major premises that are interwoven throughout the book, each of which is described in the following sections.

      Language

      The first premise is that language used to name people denotes values. The term “elders” refers to people over the age of 65, although the majority of elders in nursing homes are over the age of 85. I have used this term because it denotes an aura of respect and wisdom. It is the term used by aboriginal people for older adults, who are revered in their communities.

      It