An older adult is ready to move into an independent living community and undergoes a “pre-placement” health assessment by the facility’s physician. Based on the findings, the physician indicates that the older adult “needs assisted living.” The older adult and her family object to the “needs assisted living” classification. They meet with the sales professional at the senior living facility and strenuously argue against the recommendation. “I don’t need assisted living” the older adult tells the sales professional point blank. Now what?
The transition between living spaces is always a dilemma. The loss of control, the need to let go, and the disorientation of the new surroundings are difficult enough without a surprise and unwanted change in competency (i.e. you need assisted living). In this case, the facility stuck with the physician’s recommendation, the family balked, and the move was “off.” But there were other options, albeit more time consuming and requiring more creativity, that could have helped both parties work their way towards an acceptable solution:
1. Map out and beter understand the details of the health assessment. What were the specific ADL issues in the health assessment that led to the “needs assisted living” recommendation? Were they dramatic deficiencies or “entry level” limitations? How is the aging parent currently managing these issues in her living environment? The goal of this conversation is to help the family understand the scope and degree of the ADL concerns and, at the same time, help the facility understand the context and history of the older adult’s functionality.
2. Consider a PT enhancement program to improve overall functionality. Deconditioning is common in older adults and undermines all aspect of their functional ability. Have the older adult’s physician order a PT consult to assess movement, strength, and gait. Then have the PT professional map out a treatment plan that combines PT sessions with at home exercise program. This type of intervention returns control to the older adult (i.e. you have choices to improve your functional status) and can have a significant impact on ADL status and overall well being.
3. Consider a “stealth” assisted living program. This option requires a committed engagement by local family members to supplement the independent living environment with hands-on support. While its main benefit is an initial placement in independent living (with a little help from family and friends), it also provides a softer approach for adding assisted living in the future.
4. Consider a trial period of independent living. Sometimes only a trial period will suffice. Opt for a 30-day trial period of independent living, track the details, and then assess the outcome. While this may be a short-lived trial, it provides the dignity of choice and the kindness to admit that none of us want to be seen as “in need of assistance” if we can safely avoid it.