The Connection

When Jim Upp’s wife Jeannie died in 2006, the Fairfax senior citizen found himself surrounded by a lifetime of memories in the spacious home where the couple had raised three children.

"We lived on a one-acre lot with plenty of trees all by ourselves," said Upp. "I was alone, and there was a large house and an acre of land to take care of. It took me about five days to realize that wasn’t where it wanted to spend the rest of my life."

Upp moved to a retirement community, which he called a one-stop center for medical care, activities from bowling to television production, and socializing with people with similar backgrounds.

"I did not know a soul when I came here, but I know hundreds of people now," said Upp. "There are more than 200 activities here on campus. There are five or six doctors here everyday. If I have a problem, I can just go down and see a doctor anytime."

WHILE UPP’S TRANSITION was uncomplicated, methodical and borne out of a self-made decision, other moves are not so seamless.

Deciding that one can no longer live alone, selling a house that has been a home for decades and relocating to retirement facility can be an emotionally charged and physically challenging feat. Recognizing the warning signs that a change might be necessary and developing a plan can help make the move less complicated.

"There is usually a crisis that bring someone into a facility," said Catharine A. Kopac, Ph.D., a certified geriatric nurse practitioner and chair of the graduate nursing program at Marymount University in Arlington. "Often the family gets no counseling and the move is made in a hurry."

Knowing when it is time to transition to a professionally run living environment is a decision with which many struggle. Gerontology professionals say there are a few red flags. Topping the list is the risk of vulnerability. "Is the person safe?" asked Andrew Carle, executive-in-residence, at George Mason University’s Program in Senior Housing Administration. "Are they are on [multiple] medications and it’s hard for them to manage? Are they at risk for falling or do they have Alzheimer’s and are at risk of wandering?"

If the answer to any of these questions is "yes," it might be time to move. An inability to perform daily activities such as eating, bathing and driving is another indicator.

SELECTING THE RIGHT TYPE of facility requires knowing the choices: independent living, assisted living and nursing homes.

Independent living is generally regular housing specifically designed for seniors whereas residents at assisted-living facilities can get aid with daily activities such as bathing and medication management. They often include kitchens, but meals and transportation to medical appointments and other errands are usually provided as well.

"Many people don't understand the difference between a nursing home and assisted living," said Carle. "Unless a person is bedridden, they probably don't need a nursing home."

Identifying a person’s specific needs and finding a facility that is equipped to meet those requirements is vital. "If one needs any rehabilitation, then you would want to choose a facility that offers rehab services or therapy," said Dr. Jean Glossa, M.D., medical director for Fairfax County Community Health Care Network and Molina Healthcare. "If one has dementia or Alzheimer’s disease, then you would want a facility that has trained and experienced staff in working with patients who suffer from either disease."

Geriatric care specialists, who can be found through the National Association of Geriatric Care Managers, can help assess a person’s needs and help match him or her with an appropriate community. The Assisted Living Federation of America is another source for information on facilities, and experts recommend visiting www.medicare.gov when looking for a nursing home.

"CMS [Centers for Medicare & Medicaid Services] has the Nursing Home Compare website, which provides basic data about nursing homes, including staffing, past violations in recent surveys by the licensing agency, quality measures and more," said Glossa.

Experts say it is important to visit multiple communities before making a decision: "You should always tour at least three," said Carle, who lives in Herndon. "It is like test driving a car. You don’t just test one car and buy it."

Meet those who run the facility. "A community is only as good as its administrator," said Carle. "Have the administrator give you a tour. It doesn’t matter if the facility has a glass chandelier or a baby grand piano. As you’re walking around, if the administrator doesn’t know their own employees or residents, that would tell you a whole lot more than any brochure would. Families should look for an administrator who clearly has a love for seniors."

When meeting the staff at retirement facilities or nursing homes, there are key questions to pose. "Ask about the longevity of the staff and the average years of employment in the facility, the community’s philosophy on aging in place, transition expectations as the person declines and needs additional services," added Karen Boyce, the administrator at Renaissance Gardens at Greenspring in Springfield. She also recommends staying for lunch or another activity "to experience the sense of community, and staff interactions with other residents and each other."

LOCATION AND ACTIVITIES are other key considerations. "Is the facility close to family?" said Dave DeClark, director of marketing at Vinson Hall in McLean. "Is it close to a social network or former business associates? Is it in a geographic location that they find desirable?"

DeClarke suggests contemplating social aspects. "What type of environment would the individual or the couple really thrive in? What are their outside friends like? What are some of the things that they used to do and would like to continue doing?"

The cost of the facility is important too. "Discussing payment methods in advance also helps alleviate financial issues in the future," said Glossa. "If you or your family member has Medicaid or Medicare, make sure the facility accepts residents on either or both programs."

Experts say such moves require sensitivity and planning. "Don't take control. Leave control in the hands of the elder like when to move, what to take, what to buy new, all the details, no matter how long it takes or how weird it may sound to you," counseled Potomac resident Linda Berg-Cross, Ph.D., a professor of psychology at Howard University.

Carle added that guilt is a common barrier to assisted living or nursing home placement. "Many people feel that they should be taking care of their parents," said Carle. "But families need to be honest with themselves and understand that the world is different now than it was one or two generations ago. Many people would be happier in an assisted living facility where they have activities and friends than they would be living all by themselves. We should look at this as helpful and not something to feel guilty about."