We often learn the most about working with seniors from our own families. My parents, Will and Esther Littell, have made many (to my surprise) excellent decisions in retirement. Probably the best -- both from their and my perspective -- was choosing to move into a life-care community.
In their late 70s (about 15 years ago) my parents announced they were moving into the Presbyterian Home in Evanston, IL, about a 20-minute drive from their home of 60 years. The Presbyterian Home was first-rate, with a range of housing choices and levels of care. They entered into a comprehensive contract: In exchange for a significant entrance fee and a monthly assessment, they were promised lifelong care at the same monthly rate, regardless of whether they were in independent living or the home's nursing facility.
They first moved into a two-bedroom, newly renovated townhouse separate from the rest of the retirement home. With a smaller living space, regular maid service, easy access to a fine dining facility, and all-new appliances, my mother's first comment was, "Now, I get to retire."
For the first few years, they continued going to the same church, maintained many friendships from the old neighborhood, and traveled regularly. As time passed and getting around became more difficult, they didn't resent spending more time at the home, since they had developed a social network and enjoyed a range of activities.
Several years ago, near the end of my mother's life, she had a heart issue that resulted in some dementia, and the best place for her was the early Alzheimer's nursing unit. My father stayed in the townhouse, a few hundred yards away.
After she died, my father stayed in his townhouse until a health issue required that he move into assisted living. At first, this transition was not easy. But recently he has become more himself, and at 94 he has a full life, taking photos, learning how to use the Internet, and driving around the campus every Sunday so that he can continue to pass his driver's test once a year.
Both my mother, throughout her life, and my father have always had nothing but praise for the home. I'm sure their experience is not universal, but it seems to be the norm at the Presbyterian Home. When they moved in, they said what many people say after making the life-care community decision: "We don't want to be a burden on our kids."
I was skeptical at first, but over the years I have observed what an independent, interesting, and complex senior living experience that they have had. I've become an advocate for quality life care communities and try to dispel misunderstandings that people have about them. Here are some of my observations from following their experiences.
More, not less, freedom
In her mid-80s, my mother began to require daily shots of insulin for diabetes. My father could administer the shot but couldn't see well enough to fill the syringe. Every week the nursing staff delivered a new supply of properly filled insulin syringes. In other words, they received enough health care to make their lives simple, but they were allowed to be as independent as they could be. This is when I learned that releasing seniors from the drudgery of the increasingly difficult tasks of daily living gives them more freedom to pursue more meaningful activities.
Nursing care is never easy
The Presbyterian Home is terrific, but nursing care is always a difficult experience for the resident and family. In my mother's case, she was restless and disoriented and in danger of falling out of bed. Even in a great home, she needed the kind of care that can only be given by private-duty nursing. This was an unpredictable and significant expense.
On the other side, when a life-care community resident enters nursing care, the experience is much different than moving into a new nursing home. Because they had been at the home for a long time, my mother had many visitors throughout her stay, and my father could be there regularly. As a resident of the home, my father's needs were met during this time, too. The social worker stayed in close touch, and he was in a caregivers' support group.
Count the services, not the square footage
The life-care market is getting more competitive, and many new facilities are offering larger and more impressive living spaces. However, as residents age, their quality of life will be measured by services and not square feet. Key questions suddenly become: Does the home have a pharmacy? Can you get rides to the doctor? Are there nurses and social workers assigned to each resident?
When and where
I would bet that it's tempting for many contemplating a move into a life-care community to wait until a very late age or to choose to move to a new community. Both of these decisions heighten the pressure of the move and probably the risk of disappointment. As you can see from my parents' experience, moving into a community close to their home at an age when they were still vibrant and active worked very well for them.
Adding quality years to their lives
I have no empirical evidence that the Presbyterian Home adds years to the lives of the residents, but I have a hard time believing that it doesn't. Starting with the simple things, the place is "senior proof," minimizing the chances of life-threatening falls or other incidents.
The support system also helps minimize serious health threats. For example, a number of years ago when my mother was very short of breath, my father was able to take her directly to the nurse's office at the home, instead of making an appointment at a far-away doctor's office. When the nurse discovered an extremely low heart rate an hour later, my mother was in the hospital, three hours after that she had a pacemaker, and the next morning she was home. For the next two weeks, they ate a few more meals in the dining room, received daily visits from the nurse, and went right on living a normal life. They also received cards, calls, and visits from their many friends at the home.
In my -- and their -- opinions, the Presbyterian Home added both longevity and quality to their lives. And it definitely has brought peace of mind for me and my sisters -- my parents' original goal. In my father's words, "The place is super."
David A. Littell, JD is the Joseph E. Boettner research chair and a professor of taxation at The American College. For more information, visit www.theamericancollege.edu or call 888-263-7265.
