Seniors and Residential Transitions: Making It Work

Relocation Stress Syndrome

No matter where an older adult is moving, or how well thought out the move, it can be a very stressful, life-changing event. Also known as transfer trauma, relocation stress syndrome (RSS) is a set of psychological and physical symptoms that may include disorientation, heightened levels of anxiety or depression, exhaustion, and problems with sleep. It usually follows soon after the move, but its onset can be sudden.

Seniors who are frail, in poor health, live with dementia, have another form of cognitive impairment, or have weak support systems are especially prone to RSS. Left unattended, RSS can escalate into an adjustment disorder, major depression, or even suicide. If your patient or client is planning a move, caution her about the possible effects and provide her with information on local mental health services.

Seniors and Residential Transitions

Whether because he has fractured a hip, had a stroke, or experienced some other medical event, a senior sometimes has to be hospitalized. After stabilization, surgery, or other treatments, seniors often require transitional care and cannot go home right away. If they require extensive or specialized care, they may transfer to an acute care or rehabilitation hospital; otherwise, a discharge planner may recommend a skilled nursing facility. Sometimes nursing home placement follows a stay at a rehab hospital or acute care facility.

In some cases, your patient won’t need skilled care at discharge. If he is at a high risk for falling, is unable to shop for groceries, keep up with his medications, or perform other necessary tasks — and has limited support at home — a discharge planner might suggest rest home or assisted living placement. In assisted living facilities, patients are ambulatory and able to provide for their activities of daily living, primarily personal care. These facilities essentially provide room and board along with other services such as transportation, bathing, and medication management. Some facilities provide multiple tiers of care, from independent living apartments to assisted living and skilled nursing with hospice services. If he can afford it, a resident can stay at the same place (not the same room) and have good care for the rest of his life. The discharge planner can provide a list of elder services in the area. The local United Way, social services department, and Area Agency on Aging are reservoirs of information.

When working with a caregiver, it is important for her to know that the discharge planner will tenaciously insist the patient is the person who calls the shots. If the caregiver wants to be involved, the patient either has to give consent or be legally incompetent — and the caregiver must have power of attorney or guardianship.

Nursing home placement often conjures dread among seniors. As a healthcare provider, it’s important that you work with your senior patients and their families to help them overcome that dread, and have the greatest possible chance of succeeding. Here are some things to keep in mind when discussing a patient’s move:

• It’s best to work with the senior to enlist his involvement and as much as possible allow him to choose his facility.
• Advise that he be allowed as much time as possible to prepare for the move.
• Provide him with such information about facilities as a floor plan, amenities, and what can be brought from home.
• Instead of hollow assurances (e.g., “You’ll love it there”), validate his feelings about moving.
• Ask the facility to match him with another resident to help with orientation.
• Encourage his family to duplicate some favorite activities in his new residence.

Moving in With Family

Whether from the hospital, facility, or her home, sometimes a senior may opt to live with her caregiver, and in most cases this person is one of her children. This option involves two major operations: the senior leaving her home, and the senior adapting to life with her caregiver’s family. The key to success in this situation is planning. A great deal of thought should be made before a well-meaning caregiver moves a senior into her home. To help a senior’s family reduce stress and ease the emotional toll of such a move, recommend that they consider the following questions, and discuss possible answers and solutions with you:

• Do personalities clash between the caregiver, her family, and the senior?
• Is the caregiver and family fully apprised of what kind care the senior will need?
• Have they thought about finances — who will pay for what?
• If the caregiver or senior receives any kind of benefits where household size or income are calculated, what impact will a new resident have?
• Is the caregiver’s home safe for the senior? Have her make a list of the senior’s safety needs.
• Will any modifications need to be made to the caregiver’s home?
• How much involvement has the rest of the family had in the decision?
• Can the senior move her pets (if any) with her? Many older adults are deeply attached to their pets and may cling to home just for them.
• What can be done to ensure the senior’s safety when she is left alone at the house? What if she were to fall outside of the home, for example?
• Is there a plan in place to address any emergency situations?

For apprehensive families, moving a senior gradually (though not always possible) is one way to test the waters. Suggest that the family have their loved one spend a few nights with them at first. Recommend that they take her on family outings while increasing visits and lengths of stay. And, perhaps most importantly, suggest that they arrange a backup plan in the case the joint living situation won’t work out.

Great care should still be taken when a caregiver moves his senior into his home. This involves more than physically transporting her body — her life, and a long one at that — is being moved. When working with patients and their families in an emotional or mental health capacity, provide these tips and reminders to your clients to make their transition more likely to succeed:

• Incorporate as much of the senior’s previous life — possessions and routines — into her new location as possible.
• Design her room as close to her personal style as possible, using her furnishings and pictures. To help remember where things go, take photos.
• Give her a patient, ongoing orientation of the neighborhood — the location of her doctor, grocery store, pharmacy, and hairdresser, for example.
• Be patient and gentle with her. Listen to her complaints and let her vent frustrations.
• Become aware of resources.
• Both caregiver and senior should be very honest with themselves. There is nothing shameful about a caregiver putting her own and her family’s needs ahead of a senior parent’s.

Living with a Senior Parent

Many of the same issues regarding seniors and residential transitions to a facility or into the caregiver’s home apply when a caregiver moves in with a senior. The first question is whether the caregiver has a family. If so, moving in with a parent probably won’t work. Such a plan may need to be modified into frequent visits or the enlistment of additional help. It might be wise to engage other family members in the visits, but only to the extent they want to be involved.

If a caregiver of your patient is considering moving to his loved one’s place of residence, caution him about caregiver resentment, which can be an issue for caregivers who abandon a place, person, or thing they love in favor of moving in with their loved ones. Encourage the caregiver to consider the same questions asked before moving a senior into the caregiver’s home, and recommend they consider these additional items before making such a major life change:

• How well the caregiver and senior get along
• How well they settle disputes
• What level of involvement the caregiver will have in major decisions
• If the caregiver has children, the rules that will be enforced and by whom
• Whether an aging parent will treat a caregiver like a child, or vice versa

Before moving a senior anywhere, it is imperative for her to have advance directives completed. To help your senior patient or his family reduce pre-move stress, suggest that they work out any property or legal issues with an elder law attorney, and address these advance directives:

• Her will. Ensure that the older adult spells out her wishes for after she is deceased.
• A durable power of attorney. There will always be a primary caregiver. To prevent family conflicts over authority, it’s wise to appoint that person durable power of attorney (POA). The primary caregiver can then manage the senior’s affairs if he is unable to do so himself.
• A healthcare power of attorney. A healthcare power of attorney is the same as a POA, but is limited to medical decisions. If he chooses, the senior can specify particular things the healthcare POA can or cannot do.
• A living will. In a living will, the senior lays out in advance what specific medical procedures can or cannot be performed. This is primarily used to avoid living artificially on machines.
• DNRs, if desired. Determine whether the older adult desires a do not resuscitate (DNR) order. If he were to go into cardiac arrest, emergency procedures to revive him would not be taken by professionals.

When it comes to seniors and residential transitions, it’s important that healthcare providers help both the senior and family caregiver by reviewing some of these tips with them. If a family doesn’t want to be involved in the heavy work of moving, they can hire the services of a senior move manager. Primarily real estate agents, these professionals are skilled at helping seniors and their families with moving and its associated challenges. Another option is to hire the services of a geriatric care manager, who can achieve a great deal in helping a senior stay home and find appropriate placement if they cannot.

Starting small, being patient, and considering the senior without surrendering her personal needs is the best way to begin the process of transitioning seniors’ residences. It’s important to remember what is being moved, as well as whom. Instead of the caregiver swooping in to save the senior’s day, she needs a gentle reminder that a life is about to change — a process through which the senior deserves help and the utmost respect.

A strong support network and a sense of security are critical to a senior’s successful transition to new living arrangements. A medical alert device can help; learn how to refer your patients to Lifeline’s services.