Making the Transition to a Long-Term Care Facility

Making the decision to have your parent or loved one move into a long-term care facility can be difficult. Maybe you have been caring for your mother for the past five years and feel that you can no longer do it.  Perhaps your 85-year-old mother can no longer care for your 90-year-old father without help and she has asked you to step in. Maybe your parents have declared, “I never want to live in a nursing home,” and now you feel guilty for making the decision to find a place for them to live.  Whatever your situation may be, making the right decisions about long-term care can help make the last years of your parents’ lives much more pleasant and dignified while giving you peace of mind that you have done the right thing.

When should we make the transition?

Many people aren’t sure when to begin thinking about long-term care for their parents. The most important thing that we tell most of our clients is to never wait until the situation has reached a crisis point. All too often, our clients wait until Mom has fallen at home and broken a hip before they consider long-term care. Sadly, if they had faced the situation earlier, Mom would have had the help and guidance she needed to prevent a fall from ever taking place.  It is always best to consider in-home care or assisted living help if you notice any of the following with your parents:

• Difficulty cooking, cleaning or maintaining the house
• Difficulty driving or inability to drive
• Mild confusion
• Frequent episodes of dizziness or clumsiness that result in minor falls.

If you parent is experiencing any of these problems, you might want to consider having someone come into the home to help them with day-to-day activities.  Additionally, while many people wish to stay in the home for as long as possible, others may want to move into an assisted living facility. Assisted living facilities do not provide 24/7 nursing care like a nursing home does, but the staff and nurses in the facility help with some activities of daily living like dressing and giving out medication.  These communities have the advantage of allowing your parent to have social interaction on a regular basis. Most assisted living facilities have regular social events such as movie night, bingo, and church services, as well as periodic outings to museums, local malls, grocery stores, and the bank. If you believe that your parent would thrive with more social interaction, an assisted living community may be the best decision for them.

One problem that we see all too often is that people wait until it is almost too late to make the transition to long-term care. If you wait until a tragedy has taken place, such as the death of a spouse or a severe illness, the trauma and confusion that come with moving into a long-term care facility will only be worse.  The best time to make this change is while your parent is still able to process the transition and welcome their new environment.

What do I need to do to prepare?

Obviously, the goal here is to make the change as smooth and painless as possible.  While it will never be easy to move your parent out of a house that they may have lived in for decades, there are some things that you can do to make the transition easier:

• Make the move gradually. Nothing is worse than rushing a move to a long-term care facility. If it is at all possible, make the transition over the span of a couple of weeks or even a month.  If your parent has lived in her home for decades, organizing, packing and moving everything out of the house will take a great deal of time! Start with rooms that are not used very often – decide what to donate, what to put in storage, and what to bring to the new facility.  Go through every room until all of the work is done.  This might take a while, which is another great reason not to wait until the situation has reached a crisis point.
• Familiarize your parent with the facility. Before your mother or father moves into the new community, take them to visit it a few times. Show them what their new room or rooms will look like, have them eat a meal in the dining room, and have them talk with some of the residents and staff.  The transition will be much smoother if they are already comfortable with the place and the people who live there.
• Don’t give your parent too many responsibilities. On the day of the big move, try to make things as carefree as possible for your parent. Take him/her out to lunch or somewhere tranquil while others move the rest of his belongings into the new facility.  Make sure that the move is as stress-free as possible for your parent.  If they want to be involved, be sure to include them in as many decisions as possible.  Only you can gauge what level of involvement would be best for your parent.
• Make sure they have an estate plan in place. This last step is the most important. Unfortunately, it is also the most overlooked one in the process. It is absolutely essential that you make sure that your parent has all of his/her legal and financial affairs in order before moving into a long-term care facility.  The cost of assisted living and nursing home care is several thousand dollars a month, and it is increasing steadily.  Most people do not have enough assets to cover these costs for more than a few months to a year.  It is vital that you meet with an experienced elder law and estate planning attorney who can give your parent advice on how to shield his/her assets from a Medicaid spend-down.  Your attorney can also give you important information on how to qualify for veteran’s benefits, if your parent is eligible, and can ensure that your parent has a plan in place in the event that they become unable to handle their financial or medical affairs on their own.  Without these documents in place, many people are forced to go through the lengthy, stressful, and expensive process of getting a guardianship and conservatorship so they can help their parent.  If there is no plan in place for how the parent’s assets will be distributed after death, the child may need to go through even more legal hoops, including the probate process and making difficult decisions that could have easily been made by the parent when they were still alive.

Making the transition to a long-term care facility is always difficult, but it doesn’t have to be a traumatic and stressful event for your parent – or for you.  With a little bit of advance planning, the transition can be made smoothly and a plan can be put in place that will help give you and your parent peace of mind for years to come.

Ask Kit Kat – Foals in Outer Banks

Hook Law Center: Kit Kat, what can you tell us about the new arrivals to the herd of wild horses in the Outer Banks of North Carolina?

Kit Kat: Well, it looks like some new foals have been born recently, which is exceedingly good news. In the past year, the herd had been reduced by eleven horses. Two older horses died of natural causes. One mare was hit by a vehicle and died. One stallion died after a fight with another stallion. Six horses were removed after repeatedly escaping through an opening in a fence, and munching on local lawns. Finally, one of the five foals born this year died. So with the birth of a filly born in August, which was the fifth for the year, fans of the wild horses there are rejoicing! According to Jo Langone, chief operating officer of the Corolla Wild Horse Fund, usually only three or four foals are born each year. Two more are on the way. This year exceeded everyone’s expectations.

The herd size is a bit of a balancing act, according to Langone. The ideal size is around 120, which permits enough room for the horses and less stress on the habitat from over-grazing, especially within the Currituck National Wildlife Refuge. Currently, the herd size is around 100 and managed through birth control of the mares between certain ages. Mares under age four and older than twelve receive a contraceptive called PZP. Certain mares which have already had several pregnancies also are vaccinated. Before this program started in 2007, 26 foals were born. That was too many. But now, a few more foals is desirable. Experts don’t want the herd to get too small, because inbreeding could then lead to disease or birth defects. They continually monitor the numbers, and make adjustments as necessary. (Jeff Hampton, “Baby boom among Corolla’s wild horses brightens spirits after deaths and dismissals,” The Virginian-Pilot, August 31, 2018, p. 4)

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