Thank you that was very helpful.

I will use that for my mother.
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My 92 year old parents are in assisted living. Costs have skyrocketed over the last 3 years due to increasing health issues and inflation, so all financial planning is out the window and they will need to be moved to some facility that accepts medicaid. The best decision for them was to avoid assisted living until it was absolutely mandatory, even though it was a trade off of health risk versus happiness. The other thing I learned was that any agreement about costs or care must absolutely be in writing and signed off by someone at a higher level than the local facility manager, rapid turn over of staff/mgmt seems to be very common and nothing that was promised verbally is respected when the person(s) making the promise(s) leaves.
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Carol, As always, very informative and useful information. Considering my mom is 93, this is also of great personal value. Thank you, kp
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You should always plan ahead, because you have to find the best place for your beloved one, especially one which is affordable and good at the same time (this is the most difficult part). For example, home care Denver (https://rahomecarellc.com) provides perfect services, like in-home care. You can choose your own caregiver, as well as the days and times of the service. I think this is really nice.
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So, how do I pay for all of this? Words are cheap, and they dont pay the bills. All great if you have a big bag of money
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It's a very good article and quite helpful but i think not every body can afford this assisted living.
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I am finding this incredibly difficult. You cannot reason with dementia. One minute she say’s she understands it is the right thing to do, then she starts with the “I don’t want to go!!!” “Say you aren’t doing this right away!” I took her to a lovely facility and she loved the room, was an instant hit with the people there, then she backpedals and we are back to her digging in her heels and bemoaning the loss of her inlaw unit and possessions. I want to beat my head against the wall. She is so difficult, I have given up everything for her over the years of agreeing she move in with husband and I because she was not safe in the two story, 4 bedroom house I grew up in.
Now, she is not safe in the inlaw, she is a major fall risk and am tired or worrying about turning my back to clean, do laundry, to find her on the floor, once again to hit her head and end up in the ER. I am WORN OUT!!! But one minute she gets it and the next she goes right back. Somebody kill me.
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Awesome article, as usual. Unfortunately if the older adult has dementia, all persuasive efforts and teaching moments may come to naught. Would love to see you address this issue in a future article!
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Good article; however, all this assumes that they or the family can afford the costs of an assisted living facility.
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After my 82 yo father fell for the 3rd time in a week, I told him I could no longer be on call. The 3rd time, he forgot it was my morning at the gym, kept calling an texting for an hour, thinking I was on my way over for Sunday morning coffee. He finally managed to get up and when I arrived was angry and berating me for not responding sooner (1 hour at the gym). Even though he had gotten himself up and was working on bandaging wounds, I called the paramedics to check him out. Went to the ER for x-rays etc. He was mad at me for 2 days. Oh well. He's been mad before and probably will be again. I told him as his only child, I will continue to do what I think is needed for his personal safety and health.
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Thank you for the suggestions Carol. In my case (85 yo mom) I think the main obstacles are trying to overcome fear of moving, fear of change, and the traditional stigma associated with an "old folks home". I'm not sure logical arguments help at this point. It's trying to overcome fear and excuses.
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This article was a huge help to me! Thank you.
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My mother only will go out to dr or grocery store. She won't consider it I do worry about her. She wants me to stay home all the time, won't wear the life alert necklace I brought her. I do worry, but have gotten so tired of watching family vacation and enjoy life while I don't. I go for few hours at a time now but not a single overnight getaway in over 10 years. I'm tired, my health is suffering and I cry all the time. No help is here, so I don't try for that anymore. I now find mom to be selfish, but really my siblings are more and always have been. How do I get mom to check out places while she may enjoy the benefits there when she won't even consider it, she's so stubborn I really don't want to wait till I can no longer do it and have to tell them and al she gets out of it is a bed and nurse. Mom needs friends and activities, or she will just continue downhill till all she can do is lay in a bed. I'm so lost, what do I do?
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This was a great read.
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good ideas, mom has resisted every idea-we tried your ideas, still refusing- has needed an ambulance to pick he up off the floor twice in 1 week. we are afraid for her now what do we do?
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you didn't let your mom down - no way. hugs, again...
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They want to be paid? Shocking. Surely they can provide housing, catering, nursing, domestic, security, advocacy, administration, facilities management, staff training and activities services without demanding fees.
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Nasmir, I am sorry for your loss.

People can get c. diff from almost any setting; most commonly it happens after broad-spectrum antibiotic treatment, and normally they are put on isolation if in a healthcare facility in an attempt not to spread it. You have to wash with soap and water as hand sanitizers will not kill it. It is usually not fatal in someone who is not already debilitated but it can be if treatment does not work. By itself, just acquiring c. diff does not mean a facility was negligent, which you have probably found out if you tried to report or file a suit. You are hurting and you are angry and that is very, very understandable. We've been arguing with you mainly because we don't want other people like us to feel totally horrible about using a skilled nursing facility when it is really needed, and most of us do feel badly enough to start with and wish we could handle or could have handled things at home.

Again - my sincere condolences though!
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This article was first printed in 2010 and I always appreciate Carol's information and insights on these subjects.
However the main barrier I see to assisted living is the cost.
Long term care insurance is way too expensive for many people and the benefits are often limited and the company like most other insurers are slow to respond to claims even when the case is very urgent.
Assisted living would be an ideal solution for me in the not too distant future but alone not in a married situation, where, as we age our long term partners need their space.
Being solitary by nature the idea of sharing a room with another resident in a nursing home is my idea of prison and being encouraged to participate in the "fun" activities is my idea of punishment.
Just the way I feel but I can so empathize with the elderly who are being encouraged in this direction. I don't have dementia so can see the sense and need for such a move but not to a sub standard facility because I can't afford something really nice. I am not difficult to deal with - I take that back, I am very difficult when I experience less than professional care. For example being given only yellow gowns as I was labelled a "fall" risk. I admit I could be if I was not competent enough to take very great care. I am also competent enough to know when if is necessary to use assistive devices. Also on one occasion being addressed as "Love Bug" by an aide really steamed me. Fortunately I only saw her once.
We do have friends who made the decision to move into a progressive assisted living community well before they needed to so they can have the security of progressive steps up to full care should it be needed BUT the buy in price was $4000.00 and not too many people have that kind of cash lying around.
To sum up I think I would have to be too incapacitated to argue before I agreed to be placed.
This is not to say that i think all the sons and daughters who have given up their lives to care for elderly and usually ungrateful narcissistic parents should be expected to do that, with no help from society thus increasing their burden on society after they too become needy because they were prevented from providing for their own needs.
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WileyJ - Where you said: "I have a problem with some of the patronizing language I’m reading in this comment section" - you are not alone!

Some people pass very rapidly from caring about their elder loved ones to trying to usurp the right to decide what is in their best interests. Well, if that's you, you let me know when you think *you* will like being told what's good for you.

Assisted living can be an extremely good option. I plan to prepare myself for it in due course, and if possible move in well before I'm forced to by circumstances. But some people genuinely would rather die than move away from everything they've ever known, the home that's been their adult life's work. They haven't the least interest in making new friends, or the energy to enjoy stimulation. Please respect that choice too.
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Nasmir, I'm so sorry. I totally understand where you're coming from now. That's such an awful experience your mother and you just went through and my heart goes out to you. I can see why you think it would have been so much easier if she'd have just died outright in the beginning. I just don't agree that someone should have made that decision for her. I really am sorry you had to go through all that though.

I had to watch my mom slowly die in the hospital from lung cancer. It took her three days to die after we took her off the ventilator... fortunately she was full of morphine most that time and was mostly unaware, but it broke all our hearts. She had no chance of survival and she had a living will she'd written a couple of years before she got cancer that asked, if it were legal at the time of her death, that she be given a physician assisted suicide if death was inevitable. Sadly, it wasn't, so instead we all took turns sitting with her around the clock so she wouldn't die alone. So I do feel for you.
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Nasmir, I usually try to be sweet and positive and supportive and all, but dang! You really do want an answer that is "simple, neat and wrong!" You really do think that people should just be healthy and avoid getting dementia, but if they can't they ought to just off themselves! Nice way to never have to deal with the problems of aging...

But seriously - what brought you to AgingCare if you really think there should never be an actual problem? Can you share what is really going on with your life, and/or your loved ones?
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Nasmir... I do agree with a person's right to choose is there is no hope for any future quality of life.

But heaven forbid...I definitely do not agree with your second point at all. How would you like to be the 64 year old with Alzheimer's who they (and who would they be, pray tell) decide to kill when one year after your death they find the cure that will reverse the illness?
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Ah Alas Nasmir, if only you were correct. Sadly, that's not what the experts say...

"The experts say that in just a few short years, as the population of baby boomers retires, long-term care of the elderly will become a national crisis. In fact, it’s estimated that 70 percent of Americans who reach the age of 65 will need some kind of long-term care for at least three years during their lifetime."

Thus says a quote from an article entitled "Why Long-Term Care for U.S. Seniors is Headed for ‘Crisis’" on PBS.org.

I do have to agree with Vstefan's though...This is all a moot point to those in this forum who are struggling with their loved one who is among those 70% in the hear and now. They have come looking for empathy and support in their current battle against their senior's symptoms of aging regardless whether it was lifestyle, genes or simply time that's caused em.
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Nismar...I think you must not have read my full post. I said (and will, more often then not, need help). In other words, some will live to a ripe old age and die with no help at all, but many more then that will need some help before they die, regardless of how they lived. Some will need more then others, but help will be needed by most somewhere along the path to death.
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Um, no - unless you have one of the autosomal dominant genes for early-onset Alzheimer's or CADASIL (early-onset severe vascular dementia) what you choose to do lifestyle wise makes a huge difference whatever genetic cards you've been dealt. But 1) there is no absolute *guarantee* that healthy eating and physical and mental activity will stave off all illness or disability lifelong; not all of us will be "wonderful one-hoss shays" where everything conveniently falls apart at once and any of us could need a little care some day. (I personally work hard at the lifestyle things, well aware of my crummy family history and a few bad things on 23andme that help expalin it - AND have long-term care insurance...) and more importantly 2) people on here are trying to deal with what IS not what could be or should be.

BTW, using an assistive living or skilled nursing facility is not a death sentence - I've had friends go back home after rehab, and lots of us truly cannot manage care by ourselves and need to use one, and if you stay on top of things and are willing to switch if any given facility is a bad fit, someone may live longer and better than with home care or no care for sure. It can be about getting as much out of life as possible even when time is limited and the circumstances less than ideal.
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Yes, you can reduce your risks of vascular dementia, and maybe Alzheimer's depending on your genetics, via healthy living, but it is not necessarily easy and that does not mean you can eliminate these things. And you can't make someone else live a healthy life nor can you reverse things for someone else who has not been healthy for many years. Wishful thinking is no help to people here on AgingCare.
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Regardless of how hard you try to keep the body and mind healthy you're going to get old, the mind and body are going to fail, and you are going to die (and will, more often then not, need help before you do).
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Moving to a new community can be a very stressful event in the lives of older adults and their families. It is frequently accompanied by major losses: changes in health or cognitive status, mobility, spouse or friends, possessions, driving ability etc. A striking amount of research on relocation of older people has found that if the move is involuntary – the older person feels forced against their will – their self-esteem and health suffer. However, if they are part of the decision to move they often have a more positive adjustment to their new home.
Think of how you would feel if your children plotted behind your back and neglected to include you in decisions that impact your life? A diagnosis of dementia certainly complicates the situation – because change is very unsettling. But you can still explain simply and gently why are where they are moving and highlight the positive aspects like meeting new people and enjoying fun activities. They are still a person fist and foremost who deserves to be included, and treated with dignity and respect.
I have a problem with some of the patronizing language I’m reading in this comment section. Older adults are not ‘children’ who can’t be reasoned with. Just because they aren’t excited about moving from their home doesn’t mean they don’t know what’s good for themselves anymore. Our homes are so much more than physical structures – they contain our memories, our identity and offer us privacy and comfort. When our needs outgrow our homes, it likely won’t be an easy decision to move for us either. Which is why it’s so important to reframe the conversation – when we feel a part of that decision we will feel empowered, respected and view the move as more desirable. The adjustment will take time, and you have the best intentions for your parents, but please remember to treat them with the respect you’d wish to be treated with at their age.
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helpImhumantoo, I fully understand, there is a lot of resentment when our elder parents want to continue with their lifestyle while we need to change ours.

My parents had a wonderful fun filled 25+ years of retirement traveling all over the place, eating out, going to plays, going to the movies, etc. But once they stopped driving in their late 80's, I became their wheels, and had to take time off from work for all of the appointments, shopping, groceries, haircuts, etc. Eventually a job I had for 24 years was gone, headquarters decided to eliminate the position as others were doing my work. Thankfully I found other work, but it was only part-time.

My resentment is that I am pushing 70 and when I look ahead to retirement it won't be what I had planned. My health took a terrible turn due to all the stress, and I look like I had aged 20 years in the past 7 years. No vacations, as who can enjoy themselves worrying about who has fallen now, did someone get sick, was 911 called, etc. My Mom refused caregivers.

Is this what my parents had wanted for me? Probably not, but their world stopped at their front door, and my parents still viewed me as being 30-something.... [sigh].

Move ahead to today, after Mom passed, two weeks later Dad said he wanted to move into senior living... say what?.... poor Dad, he wanted to do that years ago but Mom refused. He really feels that she would be here today if she wasn't so stubborn.
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