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How to Prevent Independent Living Residents from Moving Directly to Skilled Nursing — Love & Company

By Chris Carruthers, Vice President of Health Services

The best way to prevent independent living residents from skipping over assisted living or memory care services, and moving directly into skilled nursing, is to have them move into the right level of care at the very beginning. As sales counselors meet with prospective residents and their adult children, they are responsible for obtaining information during the initial discovery visit. Over the course of these conversations, they are trained to uncover the prospect’s current lifestyle habits, financial situation and health status.

Most independent living prospects explore retirement living options when there has a been a recent change in their current lifestyle due to home repair, lack of socialization or a change in their health. Asking the right questions ensures that the prospect moves to the appropriate level of living in their community, ultimately preventing them from skipping over assisted living or memory care. The discovery visit is the time to set the expectation of what level of care will work best for them.

There are three common scenarios that develop from the discovery process:

1. The prospect is a healthy, independent senior who may have lost a spouse, or is living alone.

In this scenario, the sales counselor should establish the expectation that as people age and live alone, the best option for future assistance is in an environment that provides socialization, a balanced diet, and possibly medication assistance.

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Ambulation limitations can prevent an independent living resident from coming to the dining room and attending social activities. While care can be provided in an apartment or cottage, there are always issues with caregiver turnover, the cost of services over time, and the quality of life within those four walls.

2. The prospects are a couple, and one of them has a health need, with the spouse acting as a caregiver.

In almost every instance, when couples make a decision to move to a retirement community, there is a known health condition with one or both of the spouses. The most common situation is when one spouse acts as a caregiver, which means the spouse turns from a loving partner to a loving caregiver—a role that they believe they should assume, but one that drastically changes the dynamics of the relationship.

Depending on the financial situation, it may not always be possible for a couple to pay for both levels of care simultaneously. Many feel they can wait until both spouses need the same level of care, and that rarely occurs. While this is a tough conversation, it is important to share the reality that people do not age in the same timeframe. Mention that one spouse could downsize to a smaller residence when it’s appropriate for the other to make a move to another level of living.

3. The prospect is a senior with medical issues and possible memory loss, with family members acting as caregivers.

This gets a little tricky because many seniors who move to independent living may have some form of memory loss or a few medical issues, but they may not qualify for assisted living. However, in order for them to move to a retirement community, the family encourages them to move to independent living, instead of waiting for assisted living, knowing that they will have the services they need. In this case, it is important to establish some sort of expected timeframe of when a move may become necessary, given their current situation.

A move can be very difficult for a senior, and while they may function well in a familiar environment, the change to a new environment may require an adjustment period that can take weeks or months. In this situation, the care manager or social worker needs to consistently communicate with the resident and family member, so that when services are needed, a move happens sooner rather than later.

Consistently support the expectation

Care managers or social workers who may be involved with a future internal move should continue to set expectations initiated by the sales counselor. It is important to be clear about the process, and how a move is managed.

Many mistakenly believe that a decision to move to another level of care is made within a very short timeframe, and that the residents and their families are not involved in that process. Be sure to explain that the decision would be reached over a period of time based on any changes in health or memory. There are often safety concerns (i.e., fall risk, depression and other risks) if someone remains in an environment that does not support their changing lifestyle and needs.

Flexibility and Communication

The most important conversation to have with prospects and residents is to let them know that every person’s situation is different, and while the ideal situation for everyone is to age in place in their independent living apartment or cottage, it is not always the best decision.

Retirement communities often limit the amount of time that services can be offered in someone’s home to 4-6 hours, but the conversation is a difficult one when a resident needs more care and does not want to move. Consistent communication about why such policies are in place will keep the prospect and family members aware that a move is pending. Give them enough time to prepare for the potential move, and work to create the same sense of home and décor in their new environment.

If you would like to learn more about managing conversations about different levels of care, please contact Tim Bracken at 410-207-0013 or Rick Hunsicker at 214-906-3801.

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