Of Course I Want Choices!

May 20, 2020

It’s been weeks (sometimes feels like months) since I began writing this blog to chronicle my thoughts as an older adult but one who is still working and “in the field” as they say.  Although most states are open to some degree, the show of disgruntled residents making the nightly news along with the growing numbers of those who have contracted the coronavirus and the deaths only increases the stress.  Oh my, the number of deaths continues to increase as well.  But what about those older adults who have been placed in nursing homes and assisted living facilities unable to be with others and quarantined in their rooms?

Interestingly enough, more information has come to light since I last wrote about Placement – “the action of putting someone or something in a particular place or the fact of being placed. “ … ”the assignment of a person to a suitable place.” (  This is the common term when an older adult usually with disabling conditions moves into one of these places.

As a reminder, an assisted living facility is a non-medical place whereby a person moves in when it’s becoming more difficult to live independently.  A person is admitted to a skilled nursing facility (SNF) when there are serious health issues and after a hospital stay.  These are the types of facilities where a person is “placed”.

The general public has never had a positive view of nursing homes. I’ve heard clients describe them as “the end of the road” or “warehouses to die in”.  Prior to 1981, a nursing home was the only place to go.  Social discomfort and reluctance to place someone in a nursing home led to the first assisted living facility established in Portland, Oregon.  Today there are over 31,000 assisted living facilities—many are part of a large corporate structure.  As each is licensed and operated differently, assisted living facilities work hard to convince potential residents and their families that it’s a good choice.  It may be.  However, these same residents were also locked in—and have been for weeks.  How are they doing?  How do their families feel on the outside? A survey taken March 25-30, 2020, by UsAgainstAlzheimer’s Survey (4/8/2020) states:

  • 74% of respondents who have residents in facilities are unable to see their loved ones.
  • 67% say they are unable to assess the health of their loved ones.
  • 35% are less confident about the level of care.
  • 82% of the caregivers say their stress is higher now because of the coronavirus.

In a sense, these were in the early days of the pandemic information and families were concerned.  The facts about long term care facilities (nursing homes & assisted livings) have been slow to come out with almost a veil of secrecy around the residents’ lives and the people who care for them.  I wonder how everyone is doing now almost 2 months later with more information out about the number of ill and dying in long term care facilities.

A headline in the Sunday edition, Sacramento Bee, 5/10/2020 states, “Nursing homes source of nearly 50% of state COVID-19 deaths”.   As of Friday, 5/8/20 “ 1,033 nursing home residents in California have died of COVID-19 related complications..  Nursing home residents make up less than 1 percent of the state’s population but account for 40% of the state’s 2,585 deaths. “ If this isn’t shocking in itself, 11% of the facilities did not have any information listed in the state’s data the article states.  Not surprising since both types of facilities regulated by different state agencies have self-reporting guidelines that do not encourage or demand accurate statistics around their residents.  There is a widespread belief that these numbers are underreported and the death tolls are much higher.

So…let’s get back to choices we as older adults should consider going forward.  For those of us who are living in a home setting there is some planning needed around these issues:

Where do you want to spend your later years?  Geographically stay where you are now, move to another more accessible house, in another part of the country, closer to adult children or other family.

Once you decide Where, see how you can make the house and yard less work and safer to live in.  For example, consider replacing doorknobs with levers for easier opening, making showers easier with handheld showers and grab bars to get in/out.  If you garden, build raised beds for less stress on your back and plant more perennial flowers so you don’t have to replant every year. Look for someone to help mow, trim, and install drip irrigation with timers.

The Where is a big issue and one that many of us who are elders have talked about many times over until we came to a long term decision.  Not an easy discussion either but some have chosen to downsize and move into an adult community.  Others have moved to another part of the state, to a different state, moved closer to adult children while others are aging in place in a home of almost 40 years or already in placement somewhere.

If the Where is moving into congregate living i.e., retirement home or assisted living, do your homework.  Understand the types of facilities. Begin touring this type of housing months before you’re ready to make a decision.  The tours given by a marketing person will point out the amenities but be aware of the other residents as you walk around. Are they friendly?  Do they look at you, at the marketing employee?  Do you see group activities?  How old are the residents?  Ask specific questions about contract requirements for you to move in.  Is there a community fee?  (Note:  A community fee is a nonrefundable amount that is paid at move-in.  It can be from $500 – $100,00 or more for a Continuing Care Community – nonrefundable.)  Understand the “point system” or “levels of care” assigned by a staff person that translates into a higher monthly rent if a person falls, needs medication assistance, or needs supervision.  Fees are shown as starting fees or base amount.  Be sure you understand that once you move in, those decisions are made by facility staff not you.  If you decide to move out, are there penalties?

If the Where is to remain in a home setting, there are community resources that, with some research and planning, can assure a high degree of safety, well being, and independence.  This may be contrary to the belief that:

  • There aren’t resources out there to help.
    • There are. Every county receives state and federal funding for qualified older adults.
  • Staying in a home setting is too expensive long term.
    • There are costs but with some help in identifying needs,  the costs are considerably less than moving into an assisted living facility.
  • Eventually, everyone must go into “placement”.
    • This is not true, and many older adults are able to age in place as their health needs increase.

Remember when you got your first job, moved to a new community, or decided to retire?  Although we looked forward to the change, there was a sense of unknowing and nervousness.  Change can happen to you or you can be part of the change process.  Remember the decisions are yours to make.  If you don’t actively participate, someone else will take over and make those decisions for you.

HAVE QUESTIONS: Do you wonder Where you’ll grow older in years to come?  What are your concerns?  Send questions to

Carol S. Heape, MSW, CMC is an elder herself and continues to search for answers on how to grow older.

Categories: Care Management