A Geriatrician's Search for Senior Living

Sally Brooks is a geriatrician by training, making her well versed in the challenges and issues of caring for our older senior population. She is also vice president of physician and medical development for Kindred Healthcare. However, several years ago she found herself facing a common dilemma: caring long-distance for two elderly parents while juggling a career and raising young children, thus making her one of 24 million sandwich-generation caregivers nationwide.

Brooks realized that her parents, who lived two hours away, needed more care than she could provide during weekend trips -- trips that were exhausting her and taking time away from her young daughters. Her mother had suffered for more than 25 years with chronic depression and also had hypertension and limited mobility, often using a walker or wheelchair for long distances. Her father was originally diagnosed with MCI (mild cognitive impairment) but was showing progressive signs of dementia. One symptom of his dementia was wandering. Brooks had taken the precaution of installing a door alarm to alert her mother if her father left the house unexpectedly, but one day her mother didn't hear the alarm and her dad wandered off for hours. A good Samaritan helped get her dad to the local police department, but this became the tipping point for Brooks to consider necessary changes to keep both her parents safe.

"It was a difficult decision to pack up my parents' home, where they had lived for 35 years, and downsize [them] into a smaller apartment. But the reality was that a move was inevitable for their long-term health and safety," says Brooks.

The solution became a continuing care retirement community (CCRC), where her mother could live in assisted living while her dad was cared for in the dementia-care facility on the same campus. They could be near each other for easy visits but get the individualized care they both needed.

"Over the years I watched families being thrust into these decisions, so a couple of years before I moved my parents, I toured a few facilities and found one near my home," says Brooks. "However, my grand plan did not work perfectly, because when the time came to make the move, the facility I liked had no vacancies, so I still had to do research on my own to find another place for them near me."

Brooks' criteria for finding the perfect new home for her parents included three things: It had to be a few minutes from her home so she could be engaged with the facility staff on a regular basis and be able to see her parents more often. It had to accept the Medicaid waiver she had helped her parents secure to afford the long-term care they needed. And it had to accommodate each parent's special needs.

"My parents were half of a whole person," explains Brooks. "My mom had cognitive ability but was physically challenged from walking, driving, or getting around easily. My dad was suffering from dementia, which included his wandering, yet in other aspects he was in great physical health."

While she didn't have the luxury of time to find a facility for her parents, since the move had to happen immediately, her background in healthcare served her well when she visited the facility she finally chose. Brooks doesn't place great emphasis on appearances, such as beautiful grounds, a nice dining room, and a full calendar of social activities. Instead, she knew to look for essentials, such as therapy for her mom and dad and keypad doors in the dementia care unit to prohibit residents from wandering. She also checked the facility's quality rating from the Centers for Medicare and Medicaid Services (CMS).

The family experienced a hiccup early on, when her father left the facility unsupervised (he had his hat and coat on and started a conversation with a doctor in the hallway, who thought he was a visitor and so allowed him on the elevator). But for the most part, the change has been reasonably smooth. Brooks says she manages by engaging those at the facility who provide the hands-on care, so she can focus on what matters: being present with her parents. While she manages the healthcare coordination with the facility, her husband handles the financial paperwork. Her sister and brother-in-law live in the area, and they take turns getting their parents out for meals. Brooks's daughters continue to involve their grandparents in their lives by inviting them to events that include their music and dance recitals. Brooks also finds tremendous help from a network of friends in her neighborhood. One retired neighbor makes monthly visits to her dad, which gives her father a social connection and her neighbor a sense of purpose.

What Brooks learned through her experience is that caring for older parents is like caring for children who go to school or college -- no matter how much you think you know, there is still much to learn.

"You have to stay involved, whether it's checking in with them, planning extracurricular activities, etc. You cannot defer all the caregiving responsibilities to the facility staff," she advises. Brooks also found that if you just ask, people will be helpful -- volunteering to drop off a meal for your family because you have to be with your parents, for example, or responding to questions about how to handle a healthcare dilemma.

Brooks advises other family caregivers that professional caregivers may work 12-hour shifts, but eventually they get to go home and have a break.

"Many caregivers feel guilty when they move their parent into a facility," says Brooks. "But the reality is that you might be a better caregiver for making that decision. If you're trying to care for a parent at home yourself, you never get that break, and it can impact your ability to be the best caregiver you can be."

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