Can I Change My Mind?

The decision to leave home and move into any kind of adult-care community is a heavy decision. People considering it ask endless questions about accommodations, costs, medical care, social and educational opportunities, staff, policies, food. When we think we have all the practical answers, we still wonder: What if I am unhappy there? Can I change my mind?

This too is a fair question, because some institutions are not what they claim to be, and we also are capable of making mistakes.  A road with no exit is a scary road.

I will try to help you find the answer to this question. I will also try to help you avoid the need to ask it.

The question of your ability to leave a place you have chosen brings up immediately the matter of your financial plan.  In some homes for the elderly, you pay for the care you need when you need it. You might enroll in Independent Living, paying basically for food and lodging. But, then, as you begin to need help, you will have to pay also for the services you get. Maybe you need assistance with bathing, because of the danger of falling. Maybe you need a licensed medical person to bring your medicine in the right amount at the right time. Such services are provided, but you will need to pay for each one.

Depending on the cost of each added service, this seems to be a perfectly reasonable system, but it involves uncertainty about what your expenses will be in the future. Do you know the cost of potential services? If you decline mentally as many of us do, you will need special care, at a price you have not calculated. You may be moved to a memory care unit with a much higher monthly “rent” than you and your family have anticipated.  

So what if you then see your mistake and want to leave?

Usually you will have paid some initial fee that might be called something like a “community fee.” This fee will be non-refundable. How you feel about losing it as you leave will probably  depend on how long you have lived in the facility.

There is another financial plan, often called a “life care plan” that involves a large down payment, a kind of “buy-in” fund. This initial cost can be an obstacle to many with limited funds but should be viewed as an investment or insurance. In fact it makes the new resident a member of the community, with life-long rights to whatever care is needed.

Normally a new resident will be given a period of months after which this money will be refunded if she decides to leave.  This period will give her time to be confident of her choice. Once it has passed, the “down payment” cannot be retrieved.

The advantage of this system is that every resident knows that whatever their needs are in the future, they will be provided, with no increase in their monthly expenses. Their monthly fee relates to the size and quality of housing chosen, and this is what they will pay even after they move to Assisted Living or Memory Care or Skilled Nursing.

In other words, the cost of a specialized environment and perpetual attention is the same as the cost of independent living. No one will want or need to leave the community for financial reasons. At the same time staying in the community is financially advantageous.

These are two common financial models. Knowing these may help you find and understand other somewhat different plans. Some Christian denominations manage homes for their own constituents which are unique and may be subsidized.

Of course, there are other issues besides money, other reasons why you might discover that the place you have chosen disappoints you.  The quality of care, the promised activities, opportunities to grow, the food in the dining room, the atmosphere on the halls, your neighbors in the building, the efficiency of the administration, these could be sources of happiness or unhappiness in the home you have chosen.

At the same time there will be comparable reasons not to leave. You will have friends, people you enjoy and trust. And moving is expensive drudgery.

Such a predicament should be avoidable. We simply need good answers to certain questions before we come.  It is important that these conversations not be limited to the marketing department. If possible, talk to the people who live in the community.

How long have the present residents been living there?  (If the place is new, of course, this question has little value.) Exploring the possibility of a certain home, M happened to meet in the hall a woman whose age was suggested by her frailty and quavering voice and asked her how long she had lived there. The woman gripped the handles of her walker, hesitated, rethought her response and finally said, “I forget exactly how many years it has been, but I was on the waiting list when this place was a hole in the ground.”

What exactly do they like about living here? This is a question to which you need numerous answers, because the answers will vary from “convenience,” “comfort,” “activities,” to “the people.” And what is important to you will determine the significance of each reply.

Try to learn from the residents: Do they find that the advantages presented in the publicity really exist?

Are they happy with the food? The food served in the dining hall turns out to be a general source of satisfaction or irritation. And this is true whether residents are dependent on the dining room for food three times a day or only one. Most of us want variety, along with our favorite things now and then. We want nutrition suitable to our needs.  And we want some variety and surprises along with the basic things. We also want to be able to invite a guest and feel they enjoyed the meal. After all, this is our home.  

We might want to question also the woman pushing a cleaning cart: “How long have you been working here?”  In a well-run facility, even the cleaning staff is likely to stay. 

And we do want to know: How many administrators has the facility had? Administrators and their attitudes affect policies and attitudes in a community. Frequent changes in leadership might signal that policies are undependable.

Most residents discover that the character of the people in the community is the most important factor in their satisfaction. After all, we are going to sit with them in the dining room, exercise with them, play Bridge or Bingo, share books, study and even worship with them. They will be our neighbors.

How much control do residents have over life in the community? When R was touring a home in which she was interested she noticed posters about coming musical events. She was elated to know that she would find the music she loved in this community.

If the people who live together in a home have become a real community, many of the activities will be their own creation. The Bridge games, the dog park, the vegetable garden, the book clubs, the wood-working shop may all exist because residents wanted them, and the administration cooperated, providing space, time, etc. Meeting some of the residents and talking with them about life in the community is important.

Of course it is fair to ask, What needs do I have that will not be met in this place? If there is no library or no resident organization, ask why. The answer may give you hope. Or not. In an active and influential community there is a strong possibility that you also will impact life in the community. You will help to make it the place that you will never want to leave.