Senior Class: It's about the people

"People" she said. "It's about the people."

I had the pleasure to attend the 40th anniversary celebration at Bethany Good Samaritan last week. Judy Mills, payroll coordinator, was hired the day Bethany opened 40 years ago. She explained to us that the entire 40 years had been built around her relationships with the people - residents, staff, volunteers, community. "The people I've met and worked with are what have made the difference and kept me here 40 years," Mills said.

In the past two articles I've emphasized the importance of giving your aging loved ones the gift of helping them plan for their future and the gift of being educated in the options they have (refer to www.4070talk.com ). Most prefer to be at home for as long as they can, and with family or professional care to support them that's often possible. I've also indicated that you need to watch for the signs that your loved one might be in trouble (check www.caregiverstress.com for that list). There are choices for non-medical care at home and for medical home health care at home.

But sometimes, it's about the people. Not every senior wants to age at home and not every home is the best place to age. For some, the answer may be to sell the family home, take the proceeds and build a senior-friendly addition onto a relative's home. This allows certain freedoms, like the ability to travel and still the security of being close to family, of being with people. Sometimes, retirement communities are the right choice. But, as with any stage of care there are many questions that must be answered before any decisions are made.

Retirement and independent living communities can be perfect for healthy, independent seniors. One of the basic questions is what kind of living arrangement is desired? There are many types of communities that are designed for seniors, and they range over a wide spectrum of provisions and costs. Some are luxurious and offer a variety of sports, recreation and entertainment. Others are modest but still offer basic services, like bus transportation and housecleaning. Some are communities of houses. Others are condominiums and apartment buildings. And many are a mixture of all three.

In deciding which of these options is right, seniors need to consider all the costs, including the ones that may not be apparent at first glance. You don't want to be blindsided by charges for, say, trash removal, lawn care or snow plowing. Your loved one also needs to think carefully about whether a move, that may look great in a sales brochure, is really right for them. Many seniors leave retirement communities, for a variety of reasons, including failing health, shrinking financial resources and loneliness for their children and grandchildren.

If the time comes when your loved one needs more support, you might consider assisted living communities. Assisted living communities lie on the senior care continuum somewhere between retirement communities and nursing homes. They provide not just housing, but also help for seniors who have started to decline physically or mentally. This help is not oppressive or overbearing, however. The residents come and go just as freely they would at home, and they don't have mandatory meal times or bed checks.

According to the National Center for Assisted Living, nearly one million older Americans live in about 38,000 assisted living communities. Those numbers are bound to grow as the boomers age.

Many seniors find assisted living communities the ideal solution to their need for an active social life supported by professional medical care, and they live out their years in these facilities.

But changes in your loved one's medical situation may require a higher level of attention, which may disqualify them to continue residing in an assisted living environment and that gets us to skilled nursing homes.

In the past, nursing homes were one of the few options for the aging, and many families faced them with dread. But today, nursing homes are better financed, and by and large they have improved dramatically. Typically, they are places where seniors are encouraged to express their full humanity, as they cook, take care of dogs, raise birds, grow flowers and generally devote themselves to enjoying life.

The best of the nursing homes are staffed with teams of registered and practical nurses, supported by certified nursing assistants. And doctors and psychiatrists are close at hand to deal with a medical or mental crisis. Just like the other choices of care for your loved ones, if the time comes to consider this option, you should choose with care. The support of the staff, again, the people, is a very important consideration in choosing a nursing home.

Now, the time may come when your loved one no longer responds to medical care. Or the doctor may tell you that medical intervention is causing more suffering than is justified by any possible improvement in her condition. This moment could arrive while your loved one is in a nursing home or a hospital. It could happen while they are under the care of you or other family members. It could even happen while they are living independently. Whenever it occurs, it may be wise to think about hospice care.

What does hospice care mean? Perhaps no part of the senior care spectrum is as little understood as hospice care. But it is a growing and important option. The best way to think of it is not as a place, but as a service delivered by a medical team. The care may be provided in a separate building. But it may also be delivered in a private home, in a hospital, in a nursing home or in some other appropriate place. Basically, hospice care is limited to those who are judged by medical professionals to be at the end of their lives. They are usually the elderly, but not always. Younger terminal cancer victims might also be candidates, for example.

Hospice patients receive palliative care that is designed to eliminate, or at least control, pain and suffering. The difference between this and other forms of palliative care is that there is no attempt to cure the underlying illness or to prolong life. Instead, the promise of hospice care is that the patients will be able to spend their final days and weeks with as little pain and as much dignity as possible. Some members of the hospice team can assist patients with the emotional and spiritual aspects of death as well.

It is up to medical professionals, not loved ones, to decide when treatment is no longer effective for a debilitating disease. The doctors make that call. But it may be up to you to tell your loved one about the diagnosis and to help them with the decision to enter a hospice program.

This could be the most difficult conversation of your life. But bear in mind that guiding a loved one through hospice care can be an ennobling experience. It can be a chance for your loved one to reflect on life. It may be an opportunity to reconcile with family members or friends who have become alienated over the years. And it may be a chance for you to sustain your loved one through his or her final wishes and duties.

So this article wraps up the overview of the continuum of care that is available for your aging loved ones, starting with that first conversation with them and ranging over many, many options for care until the final days of life. As Judy Mills stated, the whole foundation is about the people. It starts with you in helping your loved one make these decisions and family taking turns when things just aren't as easy as they used to be. Non-medical professional caregivers may be needed when you notice those signs of trouble, and possibly medical caregivers right in their home, whether that's their residential home for many years, or a new retirement community. I know we all will agree that it's the people at the assisted living facilities and the skilled nursing homes that turn a building into a home. And finally, the wonderful care from a hospice team can be the perfect people that are needed for the last days for your loved ones, and for the remaining family.

Yes, Judy, it is about the people, no matter what stage of care our loved ones are in. If you take home only one thing from this basic information on the continuum of care available for seniors, please make it the commitment to having the conversation about what they desire in their aging years so you can help them fulfill that wish.

DEB CRANNY is the executive director at Home Instead Senior Care in Brainerd.