Family Caregivers BC

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Episode 13: Facility Placement: Managing the Transition to Long-Term Care

Caregivers Out Loud

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For many people as they age, living as long as they can in their own home is ideal. We love our comforts, our routine, and our independence. But there comes a time when the decision to have more support or to move into long-term care becomes a reality, whether because of a medical condition or safety concerns. This decision can be a significant challenge as there are many factors to consider when needing additional support.

In this episode, Janet Power, Executive Director of Sunrise Senior Living in Victoria BC, shares great information around transitioning to residential care and steps for gaining more support for the care recipient and caregiver.

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Quotes

“I think everybody in life, whether they’re young or older, wish to have quality of life and it is through interactions through play that we gain quality of life. Who wants to live a life where there’s no play? One of the key things that I would suggest for somebody looking for care for a loved one is to look at what activities they have to offer.” 

“There’s never enough resources. I think any community will tell you they’re open to any resources coming in, any new ideas and sharing. So caregivers who are coming in with their loved ones, sharing those resources, sharing ideas for us, to us, is vital. We can’t do without them. So bring it on, bring on more ideas. Yeah and we’re open.”

“Hand-in-hand with communication is trust. In our profession is not only important to communicate, but in order to gain trust, we have to make sure we follow through with what we promise.”

Resources

Online Tools and Apps

Route 65 was developed by EngAge BC, a non-profit operating arm of the BC Care Providers Association (BCCPA), in response to a visible gap in quality information about seniors’ living and wellness options in the province. On Route 65, seekers can find more information on independent living, assisted living, long-term care and home health care options.

Route 65 also helps users navigate the seniors living and wellness continuum through our Glossary, Frequently Asked Questions and Resource pages, along with Walter, our 24-7 virtual concierge chatbot, who helps triage seekers to the most appropriate options.

Call 1-877-955-6565 or learn more at https://route65.ca/.

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Transcript

Bill

[00:00:09] For many people as they age, living as long as they can in their own home is ideal. We love our comforts, our routine, and our independence. But there comes a time when the decision to have more support or to move into long-term care becomes a reality, whether because of a medical condition or safety concerns. This decision can be a significant challenge as there are many factors to consider when needing additional support.

[00:00:37] This is where Janet Power comes in. Janet has been involved in senior care for over 32 years with most of those years working in long-term care. Her true passion is in residential care, which offers full-time care for residents. She’s currently the Executive Director of Sunrise Senior Living in Victoria. Today, she’ll share her experience with assisting families transitioning into long-term care.

[00:01:08] Janet, what is it about long-term care that keeps you working in this industry for so long?

Janet

[00:01:14] Well, I think there is a need for support for those individuals. And often there’s a lot of advocacy for those individuals. So it’s up to people like myself and people who work in the field to represent people who cannot represent themselves. 

And of course, there’s always the family that do a great job, but we also need to support the families.

Bill

[00:01:36] So we’re going to focus on that long-term care, but probably get applications from people who are in independent living and those who are in assisted living wanting to get into long-term care.

[00:01:48] Can you say a word or two about those first two categories?

Janet

[00:01:52] Well, independent living is just that. It’s the persons who live independently and often do not need any support. So that could be an individual living in the community in their own home, their own condo. And now there are services where people can stay at their own home and condo and have services coming in if needed.

[00:02:10] But then there’s people who choose to move into an independent living setting and have the hospitality services. They’ve worked a long time. They’re retired, they want to have the meals and the housekeeping, and so forth. So they move into a retirement living type of setting. So that would be your more independent. And nowadays a person could live in an independent and still have resources come in to support some care. So that has changed. 

[00:02:34] Then, the next one would be the assisted living. Assisted living in BC is under the Licensing and Assisted Living Act, in that, persons moving into an assisted living need to meet a certain criteria. In assisted living, some of the key areas would be your hospitality services, like your housekeeping and your food services, but also socialisation activities and the care component, which is often what drives a person into moving into such a setting. 

Bill

[00:03:04] I see. Like, sort of, minor health care issues and things like that? 

Janet

[00:03:10] Correct. There’s two key components that are important when a person is to remain in assisted living. One is they don’t require a lift. So they’re able to weight bear and walk a certain distance. And then the other is that they can live in an assisted living environment and understand what to do in case of an emergency.

[00:03:30] So they know to call nine-one-one, they know, to ring their call bell, or press a pendant. Those are two key things that determine whether a person stays in assisted living or not. 

Bill

[00:03:41] When the time comes for them to begin thinking, or at least anticipating, if not actually applying for long-term care, now what circumstances are necessary to qualify?

Janet

[00:03:55] That one is quite diverse as well. So in long-term care, you have owned and operated communities by the health authorities. So we have five health authorities in BC. So I work in the Vancouver Island Health Authority. You have the owned but affiliated with the health authority. So it may be a private paid community who has, whether it’s all of their rooms, subsidised or partial, so maybe private and some may be subsidised. And then you have a community like myself, where ours are all private. Regardless of which type of community you’re living in, all are registered under the licensing.

[00:04:35] And under licensing, of course, all these communities have to follow set regulations. So that would be regulations around our staffing, our physical environment, hygiene, communicable diseases, care, supervision, meds, nutrition, and you name it. So all of these communities have to meet these guidelines and if they don’t, then we would be responsible for the patient quality office to address any contraventions we may have. 

Bill

[00:05:05] Ofttimes, people are thinking about long-term care tend to delay the research and their decision-making. Like any good family caregiver, they feel responsible and they can take care of a lot of the things that are going on with their care recipient.

[00:05:22] Can you say a word about that anticipatory planning, starting to think ahead, even if it’s maybe an independent living that they’re in now or an assisted living about the need to start thinking ahead?

Janet

[00:05:36] Okay. Well, I think first and foremost, they have to have a good relationship with their doctor. So the doctor, following the person’s health, because one of the key things is most people want to stay home longer. Wherever that home may be. 

[00:05:50] And when you notice that you may need help or your spouse, or you’re noticing a loved one, whether it’s your mom or your dad or aunt, is starting to have some decline then you want to make an appointment with the doctor and try to see if those things are treatable. If it’s something that may be a slip where they’re needing more support, then what happens – the physician or yourself can make a referral. Actually, you can go through VIHA, online, and make a referral for community access, and case manager would come in and assess your loved one, or yourself, and see if you’re eligible for any care to come into your home or to see if you’re eligible to move to an assisted living or for some people, they may be in a hospital setting or even at home and need to move to long-term care. So physician, then linking with the health authority via yourself or through the physician and there, the steps will follow and get the support you need. 

Bill

[00:06:49] Now, if I’m going to go into long-term care and I have a primary doctor, can I keep my doctor or what doctor would I have if that isn’t the case?

Janet

[00:07:02] Well, there has been some changes over the last few years, for the better. Some communities you can still keep your doctor. Well, there are many communities now that are moving towards what’s called the torch program or the core program, which is in my view, a great thing in that each community would have a group of doctors, who would rotate in taking the new residents coming in.

[00:07:28] And those doctors would form a, for example, the core program would form a core group of people who would meet regularly and who would have steps they have to follow in that they would visit their patient, the resident monthly, they would get involved in care conferences, and they would have much more involvement in the resident’s life. And therefore, hopefully improve the quality of life for that resident, because there’s so much more contact. 

Bill

[00:07:59] Yeah, a pretty sophisticated process, it sounds like.  So what about transportation? If I go into long-term care for things like outside appointments, and even just a wheelchair access, wheelchair-friendly transportation, can you respond to what happens in an LTC Community in that regard?

Janet

[00:08:20] So, it differs from independent and assisted living, where they often, they have a car to bring you to appointments, or they may have a bus trip that drops you off at a particular spot and then picks you up later. In LTC, for the most part, most transportation is for activity-based. So scenic drives, destinations for outings. But that’s not to say there aren’t communities out there. But, for the most part, there are transportation from the minivan service or taxi services that may have a wheelchair lift, but that’s something I think would be a need for a focus, seniors’ advocate group to focus on for seniors because often that is not available. Particularly when seniors in care don’t have family who live close, and trying to make appointments, and having a service there, would be a great thing.

Bill

[00:09:17] What kind of mental health supports can be arranged in a long-term care community? Is there a process for it? Like the one you mentioned for the physical care.

Janet

[00:09:28] The way I see it, when you’re in care, in a long-term care setting, it’s about the person, it’s all parts of the person. So mental, physical, social, cognitive, et cetera. So that’s one aspect of care. But most communities, if not all in long-term care are linked with the geriatrician or Geri psych, I should say. And they can reach out to the Island Health to get support with persons that need an assessment or some support that may have been deemed necessary from the team at the community. 

Bill

[00:10:02] And in terms of the engagement of the caregiver and, you know, even prior to coming into long-term care, how do they advocate then for enhancing level of care? The example being for a therapeutic modalities or additional activities and support while they’re in long-term care?

Janet

[00:10:22] I think everybody in life, whether they’re young or older, wish to have quality of life and it is through interactions, through play that we gain quality of life. And being from a background as a recreation therapist for a number of years, I know the importance and I know the importance for myself, you know, engaging in activities.

[00:10:44] Who wants to live a life where there’s no play? One of the key things that I would suggest for somebody looking for care for a loved one is to look at what activities they have to offer. And also look at what therapy services can come in. Most communities are pretty good. They’ll allow services to come in, particularly if you’re wanting to pay for them yourself. There’s never enough resources. I think any community will tell you they’re open to any resources coming in, any new ideas, and sharing. So caregivers who are coming in with their loved ones, sharing those resources, sharing ideas for us, to us, is vital. We can’t do without them. So bring it on, bring on more ideas. And we’re open. 

Bill 

[00:11:29] It is not always easy having conversations around care transitions and the need to move from home to a facility for more support. Facility placement is one of the most difficult decisions that families need to make and many emotions may arise for family members, such as guilt, grief, anger, and anxiety. 

[00:11:52] Because it is such a sensitive topic, communicating with care and compassion is very important. Janet, what suggestions would you give caregivers about communicating with staff in a long-term care facility?  

Janet

[00:12:10] I think everybody will agree, communication is vital. And do we do a great job at it? I would say there’s always room for improvement. An everyday thing that I work on myself in an executive position, and particularly when somebody’s moving in, but thereafter, just that much more because you want to communicate what you believe they will have, and you want to make sure that you live up to those expectations. 

[00:12:38] So when a person comes in to seek, if we’re the right community or any community is right for them, I think it’s important for those people to ask a lot of questions. There are a lot of things online you can find of questions that you can answer when you’re looking for a place. And when the person decides to move into care, I think it’s important to make sure you know who to call when there is a need. Who’s who? Basically, if it’s a nursing question, if it’s something to do with the light bulb in a room. Like, where do you go to get those questions answered? And it may sound like a small thing, but when you’re holding all that responsibility to help move a loved one into care, you’re not able to often answer the simple questions that you once could because you’ve got a lot of strain on you. 

[00:13:30] So whatever we can do to simplify that, we must.

Bill

[00:13:37] I think those kinds of details help you convey to the applicant that you’ve got some restraints on your own capacity, just the sheer volume of work you have to do. And that it’s not that you don’t care, there’s no limit on your compassion and wanting to do a good job. So it’s important, I think, that gets communicated even as they make application and come forward. 

[00:14:05] But let’s step down now a step in terms of ongoing communications with line staff. For example, you know, family members always want to come in and they want this and that. And sometimes they can’t get that. What’s the bottom line here in terms of your staff and the limitations of your capacity to serve on a day-to-day, hour-to-hour basis of those people who are concerned and interested?

Janet

[00:14:31] Well, I think it’s important to say, back to communication, that communication and expectations and so forth, that it’s important to not over-promise something that you can’t deliver. Even if you state something that that person may not hear it or may not understand it at the beginning. And hand-in-hand with communication is trust.

[00:14:52] So in our profession, is not only important to communicate, but in order to gain trust, we have to make sure we follow through what we promise. So if you think of it this way, when somebody is helping somebody move into care, they’re trusting to care for somebody that they may have been caring for, for a number of years. And they know everything and anything about them.

[00:15:17] And now they’re going to pass that over to us, who they’ve just met, maybe in weeks or days. So communication along with the trust and ongoing communication to let them know what’s happening. So if there’s any changes in the person’s health, or if there’s good things happening, you know, a lot of communities have newsletters. A lot of communities have email where they forward things via special programs that they can look at pictures of families involved in activities. What are they participating in and so forth. So all of these are forms of communication. It doesn’t always have to be, you know, mom fell. Mom participated in a program. Mom now wants something new to our room. Like, share many things and never feel that sharing is something that’s not wanted. The person will let you know if they don’t wish you to communicate as much. But I think it’s important that build a trust, share appropriately, and let the family decide whether or not some of the information you’re sharing, right?

Bill

[00:16:23] When the decision to apply and transition to a facility happens, you may feel fearful, like you’re losing control over the care of your recipient. Or maybe guilt arises because you feel like you should try harder or, like, having the feeling like you are giving up. Many caregivers have told us here at Family Caregivers, that while it’s definitely a change, you will still be involved in your recipient’s care. 

[00:16:53] Please talk through these feelings with someone you trust – or join a Family Caregivers of BC “caregiver support group” to process your thoughts with others who have been down the same road. You can find a support group on our website under the heading “Get Help” at www.familycaregiversbc.ca. You can also call our BC Caregiver support line at 1-877-520-3267 to speak with our trained and compassionate support team. 

[00:17:27] As we close our conversation, Janet, what would you offer to family caregivers who are hesitant about transitioning to long-term care services and if long-term care is right for their family?

Janet

[00:17:40] Well, first and foremost, you’re not alone. There’s many before you that have gone through this. And there’s many others that will continue to do after you. 

[00:17:50] Also, can’t stress the importance of communicating. And if there isn’t good communication, feel free, I think at whatever community you go to, to ask, to have a meeting. For you to set up that communication process, if it doesn’t exist.

[00:18:05] And I think lastly is that you, as a caregiver, need to begin to look out for yourself. You have been carrying the load probably, as I said before, days, weeks, months, for some people, years. And it is time for self-care. And you need to let the community do their job. They’ve been trained to do it, whichever place your loved one may be.[00:18:28] We all follow a set of regulations. We all, for the most part, have great intentions. And nobody sets out to create any undue towards a resident. There is good-hearted people in this field and we’ve chosen it for a reason. So let us do our job, but really look after yourself. It is very important to be there for your loved ones. So take that time.