The change may be sudden: You get a call at 3 a.m. that your 65- year-old mother has fallen for the third time this year, broken her hip and is being rushed into surgery. The doctor is adamant that she can no longer live alone.
 
Or it could happen over time: Those weekly social outings with your 70-yearold dad are turning into twice-weekly, in-home marathon visits filled with a laundry list of chores he can no longer complete on his own. He’s also a bit more frail each time you see him.
 
Or the decision to move to a place that can help you as your health needs change may be yours alone.
 
Whether it’s a realization that you come to because of your own aging process and health status, or it’s your family members who are worried about you and are raising the topic of making a move, it’s never an easy process to come to terms with.
 
But there are ways to make the road ahead easier to navigate.
 
Broaching the Subject
 
Every family is different, and that’s no more apparent than during discussions of upcoming life-altering changes. If you are the person contemplating making the move, Elinor Ginzler, director of livable communities for Ohio’s AARP, recommends taking into account your health needs now and in the future, and making an assessment of where you are physically, financially and emotionally.
 
Admittedly, says Ginzler, “there’s a little bit of crystal-ball thinking involved because no one knows exactly what the future is going to bring.” But, she adds, health history — not only yours but also that of close family members — is a good indicator of what may be around the bend for you.
 
“Think about the age span of the relatives you know,” she says, “and ask yourself: How long did my parents live? What kinds of conditions did my parents have when they were living to whatever age they were? Do certain chronic conditions run in my family?
 
“Do you think there’s going to come a time when you might need some help with areas like bathing and dressing and cooking, because that’s going to drive what kind of housing setting you want.”
 
If you are the adult child helping a parent or other loved one plan for a move, Roland Hornbostel, deputy director of the Ohio Department of Aging, advises that it’s never too early to start talking about it.
 
“The hardest time to discuss this subject is when a crisis hits,” says Hornbostel. “Often a loved one enters the hospital and families are limited in terms of what they can do.” The deputy director understands firsthand how emotional the process can be for children. He thinks back to the day six years ago when he realized his mother, Elaine, was exhibiting signs of early Alzheimer’s disease.
 
“As hard as it was, I knew we had to discuss what her wishes were while she still could,” he recalls. “What mom did tell me were really critical points: She told me that having a private room was really important to her. She told me she wanted to be in a facility where she wouldn’t have to move all the time, which meant we’d look at places that offered a spectrum of care — from assisted living to skilled nursing.
 
“As her dementia has progressed, mom has not exhibited any of the [violent] tendencies people fear most with Alzheimer’s. I really believe that’s because we involved her in making choices while she was still able to.”
 
Ginzler also encourages adult children and parents to employ honesty — mixed with a healthy dose of diplomacy — when discussing housing options. “It’s OK for adult children to share their own perspective,” she says. “We need to be honest. The way to do that is to say something to the effect of: ‘I get so worried about you alone in that house. I am afraid you might fall down those steep basement steps,’ or ‘I’m afraid that your arthritis is getting worse and you need more help than you’ve got right now.’
 
“It’s probably not OK to say, ‘Mom, you’re not living in this house anymore. We’re putting it on the market tomorrow.’”
 
Visit Early, Visit Often
 
Just as it’s never too early to talk about what kind of move to make when health needs change, neither is it premature to visit facilities for you or your loved one.
 
“You want to look at a lot of places,” Ginzler says. “My line is, ‘If you’ve seen one assisted-living facility, you’ve seen one assisted-living facility.’ Not only is each place different, people are going to react to each one differently. I might like it. You might hate it.”
 
Hornbostel encourages visitors to understand the parameters of each one. “Some assisted-living facilities, for example, will say that if mom is incontinent, she needs to leave,” he explains. “Others will say no problem. Each facility’s tolerance level is different, and it’s important to know that before you make a final decision.”
 
AARP’s Ginzler also advises that those making the decision think of each facility as an extension of the life you or your loved one has been living. Consider the comfort level of the person who will be moving. Is he or she a people person? Does he or she like the idea of being in an environment that’s very social? If so, you’ll want to look at places that have a really good track record for providing engaging activities. If you choose a community that has a tradition that everyone gets together and engages in social activities, and that’s not your cup of tea, will you be comfortable there?
 
However, she’s quick to add, an entirely new environment can be a change for the positive, especially if you or your loved one is really a social butterf ly who’s been resigned to living alone.
 
“It’s really amazing how many times people are appropriately nervous about making the move, and then upon reflection, say, ‘The opportunity to now engage with people and have so much fun and be involved in so many activities is a new lease on life. What a great idea it was to move,’” Ginzler says.
 
And, she adds, when it’s time to begin making visits, once is not enough. It’s crucial to see how staff members on all shift levels interact with residents, as well as learn how they and those in their care feel about the place.
 
“If you hear that the peas are cold, that’s one level of concern. But if you hear, ‘I can never get anybody to come help me when I need them,’ that’s an entirely different level,” Ginzler says. “Employee satisfaction is also important. If staff members have been there for a long time, that’s often an indicator of quality. If it is a good work environment, they like it there and do their jobs well.”
 
Season of Change
  
They’re treasures of a lifetime and they’re everywhere: in the basement, the spare bedroom, the attic. Making a move often means relocating to smaller quarters, so you or your loved one are not only parting with a houseful of memories, but also with some of the items that made it a home.
“Don’t take this [downsizing] step lightly,” Ginzler says. “It can be as traumatic as you think it might be.” Sometimes the person making the move will want to tackle the task themselves. Other times, help from a trusted family member is needed and welcomed.
 
“I have heard family members say they were uncomfortable because in this process, mom was giving things away,” Ginzler says. “And they thought, ‘I don’t want to take that from you.’ “You know what, take it. It’s being given as an act of love and it’s also mom’s way of thinking, ‘This is going to live on. I may not be able to fit this in my house right now.’
 
“Family members need to accept those gifts with total grace.”