Maintaining Dignity
It’s important to help your loved one maintain a sense of personal dignity. If she or he understands what is happening and can communicate, this may involve primarily being respectful and patient. In situations where an older adult has problems performing daily tasks, communicating or understanding due to either a physical condition such as a stroke or a cognitive disorder such as Alzheimer’s disease, the most generous gift you can give may well be enabling him or her to maintain dignity. Some of the things you might do to help preserve your loved one’s dignity:

• Be patient and calm.
• If an older person has difficulty hearing, speak slightly slower and use a lower pitch. Use simple, short sentences, and let your loved one see your face and expressions when speaking. Repeat and clarify when necessary — without being patronizing.
• Encourage him or her to be as active and independent as possible; reading, hobbies and helping out around the house can be marvelous therapy.
• Welcome visitors and encourage continued participation in groups, clubs and organizations, card games and discussing memories.
• Be sensitive to feelings and preferences. Acknowledge his or her desires even if they are different from your own.
• Be aware that your efforts may not always be appreciated.
• Be honest if you have concerns, and don’t make promises you can’t keep; take your loved one’s concerns seriously.
• No matter how helpless a loved one appears, don’t reverse roles. Treating an aging loved one like a child can crush any remaining feelings of dignity and independence.

Monitoring Care
When an ailing, older person lives at home, it’s important to monitor how things are going. This is true even if there is fulltime home care in place.

• Get updates from neighbors or relatives who may be assisting or who visit on a regular basis.
• Communicate regularly with your loved one. Give him or her a chance to tell you who or what is wrong, even when signs of dementia are present.
• Make visits, both planned and unplanned, to see all aspects of his or her care (e.g., at meal time, at bed time, during recreational times).
• Talk with the individual care providers (e.g., the aides), and the agencies providing the services.
• Trust your instincts, especially if your loved one is unable to communicate what he or she needs or what may be wrong. If you are uncomfortable, or if your loved one complains about a specific person, it may be time for a change. Always err on the side of caution.

In certain situations, you may feel that more oversight is needed than you or nearby family members can provide. If you choose to work with a GCM, he or she can formally monitor your loved one’s care, at your request. This approach may be especially important if you live far away and cannot visit on a regular basis.

When Your Loved One Can No Longer Live at Home
If a person’s care needs cannot be met in his or her own home, a permanent change in living environment may be necessary. Moving to a new living situation will involve a period of adjustment for your loved one. This adjustment time will be needed regardless of whether he or she is moving to a nursing home, an assisted living facility, an apartment closer to you or into your home.

When a Loved One Moves in with You
If you’ve decided care in your home is appropriate, you’ll probably need to make some changes around the house. Changes can be as complex as adding another bathroom or converting a first-floor den into a bedroom. Or changes could be as simple as attaching a safety rail to the shower or having an amplified receiver installed on the telephone. In addition to making necessary physical changes in your home, you’ll want to make sure your loved one feels welcome in your home by displaying favorite possessions — particularly mementos and photographs — in plain sight.

Assisted Living Facilities
Those who need care beyond what they can receive at home but not requiring the level of care provided by a nursing home may find the help they need in assisted living facilities. Many of these residential facilities provide a home-like atmosphere, and some are structured so that individuals have their own apartments. Staff is available to assist twenty-four hours a day. Depending on specific needs, residents can receive assistance with housekeeping, meals, and personal care, including help with daily activities such as eating, bathing, and dressing. There are no federal regulations for assisted living facilities, and the licensing requirements vary from state to state. Assisted living facilities may be referred to by other names such as personal care home, residential care facility, and adult group living facility.

Nursing Homes
Nursing homes, also referred to as nursing facilities, are residential facilities that provide round-the-clock care and supervision. Nursing homes offer a range of services from skilled care for seriously ill people who require close supervision by a licensed nurse to custodial care, often provided by nursing assistants supervised by a nurse.

All states have licensing requirements for nursing homes and perform surveys to evaluate the quality of care. Most states maintain databases you can access to get general information about a facility (e.g., number of beds), resident details (e.g., percent of residents who are physically restrained), and staffing details (e.g., staff hours/resident ratio). You can also see the results of state evaluations and often summaries of complaints lodged by residents and families. This information can provide a starting point for selecting a nursing home.

Choosing a Nursing Home or Assisted Living Facility
Before selecting a nursing home or assisted living facility, investigate several. You can use your state’s database and get recommendations from friends. You can tell a lot about a facility by walking around and observing the residents and staff. You should also, where possible, try to speak with residents or their family members to see what their experience has been.

In addition to what you see, you’ll need answers to many important questions to determine if a facility will meet your needs and expectations. There are excellent resources available to help you identify the information you need to evaluate a residential facility; some provide a checklist. One such resource is the National Citizens Coalition for Nursing Home Reform website. See For More Information for links to this and other helpful websites.