Transitioning into Assisted Living Helping Residents and Families Make a Successful Move

Transitioning Into Assisted Living Many of the slides for this presentation have been provided by the National Center for Assisted Living (NCAL) and are based on NCAL’s inservice training tool “Moving Into An Assisted Living Residence: Making A Successful Transition.” Visit for additional resources. To order the brochure visit: NCALpublications.org.

Issues New Residents Face Realizing a decline in doing things for themselves Fear of losing personal control Disrupting familiar routines Giving up their own home Having to make new friends Potential severance of emotional attachments to friends, community. (Journal of Gerontological Nursing, Oct. 2004)

The Genesis of Transition Acute health episode Loss of spouse Social isolation Chronic decline (physical and/or mental)

Research: Less Than 50% Less than 50 percent of women in a recent study experienced a healthy successful integration into a new congregate setting. (Qualitative Health Research, Jan Rossen & Knaff)

Why Successful Transitions Are Important Potential for bad health outcomes on residents. Reduces transfer trauma. Increases positive feelings and impressions about your facility’s environment and services.

NCAL Focus Groups Approximately 30 NCAL member facilities in different states conducted focus groups with their residents to solicit specific feedback on what worked and didn’t work during residents’ transition periods.

Common Questions What furniture can I bring? Who will give me my medicine? Will “they” tell me what to do? How will I get to the dining room? Will they have food like I cook at home? Who will I sit with? Is my family going to leave me?

Residents’ Expectations of Staff Smile, be friendly Be helpful, attentive Listen Wear name tags Introduce yourselves Get to really know the resident Be knowledgeable about facility operations and activities

What Residents Said Was Helpful Staff calling them by their name. Staff being kind, answering questions, being considerate, offering reassurance, and being attentive to their needs. Staff reassuring them that the facility is their home. Staff introducing them to other residents. Staff or another resident escorting them to the dining room.

More Suggestions From Residents Placing welcome signs on doors. Introducing new residents when entering the dining room or making a special seat for them in the dining room. Escorting new residents around the facility during the first few days. Encouraging residents to speak for themselves. Helping them to pick out their room or helping to arrange furniture. Treating them like “normal people”.

The Emotional Transition Recognize the decision to move into an assisted living facility and the actual process of moving is physically and emotionally exhausting for a resident. Remember residents experience doubt about their decision and may even experience waves of panic and sadness. This is normal. Recognize that families can often experience guilt about not being able to care for their loved one in their own home.

An Actual Resident’s Response The staff brought my meals to my room during the first two days. “I was so exhausted from the move.” The care staff coming to my room to see if I had any needs. Staff showed me around the building and made me feel like I was important. Staff made me feel like this is my home and that I had control over what I wanted. They let me keep my independence. Staff took time to ask me about what I like done with my bath.

What Staff Should Not Do Call residents “hon,” “sweetie,” or “patient.” Ask ‘How are you?’ but not take the time to listen to the reply. Ask too many personal questions. Gossip about other residents.

What Staff Should Not Do Show a resident’s apartment without his or her permission. Be bossy or talk to them like children. Speak in a foreign language or raise your voice if they don’t understand you. Tell them they have to sell their home or get rid of their possessions.

Loss Of Independence Is A New Resident’s Number One Concern Have new residents make as many decisions as possible. Involve the new resident as much as possible in the pre-admission decision making process. This fear of losing independence is magnified for residents who were not directly involved in choosing the facility. This increases the transition challenges.

How To Empower Residents Give them menus and have them select their meal choices and dining times. Determine food preferences or dietary restrictions. Involve the residents in many daily decisions to ease the fear of having no control. If the resident needs personal care assistance, have staff meet with the resident and coordinate the service times with the new resident.

Maintaining Privacy Provide each resident with his or her own key. Knock before entering any resident’s apartment and wait for an answer. If the resident is hard of hearing and cannot hear you knock, ask them what they would like you to do. Devise a system with the resident. Ensure privacy with their mail ― both incoming and outgoing mail.

Getting To Know Residents Visit with the new resident Don’t rush conversations Share what you have learned about the resident with your co-workers

Assess Support System & Social Patterns Are family members involved? Do they have friends in the community? What civic or religious activities did they participate in before moving into residence? Do they have a craft or favorite hobby? What was their daily routine?

Remember: Isolation Extends the Transition Period New residents tend to stay in their rooms. While it is quite natural to be shy and withdrawn in a new environment, residents say that isolation makes the transition period longer and more difficult. Know the activities schedule. Meet with the new resident to find out what time and types of activities they prefer. Extend a personal invitation to the new resident to attend. Remember to offer to escort them to all meals and activities for the first few days after they move in.

Peer Assistance Pair up new residents with other established residents. Residents said it helped them cope with moving in and they learned more quickly about the residence. Ask a current resident to be the new resident’s buddy for the first few weeks to help them through the transition.

Strategies To Minimize Isolation Ask the new resident’s buddy to accompany him/her to formal and informal activities and introduce him/her to the others. Gently encourage new residents to come out of their rooms and be sure to make them feel welcome when they do.

Transition We all experience transitions throughout our lives. The difference between you and I transitioning from one place to another varies based on our individual coping abilities, life experiences, cognitive abilities, emotional status, attachment to residence, community, and support systems. The same is true for residents.

Residents Want Information Delivered in Multiple Ways Walking tours of the facility are helpful. Residents want the written materials to review after the verbal explanations. Avoid explanations over the phone. Residents said Web sites were not helpful to them but were used by their adult children. Know that you are going to have to repeat basic information.

Our “New Resident” Materials

Resident Suggestions for Family Members The focus groups also offered advice and suggestions for new family members  Be involved in the move but don’t dictate. Remember to involve the resident in the setting up of the apartment so that it satisfies the new resident’s needs.  Don’t treat your mom or dad any differently. They haven’t changed, just their address has changed.

Suggestions for Families Use discretion when speaking about finances. Recognize this is a traumatic process for their loved ones. Recognize that this is all about the resident, not them. Visit often during the first few weeks but don’t overstay your welcome.

What You Advise Families To Do Let the resident make as many decisions as possible Validate the resident’s feelings that the move is a major life change and is traumatic Keep the atmosphere upbeat and positive Have lunch or dinner with your loved one occasionally Give lots of hugs

Important Factors To Reinforce Independence Privacy Decision-Making Preservation of Relationships Individuality

Strive To Create Normalcy “Our goal is to make moving into an assisted living facility an address change, not a dramatic lifestyle change,” --Robert Lohr, former NCAL Chair, in testimony before the Senate Special Committee on Aging, 1999.

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