Assisted Living - How do we find place & transfer Grandma nearer to us?
July 7, 2018 3:21 PM   Subscribe

My 91-year-old Grandma has been moved into assisted living this past week. She lives across the country, far away from all of us family. If we were to transfer her here, what would that process look like? How do we find a good facility, how do we charter the flight, how do we X Y and Z? Lots of questions!

My grandma just turned 91 a few weeks ago and unfortunately has had a string of recent bad health situations piling up.

First some background -- she is my paternal grandmother and both of her children have passed away (my dad & uncle). It's just us three grandkids left in her lineage, me (in central NC), my older sister (in IN), and my brother (NC also, but unable to help out at the moment for Reasons.)

She was very, very diligent for the last decade in getting her will, power of attorney, health care power of attorney and all other logistical matters very much buttoned up. We had a big celebration for her 90th birthday last year in Arizona and made sure all the paperwork was in place as needed. THANK GOODNESS.

In January she sold her home and moved into a retirement community. Then, about three weeks ago fell and broke her pelvis, and at the same time started experiencing debilitating sciatica and also what appears to be peripheral neuropathy in her fingers and toes, which is causing a loss of fine motor control. She went to a rehab facility for a couple of weeks to try to get some dedicated help with physical therapy for the pelvis and sciatica. It was determined she would need to go into assisted living.

So, on Thursday she was transferred into an assisted living facility. And, by the way, she's still with it mentally, 99%. My sister flew out this past weekend for two nights, to get the remaining logistical items taken care of and check on her wellbeing and figure out the bill paying and talk to everyone around her who is helping out.

And that's the thing -- she has some people around her who love her, and we have a caretaker who does the errand running. But they're not family. And they shouldn't be expected to do all the things family would do in that situation. I feel like this is the time where she should be close to us here in NC.

I've been doing some research today regarding the possbility of transferring her from Arizona to here in North Carolina. She'd have me close by, my mother (even though my parents split up when I was 19, my mom and her still keep in touch and love each other). Also, she'd have my stepmom, who loves her so dearly and also wants to help take care of her. All three of us live here in Winston-Salem, NC, and could be advocates for her care on a day-in-day-out basis.

We're all three willing and able, and my brother will be able to help after a while, as well. Grandma now laments that she didn't move out here after my uncle passed away, to be closer to us. She really wants to be here. And my sister in Indiana is a busy physician, wife and mom of three kids, so the most logical place for Grandma is here in NC.

My grandma has financial means. Financial means to do the move, even if we needed to charter an air ambulance-type set up, which might be the best option. She has long-term care insurance that she paid into for decades which kicks in after 90 days to pay 100% of her assisted living costs.

So what is my question? I'm looking for anecdotal stories of anyone who has gone through this themselves -- transferring a frail but mentally with-it loved one from assisted living states away to assisted living nearby. How did it go? How did you find a quality assisted living facility near you? Are there reputable third-party services that can help us evaluate the myriad facilities?

When you did the transfer, what would you have done differently? Did you charter a flight, or was your loved one able to fly commercially? If you chartered a flight, what kind? Just a regular private plane, or an air ambulance kind of set up? How did you move your loved one's possessions? (There aren't too many at this point.) Anything you didn't consider, logistically? What tips or best practices do you know of, or any resources that we should look into? Center for Aging in her community? Elderly ombudsman of some sort?

Thanks for any and all advice! We're not sure of what's going to happen next, and maybe this won't pan out. It's up in the air at this point. But I think my grandma really wants to be out here, and my mom, my stepmom and I really want to be able to help ensure she has excellent and loving care.
posted by bologna on wry to Grab Bag (11 answers total) 4 users marked this as a favorite
Cross-country air ambulance could run you tens of thousands of dollars. What is her mobility like? A better option could be to travel by commercial air, even using a wheelchair in the airport and flying with a family member in first/business class.

You can work with geriatric care management companies like Elder Tree to help you find an appropriate facility and make sure that her long-term care insurance will be accepted there.
posted by shiny blue object at 5:14 PM on July 7 [2 favorites]

Commercial airlines are pretty good at transporting the wheelchair-bound these days, especially if one of you flies out to accompany her. A standard wheelchair (maybe your own, maybe the airport's) can take her from the curb to the gate; if she can't walk down the aisle of the plane by herself, they also have special narrow wheelchairs that can fit down the aisle. Do spring for first class since you can afford it.

The only tricky bits here are notifying the airline in advance of your accessibility requirements, and having contingency plans if they lose your luggage (i.e. your personal wheelchair, whether checked as baggage or gate-checked; either way, this is the most likely point of failure). Consider purchasing an additional wheelchair on the NC side and having a second family member bring it when picking up you + grandma at the airport.

I think this trip is totally doable by commercial air unless grandma is so ill that she's bedridden with medical devices attached. The fact that she's only in assisted living, not full time nursing care, implies that she's probably not at that point yet.
posted by serelliya at 5:24 PM on July 7 [2 favorites]

We did this a few years back when my MIL was widowed. She was very deaf, pretty blind and had broken a hip but was cognitively all there. In terms of figuring out where to move her we asked everyone we knew who had dealt with eldercare issues locally (not too many at that time), looked for reviews online and for state reporting on violations. We visited multiple places asking about staffing, activities, options and costs. When we visited we looked for people busy doing things rather than parked in a hallway, smelled - does the place smell clean or like stale urine? And we ate at least one meal at each of the three places we seriously considered. Ultimately we ended up moving her into a place with continuity of care. At the time that seemed important and she did bounce in and out of the nursing home attached to the assisted living several times. The biggest negative about the place where she ended up was really mediocre food. At this point I really regret that - food becomes ever more important when your other activities are really constrained by illness and disability.

Moving her was not a huge problem - couple family members drove her from NC to MI but she was less disabled than your grandmother. Someone flying with her with disability help and wheelchairs at both ends would probably be fine. If you can spring for first class this would be a good time for it.

And it sounds like it would be very worthwhile to move her for her quality of life and all of yours as well - caregiving long distance is hard! We were so glad to my MIL near us for the last couple years of her life. She got to spend a lot of time with my kids, going to their school events when she was up to it and we were better able to help as she declined and needed more support.
posted by leslies at 5:30 PM on July 7 [1 favorite]

This is good to know that commercial flight (definitely first class!) may be a viable option.

(The air ambulance set up is definitely pricey - $25K-$35K, but they take care of door-to-door bed-to-bed transport, with two medical staff on board, no family members needed. By the way, if anyone is reading this in the future, Andy, the owner of Air Charter Advisors, Inc. was suuuuuper kind and helpful, and even offered to give us his expert opinion on any company we decide to go with, if we do decide not to use his services and charter a flight directly ourselves. Really quality guy.)

So her mobility -- it's low, but not completely gone. And she's not on any IV meds. Needs quite a bit of strong assistance getting to and from the bathroom. And needs help cleaning herself after visiting the bathroom. The thing is I don't think she would allow us family members to help her with that, and I respect that decision. But I wonder, then, if there's such a thing as, like, a medical travel companion or such?
posted by bologna on wry at 5:36 PM on July 7

We didn't do this exact thing, but when my relative was at that cusp of needing to leave her home and enter a facility, we engaged the services of an eldercare advisor -- a person we paid money to, to navigate this whole scene. It was a literal godsend. The best thing for you to do is ask around to your contacts in NC -- you will want someone who knows the area very well, knows all the available facilities, which are good, which are bad, etc.
posted by BlahLaLa at 6:09 PM on July 7 [4 favorites]

I can't weigh in on the air ambulance v. 1st class issue, but I am here to tell you that long term care insurance might not be as helpful as you and she are assuming. My dad paid big bucks (thousands a year, I was quite shocked at the bills) for decades - (he was 88) for a comprehensive long-term care policy. He and his wife were confident that he was covered for everything he'd need after he was diagnosed with cancer and chose home hospice. Hospice doesn't cover home health aids (backside wiping, bathing, and other personal care). They hired a registered and licensed care agency for 10 hours per week so his wife could leave the house occasionally and be confident someone would be there for him. The insurer refused to pay. Over and over again, over several months, they refused to pay. There was always some problem with the agency or the services provided or some other delaying and frustrating bullshit. This was perhaps $400 a week, not an air ambulance! As far as I am concerned, this was a scam. My dad died. His wife is exhausted with fighting them and gave up. I don't know if going through the state insurance commissioner's office or a legal suit would have helped, but she didn't have the stomach for it, and as a daughter and not a spouse I have no legal standing.

Therefore, please, please investigate the longterm care insurance very thoroughly before proceeding with the confidence that they will cover your grandmother's needs. Be specific with all the possible scenarios you can imagine for levels of care (home care, assisted living, hospice, were it eventually be needed). She herself will need to speak to them (I'd recommend this be done by email or letter for a paper trail) as they will not speak with a family member without clearance by the policyholder. You might also want to suggest to your grandmother that a conference with a specialist in elder law would be prudent because even though this kind of insurance is expensive, and you'd think insurers would be content with X amount of profit, if they deny claims they can actually get X+Y profit! And why wouldn't they? If her insurance won't pay, this compassionate plan you and your siblings are trying to cobble together might not work.
posted by citygirl at 6:33 PM on July 7 [4 favorites]

So I work in a field adjacent to this and you very much can hire a medical escort to accompany her on a commercial flight—if you’ve got the resources, she could fly with you (or another family member) and the escort. The escort handles any health needs that come up during the flight, such as toileting, and you’re there for company.
posted by whitewall at 10:31 PM on July 7 [1 favorite]

Last year we drove my grandmother across states. I agree strongly that having her near you is the right move. Is sitting painful for her? If so, consider that when pursuing transportation. My grandmother couldn’t have dealt with the rigors of flight because of needing to lie down. She lay in the backseat for the trip. Even with first class, she’ll have to sit for a long time at the airport.

When looking at places to live - are there people who live there out and about in common areas? Do they seem happy? This is, without a doubt, the best signal you have about the quality of care. Ask about turnover for the aids - the lower the better. Look for somewhere they pay above market rates to employees. Happy carers are better carers. It makes employees really sad if they aren’t given the resources to care properly- so if they all seem surly or apathetic, that tells you she won’t be happy and safe.

Strongly strongly suggest private home style places - six to ten residents in shared or private rooms. Not somewhere with apartments. This is very likely the last move your grandmother will be able to make, you don’t want to pick a facility that won’t give her end of life care. If she wants her things, pack them all in a u-haul and have them put in storage. You can bring her things as she asks for them. She doesn’t need and will never need again full private amenities like a kitchen. This is a brutal transition for some people, but it’s expensive to get into somewhere and you don’t want to pay that fee twice. There’s also a hefty health cost to her involved in a move, even if it’s just across town.
posted by stoneweaver at 12:17 AM on July 8 [2 favorites]

The thing is I don't think she would allow us family members to help her with that, and I respect that decision. But I wonder, then, if there's such a thing as, like, a medical travel companion or such?

Any nursing staffing agency that isn't a medical mill can find a nurse who will travel with your mother and then fly back and it will be considerably less than the cost of the charter.
posted by DarlingBri at 4:28 AM on July 8 [1 favorite]

I moved my mother (with dementia, so slightly different from your situation) from Colorado to Washington State. Regarding finding a “good”facility. The places I looked at were roughly equivalent in the services they provided, so I opted for the best deal per square foot, figuring that she’d appreciate the space after moving from a 1400 sq ft home.
My mistake was that this place was about an hour’s drive from me, so it made visiting much more of a chore. Also, the place had some pretty snooty residents, and they weren’t the most welcoming. That is nearly impossible to suss out though.
Oddly, the best place was one that was 5 minutes from our house. I could drop in whenever I wanted to, the residents were friendly and very kind, and the staff was amazing. I had crossed it off the list because the rooms were smaller, and the place didn’t look as “nice”. I later found out that a neighbor’s mom had lived there for years. So ask around and see if anyone you know has loved ones in assisted living, so you can find out first hand. And pick a place that’s close to you.
Very best luck.
posted by dbmcd at 10:00 AM on July 8 [3 favorites]

Can you have her briefly move in with you or a relative, and then go look at elderly residences? It might reduce your anxiety to have her tour the places on your short list.

Don't worry terribly about choosing the wrong assisted-living place. Choose the one that seems best. If it doesn't work out, it's not very hard to move to another one nearby. The hardest part is gathering all the necessary paperwork from the first home. Then there's moving the actual furnishings and clothing, but you can hire someone to do that.

In case your grandmother has another injury, consider what rehab arrangements the assisted living facilities typically make. Some even have their own rehab on the grounds. And carefully look at each place's "levels of care" and various costs. At one of the places my mother-in-law looked at, just needing help using the bathroom would put someone in a higher bracket.
posted by wryly at 1:44 PM on July 8 [2 favorites]

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