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Advice for loved one going into assisted living?

molinePDG

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Hey y'all,

My grandfather is 92 years old, and the time for assisted living has finally come. It's a different kind of sad than my grandmother, who had severe dementia and needed full time memory care. My grandfather is just as mentally sharp as he ever was -- he's just physically deteriorating and it's not safe for him to live by himself anymore.

Was wondering if any PS folks have gone through the same, and if anyone has any thoughts/looking back advice for the new territory. Things to help him feel not so lonely? Things to look out for/know that you wish you'd known the first time?

My grandfather is extremely fortunate to have had a successful career as a dentist, so he was able to choose where he is moving to, and the financial aspect of (often stupid expensive) assisted care is not a concern, so I know that aspect has been nice peace of mind for him being able to make that choice his own and knowing it won't be the responsibility of family members to pay. But I know the loss of some of his independence has been harder than he lets on. This is especially tough at the moment, where most assisted living/nursing homes in our area are still on strict COVID related no visiting policy (or call through a window). Hopefully that changes soon.

But I thought I would turn to the great folks on this forum to see what tips or words of advice might be found. :)
 

tyty333

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Just a few notes from my experience with my MIL...

Try to find a place that has friendly, caring employees/workers. I think that can make a big difference.

Can he use a laptop or Ipad? That should help keep him busy some. I know its not the same as face-to-face interaction but it
may be second best in these times (covid). Are there games he can play online with family members so he is not feeling so
alone?

When possible, visit a lot. Have family members in the area visit as often as they can. For my DH's mom, the kids had certain nights
of the week they would call and check on her. Can he facetime?

Is he still mobile (safely)? He needs to get out and walk every day.

You might help him find a routine where he has things to do
every day but not the same thing every day so he doesn't get bored with it quickly.

My SIL, a nurse, says, "Use it or lose it." She was always trying to get my MIL to exercise or use her mental facilities.
 

Elizabeth35

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Check with the facility to see if there is new resident protocol.
My Dad's place was in constant contact the first few weeks and we discussed things like his table mates in the dining room, what activities he was enjoying and how he was adapting. Once he settled in we had regular meetings via conference call to discuss any physical issues and his mental state.

My advice is to be there as often as you can and to establish good working relationships with anyone who is dealing with your Dad. Make sure you understand the chain of command for any issues you want to address. Plan for the future as well---what is the process for adding more help if he needs it for things like dressing, eating, showering, etc.

How will such mundane things as haircuts and toenail trimming be handled?
Put thought into what items he takes with him--things that bring him joy like family photos, mementos from trips or his career.

I always brought my Dad a treat when I visited and he seemed to enjoy that. Maybe bring hims some fruit or flowers or cookies---whatever he enjoys. Give him lots of TLC while he adjusts. And listen and observe---is he happy, does he need anything, is his unit comfortable with everything he needs easily accessible?


Sounds like he will do very well though. Good luck! It's a bit like sending a child to kindergarten---very nerve-wracking only this time you are being the parent.

Edit to add: My Dad had Alzheimer's so I was overseeing his adjustment differently than if he did not have dementia.
 
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marymm

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Are you close with your grandfather? Will you be able to see him regularly?

If not, make sure someone who is related and loves him does visit regularly -- have that person be vigilant about monitoring your grandfather's appearance (is he clean, including hair and fingernails? is his skin in good condition? is his hair and nails regularly and well-trimmed?), and also monitoring your grandfather's belongings (are his clothes being regularly laundered and timely returned in good condition? are all of his personal belongings still in their usual place in his unit?, are his bath and bed linens regularly changed and in good condition? is his unit kept clean?)

If your grandfather does need physical assistance with bathing/grooming/dressing, I recommend implementing a bi-monthly body check, meaning that someone who loves your grandfather and who your grandfather feels comfortable with, checks out your grandfather's entire body, head to toe, front and back. Of course this should be something discussed with your grandfather, and something he consents to! The check can be done top half, and then bottom half, so your grandfather is never whole-body-naked, with a sheet or drape as appropriate to help maintain his dignity. The person is monitoring for bruises, abrasions, skin ulcers, rashes ... hopefully your grandfather's skin is in good condition, and occasional bruises and abrasions happen in every-day life, and of course if staff witness your father bumping his shin or elbow in moving about it would be logged and mentioned ... the regular body check is part of the "trust but verify" process ... skin integrity is vital and another set of (caring) eyes is useful since your grandfather cannot see his own backside nor likely between his toes and behind his ears, but this check also helps ensure that those taking care of your grandfather indeed are taking good care and as well confirm any skin conditions seen in the body check correlate to those already noted by staff.
 

MollyMalone

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:wavey:Hi, @molinePDG

Does your grandfather presently require "assisted living" in that he now needs help with personal care (e.g., dressing, showering/bathing, going to the bathroom), medication management because he can't reliably take his meds as prescribed, meal preparation isn't really viable, etc.? Or is he actually a candidate for independent living, i.e., his own unit with kitchen in a community that offers, among other things, dining options, recreational-other activities, transportation to shopping, doctors, because he isn't/really shouldn't be driving nowadays?

Regardless of which of those 2 levels would be most appropriate at this point, I highly recommend -- if there are such options in the area & it's financially feasible -- a facility/community that offers skilled nursing care as well, i.e., not just assisted living or not just independent living + assisted living. Better still if they are non-profit, such as those under the auspices of the Society of Friends or another non-profit (which is not to say that you can expect them to be charities with deeply discounted pricing).

My dad was several years younger than your grandfather when he gave up his house and moved into an independent living 1-1/2 bedroom apartment in a lifecare community. My brother & I were so grateful that he had chosen such a community when he experienced sudden unexpected medical issues & could be immediately transferred into the skilled nursing unit -- without us scrambling to find an available bed for him in a good facility elsewhere. (Based on friends' experiences, the places that typically have beds available would be low down on your list if you had a choice.) We felt comfortable with the skilled nursing unit because (a) it wasn't a stand-alone facility, and (b) there was fluidity: residents in the skilled nursing unit who no longer needed that level of care could return to assisted or independent living in the same complex). So beyond the fact that the skilled nursing floor was nicer than any nursing home we'd seen, we thought if the skilled nursing care was bad, there would have been reports from residents about that which presumably have been addressed. Lastly, there was continuity of social contact for my dad because it was easy for the friends he had made in the community to visit with him in his room in the skilled nursing unit. Dad recovered sufficiently to return to his independent living unit (with medication dispensation by staff because his mental acuity had slipped) before he later died under hospice care.

The lifecare/continuing care communities -- those which offer the skilled nursing care in addition to independent and assisted living -- typically require an advance payment "buy in" that isn't a trifling amount. But because of the guarantee of skilled nursing care when needed, a nice chunk of the buy-in was tax-deductible as prepaid medical expenses. Don't know if that's still true under the current IRS Code but the sales reps at these places should be on top of that in addition to military veterans' financial aid and so on. (I actually liked the fact that at the 4 places we toured, they candidly called themselves sales or marketing reps vs something like "transition counselors" -- although the sales rep at my dad's place was also helpful re his transition).

My dad was a trusts and estates lawyer who didn't retire from the firm until he was 88 (and downsized), so had visited clients and friends in a number of the facilities-communities in-around his Midwestern town. I flew out from NYC to tour his initial 4 choices with him and my brother. None of the places had the same financial arrangements-responsibilities. Nor did the dining and transportation options and costs mirror each other. So be sure to get copies of the current agreements, the Annual Reports including accountant's financial statements. new residents packet, the weekly/monthly newsletter, activity calendars and menus for the past month, so you and he can review all of that at your leisure. My dad made up a comprehensive spreadsheet; that was not only of practical use, it also enabled him to feel less "old" (feeble), that he himself was charting his future. And it sounds like your grandfather might be in the same place, mentally and emotionally, as my dad was. One place we immediately agreed should be scratched off the list because we had to ask for the financial documents, and the sales rep didn't immediately say, "Of course." And her preceding description of the residents' financial obligations, etc. glossed over some important things that we had to ask about. In contrast, the sales rep at the community he decided upon anticipated virtually all of our questions and was very "transparent."

My brother, bless his heart, who lived near my dad, was the master mind of the packing-moving-interior design (at the community dad chose, each unit gets freshly painted and re-carpeted with every turn-over); you could also ask for other changes-upgrades in your unit, for an additional cost). At the suggestion of the sales rep of the chosen community, my dad and brother interviewed a couple of local outfits that specialize in downsizing. The two women hired were fabulous, really good with my dad as the 3 of them did the majority of culling of most of his possessions :personable, thoughtful-sensitive to the emotions attendant to going into what he called "the old folks home" (it actually resembles a resort-like complex on spacious grounds) yet keeping him "on target" in a way that I think would have been harder for just us "kids" to pull off. They arranged for the pickup of furniture, etc. by Habitat for Humanity (which pleased my dad immensely) & the movers they recommended were also fantastic.

On the day of the move, the movers and the downsizing women saw to it that dad was ensconced in his new home in just about 4 hours; meaning the moving of everything from his house to the new place with furniture placed per the floor plan my dad and brother had plotted; clothes were hung in the closets by color, placed in drawers; they made his bed & hung towels in the bathroom before neatly stacking the remaining linens in the linen closet; got the kitchen squared away; and books in the bookcases, artwork hung on the walls. My brother and I felt largely superfluous but I know Dad was happy for our company that day and evening -- and we did hang the window coverings, install a new light fixture, and make cocktails before going to the dining room for dinner.

I have some additional thoughts-tips, but this post is already quite long, so I'll end this one by saying we all felt the same way as Austina's MIL:
No real advice, other than to say my MIL went in to assisted living when she was in her early 90’s. A few months later, she said she wished she’d done it earlier!
 
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elizat

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Another plus one to the contuining care community recommended by @MollyMalone - many are very appealing to look at as well and don't feel like "an old folks home." It's a nice combo of independent with assistance as needed and then if he needs to transition to skilled, it's easier.

Another plus one to the suggestion of @marymm as well, if he needs more help. Please check his skin and body (will tell you a lot about his care) and get to know the point of contact that is the nursing director as well as shift leads for nursing.
 

oodlesofpoodles

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My grandmother lived in a country home for over 40 years with entry stairs and a lot of property maintenance which had become overwhelming after my grandfather passed about an hour away from my mothers house. She was asking for help a lot so my mother over many years talked her into moving into a one level smaller home with a small lot in the same neighborhood so that she could be a phone call away and at her door in minutes. It was remodeled it to make it universally accessible for when a walker or wheelchair would be needed. It did not go well as she looked to my mother as her sole friend and depended on her for everything. She is not a self starter and although she was completely independent at the time she refused to make new friends or go anywhere without my mom. My mother suffered a spinal injury which was life altering and has required many surgeries. After three years and realizing that my mother was not ever going to be able to help her in the way she expected or wanted she moved into a retirement home with small connected apartments with a shared dining hall, activities, church, crafting, and a true community where she has made many friendships and is so much happier. She receives physical therapy regularly and her mood is much improved. I would bet she would admit she should have done that to start with but hindsight is 20/20.
 

molinePDG

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I came back just on my phone to check this thread and all of the replies exemplify why I love being in the jewelry industry, because everyone is just so kind and immediately willing to help. :)

Couple things --

He will, indeed, be going to an assisted living facility that has on-site medical staff, and it is connected to (a building away) the same company that has a full nursing home, if he should end up needing that kind of care. Good to know that this is something that was recommended -- we thought it would be helpful for sure that there can be back and forth movement if needed.

It's in the same town where me and my father are at, fortunately -- so he won't be short on some family nearby.

Great advice re: the body check and so forth. That's really helpful, and not something that we may have thought of without it being mentioned.

We (as in, the family) have to move everything like furniture, etc. over ourselves -- bummed that there aren't movers to help with this sort of thing, but it works out all right and we have a truck that we'll be borrowing to make the move.

I'll read more in depth and of course any additional replies that come up, but just wanted to say once again that I am extremely grateful for you all taking the time to leave your thoughts, advice, and wishes. :)
 

tyty333

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@MollyMalone Those "downsize" ladies sound amazing. We had such a hard time trying to get my MIL to make decisions on which clothes
to part with and which to keep. She had a lot of clothes and it took forever to get through them. In the end, she still had too many clothes but I
figured after she got to the facility she could figure out what she no longer needed.

As far as furniture and other belongings, after we figured out what she could keep we then brought in a company that did an estate sale. She really didn't get that much money from it because a lot of her belongings were old (from her time frame) but the best thing they did was to clean the house out and to donate what didn't sell...win, win.

Also, the place my MIL went to had stepped up care which was nice but we didn't find it all that great. The issues were if she only needed to go for
a short period of time and then got to go back to independent living you got to pay for two apartments for that timeframe. So, like paying double
for a month. Not cheap.... If she needed to be in assisted for several months then she would have to pay for each apartment or we would have to
move her out of her independent apartment. Of course, moving her out of one apartment and into another was a pain.

The first time she fell and needed to go to assisted for a while she kept both apartments. The second time she fell and was going to be in
assisted for a much longer period, we moved her into assisted permanently.

Ok, so now I'm rambling....:)
 

canuk-gal

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HI:

I agree that cultivating a positive relationship with your Father's caregivers is very important. And a current contact list with relevant phone numbers and up to date email addresses is important--who do you contact if there is an issue; and who can contact your family if there is an issue (for facility staff and Medical staff alike). I think the US FOIP laws are much like our here in Canada; patients are require to give consent to have medical appts/info shared with family members, KWIM? In addition, I would make sure his personal directive and will are up to date.

cheers--Sharon
 

MollyMalone

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I don't know how it would have worked, @tyty333, had my dad shuttled between independent and assisted living. But my (dim) recollection is that under the terms of his contract, he could have been in the skilled nursing care unit for up to 30 days for "free" -- apart from the additional charge for a private room in the skilled nursing care unit (it had both double and single occupancy rooms), plus meal charges. The latter was because he had X number of dollars' credit/month to use at any one of the 4 dining options (the fanciest restaurant, a cafe, the primary dining room, and the pub), but there was no way to integrate those credits into Medicare's billing system (Medicare kicked in for the skilled nursing stint). Fortunately, he didn't require skilled nursing care for more than 30 days, but I imagine he too would have had to then double-pay in order to hold onto his independent living unit when he wasn't actually there.

It was nice to have the option of paying for assisted living services when a resident in independent living (those were billed on an "a la carte" basis), but that wouldn't be suitable for everyone.
 
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MMtwo

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My Mom moved into a retirement apartment a few years ago. It is not supported by services, but is attached to a complex that has additional levels of care. When we first toured, she made a sour comment about the "old people" and how she was not old yet. By the time she moved in, she was so relieved. She has made friends and keeps busy. Her apartment has call buttons in case of emergency. She loves it now.
 

canuk-gal

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My Mom moved into a retirement apartment a few years ago. It is not supported by services, but is attached to a complex that has additional levels of care. When we first toured, she made a sour comment about the "old people" and how she was not old yet. By the time she moved in, she was so relieved. She has made friends and keeps busy. Her apartment has call buttons in case of emergency. She loves it now.

Independence is a very personal powerful tool in the same way that loneliness is a powerful health deterrent.

In context--your Mom is no longer alone, yet she is still independent. My DH grandfather said exactly the same thing. While he was sad to leave the house/life he'd known for decades, he was never so happy as to have companions again. He lived very well and happy for several years. I hope the same for your Mom and all folks who make these life decisions.
 
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Daisys and Diamonds

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Hey y'all,

My grandfather is 92 years old, and the time for assisted living has finally come. It's a different kind of sad than my grandmother, who had severe dementia and needed full time memory care. My grandfather is just as mentally sharp as he ever was -- he's just physically deteriorating and it's not safe for him to live by himself anymore.

Was wondering if any PS folks have gone through the same, and if anyone has any thoughts/looking back advice for the new territory. Things to help him feel not so lonely? Things to look out for/know that you wish you'd known the first time?

My grandfather is extremely fortunate to have had a successful career as a dentist, so he was able to choose where he is moving to, and the financial aspect of (often stupid expensive) assisted care is not a concern, so I know that aspect has been nice peace of mind for him being able to make that choice his own and knowing it won't be the responsibility of family members to pay. But I know the loss of some of his independence has been harder than he lets on. This is especially tough at the moment, where most assisted living/nursing homes in our area are still on strict COVID related no visiting policy (or call through a window). Hopefully that changes soon.

But I thought I would turn to the great folks on this forum to see what tips or words of advice might be found. :)

Keeping his mind sharp is important moving forward
all of a sudden there will be a lot of things he won't have to think about and i don't think that is good for the brain
although our loved ones had dementia issues my father in law suffered from lack of male company in the home so i would be looking for a place with a good proportion of male residents
And with plenty of good enjoyable activities your grandad would enjoy
Also althougj he is having difficulty with mobility i think its important he keeps moving and walking as much as he can
this is just my observation but older people often go into assisted living facilities with good muscle tone and next thing you know they fall in the shower and break their hip and then its all down hill because they don't do anything
they don't get up to make a cuppa, they dont go to the letterbox
its important to keep grandad as active as he can be
Look at Prince Philip - it wasn't all money and privilege - it was also being physically active and also having something stimulating to do with his time that allowed him to live a long and mostly well life

best wishes to your grandad

Oh and when you are 'shopping' for the right facility listen to the staff
thankfully my country has had few covid deaths but in the initial outbreak we had mass deaths in old age homes
one was a place my sister looked at for my mother
but a nurse aid whispered in her ear "you can do better for your mother"
 

Daisys and Diamonds

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I came back just on my phone to check this thread and all of the replies exemplify why I love being in the jewelry industry, because everyone is just so kind and immediately willing to help. :)

Couple things --

He will, indeed, be going to an assisted living facility that has on-site medical staff, and it is connected to (a building away) the same company that has a full nursing home, if he should end up needing that kind of care. Good to know that this is something that was recommended -- we thought it would be helpful for sure that there can be back and forth movement if needed.

It's in the same town where me and my father are at, fortunately -- so he won't be short on some family nearby.

Great advice re: the body check and so forth. That's really helpful, and not something that we may have thought of without it being mentioned.

We (as in, the family) have to move everything like furniture, etc. over ourselves -- bummed that there aren't movers to help with this sort of thing, but it works out all right and we have a truck that we'll be borrowing to make the move.

I'll read more in depth and of course any additional replies that come up, but just wanted to say once again that I am extremely grateful for you all taking the time to leave your thoughts, advice, and wishes. :)

How fortunate you have been Andrew, to know your grandad as an adult grandchild =)2
And may this move to assisted living give you even more time to enjoy each other's company

One thing we did for my mum was we got her a really good chair for when she sat in the communal lounge
It was a very nice and new exspensive place but my sister picked up on the posture of the residents sitting in the lounge

With your grandad having mobity issues he may be spending a lot of time sitting down - hopefully in good company and doing activities he enjoys

For the sake of his back and comfort from other aches and pains please have a look around at what the lounge chairs are like

My mum was mostly doo- larly so she couldn't really tell us how she felt but your grandad in sound mind might not either - may not want to cause 'any more trouble'

My dad managed a furniture factory and we thought it was particularly important to honor his menory by making sure my mum had a high quality supportive chair because that was something he would have picked up on
 

Daisys and Diamonds

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Oh dear if i can chip in again :lol:
the funnist thing that happened (over a very unfun period)
My sister turned up one day and my mother was in a very unmatched outfit - i mean trully awful
My sister thought this showed a lack of dignity
Also her clothes were pilled
my sister was very good shopping for mum but you have to make sure grandad's clothes are easy care because they all go in the wash together no matter what it says on the care label
Well my sister who is very fashion conscious possibly (or maybe didn't) overreacted

When i went to visit the very kind male nurse was still apologising - it just wasn't his area of expertise,:doh: and that morning it had been him who had got mum dressed
but to his credit he was understanding about why it was upsetting and he learnt from it =)2
 

Calliecake

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Thank you for starting this thread @molinePDG . Listening to everyone who have contributed to this thread has been very helpful.
 

kenny

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Don't bring jewelry.
That's where my mother's wedding ring was stolen, while she slept.
 

Daisys and Diamonds

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Don't bring jewelry.
That's where my mother's wedding ring was stolen, while she slept.

That's terrible Kenny
personally i think if sucks

it upset my sister to have to take mum's rings away from here

in a perfect world why shouldnt they be able to sit there in all their finary
the fact it was your mum's wedding ring makes it worse

my sister created Mary hell when mum's new bottle of purfume went missing
(The home replaced it)
 

tyty333

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I don't know how it would have worked, @tyty333, had my dad shuttled between independent and assisted living. But my (dim) recollection is that under the terms of his contract, he could have been in the skilled nursing care unit for up to 30 days for "free" -- apart from the additional charge for a private room in the skilled nursing care unit (it had both double and single occupancy rooms), plus meal charges. The latter was because he had X number of dollars' credit/month to use at any one of the 4 dining options (the fanciest restaurant, a cafe, the primary dining room, and the pub), but there was no way to integrate those credits into Medicare's billing system (Medicare kicked in for the skilled nursing stint). Fortunately, he didn't require skilled nursing care for more than 30 days, but I imagine he too would have had to then double-pay in order to hold onto his independent living unit when he wasn't actually there.

It was nice to have the option of paying for assisted living services when a resident in independent living (those were billed on an "a la carte" basis), but that wouldn't be suitable for everyone.

This sounds like an excellent way to do it...wish my MIL's place had the "less than one month for free" policy. It gets terribly expensive
paying for two rooms/apartments at once. She could afford it for a month, but when you think of paying $7.5k for one month care:-o!
That's going to add up quick!

I can ditto @kenny 's suggestion of no jewelry. A large gold chain was stolen from my MIL. I was hoping it would show up when we moved
her out (behind a dresser or somewhere) but no, it was gone! :confused2:
 

tyty333

Super_Ideal_Rock
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Hopefully, you wont have to deal with this but my MIL encountered a lot of "mean" girls at both living facilities she was at. Some older people
lost any filter they might have had and said mean things to her. One time they kicked her out of her regular dining table so a
new guy could sit in her seat. She was very hurt, understandably. She refused to go back to the cafeteria and ordered trays for her room.
Of course, we wanted her to get out of her room but she was very hurt. My SIL nicknamed one of the other ladies at the table "Queen B"
because she would tell everyone where they could or couldn't sit. We knew she didn't like my MIL but when we were there she would act
overly friendly to us and my MIL. We could see right through it though!

Anyway, hope there arent any "mean" guys there like there are "mean" girls! Looks like it doesn't end in High School!:doh:
 

azstonie

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My older relatives all made the choice to go into CCRCs 11 years ago, as they all turned 80 (in good shape mentally and physically). The difference I noted that should be mentioned is btw ALs and CCRCs that are nonprofit (with resident boards) and for -profits (only objective is profit/payouts to shareholders). Based on 11 years of comparing the two, I'll go with a nonprofit when it's time for me to go into a CCRC.

Regarding mean girls/boys in these places: Its like high school but with money. And pretty much everyone acts badly/entitled. You usually find your peeps and stick with them. It's tough if your peeps predecease you/you're the Last Man Standing.
 

Daisys and Diamonds

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Hopefully, you wont have to deal with this but my MIL encountered a lot of "mean" girls at both living facilities she was at. Some older people
lost any filter they might have had and said mean things to her. One time they kicked her out of her regular dining table so a
new guy could sit in her seat. She was very hurt, understandably. She refused to go back to the cafeteria and ordered trays for her room.
Of course, we wanted her to get out of her room but she was very hurt. My SIL nicknamed one of the other ladies at the table "Queen B"
because she would tell everyone where they could or couldn't sit. We knew she didn't like my MIL but when we were there she would act
overly friendly to us and my MIL. We could see right through it though!

Anyway, hope there arent any "mean" guys there like there are "mean" girls! Looks like it doesn't end in High School!:doh:

Oh that's awful
your poor MIL
it must have felt like high school
boo hiss to all mean girls weather they be 6 or 86 !
 
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