Moving On: The Transition from Assisted to Supportive Living

Aging in place is a phrase we hear often. While we often hear it in reference to people being able to stay in their homes as they age, my friend and Canadian politician, Nello Altomare, recently referred to aging in place as having the availability of personal care homes in a neighborhood so people don't have to move as far from their homes and can stay in their community - even if in a different place.

My grandma's apartment is just 3 kilometers (1.86 miles) from her old house, and recently, one of her friends also moved into a building in the complex. I had a feeling that as she got settled, she might find people she knew or people she once knew and would be able to reconnect with. After all, sometimes the long-ago memories are more at hand! But of course, as her needs change, we have to begin asking ourselves, where is the best place for her to live at this stage?

Like everyone else on this journey, we have watched ups and downs with her dementia and have recently been asking the question about when it might be time to move on from assisted living to somewhere that can provide a greater level of support.

Processing the process

Where we live, a qualification for home care services is the first step to getting into long-term care facilities other than assisted living. It was quite a while ago we started the process of getting home care for my grandma, first, reminders to take her medications, and later, for showering and bathing.

Navigating the process wasn't as straightforward as it could have been, but with help from staff at the local Alzheimer's Society as well as my grandma's doctor, family members' experiences with others, and in later months, the home care intake nurses themselves.

I won't detail the process too much here, as every jurisdiction is going to have its own processes for how this works, and of course, private options are generally available when you have the means to pay for them. Most importantly, for our purposes, know there are allies out there to help you navigate. Your family, primary care doctor, or telehealth advice lines may be a good place to help provide support in navigating the system in your area.

Our experience

In our case, the referral to home care came from my grandma's doctor, but the assessment from home care determined what services she needs. Families and their home care coordinators can make adjustments on their own once a person qualifies.

Still, though, the ups and downs are getting rockier, and we have to be on alert to what the best situation is and when the current situation will no longer be the right one.

Hopefully, ahead of when that happens so we can ensure supports are in place. Talk about dealing with the challenging ups and downs of dementia!

The next step up: supportive housing

In Manitoba, the next step up from an assisted living facility is referred to as supportive housing. In assisted living, meals are made and eaten in a common dining room, housekeeping is provided, a medical alert lifeline system is included, and daily safety checks are done. Still, tenants must otherwise care for themselves or receive home care services.

From my experience, supportive housing takes that one extra step and rolls up a lot of support into a more cohesive package that still provides independence and autonomy to tenants.

Supportive housing includes a private apartment but adds a few extras to what is offered at my grandma's current place. It's kind of like a bundle, rather than having to choose all the services a la carte as we would through home care.

Home care can and may still remain part of the picture. For instance, she can get laundry support or support with additional personal care tasks through home care, but it's included at a supportive housing complex. Someone is also always around if needed - they offer 24-hour support and supervision rather than a once-a-day check.

The other thing is, in many supportive housing buildings, the footprint is quite a bit smaller. One such building here has self-contained "neighborhoods" with 16 tenants per area. Whereas at the current assisted living, some activities are quite a long walk from my grandma's apartment. In supportive housing, the spaces and amount of tenants in one building is smaller and more connected.

And my personal favorite feature of supportive housing? Supported recreation!

When I was in high school and university, I volunteered as a recreation assistant at a personal care home (PCH). When my grandma moved into her apartment, we were so excited for her to be able to participate in recreation. However, this has been a challenge as activities weren't running when she moved in, and when she's gone to certain events, she's been disoriented after the change in routine.

Sometimes things are just far away and hard for her to get to independently. If the woman next door offers to walk down with her, she is still apprehensive because she may have to navigate getting back to her room by herself.

When I volunteered in PCH, this was the biggest part of our jobs, getting people there and back! Every week at least one resident (and often 10) would ask, "Will you take me there?" and "Will you help me get back?" Sometimes even, "Will you sit with me?" And truly, this is not a lot, but it can be a bit beyond what assisted living is meant to offer, though it is provided sometimes. Supportive housing, however, does provide this consistently!

Keeping grandma social and engaged

I have just about never loved anything more than when I heard, "On [Winnipeg] Jets game nights, they round up everyone on her floor and bring them to the living room to watch the hockey, and every time I go in there, I get told how much fun she had!"

I think this kind of stuff, and the encouragement to get out to talk with people, will be a game changer when she does move to a place like this! In the meantime, we just have to continue to do what we can to ensure things work out as well as possible.