When the process of deciding is done, it is time to prepare for the transition into the chosen care. This transition period can be a difficult and emotional time for both the elder and the family.
The start of care, in whatever form that care will take, requires that the elder adjust to being cared for. Elders often perceive a loss of valued independence when this occurs. Their daily routines must change to accommodate the needs of their care providers, rather than themselves. If a home health worker has been hired, the elder will have to adjust to having someone share their personal space and structure their daily activities. This can be very frustrating for elders used to living alone and setting their own schedules and routines. In addition to frustration, elders may feel shame at the thought that they now require help to get by. They may feel significant grief for lost vigor and youth.
The situation is even more jarring and stressful for elders who must now move to a care facility. Moving to a care facility often means a loss of personal space, identity and possessions, as well as the disruption of long time relationships with neighbors and friends, in addition to the loss of control over scheduling meals, activities and health services. Elders who are used to living alone may find the large number of people in a care facility to be overwhelming. These elders too are likely to experience shame feelings and significant grief. They may also build up feelings of resentment towards their family members for not working harder to keep them independent. Elders with insight may intellectually understand the need for them to make the move to a care facility, but this doesn't mean that they will feel good about it in their hearts. In their hearts, they may feel abandoned.
Significantly, many elders will have to adapt to the loss of driving privileges. This loss may occur when elders move into a facility, or simply as a part of the aging process; the slowing of reflexes and the loss of eyesight. Not being able to drive can be an incredible loss to elders who will immediately feel confined to their living space and to have involuntarily regressed to the state of a child who must ask others to take them places. Elders may understandably become angry and frustrated or feel ashamed at the prospect of asking others for assistance. Some elders will deny their impairments causing family members to have to intervene or hire a professional to convince them of the necessity of not driving. A doctor's recommendation and a trip to the Department of Motor Vehicles may be required to revoke the elder's driver’s license. Many families will simply go along with their elder's denial state and leave their elder at risk of harming him or herself and others in an accident rather than confront them with the reality of the situation. Other families will find the courage to confront their elders, but then become frustrated by having to function as their chauffeur, driving them to appointments, shopping or to other places that they would have gone to on their own in the past. It is important that family members and elders maintain open communication through this difficult period of adjustment, acknowledging the stresses felt by all.
Because the transition into care is stressful, it is helpful that it occur in stages, over a period of several years, rather than all at once, if a staged progression of care is possible to accommodate. Breaking the transition to care into stages makes it possible to break the stress associated with care into more manageable chunks. For example, as an initial stage of care, a home health worker might be hired to help elders remain in their homes for as long as possible. When the home health option is no longer appropriate, elders can then transition into an independent living or assisted living facility, which functions to preserve their independence as much as possible, while also increasing their access to care. Ultimately, a nursing home environment may become necessary should a health condition worsen and 24-hour care be required.
The stress of transitioning into eldercare affects family members as well as elders, although not as intensely. Family members used to seeing their elder in the family home where they grew up will likely feel a need to grieve when the elder ultimately has to move out of that home, or even when they can no longer remain in that home without external assistance. Simply put, it can be very difficult to see beloved elders needing assistance with managing basic activities of daily living that used to be taken for granted. Progressive illnesses such as Alzheimer’s disease add a further layer of reason for grieving, as they will require the family to endure the progressive loss of the elder's personality and memories even while needing to maintain that elder's body. Towards the end of Alzheimer’s, it is fully likely that elders will not recognize their children, who will then have to grieve the loss of their parents before their parents have died.
While this transition process can cause a great deal of stress for elders and their family members, there are things that can be done to make the transition happen more smoothly. Family members can commit to visiting the elder on a regular basis, even going so far as to schedule in advance when visits will occur each week. Scheduling visits gives both parties something to look forward to and reduce the likelihood that the relationship between elders and family members will suffer. Regular visits also provide family members with a means to check on how elders are doing and to verify that appropriate quality care is taking place. Seeing elders receive and respond to quality care can go a long way towards reducing any guilt or worry that the family may be feeling over having initiated the eldercare process.
When regular visits are not possible due to distance, families can schedule regular telephone calls with their elder or write their elder regular letters. The telephone can also be used to contact doctors and other caregivers who can keep family members up to date on their elders' adjustment and response to care. In addition, special in-person visits may also be scheduled to occur at regular times during the year.
As is the case during any difficult time, the family's ability to communicate openly and honestly with one another during the transition process will go a long way towards reducing stress. It is important that families make sure their elders know that they can always contact them to let them know that care is not adequate or should be adjusted or changed. The family needs to keep in mind that elders' feelings of loss, frustration and anger are fairly normal occurrences that do not need to be taken too personally. For example, families should not assume that because an elder is upset about the need to be in a care facility that it was a bad decision to move that elder into a care facility. Family members and their elders may benefit from talking with a counselor who can help them cope with feelings of grief and loss.