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Mon, Aug. 19

THE GOOD PATIENT: Moving from independent living to assisted living

This is the ninth in a series of articles intended to demystify the experience of living in a retirement community.

Suppose that you move into an independent living apartment at Alta Vista, Good Samaritan, Granite Gate or Las Fuentes and then over time it turns out that you need assisted living services. What arrangements are required to get that additional care?

The transition is easiest at Granite Gate: you stay in the apartment that you're already in. They bring the services to you. This arrangement is especially useful when one spouse needs assisted living and the other one doesn't. And it's very convenient: no packing or unpacking is required, and there's no need to get used to being in a new space.

In the other communities, you would need to move to an apartment designated for assisted living. These apartments are typically clustered in their own wings, include a dining room/restaurant within the unit and offer additional services and attention. For example, they ensure that residents have snacks available.

If you were in independent living at Good Samaritan in Prescott Valley, it would mean moving to their assisted living unit in Prescott because they don't offer assisted living at their Prescott Valley campus.

At all of the sites except Granite Gate, for people to start getting assisted living services from the retirement community's organization, there has to be a vacancy in the assisted living wing. But usually this fact doesn't pose a problem. Because the need to move to assisted living often develops gradually over time, residents or their representatives can generally work out this transition with the management of the retirement community.

What if you can't wait?

At Granite Gate, the issue simply doesn't arise, since no move is needed. At the other three communities, residents or their representatives can probably make arrangements for home health aides and/or a skilled nursing service to come to their independent living apartment and provide services as long as they need them. Every retirement community can recommend agencies that some of their residents use.

These services are divided into two buckets: medical and non-medical. Generally, nurses provide medical services. Home health aides provide other kinds of services. For example, some of the services listed by one agency are: walking the dog, preparing meals, running errands, going grocery shopping, helping manage the calendar so that people don't miss appointments, helping with mail, and going with individuals to their doctors' appointments.

Residents pay for such services a la carte, instead of having much of their care simply bundled into the monthly fees that they pay to the retirement community. It's more work to manage, and in some cases may be more expensive. But it's an option, especially in the short term.

Some people simply don't want to move -- they like their independent living apartments and want to stay there. Nothing (except possibly money and the need to manage the situation) stops them from bringing in services from the outside day after day, year after year.

Care management in this case is no different from what it would be if you were living in your own house. There's nothing to prevent you from arranging any kind of care you want or need to be brought in, assuming that you can pay for it.

Moving from one level of assisted living care to another level that the retirement community is licensed to provide does not require any additional moves. That is, you do not need to change apartments as you need more of the assisted living services that they offer.

Alta Vista's license covers two levels of as-sisted living care but not the third and high-est level of assisted living licensing that the state offers, called "directed care." Good Samaritan, Granite Gate and Las Fuentes are all licensed to provide all three levels of care.

Next week's column will talk about what happens if you need a level of care that exceeds the unit's license. That is, it will cover what happens at Alta Vista if you come to need care beyond the second level of assisted living, and what happens in all four organizations if it turns out that you need long-term nursing/skilled nursing care.

Elizabeth L. Bewley is president and CEO of Pario Health Institute and the author of "Killer Cure: Why Health Care Is the Second-Leading Cause of Death in America and How to Ensure that It's Not Yours." To tell Elizabeth your story or to ask her a question, write to thegoodpatient@pariohealth.net.

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