Making Choices in Old Age

It is a very daunting task when you need to make major life decisions and choose one option from a number of competing alternatives. In old age, these choices and decisions are most likely to be around health, finances, and living arrangements. If you don’t make these choices yourself, you are choosing that someone else will make them for you.

Moving to residential care is a huge adjustment for anyone. In my experience, those who have chosen where, and when to move, adapt and enjoy this life stage better than those who have not chosen.

I am motivated to write this, my first blog, because over the past 20 years of working with older people I have seen time and time again the end result of older people not taking control of their future. They frequently end up depressed and miserable in a residential care setting not of their choosing. With this, they suffer a sudden loss of autonomy; losing their independence, home, social roles and networks, belongings, sometimes pets, and all things held dear for many, many years. Whereas those that choose when and where to move, are in a better position to cope with the accompanying grief and loss issues, as they maintain some degree of control in the situation.

Why does this happen?  My sense is that a number of factors will influence our choices:-

  1. Individual values are the most important driving force behind our choice of action. Let’s take the example of deciding when to move from home into a residential care facility.  If we value our ‘independence’ we might choose to stay living at home for as long as possible. However, if we value ‘control’, we might prefer to make the active choice of where and when we go into residential care rather than allow others to make that choice if we are not able, which is so often the case if we leave it “as long as possible”. So, in this example, we need to weigh up and balance the values of independence and control. This is not easy, but old age equips us well for this challenge. With ageing, comes wisdom, a collection of life experiences and knowledge gained through those experiences, which help us negotiate a course through such dilemmas.
  2. Flexibility is also key in such cases of value adjustment. Values that serve us well in one stage of life, may not serve us as well in a different stage, and may need some adjusting. For example, if we clung to our willful independence of teenage years, it would be difficult to form long term relationships where there is a need for some degree of mutual dependence.
  3. Old age changes our perception of loss. Recent research found that older adults are more prepared to take risks with loss than younger adults.We become more familiar with loss, over a lifetime of experiencing different types of loss, and therefore are prepared to take more risks in relation to loss.  This research relates to our choices when it comes to moving to residential care. We are more prepared to sit tight in our current situation and accept the unknown future risk, rather than take the inevitable and known loss of moving now, while we can still make choices.

What can we do about this dilemma, and ensure that you have the best possible quality of life in your later years?

Design a Residential Care Moving Action Plan

  1. Start a conversation with your family or support person/people about the criteria that you and they might think need to be met for you to seriously consider moving to residential care. See https://www.myagedcare.gov.au/getting-started/starting-the-conversation-about-aged-care
  2. To establish the criteria ask yourself questions such as:- How’s my health, and what are my medical needs (medications, dressings etc)? How’s my mobility (do I need walking aids or wheelchair access); Am I still able to get around town eg. drive or take buses/trains? Am I still in control of my bowels and bladder? How’s my short term memory? Am I at risk of falls? What’s my current support at home? Is the possibility of more support available? After you’ve asked these questions of yourself, you may wish to ask them of your family member, with whom you are discussing the issue. They may well have a different perception of the situation. Attempt to be open-minded and flexible as you discuss any differences in perception.
  3. After establishing some agreed upon criteria for when you think it will be the best time to move, weigh up the pros and cons of moving versus staying at home. Write them down, and discuss them with your family or support person/people.
  4. When you make the decision that you might want to trial a period in residential care, you will need an ACAT assessment (Aged Care Assessment Team) to classify you as high or low care. Call 1800200422 or visit the website at :-http://www.myagedcare.gov.au/eligibility-and-assessment/acat-assessments
  5. Phone and book an appointment to go visit some places that you would consider appropriate for when you are ready.
  6. Consider a period of respite in a residential care facility to try it out, and put your name on a waiting list. The government allows you 63 days of respite per year.

If you would like to book an appointment to discuss any of the above with us at Amazing Ageing Psychology, please call 02 98445403, or send us an email via our website.

2 thoughts on “Making Choices in Old Age

  1. Mark Rushton says:

    Well done Jane on a comprehensive yet succinct ‘first Blog’ on such an important aspect of life, being residential care and the adjustment/s to such.
    I worked in Aged Care for 7 years back in the 1990’s, in a Nursing Home, a mainstream hostel and a dementia-specific hostel and witnessed first-hand so many men and women and their respective families adjusting to residential care in these facilities. I remember all too well the initial grief and loss revealed by all of our residents in those initial 2-3 months.
    Without being religious, I was blessed to be running the mainstream hostel and dementia-specific hostel, hence able to help provide a home-like environment and also promote a social model of care. These factors in-turn helped many of our residents to more easily adapt to their ‘new home’. I also recall chatting with many daughters (more times than not the primary carer within the families) of our residents that we would not be able to provide the ‘loving care’ the family members have provided in the past, though we would be able to provide the essential ’24 hour care’ with staff members providing their own ‘loving care’. These sorts of comments often reassured the family members and assisted with a somewhat smoother transition for our new residents.
    The reason I have relived these memories is that I am now starting to be challenged with the prospect of the need for residential care somewhere in the future. I am a 55 year old paraplegic (10 years in a wheelchair now) and my body, primarily my spine, is ageing much more quickly than my mind and I am now starting to contemplate the need for residential placement within the next decade or so. Yes, I have started those important early conversations with key family members and loved ones. And it is so very daunting and even terrifying to think of a life without my very dear to me pets…dogs, cats and chooks. Not to overlook the loss of my garden which I toil so hard in, giving me hours of pleasure and satisfaction on a daily basis. Yes, there will be enormous loss BUT deep down I know with residential care my needs will be met, I will be safer and at less risk of the many falls I endure on a regular basis…oh, did I tell you about the fall I had in the laundry last night when I overstretched from my manual wheelchair to the dog food – perhaps a story for another day…not to forget the care staff around me assisting with my care needs which I can no longer manage myself; the outings, entertainment and activities arranged; and I am sure I will also be able to find a garden patch or two to tend to.
    In closing, once again Jane congrats on your insightful Blog and I look forward to future Blogs. I will share this with my friends who may also be considering the need for future residential care.
    Take care all!

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  2. amazingageing says:

    Thanks Mark for sharing your experience and for commenting on my first blog. It’s good to hear that you have all the care that you currently need, and yet are still able to contemplate your future care needs. Your comment also raises the issue of younger people in residential care facilities, maybe the topic of another blog. I hope your comment inspires others to be proactive and consider their future care needs and choices.
    Keep well! Jane

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