Making your first care decision? Think several steps ahead

As I said last week, it's easy to age successfully when you're healthy. Similarly, care providers have the easiest time pleasing clients who have few needs. Where the pedal hits the metal in all eldercare — whether it's in home care or residential services — is when you become frail and unable to care for yourself. Then it's a double-whammy: Not only are you vulnerable to getting poor services, but you're also less able to pick up and leave.

Which is why your first eldercare choice is often the most important: It sets the stage for what happens next. It's also why my No. 1 rule in eldercare is simple: Plan for change. You're healthy now, but what happens when you're not? Too many older people and their families fail to look beyond their noses when they start down this road. Like it or not, medical science lets us live well beyond our wildest dreams. It's something we can't predict but it's important to add to our decision-making process: Where does this provider's care end, and where will we need to go next?

Like most things we buy, marketing sells the sizzle in eldercare, and sometimes it's better than the steak. "Lite" assistance dominates. Effervescent ads promising adventure and fun catch your attention, turning scowling images of aging into smiles. That's good; negative images of aging have dominated too long. But sometimes we forget to think about the future when life gets more difficult.

I call it the "pretty wallpaper" effect — families often choose a place based on what's on the walls. I understand we like things to look nice. But what happens when your mom falls? When she needs help at night getting to the bathroom? When she becomes demented? When she's dying? The wallpaper won't be important then. Your primary concern will be the services in place to care for her.

So, as you shop, think about your full range of needs: What services will be good for the near term while you're healthy, and what might be more appropriate in the long-term when you're not? One service rarely works for both (which is why couples with different needs often require different kinds of care). People with dementia, such as Alzheimer's or small strokes, often require different services from those who are physically impaired.

Here's an interesting phenomenon: Most us want to be cared for when we need it, but we don't want to be around sick people. It's one of those "push-pull" things: Take care of me, but I want everyone else to be healthy.

A seasoned retirement-community administrator once told me about a resident who insisted that nobody living at her facility be allowed to use a wheelchair. Then one day, the administrator said, that resident herself needed a wheelchair. "Because we accepted wheelchairs, she could stay," the administrator said. "She told me she finally understood my policy."

This illustrates a relatively new concept in eldercare called, "aging in place." It began as a movement to help people live long and safely at home for as long as possible by bringing in needed services. But now it includes helping people live long and safely elsewhere, including residential-care facilities, for as long as possible. The reason: Moving is hard on all of us as we get older, so the more we can adjust the care system to fit residents' needs rather than make them move the better.

The tradeoff is that our neighbors may become significantly sicker than we like. However, when that neighbor becomes us, perhaps we'll appreciate being able to stay. This is one of the experiments we're going to see as long-term care options change in the future to accommodate more of us.

Next week, I'll tell you the basic questions to ask when "kicking tires" among residential-care facilities. There are two sets: One covers the basics, such as price, services and how they work. The second gets at quality issues — how to determine a facility's flexibility, track record and willingness to let residents "age in place."

Liz Taylor's column runs Mondays in the Northwest Life section. A specialist in aging and long-term care for 30 years, she consults with families and their elders. E-mail her at growingolder@seattletimes.com or write to P.O. Box 11601, Bainbridge Island, WA 98110. You can see all of her columns at www.seattletimes.com/growingolder/.