Both mom and dad made it to over 100. Friends, family and neighbors of their generation started looking into elder-care about 30 years before that. I got some exposure then and it simply increased over time. After 25+ years evaluating care for the two people that raised me, I have seen and learned a lot. This occurred in Virginia, Colorado and California. The are seven key points that I discovered to be the most important.

When considering a place to live, we often look at the physical aspects of a building or facility. I would argue that over-time that matters less and what matters more is the people in our proximity and the people we will increasingly depend upon.

I recently discussed this with a very good friend who had spent many years looking into these things for her parents. So, I decided to write down some of the things learned along the way.

1. It’s About the People – At Home

As we get older, we are likely to rely more and more upon caregivers to look after our needs. We are inviting them into the home to interact sometimes under the some rather intimate circumstances. These are people that will be helping in the bathroom, shower, getting (un)dressed, … I’d say, consider a potential caregiver from the perspective of would you marry this person. Yes, many caregivers will spend more, close time with us than even our spouse/partner did when we first got married.

In-Home caregivers fall into two categories:

Caregivers via management organization that employs caregivers.

This may seem/be the simplest most straight-forward way to manage the whole question of care-giving. It’s also an arranged marriage that you have little say in. They’ll always tell you that if you don’t like someone, they’ll replace them – great flexibility, right? Wrong. These businesses are all about making money. They pay the people that provide the care as little as possible. They typically don’t treat them very well (I know from having talked to countless people employed in this manner).

Also, if you’re a kind, considerate, not-demanding person, you may end up with the lowest level of care that organization can offer. Why? Because they send their best people to customers that are the most demanding and who complain the loudest. How enjoyable do you think it is for a caregiver to work for very demanding people that complain about everything. Yeah, those that are good and have options won’t choose this form of employment.

Also, they will often switch out the caregiver you just got used to and had established a trusting relationship with. All the salespeople and managers of the people will tell you this isn’t so. All the actual caregivers that come into your home will tell you it absolutely is like that.

Individual caregivers we hire ourselves

There is more overhead in finding and managing the right caregiver. However, you kind of get what you pay for (in time). Also, the caregivers get paid what you pay for care (not some fraction of that). Here it comes back to the – would you marry this person? They will be in your (or your parents’) home, living, dining, bed and bath rooms. As we get older, we spend more time in the home. Hence this could be more time on a day-to-day basis than you may have spent with your spouse when you first got married. This also under circumstances that are less-and-less under our control.

Ask yourself: do you really want the per-arranged marriage by some match-maker who is in it for the money?

2. It’s About the People – In Residence

When moving to a residence, there are also various options related to care-givers. Again, who these people are make a bigger difference in the quality of life than anything else. Would you rather live in a glorious mansion with the partner from hell or in a small cottage with the love of your life? People matter.

If they’re staff hired by the director of the facility, then you want to see what type of person the director is as it typically reflects on whom they hire and how they manage. Pay attention as they walk-around the facility giving you a tour. Do they greet other residents by name or do they pass them by as carbon-based units that generate money?

Ask about the tenure of the staff. If the caregivers have been there 5-20 years, that speaks for it being a place where they want to stay. If the tenure is 1-2 years, well, that says something else…

Have a meal in the cafeteria while the other residents are there. Does the chef/cook come out and talk to people? Do the servers know the names of the residents? How do they treat them? Is that the type of interaction you want every day? Don’t give to much creed to how you’re be served – you’re being sold – watch the interactions with the residents – if food quality matters to you see if the residents are happy when their meal arrives (you may be getting a nicely cooked filet Mignon, but are they?

The larger the facility, the less personal it tends to be and the less likely you’ll know the name of the person coming into your bedroom or bathroom with you – think about it …

A Twist – Independent Living + External Care

After looking at over a dozen places Colorado and not feeling too excited about any of them, I ended up choosing an independent living facility where residents had been there a long time, got long great and helped each other. I then hired an external, dedicated caregiver that came into the facility to provide care there. That left me in control of who was taking care of my mom.

The caregivers hired directly over the years have stayed in touch with my parents even when my parents moved. None of the caregivers brought to them through an agency or that came with a residence have stayed in touch save one – which was a small, privately owned (not part of a chain) facility.

Neighbors / fellow residents / In-Facility caregivers / Doctors (primary care physician) / Hospitals / The indoor environment – Natural light, balcony, natural air (windows that open) high-ceiling, …

3. It’s About the People – Neighbors / Fellow Residents

As we get older, we spend more time in/around home and the people we interact with most are neighbors or fellow residents. Meet them, watch them at meals in the cafeteria, knock on doors, greet people in the hallway and chat them up. Are these the people you want as neighbors and fellow residents? Also, they will typical give you a much more accurate picture of what it’s like to live there than someone trying to sell you into it.

4. It’s About the People – Hospitals

Unfortunately, as we get older, we’re increasingly likely to spend more time at/in hospitals. When we choose where to live, we should consider what the nearby hospital is like – especially the people that work there. If there is more than one nearby hospital, know which one you prefer. Again, check with the staff. The hospitals I’ve received the best care at for myself or my parents are those where the staff has been there for decades and love it there. Ask them, they’ll usually tell you how much they enjoy working there. You want someone looking after you/your parent that is happy with their job and sincere and caring.

If you choose an amazing place to live without checking out the nearby hospital(s) you may be in for a rude surprise when you end up needing to go there in a critical situation.

5. It’s About the People – Your Doctor

Unfortunately, as we get older, we’re increasingly likely to find ourselves interacting, in really important interactions with our primary care physician. If you choose a place to live without taking into consideration who might be available as a primary care physician for you there, you may find out under the worst possible circumstances that the choices you have aren’t any you would’ve made consciously.

6. It’s About the People – Family & Friends

If you’re anything like myself or my parents, family and friends matter. Hence, travel-time matters. This can mean long-distance travel – in the place you choose to live near an airport with good connections? Perhaps more importantly, short-distance travel. The difference between a 15 and 30 minute drive may seem insignificant. However, I discovered that for both family and friends, that difference (round trip time 30 vs 60 minutes) plays a big role in how often visits will happen. Moving my parents from one neighborhood to another went from walking next door to a 15-minute drive for their neighborhood friends. The drop-off in time they spent with their friends went from several times a week to a few times a year. Breaking ties with familiar faces and supportive friends had a huge impact on their quality of life.

7. It’s About the People – You

Another thing I learned as my parents moved from place to place and then I began to notice in different environments was what the indoor environment was like. As we get older, we’re likely to spend more and more time inside the home. What impacts our well-being inside the home?

• Light – Is there plenty of natural light from windows in various rooms, and from various sides? Is it morning, noon or evening light, or are the windows mostly facing north?
• Space – not only is the square-footage an influence on how enclosed we feel, but also the ceiling height. My parents, and I have always felt less cramped and more at peace with higher ceilings.
• Air – Access to fresh air and outdoor sounds can have a big impact on our emotional state. Do the windows open? Are there windows on more than one side so we can create a through draft to clear out stagnant air? Does it come with a balcony? Is it on the ground-floor with a private door to the outside with access to a green area?
• Mobility – As we shift from getting place in a car to getting there in a walker/wheelchair, suddenly a little incline, a big street to cross or a short distance further suddenly make a big difference when we want to go out for a walk, to a park, to a store or cafe, …