Assisted Living and the PACE program
Assisted Living and the PACE Program
Assisted living is a residential option for seniors who require help with daily activities such as bathing, dressing, and medication management but do not need intensive medical and nursing care. The PACE program (Program of All-Inclusive Care for the Elderly) is a comprehensive healthcare service that provides medical, social, administrative, and transportation services to elderly individuals who are still living in the community but are certified as needing nursing home level care.
The assisted living facility I finally chose for my parents provided all the daily services my parents needed in an apartment style environment. Everything from housekeeping, nursing, dining, wellness activities, bathing assistance, personal care, medication management, limited transportation to shopping and hair salons.
The best thing that the assisted living place introduced me to was St. Paul’s PACE (Program of All-inclusive Care for the Elderly), a program fully covered by California’s Medi-Cal (Medicaid elsewhere in the country).
This program was a God send. St. Paul’s PACE facility was located a few miles away from my parent’s assisted living and had a primary care doctor, nurses, nutritionist, lab, dentist, occupational and physical therapist, plus counseling. The great thing about the PACE program was all the professionals there worked on care for each patient as a team.
Their efficient coordination of transportation between the PACE team and assisted living was a huge time saver for me. PACE sent a wheelchair friendly van to the assisted living for their weekly pace health checkups. They also sent the van to any specialists that my parents were referred to.
This enabled me to spend more time at work and just show up for their specialists’ appointment. The amazing part was that the PACE care team got detailed updates from the specialists that they incorporated into my parents’ care.
They would send a social worker to the assisted living once a week to check on how my parents were doing. When my mom’s appetite declined further, the social worker worked with the nutritionist to identify Ensure with high protein would be a good alternative. She would keep a count of what my mom was drinking and make sure the supply was replenished.
I got a call one day from the PACE facility “The dentist has uncovered the reason why your mom is not eating. She has an infection on two of her teeth, top right, and bottom left. The dentist is recommending a root canal. Your dad is hesitant. If you come over in the next hour, we can have you meet the dentist, convince your dad, and get these root canal done all before the end of day today.”
I was in my car within 10 minutes and the root canals were done that day. It took my mom a few days to recover from them, but she was back eating again on day 4.
With all the convenience that PACE introduced to my life. I always felt it probably made my parents feel more independent on one hand and more isolated on the other.
I would visit them several times a week and initially I would take them out for a drive to the beach. However, as time passed their conditions worsened and neither one wanted to leave their bedroom.
“Checkmate! I finally beat you!” Followed by loud laughter and clapping is what I heard as I entered their room one day.
My dad made friends with the caregivers, med-tech, nurse, chef, cleaning crew and executive director. He started his chess club with other residents and caregivers.
“How the student is becoming the master”, my dad beaming with pride informed me, “Joe has been staying after his shifts to learn and play chess with me for the past month.”
My mom on the other hand would say, “the people here are too old.” When I would respond to my mom by saying, “But mom, there are many residents here that are younger than you,” she would respond with a twinkle in her eyes and smirk “not as young at heart”.
My mom had a mischievous side all her life that went to very occasional episodes when she started taking medications for Parkinson’s disease.
She started to sleepwalk while in that facility and would try to escape in the middle of the night. Sometimes they had to really strong-arm her to take her back to their bedroom. All her life she had been a kind, soft-spoken person who would not hurt a fly, but during these sleepwalking episodes, she would get angry.
“Your mom hit the caregiver when she was sleepwalking last night, and the caregiver stopped her from going out the front door of the facility.” The executive director of the facility informed me one day.
“I want to tell you, that is not possible. She would never hurt a fly.” I replied hoping the Executive Director was wrong.
“People are more prone to sleepwalking when they’re in unfamiliar surroundings due to increased stress or anxiety. These factors can disrupt normal sleep patterns, triggering sleepwalking in individuals predisposed to it. We have seen that with several residents in the first six months of their stay, the unfamiliar settings can act as a catalyst, especially if they are causing discomfort or anxiety.”
I called the PACE team for help the next day. “We will schedule a psychiatrist appointment for your mom. Will you be there for translation and assistance?”, my response was “Absolutely, yes!”
In this assisted living facility, they urged residents not to keep valuables, including cash or credit cards. They did not want to take a chance with theft from staff members. My parents were able to keep some money with the assisted living facility just like a bank deposit. This was one of the hardest things for my dad.
To this day, I wish I had just kept a $20 bill in his jacket to make him feel more in control. I can’t forget the disappointment and horror on his face when I asked, “Dad can I take your wallet home for safe keeping?”
He responded, “How can one be a man without access to his wallet?” He shook his head and handed me the wallet and went to the restroom, I believe to compose himself in private. I think that day part of his pride died, and his health began to decline rapidly.
My father did not bring up the desire to keep his wallet with him after that day. However, he hardly went out of the assisted living to buy anything. I encouraged him many times to go for a walk outside and get some candy from the grocery store. He probably did those six times in his entire stay at the assisted living facility.
It is hard for me to admit this but part of the reason I had a hard time was because I did not like the assisted living facility that they were in. I was the one who had found it and had convinced them to move there. It was the best we could afford. It made me sick to go to the assisted living facility because I could not stand the smell or the sad looks on some of the residents’ faces.
I visited them four to six times a week. I checked in with them daily, and their doctor or director of assisted living weekly.
Transitioning my parents into an assisted living facility was a decision fraught with conflicting emotions and the harsh realities of their health challenges and our financial constraints. The facility, while providing the essential services and care they needed, was a far cry from the warmth of a family home. My father, ever sociable, found solace in the company of the staff and residents, his charm and wit endearing him to many. Yet, my mother struggled to adapt, her nights haunted by sleepwalking episodes that sometimes turned confrontational, a stark departure from her gentle nature.
Embracing New Beginnings
Agnes and Harold had lived independently for as long as they could remember, but the years had taken their toll. Agnes’s Parkinson’s disease and Harold’s declining mobility meant they needed more help than Shelby, their daughter, could provide on her own. Shelby decided to move them into an assisted living facility that promised to cater to their needs while giving them a sense of independence.
The facility, named Sunny Meadows, was a welcoming place with apartment-style living. It offered everything from housekeeping to dining services, wellness activities, and personal care. Shelby was particularly impressed by the integration of the PACE program, which provided comprehensive healthcare services covered by California’s Medi-Cal.
One afternoon, as Shelby visited her parents, she noticed a marked change in their routine. Agnes was sitting comfortably in the common area, chatting with other residents, while Harold was engaged in a lively chess game with a new friend.
“How are you settling in?” Shelby asked, sitting next to her mother.
Agnes smiled. “It’s been an adjustment, but the staff here is wonderful. They make sure I get my medications on time and even help me find a diet that suits my appetite.”
Shelby nodded, relieved. “That’s great to hear. And Dad seems to be enjoying himself too.”
Harold looked up from his game, a grin on his face. “Shelby, meet Will. He’s been teaching me some new chess strategies.”
Will waved. “Your dad’s a quick learner. He’s got a few tricks up his sleeve too.”
Shelby laughed. “I’m glad you’re making friends, Dad.”
As the days turned into weeks, Agnes and Harold settled into their new lives. The PACE program proved to be invaluable. A wheelchair-friendly van from PACE regularly picked them up for their health checkups and specialist appointments, saving Shelby the hassle of coordinating their transportation.
One day, Shelby received a call from the PACE facility. “Hi Shelby, this is Dr. Smith. We’ve identified an infection in your mother’s teeth that’s affecting her appetite. We recommend a root canal and can arrange it today if you’re available to come and discuss the details.”
Shelby rushed to the facility and met with Dr. Smith. After a thorough discussion and convincing Harold, they went ahead with the procedure. Agnes recovered quickly and regained her appetite, much to everyone’s relief.
Despite the support, there were moments of struggle. Agnes’s sleepwalking episodes caused anxiety, especially when she tried to leave the facility at night. The staff handled these situations with care, and Shelby worked closely with the PACE team to address her mother’s needs, including scheduling a psychiatrist appointment.
As Shelby navigated these challenges, she couldn’t help but feel conflicted about her decision. “I hate seeing you both here instead of at home,” she confessed to her father one day.
Harold took her hand. “Shelby, you’ve done the best you could for us. We’re getting the care we need, and we’re together. That’s all I care about.”
Shelby smiled, tears in her eyes. “I just want you both to be happy and safe.”
Agnes joined them, resting her hand on Shelby’s shoulder. “We are, dear. This place may not be home, but it’s given us a second chance at living fully.”
The Journey to Care
Megan and Her Parents’ Story
Megan was at her wit’s end trying to manage her parents’ care. Ellen’s dementia was worsening, and Bob’s health was rapidly declining. She knew that moving them to an assisted living facility was the best option, but convincing her parents was a different story.
“I’m not leaving our home,” Bob declared one evening. “We’ve been here for fifty years.”
“I understand, Dad,” Megan replied gently. “But you need more help than I can give. There’s a place called Green Acres that offers everything you need and has a program called PACE that covers all your medical needs.”
After much persuasion, Bob reluctantly agreed to visit Green Acres. The facility was bright and welcoming, with apartment-style living and a range of services designed to keep residents healthy and active.
On moving day, Megan helped her parents settle into their new apartment. “It’s nice,” Ellen said, looking around. “It feels like home, just smaller.”
Bob wasn’t as easily convinced. “We’ll see,” he grumbled.
Despite his initial resistance, Bob began to warm up to the facility. The staff were attentive, and the PACE program ensured that his medical needs were met comprehensively. A PACE social worker visited regularly, coordinating with the assisted living staff to provide seamless care.
One afternoon, as Megan visited her parents, she noticed a significant improvement. Ellen was participating in a painting class, her face lit up with concentration and joy. Bob, on the other hand, was engrossed in a book club discussion.
“How are you finding things, Dad?” Megan asked.
Bob shrugged but smiled slightly. “It’s better than I expected. The people here are nice, and the activities keep me busy.”
Ellen joined them, holding up her painting. “Look what I made today!”
Megan admired the artwork. “It’s beautiful, Mom. I’m so glad you’re enjoying yourself.”
The PACE program proved to be a blessing. Megan no longer had to worry about arranging transportation for doctor’s visits or managing medications. Everything was coordinated through the program, allowing her to spend quality time with her parents without the added stress.
However, not everything was smooth. Ellen’s dementia caused her to wander at night, often trying to leave the facility. The staff managed these episodes with care and compassion, but it was heartbreaking for Megan to see her once-vibrant mother so disoriented.
“Mom hit one of the caregivers last night while she was sleepwalking,” Megan learned from the facility director one day.
“That doesn’t sound like her at all,” Megan said, shocked.
“It’s dementia,” the director explained. “It can cause changes in behavior, especially in unfamiliar settings. We’ll continue to monitor her and adjust her care plan as needed.”
Megan contacted the PACE team, and they scheduled a psychiatric evaluation for Ellen. The comprehensive approach of the PACE program provided much-needed support and tailored care for Ellen’s condition.
Despite the challenges, there were moments of joy. One evening, as Megan sat with her parents, Bob turned to her. “You did good, Megan. We’re getting the care we need, and we’re making new friends. Thank you.”
Megan’s heart swelled with gratitude. “I just want you both to be happy and healthy.”
Ellen smiled, her eyes clear for a moment. “We are, dear. We’re together, and that’s what matters.”
As Megan navigated the complexities of her parents’ care, she found solace in knowing that Green Acres and the PACE program provided the comprehensive support her parents needed. It wasn’t an easy journey, but it was one filled with love, resilience, and a commitment to ensuring the best possible care for her parents.
