Consider this scenario:  You’ve gotten a frantic phone call from your elderly parent who, returning from a 10-day cruise, broke her hip and is in a distant hospital room recovering from surgery.  Her nurse just warned her that her health care insurance coverage expires tomorrow, and wants to know where mom wants to be transferred.  You’re completely unprepared for this and panic sets in.  What do you do?

This is hypothetical, of course, but the fact is that more than 80 percent of us will be in a similar situation at some point.  A parent, spouse, sibling or child will experience a fall, stroke, heart attack or some other traumatic episode and after a short hospital stay to stabilize their condition, hospital personnel (and/or the insurance provider) tell you to “make other arrangements.”  Returning home is often not an option because the physician has concluded that the patient needs some level of care to perform basic life functions.  Consequently, a rehabilitative, transitional or perhaps permanent care facility must be found.  The placement depends on availability, cost, needed therapies and geographic location. 

“Help!”  Assistance is available from both paid and unpaid advisers but you need to prepare and implement an action plan almost immediately—despite the fact that you know little or nothing about the health care system.  Adding to the crisis may be the resistance or confusion of the patient who wants desperately to go home. 

Here’s help.  I’ve prepared a short checklist of items to help you make an informed decision.  Take a deep breath and do some research.  Most hospitals offer lists of qualified facilities and employ nurses or social workers to advise you.  These individuals often do not impose their preferences but they may know current availability and their list will give you a starting point. 

Search our housing directory for alternatives using the criteria suggested by the hospital staff.  Most of the care that is necessary immediately after a hospital stay involves specific therapies (e.g., speech, physical, cognitive) and time to heal, and their availability is essential to a positive outcome. 

·       Actively involve the patient in the decision.  Their greatest fear is likely a loss of control.  They may also view a long-term health facility as a death sentence even if the facility has “rehabilitative” or “transitional” in its name.  Involvement will result in less resistance and a more positive result.

·       Ask lots of questions of the physician, the nursing and other hospital staff.   Don’t forget to ask the patient questions, too.  You need to get objective answers about what is needed to achieve the most positive outcome.  Change is difficult both physically and emotionally.  Moving a person from one facility to another can be devastating.  But frequent moves may be the result of poor selections made with little or incorrect information. 

·       Transitional and rehabilitative facilities require that the patient has certain physical and cognitive ability levels upon admission; improvement in those areas is charted at frequent intervals.  One of our dear friends has undergone two moves since being stricken with a massive stroke, because she failed to make the necessary progress in her recovery. 

·       Search with your senses.  Nothing takes the place of physically visiting a facility in advance of placement.  What do you see when you visit?  Is it clean and bright? It need not be new.  Frequently—unfortunately--décor is substituted for care.  Are members the staff visibly engaged in caring for the residents?  What do you hear?  Silence for me is a red flag in some facilities.  It certainly depends on the type of facility but it sometimes signals the overuse of antipsychotic drugs to quiet the population.  What do you smell?  Is it urine?  Stale food?  It should smell like home.  

·       Ask about food choices and taste something from that day’s menu.  One of the serious problems that patients encounter is a loss of strength because they fail (or refuse) to eat.  The problem may be that the quality of the food doesn’t satisfy a patient who is a good cook or has a particular love for good food.

·       Be visible.  Visit often for the sake of the patient.  Your visits are important for the companionship and love that they provide, but they have another purpose.  Most facilities are understaffed.  Staff ratios of seven or eight patients to one care provider make it difficult for that care provider to give sufficient attention to any one patient.  But humans tend to perform better when they know they are being observed.  I have no proof to support this statement, but I have observed that staff communicates with those patients whose family and friends are frequently present.  One of our friends found that bringing a box of candy or a bouquet of flowers as a thank you gift to the staff a good idea.  We don’t say “thank you” enough and most of us respond positively when we are told we’ve done a good job. 

·       Be positive and encouraging.  Illness often results in depression.  Prolonged rehabilitation can be very discouraging when positive results are in short supply. 

·       Review our Toolkit chapter for additional tips and specific questions you might use when searching for facilities by phone or in person.  

Now that you have experienced how difficult a task this is perhaps you could take a moment to make a list of what you have learned and what your wishes would be should you find yourself in the same situation.

I volunteer at my church and is well known among the parishioners  - as is my cell phone number.  Over the past few years I have received several calls from seniors in assisted living facilities wanting to share the “goings on” of their community.  They frequently describe what someone said at dinner or the behavior of some notorious resident whose name, I am supposed to have committed to memory from previous conversations.  I frequently give advice on what response I might have to the words or deeds of these unkind acts.  For the most part this all seems rather silly or maybe the result of too little to do.    But a dear friend sent me an article yesterday that labels some of this behavior as bullying and perhaps that is what it is.

In the article Gina Kaurich, an executive director at FirstLight HomeCare is quoted as saying, “There is, in some regard, a caste system among residents,” Kaurich says. “There would be an elitist type of table in the dining room where you had people who could eat and drink and carry on conversations very well together. And if an individual who had trouble eating tried to sit with them, they would ignore them or say, ‘Why do you always seem to drop your fork?’ They’d speak meanly to them. It was like high school.”

“In the recreation room, if somebody didn’t participate the way somebody else thought they should, you’d see them get into that person’s face,” she says. “They’d be literally shaking their finger and saying, ‘How dare you call out Bingo when you don’t have a Bingo!’ or ‘How dare you sing that hymn that way!’ Even if the person was in a wheelchair, they’d be looking down at them, shaking their finger in their face.”

The article went on to quote a source called Bonifas to estimate that “10-20 percent of seniors are bullied with some type of senior-to-senior aggression in an institutional setting, much of it verbal abuse.  Both men and women can bully… but women tend towards passive-aggressive behavior like gossiping and whispering about people when they enter a room while men are more  ‘in your face’ With men, it’s more negative comments directly to the person…with women, it’s more behind your back.  But it doesn’t always stop at back-biting and bickering. Seniors have also been the victims of violence…sometimes over something as trivial as a coveted spot at the dinner table.”

I was shocked.  Somehow I thought that when we moved into the next stage of our lives it would be lovely to have all of these delightful neighbors for company.  But I found that when I hit middle age I got my first chronic ache and started to gain a few pounds.  That made me mad.  Part of the anger was directed at me for not being more disciplined about exercise and diet but some of the anger was about the aging process which I could only temper not stop.  Maybe some of these folks are angry, frustrated, hurting and end up taking it out on each other,

I checked with my own personal “senior circle” and found that indeed moving to an assisted living or skilled nursing community involves a social adjustment.  Being the “new kid” in the building can be every bit as traumatic as changing schools mid-year in grade school.  One likened the senior cliques to prison gangs with the same intimidating behavior patterns you see on TV.   She admitted that might be a bit strong but said the power of feeling picked on or ostracized in a group setting can be extremely painful.

If you have family or friends in a senior community pay attention to the dynamic when you visit.  Ask those you visit how comfortable they feel, who they like and dislike and why.  If you uncover any bullying or isolation behavior, meet with the staff or other professionals to seek advice on how to solve the problem.  Acceptance is a human need.  Isolation and loneliness can lead to depression and illness. Bullying isn’t just a kid problem.


  • In the years has been online, we’ve received hundreds of e-mails from visitors asking questions about legal documents, how to start retirement planning in their 50's, as well as advice on traveling with grandpa and the kids and making everyone happy.   We’ve also received personal stories of triumph and tragedy including the creative, often humorous ways people cope with stress, relationships, balancing career and family, 70 hour work weeks, job loss and the "agony and defeat" they encountered starting a new company.   In our newsletter, I periodically share stories about my glorious 86 year old mother and have named a collection after her.  This is YOUR SPACE.  Ask for advice.  Share stories.  I love your e-mails. It's simple.  Just click here!