There are less, but greater needs at this stage.  Banking and medical support are the responsibility of the power of attorney, or some other trustee.  It would be a good idea to have a meeting with the director responsible for residence care.  A care plan should be developed with the residence care team.  Make sure to ask for regular updates on the recipient of care.  

• • Companionship 

• • Cleaning

• • Errands

• • Exercise

• • Meals

• • Medical support

• • Mobility

• • Personal hygiene

Companionship 

Companionship is incredibly important at this stage.  Quality time with people they love, together with food and digestion are the main quality of life enhancers.  The staff in the assisted living facility should be providing some while attending to their other needs, but sadly, that happens all to little.  Getting recipients of care to activities also requires hands on attention, which sometimes staff do not have enough time for.  Mental health is a difficult issue as bodies and the brain prepare for death. common (link to article on mental health at EOL),

It is good to know the people at the home who are involved in providing care.  Make a point of talking to their caretakers on shift when you are there.  If you are out of town, get their email addresses, or other contact information.  Keep conversations with staff brief as they have other recipients they are also responsible for.  Doing this will give you information about the recipient of care’s wellbeing. 

Suggestions to improve companionship (note:  Some of these are the same as for in home care not sure if should link or repeat) 

• Communicate openly and encourage others to do so also.  Try to get the person to discuss their feelings, and also their limitations.  Sometimes too much socialization can overwhelm and greatly reduce quality of life.  Only the recipient of care can tell you what the need and can tolerate.
• It is also good support them as they learn what it is they would like to experience as they transition to ever increasing levels of dependance and ultimately death.  Discussions can progress as the person continues to decline.  Discuss ways you can help them realize their desires.  Perhaps a new hobby done other others. 
• Be sure to be sensitive to their situation and their mental and physical state. If struggling with dementia or other mind-altering conditions, it might be difficult to interact with new people.  This adds an increased demand on those close to the recipient of care. 
• Set a schedule for appropriate companionship if they are not getting enough interaction with the residence staff. This can be tricky when juggling appointments and personal care schedules.  Make sure visits with companions are not too long but provide adequate time for socialization.  Long visits can exhaust the recipient of care. SeniorSynCare can help with that. 
• You may have to hire a companion from a service to supplement what is lacking from the services offered.  Do an internet search on “finding a companion for an elderly person” and you will see a list of companies in your area that provide this service. Ask if the companion can also do other tasks such as house keeping and errands.
• Use technology to increase interactions, such as helping them make phone calls to or video chat with loved ones who may not be able to visit in person (link to Technology Consultation Services page). Make sure that those interacting directly with the recipient of care know how to use these technologies.
• Sometimes it is easier to get a neutral party to enter such dialogue.  Parents may not want to burden their children, or they may be proud and not want to show their weakness.  

Cleaning

This should be covered. 

Errands

Most needs can be met within the services offered by the retirement home. But there some things that may require somebody to run an errand. 

Things to consider:

• Grocery items the recipient of care would like to keep in their room
• Items necessary for increased quality of life (absorbable underwear, toothpaste, etc.)

Exercise

Physiotherapists can assess the exercise needs.  This should be part of the care plan. 

Mental Stimulation

There are limited activities available, but efforts should be made to get the recipient engaged.  Speak with the care providers at the assisted living facility.  It is possible that additional support will be needed.

Individual needs and interests vary, and the extent of the benefits is dependent on several factors.  If they are not getting enough stimulation during the time at the residence, there are things you can do.  Make sure you do not schedule too much, otherwise it can overwhelm and exhaust the recipient.   

• Use video technology to staying  connected with family and friends.  The best way to stay mentally agile and healthy is to engage in conversation.  It is also essential for mental and emotional health.  
• Listen to music together. Music helps with cognition and can help with memory recall (if listening to a song with emotional significance). Purposefully listening to music lyrics and processing them helps the mind stay active. 
• Work and puzzles and play board games. 

Meals

Meals are provided.  Make sure the recipient gets to choose from the menu, or alternative menu.   If there are foods to be avoided, the residence staff must be notified.   It would be a good idea to check frequently to ensure avoided foods are not accidentally introduced.   The kitchen has many meals to prepare and often things get overlooked. 

Some interesting facts: 

• The average adult loses 3-8% of their muscle mass each decade after age 30.
• Diverticular disease affects 50% of people over age 50 in Western countries and less than 0.2% of people in Japan and Africa
• Human and animal studies have shown that the gut tends to absorb less calcium with age which is likely caused by vitamin D deficiency
• 20-30% of people over age of 50 have reduced ability to absorb vitamin B12 from their diet
• Older people are more prone to dehydration as thirst receptors become less sensitive to water changes making it harder to detect thirst
  • Dehydration is a major cause of delirium
• Studies have found that older people have lower levels of hunger hormones and higher levels of fullness hormones, which means they get hungry less often and feel fuller more quickly
• Aging can affect your sense of smell and taste, which means foods are less appealing

Medical support

Most residences have resident physicians and 24-hour nursing support.  Since it is not often easy to get a person in the last years of life to their doctor appointments, this option can be attractive.  Be aware of availability.  

Other health care services are not often available such as: Dentists, medical specialists, eye doctors, hearing clinics.

Be sure that somebody who is lucid with a good memory (most likely the PoA) is at each appointment so that notes can be taken and follow up care properly provided.  It may be a good idea to take videos for procedures that may need to be repeated at the home (such as how to put in hearing aids or change a particular bandage). 

Most jurisdictions have support services, some by Province or State, others municipally, such as Para-Transport.  

SeniorSynCare can help with coordination where videos and doctor’s notes can be directly stored for community dissemination.

Mobility

The assisted living facility will ensure that mobility needs for personal care (bathing, brushing teeth, etc.) are addressed. Speak with the director of care to ensure that additional devices such as wheelchairs are available. 

Personal hygiene

These should be offered directly from the assisted living facility.  As to be sure that all needs are met. 

Things to consider:

• Bathing (includes showers, baths, and sponge baths)
• Laundry
• Nail care
• Tooth brushing
• Going to the toilet and proper clean up
• Changing bed sheets and ensuring clean towels
  • Make sure there are services to change sheets when accidents occurs

Spiritual Needs

Check to see if the recipient’s facility has a chapel or any religious services if that is of interest.  Our own fragility and mortality tends to create heightened spiritual needs in those nearing the end of life.  Religion and existentialism factor in as we get older.  

For those with an existing spiritual community, it will be important to keep them connected.  Spiritual leaders can help ensure that the person gets these needs met. 

For those who have no spiritual community, open discussion and becoming informed on things like what happens after death.

For more information see Spiritual Needs at End of Life.

Scheduling 

All these services must be communicated and coordinated.  SeniorSynCare is here for you.