Probably not the key to real estate in the elderly set. More like "handicapped accessible toilet, competent person in charge of the meds, some form of engagement besides a TV." We've tested a huge range of living options on our dad. At times, it was about as humane as testing mascara on rabbits. Here's what he's gone through in the 13 months since Mom died:
1) Live-in roommate. This fell into our laps. I stayed with Daddy the week after Mom died, and it was pretty clear he needed help. Then his neighbor suggested that one of her tenants move in with him. The man was just a few years younger than our dad, but much healthier, and with a distinct ex-hippie California vibe. He was renting a room from the neighbor. Daddy invited him over for a chat, and they decided that Roger could move in rent-free in exchange for dealing with groceries, cooking, dishes and laundry. It lasted a couple of months. It sort of drove my dad nuts to have this stranger living in his house, eating wheat germ and saying "Far out!" But it gave everyone great peace of mind, while it lasted. Roger was a rolling stone, and by late March had rolled along the way.
2) Independent living with structured help. We set up a schedule where one of us was down there every weekend. Meals on Wheels came by each weekday. The neighbors checked in. His old climbing buddy came by often. Some church people drove him to the physical therapist twice a week. We wrote out directions for him--how to use the microwave, how to run the laundry, which leftovers to heat for which night's dinner. His blood sugar was whack, and he was scarfing Hershey bars. The cat box only got changed when we visited. I think he got a UTI and a brief hospital stay in there. We kept having to drive down and help him clean up after bouts of diarreah. Nobody should have to wait 90 minutes to get cleaned up after shitting themselves. Nobody should have to take unpaid time off work to drive 3 hours round trip to deal with that. It was pretty much a complete disaster, but he didn't die, and it got us through until summer. It finally got hard enough that he admitted it was time to consider leaving the house. He lived 90 minutes from 3 of us (add 4 hours for the other daughter), so we really wanted him closer. I was initially thinking some apartment or rental home near us, but he was really not able to do anything for himself. So we started looking at...
3) Retirement homes. This didn't work for us, but it could be a good option, if you had a bunch of money and were reasonably mobile. He had a two bedroom apartment with a kitchenette, but ate his meals in the dining hall. They had assigned seats, so if he didn't show up for a meal, someone would notice. The shower was too hard to get into and out of, so he really only showered when we helped him. It seemed like it was working pretty well for a few weeks, then his legs got all wobbly and he fell, and wound up in the hospital.
4) Assisted living. When you can't take care of yourself much, you move to the other wing, where people take care of you. It costs more, and apparantly, if you're going to run out of money and go on Medicaid, they don't really want to take you. They have "limited staff" for "high needs residents" and they come to the hospital and watch you shuffle up and down the hall with your walker and tell you regretfully that they just don't fee like they'd be able to offer you the level of support you need. So we actually didn't get to try this option.
5) Rehab Center. He spent over a month here. The best part was daily physical therapy. There were a lot of worst parts. The food sucked, which is no big deal if you're there for three days, but for six weeks? They were understaffed. The rooms were shared, and the whole ambiance was both loud and lonely. Since he'd flunked out of assisted living, when he checked out, we moved on to...
6) Adult foster care. Does this thought make you queasy? There are time when I just want to shoot myself for putting my dad in a group home. But it's not creepy, really. We interviewed 3 places, all of which were run by Romanians. What's with that? We chose the place he's at because they have three cats, the guy is authorized to deal with the highest level of care (e.g. he can offer hospice when it comes to that, so we will never have to move Daddy if he gets worse off), it's about half a mile from my sister's house, they have a beautiful porch and garden, and, well, those three cats sure were cute. No wait, it was also because his room has a private bathroom with a handicapped toilet (the toilet itself is not handicapped, but you know what I mean), and the place has a spiffy walk-in shower. Plus the guy who runs it has a reputation for actually improving the health of his residents, instead of just watching over their decline. It also has a TV in the living room that is ON 24 HOURS A DAY, I KID YOU NOT. My dad hasn't had a TV since 1965. He grumbles about seeing the same Bonanza episode over and over again, but he admits to liking "that funny show with the older ladies" and Jeopardy. He has announced that he like to watch football, which is staggeringly weird to me. My dad hates sports. He's also a total pacifist. Just two years ago he tried to make male bonding talk with my husband by saying, "So, I hear there's some big game on soon," the week before Superbowl. And THAT surprised me.
Oh wait, I was talking about foster care, not my dad's strange metamorphis into a football fan. I guess it's related. If the TV weren't on all the fucking time, he might have been able to remain oblivous. Anyway. The most obvious benefit to this living situation is that with meals coming like clockwork, and medicine, including insulin, also being doled out in precise amounts and at exact times, his blood sugar is more stable than it's been in years. My dad should probably be in the Guiness Book for having lived with diabetes longer than anyone else (since about 1945). As a result, people don't really know what to do with him--there's not much precedence. He's been very lucky, and my mom was very good about taking care of him. But even before she died, things were getting wonky. Then when he was on his own, his sugars were completely out of control. Now it's great. And the people that run the place don't sleep. One of them is there all the time, and as far as we can tell, someone is always awake. He needs a pain pill at 3 in the morning, the guy comes in and give him one, logging it into his record book. When he was at the rehab center, I once sat with him for 20 minutes while he waited for someone to respond to his call light. This is by far the safest of all the things we've tried. Honestly, it's probably even safer than the last few years he was living with my mom. Which doesn't mean it's great. Instead of living in his own sunny home, with friends all around, classes to teach, an office to work in, and all the trappings of a normal life, he's living in a small bedroom in someone else's house. He gets homecooked meals, but they're not tailored to his tastes. There is company around, but they aren't his friends. The cats aren't even his pets. I'm surprised he doesn't hate it, but it really seems like he's doing okay. In just the past month, he's come out of his year of mourning and depression and has started to enjoy life. He's suggested outings to us, he's gotten a library card, he's talking about a trip to the mountain this summer, he's reminding us that his 80th birthday is coming up. He was so low last spring and summer that I felt like we were taking him there to die closer to us. But he's "not dead yet" and in fact, seems to be perking up. So despite the f'ing TV, and my residual guilt for pawning my father off on strangers, I am very happy with this arrangement.