After the Move: Transition

tran·si·tion (noun) a. passage from one state, stage, subject, or place to another : change b : a movement, development, or evolution from one form, stage, or style to another. … –Merriam-Webster Collegiate Dictionary
   
Transition is a tricky word. It can be "a musical modulation" or "an abrupt change in energy state or level (as of an atomic nucleus or a molecule), usually accompanied by loss or gain of a single quantum of energy." "Life transition," however, doesn't have a specific listing in the dictionary I consulted. However, comparing our family's recent life transition to the somewhat miraculous changes that occur in an atomic nucleus or the alteration of a substance from a solid to a liquid doesn't seem absurd. This transition has been every bit as significant and miraculous (as is the fact that we have survived it).

So much energy goes into the activities leading up to moving day that often, families are depleted and run out of steam for days or weeks following the move—which is when the real, and possibly the most important, work begins. These transitional days can set the stage for your loved one's feelings about the move over the long term. The prolonged stress over the months of this move has taken its toll on our family, generating the communication and relationship issues that, although normal, make the practical things that much harder to manage. And transitions inevitably take longer than you think they will—no matter how much you plan. As I write this column, almost seven weeks have passed since moving day, and the transition still fully engulfs us.

Advocating: A Caregiver's Role
Let's just say things didn't get any easier for us very soon. It's important for older adults to have family or friends to look out for them and to take care of all the details. While that is an ongoing role for caregivers, the first two months after a move such as the one my parents made are crucial and demand quick action—both in the practical matters, such as setting up the services and supports, and in addressing the underlying emotional aspects.

Moving day took its toll on us, but the road was very bumpy in the first couple of weeks, as my parents settled into their new home and several problems arose:

• The bathroom renovation dragged out five more days (each day, we were promised it would be done "tomorrow"), which prevented us from unpacking the bathroom boxes. Dad had to shave at the kitchen sink, and the night before the bathrooms were finally finished, my mom fell over a box. She was badly bruised and sore and sprained a toe, which led to more doctor's appointments and a lovely bootie she had to wear for two weeks. Not the fashion statement she had hoped for in her new community.
• We had been told there would be all new cabinets and appliances in the bathrooms and kitchen. In reality, the kitchen cabinets had simply been painted (including the hinges!) and new hardware installed—the latter leaving a pile of sawdust in each of the drawers.
• The closet door in the master bathroom was off its hinges and fell on me when I opened it (good thing this didn’t happen to my mom).
• The apartment had not been thoroughly cleaned after the last tenants moved out, because it was still being renovated.
• The air conditioning in the master bedroom side of the apartment broke in the first week and took several days to fix. Instead, we bought a portable air conditioning unit, which worked nicely but was noisy and impeded our ability to unpack and move around the bedroom. The freestanding unit was also a potential safety hazard.
• The window blinds were not working and had to be replaced.
• There were two thermostats in the apartment: one newer and easier to use and the other about 25 years old. The operation of these two varied gadgets was a source of great frustration and confusion for my dad, until I requested that new matching thermostats be installed.
• Large bugs began to appear as the weather cooled down (believe it or not, below 100 degrees is cool this time of year in Phoenix). The insect extermination we arranged caused another domino effect of issues. We had to unpack the remaining boxes and arrange for Jackson to be out of the apartment for a few hours.
• Financial issues came up. In the chaos of The Big Move, I never saw a letter from my dad's credit card saying they were raising his interest rate. Therefore I didn't change the monthly payment I had set up. They refused to do anything to help us when I explained the situation.
• In addition, the long-term-care insurance has approved Mom's claim, but denied Dad's, and it's been a challenges to keep up with my parents' and my finances and other paperwork. One dropped ball can have drastic effects, as exemplified by the credit card interest rate debacle. 

In addition to moving Mom and Dad, I was trying to set up a home base in their house. Attempting two moves at once doesn't work very well. I haven't made much progress in that area, which has made it harder for me to keep myself organized and to handle business and financial matters.

There have been days when I felt like the chaos would just never end. I honestly had many second thoughts about our choice, only repeatedly to come to the conclusion that the move was still the best choice. I'm sure the maintenance staff got sick of hearing from me, and I was definitely tired of making the calls. But the staff had good attitudes and were wonderful about helping. They were not only doing their best to make up for the mess we found on moving day, but they were also kind and helpful to my parents. Clearly the facility hired employees who enjoy interacting with older adults, which has helped us feel better about the move.

Because of the many difficulties with the move, I requested that the facility give us a credit on the next month's bill, which they graciously did. I'm confident that if I'd not asked, that wouldn't have happened, and it made a significant difference financially. Another example of the necessity of caregiver advocacy: My parents were angry about all the things that went wrong with the move and the lack of acknowledgement or assistance from most of the staff (aside from the maintenance crew), but I'm not sure they would have thought of asking for a credit.

Services, Supports, and Activities
In the midst of getting the apartment in shape and making time for the comings and goings of the various workers, I wanted to get supportive services set up. At my request, we met the personalized living coordinator a couple of weeks after the move and discussed my parents' needs. The flexibility their community offers in terms of the range of services—everything from dog-walking to sorting mail to changing the bed sheets to personal care—and frequency—from daily to "as needed," with very little notice required—is ideal. My parents don't have to receive (or pay for) services they don't need, and if they need something once and not again, that's fine, too. The services we set up include bathing assistance for Mom, medication reminders, and bed-sheet changes.

One of the biggest pros of the facility we chose was that they have onsite physical and occupational therapy services. Within the first few weeks, we signed up Mom and Dad for both. Now, after several weeks, I am beginning to see a real difference in their strength, balance, pain levels, and safety.

The activities at this facility are not terribly exciting. If you don't play cards or bingo, there isn't much to stimulate the intellect. But socialization is important, and I do think my parents are benefitting from meeting other residents and enjoying the company of their peers. I spoke with another resident recently who said she and her husband moved from Missouri a few months ago and were distressed because they don't drive anymore, feel a little stuck here, and don't find the activities very interesting. They miss their big house and friends. She said meeting nice neighbors helps the most as they make the transition.

The Ups and Downs
For my parents, as for many older adults who experience this kind of change, the move initially seemed to motivate higher functioning, and then health issues started rising to the surface, perhaps as a result of the stresses of moving. For example, in the first few days, Mom helped with unpacking and walked the distance, with her walker, to the dining room, whereas she had been more sedentary before the move. However, within the first two weeks, she backslid a bit, falling twice and requiring treatment for a chronic infection. Dad worked hard at learning and remembering the new routines and layouts. But then he had some major dental work done, had a bad reaction to the anesthesia, and has recently experienced heart troubles. 

Despite these ups and downs, I see many positive developments as a result of the move. Mom is verbalizing much more (she has expressive and receptive aphasia as a result of her stroke 20 years ago). I can also see that the demands of learning new routines and activities are good stimulation for my Dad's memory.

There are many appointments to coordinate, but having onsite services helps, and with reminders, my parents are now able to go to appointments independently. Dad is able to take Jackson for walks under the shade trees at almost any time of day, and Mom is enjoying dressing up a little for Sunday brunches. We have also rediscovered old treasures and displayed them in new ways in the apartment. I am thoroughly enjoying spending more time with my parents and learning from their resiliency.

It's the Little Things…
There are periods in life when it seems not much change is happening. We drone along on auto-pilot, and in so doing, we miss the fact that changes are indeed taking place. In other seasons of life, change happens quickly—and sometimes drastically and in waves. One immense change generally brings a multitude of smaller changes that may seem insignificant to the naked eye of the observer. But in reality, it is often those slighter changes in a person's life that, individually or cumulatively, come around to "kick him in the butt." The enormous change that The Big Move has brought to our lives was not limited to the moving day itself. The Big Move is a phenomenon that has already lasted five months and will continue to affect us for many months to come.

The innumerable "small" issues have proven to be the most difficult adjustments to make—different schedules and routines, finding the dog food in the new kitchen, learning to use new thermostats, washing dishes instead of using a dishwasher, finding a phone number, finding just the right placement for a lamp. These are the kinds of things that have taken a great deal of time and energy, and the things that can cause the most stress.

It really is the "little things" that have pushed us over the edge at times. It may take my parents 10 or 20 times looking for the location of a light switch before it is concretely embedded in their minds. But the good news is that it neither surprises nor defeats me—or them. I expect it, and I expect that they will eventually "get it." And most of the time, they do.

Home Is Where Your Heart Is
I think the way Jackson, my parents' 6 ½-year-old Shnoodle, has reacted to The Big Move exemplifies the challenges we are all facing. Transitions, as I've noted previously, involve new adventures, but they also involve loss. For Jackson, it was the loss of the home that he had become accustomed to; he had felt safe there. That main loss is accompanied by secondary losses, such as the routines the dog had developed in my parents' old home, the places he hid his toys, the neighborhood dogs who barked with him, and the streets he walked every day. These secondary losses have accumulated to produce insecurity in him.

The emotional side of this kind of move can feel complicated. Again, Jackson illustrates this, as he joined our family from a rescue organization last January. He had been abandoned and possibly abused. We really don't know what he's been through, but this move, not so long after he came to his "forever home," really stirred up separation anxiety in him.

The first time we left him in the apartment alone, he apparently barked the entire time. We learned this when we returned to discover, taped to the door, a nasty-gram from a neighbor demanding that we "do something about that dog." Ouch. Not a great welcome. Jackson also started leaving messes on the floor when he was left alone. He was clearly afraid we would go away and leave him forever, and he didn't feel safe or secure in the new setting. It wasn't home for him. So for the first few weeks, we took him everywhere with us. The facility was accommodating, allowing me to eat with him in an activities room. They also served us dinner outside, where Jackson could join us. He stuck to us like glue. Even when I played the piano, he insisted on climbing on my lap!

Mom and Dad have experienced the primary loss of their long-time home, and the secondary losses of their routines, furniture, and other possessions they couldn't fit into the apartment. They've also lost roles, independence, and perhaps a part of their identity that was associated with being home owners. Along with these losses comes the recognition that other losses have taken place, such as the ability to care for a larger home. With change comes uncertainty, and perhaps a sense of insecurity, until family members forge new trails, feel comfortable, and—one hopes—become happy in their new home. 

Like my parents, Jackson has begun to find some things to enjoy in his new home, such as looking out the window. He couldn't do that in their house. He has several new dog friends in the community, and I think he kind of likes his new fenced-in "playpen" (as the other residents call it).

For my parents, it has been important for them that I just be there. It seems to reassure them as they go through this change. They are becoming increasingly confident about everything involved with their new home and services.

Jackson appears to have learned what I have also realized from this experience: "Home" is a concept, not a place. Wherever Mom and Dad are, the pet's happy. He doesn't care how old they are, the level of their abilities, or their type of living situation.

On the second evening in their new home, I looked up from unpacking a box to find my parents dancing, as Elvis sang from the TV, "I can't help falling in love with you. ..." All my life, my parents have shown us through their spontaneous dances that affection is the norm. It was good to see them still dancing, and in that moment, I knew they'd make this place home, just as they have done everywhere they've lived. For them, home is about being together. They celebrated their 59th wedding anniversary a week after the move—quite an accomplishment. The anniversary clearly reminded us that in 59 years, they've weathered many changes. Surely they will weather this one and those to come, as well.

As for me, I'll be there advocating to make sure they have working sinks, comfortable chairs, a balance and variety of routines, quality care, a canine companion, mint-chocolate-chip ice cream in the freezer—and plenty of love.

A Few Tips
As I look back over the past five months, the beginning phases of The Big Move, the following thoughts summarize my lessons as a caregiver:

• Assess the needs and the wants. Of course, as caregivers, we have to focus on our loved ones' basic needs. But if we only focus on that and ignore the things that are priorities from their perspectives, their quality of life will suffer—and isn't enhancing their lives the whole point? Having a dog companion, or good food, or a garden may be just as important as help with bathing or medications.
• Involve your loved ones. As much as possible, encourage your older family members' participation in the process every step of the way. Some people think they are helping by just taking over, but in actuality, they are not respecting their family members. Nor does such an approach help them make the transition. Involving them as much as is prudent and possible without overwhelming them gives your loved ones some semblance of control as everything is changing around them. Perhaps it's too much for your older family member to make decisions about all the furniture to take in a move, but maybe he or she can make a choice between two pieces of furniture after you narrow it down. Would you want someone taking over your life without asking your opinion? I don't think so. Just because our bodies or minds aren't working quite like they used to doesn't mean we can't participate in our own life changes.
• Plan, but expect deviations. As a family, we planned as much as possible, but the unpredictable development of the apartment not being finished threw us a bit. When moving older family members, go that extra mile, make that phone call, have a plan B. It may be harder for them than for you to adjust and be flexible.
• Familiarity eases transitions. Try to pick up the old routines quickly after a move. Consistency in morning and evening rituals, mealtimes, favorite TV shows, or familiar furniture help us inch through tough transitions. Pay attention to the details. They matter, and sometimes finishing one small detail, such as hanging a photo of a loved one or organizing a shelf to put the most-used items within reach, can make all the difference in easing the transition.
• Expect it to take at least three times longer than you thought it would. Maybe for you, transitions and changes happen more quickly, but for your older loved one, they take longer. Don't lose heart; it just takes more time for them to process change. Expect it, and plan for it.
• You can't put life on hold. If we had been able to focus only on the move and transition during these past five months, it probably would have gone more smoothly and quickly. But life doesn't work that way. We've had to deal with health issues, work demands, property in three states, financial matters, and other family issues all along the way. It's important as a caregiver to constantly prioritize. Recognize that at times the basics, such as opening the mail, have to be done.
• Caregivers have to care for themselves, too. Despite my 25 years of working with caregivers, and even after my own caregiving experiences over the years, I've committed some classic "caregiver no-no's": I went days without medicine, didn't eat healthily, and stopped exercising (except for moving boxes!). I've even realized I'd actually been wearing the same clothes for two or three days! You're worth it, and you won't be any good to your loved ones if you fall apart!

I'll continue journaling about this caregiving experience here on AARP.org, so stay tuned. I know this journey for my family has just begun!