I loved visiting my in-laws in Tucson. They had retired to a beautiful patio home on a hilly golf course where morning sunshine crept up over Mt. Lemon and streamed into our bedroom. Yvonne cooked homemade organic meals and beamed when she introduced us to her friends. Tom enjoyed taking us shopping where every clerk knew him as a regular. Teasing each other and swapping jokes was the norm. They spoiled us and we felt lucky.
Then things, very slowly, began to change.
My husband, Jim, and I noticed piles of unread mail had started to grow, then they began to multiply and spread onto every flat surface. We would help Tom go through the mail, getting it organized only to return on the next visit finding the same piles made out of new mail. He stopped balancing his checkbook or keeping up his register, trusting the ATM's balance to let him know how much money he had to spend.
After Yvonne had a bad fall that hospitalized her, she began to repeat stories and started describing items when she couldn't remember what they were called. Her sweet personality changed to being on edge and frequently criticizing Tom. Their physician identified her as showing the beginning signs of dementia. We privately discussed their future but reassured ourselves that Tom was taking care of her and they would be fine.
Tom had taken on some of Yvonne's chores, he cooked frozen dinners for every meal but skipped doing the dishes, using the same paper plates (this explained the ants in their cupboard). Other chores like cleaning, washing and bathing he didn't take on. When we arrived Tom greeted us wearing his big grin and the same stained T-shirt he wore on our last visit. He smelled badly, Yvonne was even more neglected, still in her pajamas and soiled. We couldn't believe she had gotten so dysfunctional, but the mess she hid behind the bathroom door revealed she wasn't capable of meeting her own toilet needs.
We scolded Tom for ignoring her and demanded he change her immediately. They returned from their bedroom with Yvonne wearing a new cleaner pair of pants but the same filthy nightgown.
Tom and Yvonne's doctor called Jim, informing him the two of them should not be living alone. When Jim told his dad what the doctor had said, Tom didn't buy it. After long discussions and sleepless nights, Jim and I decided we would move them to Phoenix into a care facility. Our long search and education of finding just the right place for them began. We were overwhelmed with the choices and haunted at how we would actually get them to move.
Tom began falling and he couldn't get up without someone strong enough to lift him. Yvonne too many times walked next door to their wonderful neighbor asking for help. In the middle of the night, Tom fell and wedged himself between the toilet and the bathroom wall. Not until the morning did Yvonne hear his cries and went again to their neighbor. Tom was badly bruised and in pain but luckily no bones were broken, or worse.
We drove immediately to Tucson. Yvonne was a trooper and tried to rise to the occasion in helping her husband, but so many daily living skills were beyond her ability. With Tom immobile and needing care, and Yvonne's dementia growing worse, they couldn't be left alone.
One of the care facilities we were looking at seemed to be a good fit for them; we now decided the choice had to be made. We told Tom they were moving, and he wasn't as stubborn as he had been in the past. We weren't sure if it was because he was beginning to agree or didn't understand due to the pain medication he was taking for the bad fall.
The day of the move, Jim and I loaded up the rental truck. The plan was for him to drive the truck to Phoenix and the three of us would follow in the car. Jim was worried the whole day of packing if they would even leave.
Everyone's journey caring for their loved one is unique; this was ours.
We were extremely lucky. When our folks had to move, we had finally done the research to make the choice. I would like to encourage you to trust your judgment in the decisions you make. Learn what you can do now about the options available, visit the facilities, talk to the staff and the residents.
Seven indicators can help guide you through your evaluation of when it may be the right time to move your loved one. You can read these individually and feel they may not carry much weight, so be sure to look at the whole picture. Examine all the behaviors your loved one is showing.
1. Money management: Is money being managed wisely? Do you know? My husband for the longest time felt he would be prying if he were to ask his dad about his financial plans for the future. We learned Tom stopped paying his mortgage, refinanced his home three times, continually ran up his debt, cashed out his life insurance to balance his accounts and then owed taxes he couldn't pay on the cash.
2. Medication management: Tom gave Yvonne her pills but did not notice she was hiding them in her napkin.
3. Driving: It is extremely difficult for anyone to give up the independence driving provides. Many elderly websites offer easy-to-administer driving tests to evaluate your loved one's ability. In addition, discover the variety of alternative methods available to seniors for transportation.
4. Housekeeping: We saw all the changes that were around us in Tom and Yvonne's home, but it took a long time to register the "whys" behind them.
5. Meal preparation: Yvonne had always put effort into cooking healthy meals for her family. After her accident, it all disappeared but was something they still needed to be receiving.
6. Physical mobility: Because of Tom's frequent falls, the physician ordered he use a walker. He did outside his home, but was too stubborn to maneuver it around the furniture inside the house.
7. Socialization: Tom did limit his driving to the daylight hours, which kept them from attending their regular evening events. Well-intentioned friends were unsure how to react to the changes they saw in their good friend Yvonne and they were heard from less and less.
Ahwatukee is fortunate to have several care facilities. They can vary from intimate settings in a house to memory care designed for seniors with dementia. Continuing care offers three main levels of care. This reduces the need to move again as more assistance is required. When I interviewed professionals in this field, Tom and Yvonne's story was very similar to those of their residents. Frequently, it will be a major event preceding a move to a facility. Not only can the indicators be useful guides, but moving sooner than later is strongly encouraged. For many, the longer one waits to move the more difficult the transition becomes.
Two and half years ago we moved Tom and Yvonne. They currently are living in a memory care facility very close to our home here in Ahwatukee. They both depend on their wheelchairs for the majority of their mobilization.
Hospice has just begun to give Yvonne their loving care and she is responding well. Her facial expressions are what is left for her to communicate with; she's been smiling a lot.
Tom has remained a very devoted husband, always looking after the care his wife receives. He has watched as his wife slowly disappears and his healthy, active lifestyle changes to a very sedentary dependent one. I have fallen so in love with him, through everything, he still greets us with his big grin and has never complained, not once.
• Ahwatukee Foothills resident Peggy Alt, M.Ed., focuses on aging issues. Reach her at firstname.lastname@example.org.