Moving day and the first month in a new community

The two weeks before

• Confirm the admission checklist with the community: physician forms, medication list, insurance cards, proxy, the signed residency agreement. Ask what is still missing.
• Measure the room and plan what goes where. Choose the favorite chair, the bedspread, the photos, the clock. A familiar room helps more than a new one.
• Label everything that leaves the house: clothes, glasses, hearing aids, dentures, the walker. Things go missing in laundry rooms.
• Set up the pharmacy the community uses, and hand over a fresh medication list.
• Tell the community who the person is: what they did for work, what they love, what upsets them, how they take their coffee. Write one page and give it to the nurse and the activities director.
• Arrange mail forwarding, the phone, and the television. Cancel or move deliveries.
• If dementia is involved, keep the plan simple and do not over-explain in advance; a week of dread is harder than a day of change.

Moving day

• Move in the morning, on a weekday, when the full staff is there.
• Set up the room before the person arrives if you can. Walk in to a room that already looks like theirs.
• Meet the aide and nurse on shift, and introduce your person by name and story.
• Stay for a meal. Then leave before evening; long goodbyes and late-day departures are harder for everyone.
• Take the empty boxes with you. A pile of boxes says temporary.
• Expect tears, yours included. This is grief and relief at the same time.

The first week

Almost everyone has a rough first week. The Alzheimer's Association notes that a person with dementia may have sleep problems, wandering, falls, and appetite changes while adjusting, and a change in setting can bring temporary confusion. Call the nurse rather than assuming the worst, and ask what they are seeing. Ask the community how it helps new residents settle, and who checks on them at night.

How often to visit

Communities differ on this. Some suggest a few days of space so the person bonds with staff; others want family in every day. Ask what they see work. A good pattern for many families is short, predictable visits, at the same time, doing something ordinary: a walk, a meal, a puzzle. Visit at different times of day in the first month so you see the whole place, and get to know the aides on each shift by name.

The first month: what to watch

• Weight, appetite, and whether they are eating in the dining room.
• Sleep and evenings.
• Whether they are being helped to activities or left in the room.
• Medicines: match the list to the medication record at the community and ask about any changes.
• Falls or new bruises, and how you were told.
• Whether they are calling you in distress. Some calls are adjustment; a pattern is a conversation with the nurse.
• Your own sleep and guilt. Both are normal and both improve.

The care plan meeting

Within the first weeks, most communities hold a care plan meeting. Go. Bring your one-page story and your list of what you have noticed. Ask who the main aide is, how they will tell you about changes, and what the plan is for the evening hours. Ask for a copy of the care plan.

When it is not working

If after four to six weeks the person is still deeply distressed, losing weight, or you see care problems that a conversation did not fix, say so to the administrator in writing. The Long Term Care Ombudsman Program, free and confidential, can help with a problem inside any adult home, assisted living residence, or nursing home. Sometimes the answer is a different community, and that is allowed. A Cardinal advisor can help you decide whether to give it time or to look again.

In CarePair

Add the community and the nurse's line to the care team. Put the care plan meeting on the calendar. Note what you observe in the journal; a dated record is worth a lot if you ever need the ombudsman.