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Decision to Move to a Seniors' Residence
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Shawn Fremeth, MSW, Elaine Kohn, MSW, Heather Lisner-Kerbel, MSW, Frances Cossever, MSW, Barbara Biel, MSW, Baycrest Centre

Moving into a community-based seniors' residence, such as a supportive housing complex, often poses numerous challenges for older adults and their children. For an elderly Holocaust Survivor, the nuances of such challenges may take on an added complexity and intensity. Although there are differences between community-based settings and long-term care facilities, the fact remains that both are communal environments that provide varying degrees of "institutional" support and structure.

Institutional norms that exist to ensure the proper running of a community setting can be disturbing to a Holocaust Survivor. Medical staff, mealtime schedules and other imposed organizational routines set up for community efficiency may be stressful and disturbing to Survivors. Factors associated with the decision-making process, such as choice, timing and motive often have a tremendous impact on making the transition to a new living arrangement.

To better understand the challenges that your parent may face in adjusting to a seniors' residence, it is crucial for you to give staff a clear sense of how the decision to move came to be made. While your parent may not require nursing home level care, a decline in physical functioning and an increase in social isolation often precipitate a move to a supportive housing complex. While there may be an intellectual recognition of the need for more support, the emotional sequalae associated with this decision may be varied and layered.

For Survivors and their children, the decision to move to a supportive housing environment encompasses numerous issues. The degree of perceived control over one's future is of tremendous importance to any older adult. This fundamental need may take on unique symbolic value for Survivors given their lack of choice and the trauma they faced early in life.

Your parent may feel an overwhelming sense of loss of control, ranging from the tangible, (i.e. giving up possessions, what to bring and leave behind) to intangible losses (i.e. feelings of weakness and not being able to manage one's life independently). The importance of maintaining independence - defined literally as complete self-sufficiency - also takes on unique meaning. Such independence meant the difference between life and death during the War, and later on, success and failure after the War. Independence was the bedrock upon which Survivors rebuilt their lives, and to acknowledge a decline in this area -- to themselves and also to the rest of the world -- may be a source of tremendous insecurity. The Holocaust Survivor may feel it is necessary and appropriate to befriend and please staff by offering gifts in order to get what they need/want in the supportive housing environment. Such a strategy was often key to survival during the War.
Case Example: Mrs. P.

Mrs. P. survived Auschwitz concentration camp where she witnessed the deaths of her two brothers and three sisters. She sustained many losses throughout her life. For 45 years, she lived in the community with her husband, also a Holocaust Survivor, until she was forced to live alone and cope with the difficulties inherent in widowhood.

Mrs. P.'s three adult children were married with families of their own. Two of the children lived out of town, and one daughter lived nearby with her family. Consequently, this daughter became largely responsible for providing emotional and instrumental support to her mother. After 10 years of being on her own, Mrs. P.'s physical health began to decline and impact on her ability to live independently. After sustaining injuries related to a fall and a decline in ability to manage daily tasks (e.g. housecleaning, meal preparation), Mrs. P. was forced to seriously consider the need to move into an environment that would provide more support. Mrs. P. was also becoming increasingly isolated as many of her friends had passed away, and she found it difficult to travel to the community centre she used to visit regularly. As a result, she was starting to feel depressed.

Dependent on Rifka, her only child who lived nearby, Mrs. P. called her daughter and asked "what now?" Both Mrs. P. and Rifka felt uncertain about the future and didn't know what lay ahead. Rifka was becoming increasingly worn out from her care giving responsibilities, and her stress level was rising. Although she knew the situation was not sustainable, she felt tremendous guilt for even considering that her mother needed to leave home. How could she uproot her mother at this stage of her life?

Rifka was angry at times that her siblings were so far removed from the situation. Mrs. P.'s two other children felt guilty they couldn't offer more support to their mother and sister. They really weren't sure what would be best for their mother. Mrs. P. seemed to recognize many of the benefits of moving to a supportive housing complex, but she clearly felt ambivalent about making such a move. Mrs. P. wondered how she could leave an environment that held so many wonderful memories for her. She was reluctant to travel down a new and unfamiliar path.
Discussion of Issues raised in case

Leaving a familiar environment creates a great deal of stress for Survivors, since it reminds them of the time they were forced from their communities. The trials and tribulations that followed such "leavings" are unimaginable, and their impact is often felt many decades later. While Mrs. P. knew she needed greater assistance because of her increasing physical frailties and recognized that her increased isolation was causing her to feel depressed, she was ambivalent about leaving that which was familiar to her and to journey into the unknown. It is important for her children to recognize this struggle while at the same time, to support her in deciding to live in an environment that would be the best given her situation.

Some family members see this type of move as a failure to "protect" and support their loved one. An additional factor that may create further complexity stems from the geographical location/proximity of adult children. Children of Survivors often feel a tremendous sense of responsibility for their parents.

In Mrs. P.'s case, the "burden" of overseeing activities of daily living, (ie. financial and medical responsibilities, shopping, transportation, meals) fell on Rifka. For the children who do not live locally, the dominant feeling described is guilt related to their inability to provide instrumental support. This imbalance often causes feelings between siblings to become strained. Such issues may need to be addressed by exploring how each family member perceives the move, what it means to them, and what each sibling can contribute in the best interest of their mother.

In the ideal situation, there is congruence between the Survivor and all family members regarding the decision to be made. This, however, is not always the case. It must be emphasized that when an older adult is capable of making decisions regarding their living arrangements, they must be empowered to do so, regardless of what other parties believe. Although some may perceive a decision to be foolish or unwise, the right of a competent individual to make his or her own choice must be protected and respected.

The losses generally experienced as a natural part of the aging process may be magnified in a setting where a group of elderly people live. Within such an environment there is a continuum of ability/disability among residents, and the physical and cognitive losses that Survivors see in others may be striking. They may be forced to recognize such losses in themselves or speculate on what the future may hold. This may arouse feelings of anxiety and fear of the future.

It must be emphasized again that those who survived the Holocaust did so in most cases because they were well and able. They did, in a very real sense, outwit death. Moving into an environment where disease and death are more visible may stir up a wide range of emotions that should be addressed by family members with the help of health care professionals when needed. Family members should not see this move as an opportunity to offer parents less support. More than ever, parents need to know that their family will visit, will remain interested and involved, and will be there for them.