Making the Move to Assisted Living: A Guide to Knowing When It's Right and Making the Right Choice
As we watch our parents or grandparents get older, the last thing on our mind is finding a facility for them to live in. Our goal is to enjoy them as long as we have them with us. Yet, many adults find themselves in a situation wherein they have a loved one who can no longer care for themselves at home, leaving them to make the difficult decision about where to get additional care.
How likely is it that you will have to make this decision? The answer depends on how old your loved one is. According to the US Census Bureau, slightly over 5 percent of the elderly population is housed in nursing homes, congregate care, assisted living or board-and-care homes. About 50 percent of those age 95 and older are in nursing homes.
For you, it may be the fact that you visited your loved one and found that they seemed frail and as if they were losing weight. Perhaps it is the realization that your parent is in the beginning stages of Alzheimer's, leaving you to fear that they might wander off out of their home one day. You may even face a situation where your elderly loved one has a serious medical need that you are not equipped to care for. No matter the reason, if you come to a point that you cannot realistically care for your loved one on your won, and it's clear that they cannot do their own self care, then you need to start searching for senior housing and care options.
Whether your loved one is among the small percent of young elderly individuals who needs additional help or is among the majority of those over the age of 95 who need the support, when the time comes, you face a number of difficult decisions and transitions. The good news is that your options are excellent, allowing you to find the exact type of care that will perfectly meet the needs of your loved one. From finding people to come to your home and care for your loved one to assisted living facilities that feel like a resort, you will find a number of options available to help you get the help you need for your loved one. However, this transition isn't easy on many elderly people, and for that reason you need to do a little planning.
This guide will help you with that planning, giving you the answers you need and the guidelines you want to help you choose a facility and make the transition. With a little bit of help and information, you can make this transition as easy as possible for yourself and your loved one.
Is It Time to Make the Move?
One of the first questions you will have to answer when making the transition to assisted living is whether or not it is time to do so. Each family will have to answer this question for themselves, as no two situations have the same unique problems and challenges. However, there are some factors that can make an impact on your decision. Here are some things to consider.
- Consider how much help is needed at home. There comes a point in many senior adults' lives when they no longer can handle their own care, and the amount of help necessary is more than their adult children can provide, either due to scheduling, distance, or some other factor.
- Consider the individual's medical needs. When continued medical care is needed throughout the day, it's often more cost effective to have the individual's care handled at a facility, rather than through caretakers at home. This is particularly true when round-the-clock care is needed, but all adult children have jobs outside of the home.
- Consider quality of life. Assisted living facilities have programs to help keep their residents engaged and entertained. Is your loved one's quality of life suffering because they are home and alone most of the day? Making the move may actually be beneficial to them.
- Does your loved one represent a wandering risk? If your loved one tends to wander, you may need additional help to keep them safe.
- Is the home safe? Are there safety issues in the home, such as falling hazards, that you can't overcome? Safety needs to be a top priority, and sometimes elderly people cannot be cared for safely at home.
- Is your loved one having a hard time recovering from illness or surgery? Ongoing health problems are often a key indicator that you need more help to keep your loved one protected.
- Is the caretaker under stress? The health and well-being of the caregiver also needs to be considered. Caregiver stress is a very real problem, and one that can be alleviated by utilizing the help of an assisted living facility.
- Are self-care tasks being left undone? If you're noticing that your loved one isn't regularly showering, caring for their appearance, or taking care of other self-care needs, assisted living can help.
- Is there a need for more social connections? If your loved one's friends have passed away or moved to other locations, assisted living may provide a venue to make new friendships.
- Does the house need help? If your loved one can't care for the house, and you aren't able to help or hire house cleaning, you may need to consider making the move to a facility that includes house keeping services with the overall care. A clean house is essential to protecting someone's health.
- What is your gut feeling? Don't be afraid to trust your gut feeling when it comes to whether or not assisted living is needed. You know your parent or other loved one best, and when the time is right, you will know.
- Have there been any recent close calls? Whether a fall, dinner left to burn on the stove, bills that went months without being paid, or rotten food in the fridge, if your loved one has had any close calls that made you uncomfortable, it may be time for additional help.
- Are you close enough to provide consistent help? Sometimes distance between you and your loved one is the deciding factor, because you simply can't provide the help that is needed to keep your loved one safe.
For more help in making this decision, visit:
- A Place for Mom: 11 Signs It's Time for Assisted Living
- Caring.com: 11 Signs It's Time for Assisted Living
- AgingCare.com: Is It Time for Assisted Living?
- Genivity: Is It Time for Assisted Living? How to Help Your Parents Through the Transition
- Healthy Women: Six Signs an Elderly Person Needs Assisted Living Arrangements
Different Types of Carehome
If you've determined that you need to have extra help caring for your loved one, the next step is to determine what type of facility or care is right for your family. Needing help doesn't necessarily mean you must move your loved one into an assisted living facility. In fact, a growing number of seniors are choosing to make changes and get help in-home, in order to "age in place" and avoid the move to an assisted living facility. Here are the different options for care that you can consider.
- Care at home. Keeping your loved one at home may mean bringing in caregivers to help with everything from housekeeping to medication and personal care. Home health care aids can assist with the activities of daily living, and home nurses can help with medical care and some personal care. It's possible to get service 24 hours a day, but many who choose to age in place only need support for part of the day. Home care can also mean bringing the senior to your home to live with you.
- Respite care. Respite care is not a full-time care option, but provides a break for family caregivers. Respite care allows the individual to stay in a community that meets their needs for a short period of time while the primary caregiver gets a break. Many of these facilities feel like a vacation to the individual. Sometimes respite programs are used to provide a test for the assisted living facility, allowing the elderly individual to see how life in the facility would be before making the move permanently.
- Residential care homes. These are private homes that allow residents to live together with live-in caretakers. Often the seniors will have their own room and possibly bathroom, while enjoying communal common areas. Nursing services and daily living help are provided, all while allowing the individual to stay in an environment that feels more like "home."
- Nursing homes. Nursing homes are ideal for elderly individuals who are very frail or who need round-the-clock medical care. These facilities have skilled nursing services available around the clock, while also providing activities for residents. Rooms may be shared, and all meals are taken in a communal dining facility.
- Assisted living. This is the place for seniors who don't need a high level of nursing care, but do need assistance with medication and daily living tasks. They can't live on their own, but still need and want privacy and some freedom. Assisted living facilities have staff available at all hours and provide private apartments with some small kitchen areas, though meals are provided with care if they are wanted. Social activities and transportation services help keep seniors active and engaged. Those with Alzheimer's will get care in a separate area designed specifically for their needs.
To learn more about the different types of assisted living and senior care facilities and care options, visit:
- A Place for Mom: Senior Housing Options
- Alzheimer's Association: Residential Care
- AARP: Housing Choices
- Care.com: Senior Housing Options and Information
- National Association of Realtors: Senior Housing Options
What Is the Cost of Care?
The cost for care will vary significantly based on where you live and how much care the individual needs. However, here is a general guideline that you can use to plan for the costs of care.
- Assisted living facilities - $2,500 to $4,000 per month, with additional costs for Alzheimer's care.
- Nursing homes - $4,000 to $8,000 per month
- Residential care homes - $1,500 to $3,000 per month
- Respite care - $75 to $150 per day
- Home care aids - $20 to $40 per hour
As you can see, these costs can quickly add up. It may be possible to get help paying for these services, though. Medicaid can pay for a portion of these costs, and Medicare may cover medical services offered in the assisted living facility, provided the individual has no income or resources of their own. Shopping around to find a quality facility that fits within your budget will be essential during this time.
To learn more about how much assisted living costs and how to get help paying for it, visit:
- Medicare.gov: How Can I Pay for Nursing Home Care?
- Paying for Senior Care: How to Pay for Nursing Home Care
- AgingCare.com: What do We Do If Medicaid Won't Pay for My Mom in a Nursing Home and None of Us Can Afford It
- Clark: 5 Scary Facts About Nursing Home Costs (and What to Do About Them)
- A Place for Mom: Medicare vs. Medicaid
How to Find the Right Care Option
If it's obvious that it's time for your loved one to have more care than you can provide, first you will need to choose the care option that is the best fit. In order to do this, you will need to determine the level of support that your loved one needs, and choose the care option that best fits. Once you have done this, you need to determine which actual facility is right for your loved one. Here are some interview questions you can ask that will help you make the right determination.
- Do the caregivers live in the facility, or do they work in shifts? Depending on the type of facility you are choosing, live-in caretakers may not be the right solution, but find out what the situation is for your loved one.
- What is the staff-to-resident ratio? Each state has a different rule for resident-to-staff ratios, but look for one that is as low as possible. Make sure there's never less than a 1 to 15 ratio. If you're looking for memory or Alzheimer's care, the ratio should be 1 to 8 or better.
- Is there a licensed medical professional on site at all times? If not, when are they available? If your loved one needs medical care, look for a facility that has an RN on-site at all times. If not, make sure the facility has one available for those times when your loved one will need some additional medical care.
- What's included in the monthly fee? Find out what is included with what you pay, and what is not. Make sure that your loved one can afford the costs of the care as well as the items not included with care.
- What can my loved one bring with him to the facility? Having personal items at the care facility can help make it feel more like home, so find out how much the individual can bring.
- When can I visit? Make sure you can visit whenever you want, because the more often you visit, the less likely it will be that your loved one will be the victim of abuse.
- How will you meet my loved one's specific needs? During the interview, outline the needs you anticipate your loved having, and ask how they will be met by the facility?
- What kind of activities or transportation services are provided? Look for a facility that's active and has many activities to keep your loved one engaged.
- Are there different levels of care at the same facility? If so, what would cause a resident to move to a different level? Understand the way the facility is structured and if it would be able to provide care throughout your loved one's lifetime.
- Is the staff specifically trained for Alzheimer's and dementia? This is particularly important if your loved one has been diagnosed with one of these conditions, but it can be
- What is the staff turnover rate? Assisted living work is hard work, but you want to be leery of a facility with a high staff turnover rate. You want your loved one in a facility that has programs to prevent staff burnout.
- How are new staff members checked? Make sure all new staff members are background checked before working with residents.
- How is the care plan developed and handled? Senior living facilities should create individualized care plans for residents, which are reassessed at regular intervals to ensure their residents are getting quality care.
- Are pets allowed? Some facilities will allow pets, while others won't. Whether or not this is important to you will depend on your loved one's needs, but it's a question worth asking.
After narrowing down your options through this interview process, schedule some tours. Here are some things to observe during your tour.
- The smell. While nursing facilities may have a medicinal smell, strong, offensive odors from common areas or resident rooms are a red flag.
- The common areas. Do the common areas feel welcoming and inviting? Are they accessible? Would you want to spend time in them?
- Cleanliness. Does the facility seem clean? If not, look elsewhere
- The residents. Do the residents seem active and happy? Keep in mind that in an Alzheimer's facility, you may see some agitation, but the residents should seem active and engaged. You should be able to see residents enjoying common areas when you tour.
- The employees. Do the employees seem frazzled, or do they seem to enjoy their jobs. Are they engaging with the residents, or treating them like a job? Are residents greeted by name? Look for a place with welcoming and warm employees.
- The food. If you can observe a meal, notice whether it looks appealing, but keep in mind that elderly individuals need a different type of food than you may be used to eating. Does the dining area look comfortable and personable?
- The setup. Does the setup look like a home or a hospital? Do the rooms look like apartments or hospital suites? Is the layout simple, or will it cause confusion?
- An activity. Try to schedule your tour when a daily program is taking place, and observe how well it is attended and handled.
- Signs of life. Many facilities will have birds in a cage, live plants, or fish tanks to give residents a chance to interact with nature. An outdoor garden is also a benefit.
For more advice on finding a facility, visit:
- The Senior List: Choosing a Care Facility or Home
- Kiplinger: How to Choose a Long-Term-Care Facility for a Loved One
- Caring.com: Assisted Living Checklist
- Caregiver's Library: Choosing a Care Facility
- US News and World Report: 9 Things to Consider in Your Search for an Assisted Living Facility
Helping Your Loved one With This Transition
Once you've found the facility, one of the more challenging parts of the process must occur, and that is encouraging your loved one to make the move. If you are in the role of caretaker, you may have the legal right to make the decision for them, but you need to do what is necessary to help them accept and even embrace the change. Here are some tips to help make this transition easier on everyone.
- Start the conversation early. If possible, start the conversation about assisted living before you are in a crisis situation. Even a reluctant loved one eventually may come around if you continue the conversation. Make the conversation about your concern for them, and how it makes you feel worried, rather than focusing on how difficult it is for you to care for them, which makes them feel like a burden.
- Get their help with planning. Unless your loved one has severe dementia, get their help with planning, and get it early. You may be able to build excitement about the change if you do so.
- Bring something from home. Based on what the facility allows, bring some much-loved items from home that will make the new place feel more like home. Take some time to decorate and personalize the room as soon as possible after the move.
- Don't be quick to get rid of items. If your loved one is hesitant to get rid of items that they can't take to the facility, consider storing them for the short-term. This can help ease some of the emotional trauma of the change.
- Encourage friendship. Encourage your loved one to get to know other residents and make some friends. Activities are a great way to do this, so grab a list of activities and help your loved one choose some to attend.
- Visit often. One of the reasons seniors are often hesitant to go into a care facility is because they don't think their loved ones will visit. Make sure you visit often, even setting aside specific times that you schedule visits, so your loved one will feel connected to the family after hate move. Regular visits also help keep elderly loved ones feeling young and valued.
- Encourage independence. Your loved one will want to maintain as much independence as possible, so do what you can to encourage this. From cooking some snacks and treats to using transportation options to get out and enjoy the community, encourage independence whenever possible. Remember, your loved one has been an adult for years, and just because they need a little more help right now doesn't mean that they want to give up their independence completely.
For more help with this important, yet sometimes difficult, transition, visit:
- CareConversations.org: Moving to Assisted Living Care
- UMN: New to Assisted Living? Tips on How to Help a Senior Adjust
- Forbes: Six Ways to Help Transition a Loved One to Assisted Living - The Inside Story
- Melrose Meadows: Helping Your Parents Transition to Assisted Living
- Heartis: 7 Simple Tips to make Assisted Living More Like Home
Finding the Right Facility Will Make the Transition Easier
Moving mom, dad, grandma, grandpa or some other elderly loved one into a nursing home or assisted living facility isn't easy, but if you find the right facility, the transition can be as smooth as possible. Take your time when touring facilities, and start making decisions early to ensure you are not in a crisis mode when making the switch. By doing so, you will be able to make the transition as easy as possible on all involved, including your loved one.