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How Do You Know When It’s Time For Assisted Living?

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Knowing when and if a move to an assisted living community (ALF) is the best option for your aging loved one is not easy. Recognizing the signs can help with these difficult decisions.

Towards the end of my dad’s life, he spent time in the hospital, which left him weak and disoriented.

I worried that he now needed more comprehensive long-term care than he could get at his independent/active lifestyle senior living community.

So it was important to begin thinking about the possibility of moving to an assisted living. Especially since it was clear that his health issues would be changing as he grew older.

A decline in health can begin as early as our 50s, according to AARP. Because of this, it can be difficult to actually know when it may be the right time for your senior loved one to transition from their own home and into an assisted living facility.

In my case, my dad was great on some days and not so good on others, which made it tougher for us to make the decision to look into an assisted living facility or other types of housing options.

Just in case you aren’t 100% sure what an assisted living facility is, the National Institute on Aging says, “Assisted living is for people who need help with daily care, but not as much help as a nursing home provides.”

Assisted living residents usually live in their own apartments or rooms and share common areas. They have access to many services, including up to three meals a day; assistance with personal care; help with medications, housekeeping, and laundry; 24-hour supervision, security, and on-site staff; and social and recreational activities. Exact arrangements vary from state to state.

National Institute on Aging

When To Move From Independent Living To Assisted Living

Many seniors prefer to stay in their own homes as long as possible but at some stage may require assisted living or full-time nursing care.

They often do not recognize that they need to move from independent living to assisted living until it is too late.

Most of us aren’t too thrilled how the passage of time might make us a little less able to do the things we used to enjoy so easily – and how it can take a toll on our health. Some people strongly resist the notion of moving to an assisted living community, even though it might be the very best thing for everyone involved.

Their loved ones and relatives will then be faced with the challenging task of helping them make such a transition.

Before making the move, though, keep in mind that assisted living is just one of the housing options available to seniors.

Do some research to be sure that an assisted living facility (ALF) is the best fit for your aging loved one because they might actually need to live in a skilled nursing facility instead.

Take a look at our Caring For Aging Parents Checklist to see what other issues should be discussed with your elderly parent.

But generally speaking, if your senior loved one needs help completing basic tasks, performing their Activities of Daily Living (ADLs), and maintaining a home – an ALF may be the right decision for them.


12 Telltale Assisted Living Signs

These 12 warning signs are indicators (and some are safety concerns!) that the time has come to make a change in the living situation from the home or senior living community that your senior loved one is currently in.

Learn how to talk to parents about assisted living.

1) Needing Help With Activities Of Daily Living Tasks

As our loved ones age, sometimes they can no longer perform the standard daily activities we usually take for granted.

The Centers for Medicare and Medicaid Services defines these activities of daily living as “… activities related to personal care. They include bathing or showering, dressing, getting in and out of bed or a chair, walking, using the toilet, and eating.”

After my mom was diagnosed with a brain tumor, she became wheelchair-bound. The tumor caused her legs to become mostly immobile. She couldn’t dress herself, shower, or transfer to the toilet or to the bed without extra help.

My elderly father was in his early nineties at the time and wasn’t physically strong enough to help her with these daily tasks, so we arranged for an aide to come in to help.

If Mom had lived alone, the sudden change in her health status would have been a big sign that it was time to move her into assisted living or perhaps a nursing home setting.

2) Not Taking Medicines Correctly Or On Time

medications that can contribute to falls in the elderly

As seniors age, they may face more chronic medical conditions. And the more chronic conditions they have, the more prescriptions they pick up along the way

As a dental hygienist, it’s part of my job to review my patient’s medical histories and I’m often shocked by how many medications people are taking.

This can be a huge problem for an elderly person.

Poor eyesight, cognitive issues, confusion, and forgetfulness can lead to your loved one taking too many pills or forgetting to take their medications entirely.

To illustrate: a lovely elderly woman in my dad’s senior living community was found sitting on her kitchen floor, staring into space after her worried family members alerted the staff because they couldn’t get in touch with her.

She was diabetic and had just been diagnosed with shingles. Although she had taken her medications, one type was in a blister pack that reduced by one pill per day, every day for a week (Day 1 she took 5 pills, Day 2 she took 4 pills, etc.).

She got confused about how to take them and was in pain from the shingles, so she took far more than she should have. The overdose of medications reacted with her blood sugar, sending her into diabetic shock. She spent a week recovering in the hospital.

If she had been in an assisted living facility, it’s likely that a staff member would have been in charge of dispensing her medications. Safety features like this would have eliminated her confusion over the complicated instructions.

Plus, ALF staff members are supposed to check on residents every two hours, so she would have likely been found and hospitalized much sooner.

3) Neglecting Self Care

If you or your siblings notice that your senior family member is neglecting their personal hygiene or isn’t getting out of their pajamas for days, this could certainly be a sign of depression or cognitive decline and could warrant looking into changing their living environments.

When adult children notice their loved one suddenly has poor hygiene and/or an unpleasant body odor, I strongly recommend they speak to the older person’s doctor immediately.

4) Neglecting Basic Home Maintenance

The same goes if you notice that the home your loved one is living in is in a state of disrepair or simply not being kept clean and not livable.

The reasons for this situation need to be looked into to determine if he/she needs more taking care of than they are getting.

5) Forgetting To Turn Off The Stove Or Trouble Operate Other Appliances

I don’t know about you, but I’m guilty of leaving a stove burner on occasionally and I’m not even in my senior years yet.

Imagine how tough it might be for someone with cognitive issues. And what about the other appliances in the house?

Stove alarms are great for reminding your loved one that they’ve left a burner on, but if they are consistently leaving the stove or other appliances running, then it may be in your loved one’s best interest to look into senior living communities that can provide more help to them.

A senior care facility might bring you peace of mind, too.

If your senior loved one has memory issues, the facility should provide meals and food service so they do not have to worry about kitchen safety.

And, what about fireplaces, the gas pilot lights on stoves or water heaters, or using the dryer? Even something as mundane as letting dryer lint build-up can start a fire.

6) Trouble Getting Up From A Seated Position

Weak muscles and problems with balance can result in falls. Sometimes these weaknesses can mean that your loved one may have trouble getting up from a soft couch or bed.

My father was stubbornly independent, but when he began having trouble getting up from the couch at age 97, he got a folding chair to use instead.

This worked well until he lost his balance while getting up one night. The chair collapsed under him and he fell, ending up in the ER with back pain and a broken finger.

Dad was generally steady on his feet, but this is a good illustration of what can happen when someone has trouble getting up.

In an assisted living facility, aides are available for residents who need help rising from a seated position or transferring to a toilet or bedside commode, or getting in and out of bed or wheelchair.

7) Eating Spoiled Food

After my mom passed away, Dad lived by himself for a year. He refused to move out of their house which was located forty miles from me, so I called him frequently and I visited him weekly.

It wasn’t long before he started complaining of occasional diarrhea and an upset stomach. This didn’t happen all the time and a physical examination revealed no problems.

Slowly it dawned on me, however, that I was sometimes seeing the same lunch meat or milk in the refrigerator that had been there on the prior week’s visit.

I realized that Dad was occasionally eating food past its expiration date.

Even writing the “opened” date on the container didn’t help. In Dad’s mind, if the expiration date was – for example – two weeks in the future, that was the last date he could use the product.

He couldn’t grasp that food begins to spoil once the package has been opened.

When he eventually moved to a senior living apartment community that provided all his meals, his stomach issues never bothered him again.

If your loved one has trouble swallowing, read this article about How To Puree Foods For The Elderly or this one about pureeing foods for dysphagia.

8) Forgetting To Eat

One clear sign that you should consider assisted living for your loved one is if you notice weight loss for no apparent reason. The person may be forgetting to eat.

Cognitive impairment, anxiety, and depression can all contribute to issues around your loved ones forgetting to eat (dehydration can be a problem, too).

An ALF facility may be able to provide the kind of structure that would best suit your loved one if they are not eating properly. If the weight loss isn’t from something that needs medical attention and is due to them forgetting to eat on a regular basis, then looking into ALFs is an easy decision.

9) Forgetting To Pay Bills

If you notice that unpaid bills are piling up and late notices are starting to come in then it may certainly be time to consider helping your elderly loved ones with this task.

Living in an assisted living facility generally relieves them of having to deal with certain bills, such as those for utilities, cable, and insurance.

Of course, every individual person and circumstances are different. My father was still able to drive safely for the first year that he lived in an ALF so he still had to make care insurance payments.

10) Showing Signs Of Depression

Sometimes older people who are depressed appear to feel tired, have trouble sleeping, or seem grumpy and irritable. Confusion or attention problems caused by depression can sometimes look like Alzheimer’s disease or other brain disorders. Older adults also may have more medical conditions, such as heart disease, stroke, or cancer, which may cause depressive symptoms. Or they may be taking medications with side effects that contribute to depression.

National Institute on Aging

When my grandmother turned 90, I remember being appalled when she said she was ready to die. As a young person, I couldn’t imagine having that outlook, but then she told me she was lonely.

The vast majority of her friends had passed away, as had all of her siblings and cousins.

If your senior loved one is living alone, it can make a world of difference in their quality of life if they go into a senior living community or an assisted living facility.

There will be social interaction with the people around them and peers they can reminisce with about “the old days.”

Additionally, there will be social activities designed to get your loved one out of their room and engage with others.

Keep in mind that the National Institute on Aging also says that “for older adults who experience depression for the first time later in life, the depression may be related to changes that occur in the brain and body as a person ages.”

If your loved one’s depression requires medication, many assisted living facilities (ALFs) provide medication management and some also offer skilled nursing care.

11) Becoming More Isolated

If you notice that your loved one is not going out with friends as much as they used to or if they are not going to church or show a lack of interest in participating in other activities that they used to, these are common signs that they are becoming more and more isolated at home.

This is especially true if they live alone.

Depression may be playing a part of that or it may be that their friends have moved away, they are unable to do the activities they used to enjoy, or that it’s simply just too difficult to get out of the house.

In the study sponsored by the AARP, researchers from the University of Michigan surveyed a group of about 2,000 Americans ages 50 to 80. More than a third of seniors in the poll said they felt a lack of companionship at least some of the time, and 27% said they sometimes or often felt isolated; most of the people who said they lacked companionship also felt isolated, and vice versa. Almost 30% said they socialized with friends, family or neighbors once a week or less.

Whatever the issue is, if social isolation is becoming a problem then moving to an ALF may help them with that.

Living in a building with others in your same age group and participating in activities and social events that all residents are able to participate in can help alleviate those feelings of loneliness.

12) Worsening Physical Health Or Slow Recovery From An Illness

There are some health-related red flags that you should take notice of to let you know that your senior loved one needs more help than they used to.

Especially if they need more health care services than you can give or if you don’t live in the same city they do.

Ask yourself…

  • Does it seem like it is taking your loved one longer to recover from a cold?
  • Is their blood pressure or insulin levels constantly abnormal?
  • Does something “minor” turn into something serious? (i.e. a cut or scrape becomes infected)
  • Do they have a chronic health condition such as COPD or congestive heart failure that is getting worse?

Many (not all) assisted living communities offer medication management and on-site medical care. Some have physical therapy or food service.

These types of services allow your elderly loved one to live more independently than they would in a nursing home, while still getting the help they need.

Questions To Ask When Choosing An Assisted Living Facility

You will certainly want to “interview” several assisted living communities before signing the contract to enter into one. What do you look for to make sure the facility is going to be a good fit for your loved one?

Here are some questions that should be asked as you begin the initial process of selecting a facility:

  • How does a senior qualify for assisted living?
  • What would disqualify someone from living in this facility?
  • Are there different levels of care here?
  • What are the costs?

Click here for our full article on the topic, including 30 more questions to ask in your interview.

Alternative To Assisted Living Facilities

All these signs that I mentioned above may be definite signals that it’s time to start looking at some alternative living situations for your senior parents or loved ones.

But if an assisted living community is not something that your loved one is willing to do then you may want to consider any of the other senior living options that are available today.

  • Granny Pods
  • Active adult communities
  • Senior villages
  • Senior co-housing
  • Residential care homes
  • Continuing care communities
  • Nursing homes (this is normally for elderly with poor health conditions who require 24-hour care)

You can read more about these housing options in our article on Housing Options For Seniors 55 And Older.

Some seniors refuse to go into assisted living no matter what their challenges are. We have some helpful tips in our article, My Elderly Parent Refuses Assisted Living.

Frequently Asked Questions

Can social security pay for assisted living?

While there is no straight yes or no answer, in general, if a senior meets their state’s low-income requirement and resides in an assisted living facility (or, in some states, an adult foster care home), they may be eligible to receive an Optional State Supplement (OSS) on top of their social security benefit.

Does Medicare pay for assisted living?

Medicare does not pay for assisted living. If the senior needs medical care while living in an assisted living community, however, those medical expenses should be covered. Also, if they have a Medicare Advantage plan, certain support services may possibly be covered (i.e., medical transportation services or personal care assistance). Check with their specific Medicare Advantage plan for the most accurate information.

Can a resident be kicked out of an assisted living facility?

Yes, a resident can be kicked out of an assisted living facility for a variety of reasons, including behavioral issues, non-compliance with house rules, non-payment, requiring too much medical care, etc.

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