Assisted living: Staying independent
while getting extra help

What happens when Mom and Dad can’t live on their own anymore?

Moving out of their home will be one of the biggest conflicts between aging parents and adult children. Yet adult children worry about their parents living on their own as they age. You may get a call that Mom is in the hospital. Her recovery may take months and when she gets home, she is no longer able to live independently. Or you have been watching your parents not able to keep up with their home. An older parent may stumble and fall. You worry about the day you will find your parent on the floor. Or you notice that your parent isn’t getting out as much. Your Mom has rotting food in her fridge and confesses she is afraid to shower in case she falls while alone.

Recent studies in The Gerontologist report that older adults do not want to leave their homes. They fear:

High costs of care

Losing individual freedom

Living in an institutional and hospital-like setting

According to the recent AARP survey 87% of people over the age of 65 want to be able to live in their current home as they age. But 14% of people over the age of 85 years require daily caregiving and support. Where is the balance?

An assisted living facility might be the middle ground you need. But what is assisted living? Essentially, assisted living consists of a senior housing facility, a less expensive alternative to a nursing home, that includes independent living while offering extra help in daily life.

The facts on assisted living

Assisted living provides the option of long-term care while encouraging independence. Assisted living is different from a nursing home, skilled nursing facility or retirement community. Although assisted living facilities may partner with other levels of care.

What does assisted living look like?

Assisted living can fill the space between care at home and full-time nursing care. Approximately 835,000 Americans live in an assisted living facility. 70% are women. 53% are over the age of 85 years old.

Approximately 835,000 Americans live in an assisted living facility.

There are many benefits of assisted living. Most facilities offer help with:

  • Bathing
  • Dressing
  • Medication management
  • Meal preparation
  • Transportation

Having these areas covered can allow a senior to enjoy a higher quality of life without fear of being alone or not being able to care for themselves.

Beyond just physical services, assisted living residences can also provide:

  • Meals in a group setting
  • Social activities
  • Recreational events
  • Spiritual services
  • Exercise, health and wellness programs
  • Laundry and housekeeping
  • Individual urgent response devices

What help is available with assisted living?

Most residents will require some help with activities of daily living but do not require 24-hour assistance.

On average, most people will live in an assisted facility for 22 months before requiring a higher level of care.

There are plenty of options for assisted living facilities. In the United States, there are just under 28,900 communities offering almost 1 million spots for seniors.

Most communities (46%) are small with only 4-10 residents. 32% of communities will have 26-100 beds. Over half of communities are run by a franchise with multiple communities in various locations.

Assisted living considerations

Choosing to move to an assisted living facility is a hard decision to make. For some people, it is a welcome transition. For others, it is a sign of decreasing independence. Adult children are the ones who are most likely to suggest and encourage a move to assisted living. Most adult children will have concerns about their parents’ safety and ability to continue living on their own.

A senior parent may be resistant to the idea of moving to assisted living. If your parent is still mentally competent the choice to move belongs to your parent. If you are concerned for your parent’s safety, it is important to offer help. Listen to what your parent says they need and start there. Here are some specific questions to consider with a loved one to highlight possible areas of concern.

Important questions to determine when it is time to move

  • Does your loved one have difficulty bathing?
  • Do they need help with dressing?
  • Are they remembering to take the right medication at the right time?
  • Have they been hospitalized because of a fall or medical emergency?
  • Do they need extra support at home?
  • Are their needs more than you can handle on a daily basis?
  • Are they forgetting to eat? Or too tired to cook?
  • Are they concerned about their personal safety?
  • Are they staying at home because they are unable to drive?
  • Would they be alone in the case of an emergency?
  • Do they frequently ask for (or avoid asking but need!) help with daily activities?
  • Are they able to go out regularly? Are they feeling isolated and depressed?
  • Do they feel scared or worried being on their own?

Are they remembering to take the right medication at the right time?

Have they been hospitalized because of a fall or medical emergency?

Are they forgetting to eat? Or too tired to cook?

If you or your parent are answering “yes” to any of these questions, it may be time to look for extra help. Opening the door to discussing assisted living is the first step. Approaching the conversation with respect and an open attitude will benefit both parties. Make a complete list of the benefits and drawbacks of a potential move. Your parent may have different pros and cons than you thought.

Pros and cons of assisted living

  1. A maintenance-free lifestyle
  2. All the services under one roof
  3. Regular social contacts
  4. Access to 24-hour support
  5. Family can focus on the relationship instead of the caregiving
  6. Having your own living space
  7. Not having to worry about groceries, cooking or meal clean up
  8. Help available for medical emergencies
  9. Simplifying life, so all can relax
  10. Independence with help available if needed
  1. The cost may be more than living in your current home
  2. Getting used to new neighbors
  3. A change in neighborhood
  4. May not enjoy the other residents
  5. May feel staff are intrusive
  6. May not offer enough care for certain medical conditions
  7. May not allow for pets
  8. Personal choices such as smoking may not be supported
  9. Limits personal space
  10. Needs can change leading to a move out of assisted living

Assisted living communities are as varied as apartments. There are 2,000 square foot penthouse units that include multiple bedrooms and sunrooms in a facility with a full gym, spa, salon, theater and chef prepared meals. Or there may be simple 200 square foot bachelor suites with a small bathroom and bedroom.

According to the National Center for Assisted Living the average cost is $4,000 per month or $48 per year, although the price tag for each facility will vary. The largest factors that influence the cost will be:

  • Size of personal rooms
  • What amenities are provided
  • What services are on site
  • The location of the facility
  • The amount of care required

15% of assisted living residents will use Medicaid to pay for personal care...

Most people will be paying privately for assisted living, with the most common types of payment being long term care insurance or personal savings. 15% of assisted living residents will use Medicaid to pay for personal care and supportive services in assisted living communities. But Medicaid does not cover the room and board portion of the cost.

A community may have a set rate that covers all the services provided. Or there may be a base rate that only covers room and board with services such as housekeeping, laundry and personal care being charged an extra fee. Be sure to ask each facility that you are considering what is included in the base cost, what are possible extra expenses and how they are added.

Choosing an assisted living facility

Choosing the right assisted living facility will make the difference between a smooth transition and a horrible experience.

Where to find information on assisted living facilities

An internet search is usually the first place families will start looking. It is important to balance information found online with in-person conversations and visits.

When searching online look for sites that are reliable and non-biased. National organizations are often a good place to start making your list.

Consider looking at:

Eldercare Locator
National Association of Area Agencies on Aging
National Center for Assisted Living

The next step would be to talk to real live people in your area. Ask for referrals from:

  • Family members
  • Friends
  • Your doctor
  • A social worker
  • The hospital discharge planner
  • A geriatric care manager
  • Senior living advisor

Finding a facility that works for your situation will be a personal choice. The more information you have, the better prepared you will be.

What to look for to find the perfect fit

You might run into the option of having too many places to choose from. Be selective and narrow down your choices to the facilities that are the best for your situation. Make a list together with your loved one of the “must haves” and the “would be nice” features. Also make a list of the “absolutely can’t haves.” Perhaps your loved one is adamant they want to be close to their old neighborhood. Or they need to have a strong social calendar.

Make a list together with your loved one of the “must haves” and the “would be nice” features.

Use these questions to knock out the options that won’t work for your parent.

  1. Will the location work for our situation?
  2. Can the facility meet our needs now and in the future?
  3. Does this facility match our budget?
  4. Do I have a good feeling about the community?

This process allows you to create a short list. Aim to have three facilities that meet your criteria. Then you are ready for the most important part of choosing a facility: Visiting in person.

Visiting a facility

No amount of research or brochures can take the place of a personal visit. You will want to call ahead and schedule a guided tour for your first visit. Look at not only what the facility offers but at the other residents and staff members.

Do the other residents appear happy and content? How do the staff treat the people? What overall feeling do you get from the community? Try to plan to visit during mealtime so you can try the food and experience the dining room. Eating will be a major factor in your loved one’s enjoyment of the facility.

You will also want to talk to the residents and their families. Find out what they enjoy about the community and what concerns they have had.

Questions to ask when visiting a facility

Having a list of questions to ask assisted living facilities staff will help you to think through the big picture as you tour a facility. You can use this list to start thinking of your own questions.

  1. How are services managed?
  2. What services and activities are provided?
  3. What training and qualifications do the staff have?
  4. What is provided with the dining and food service?
  5. What is included in the living space?
  6. What policies does the community have?
  7. Is the facility licensed or certified?
  8. How are residents kept safe?
  9. What is the move-in process?
  10. What is included in the cost? What additional fees are there?

Alternatives to assisted living

You may have reached the conclusion that your loved one needs more help. Their living situation isn’t working. Assisted living is just one of the options available. But once you have determined what your loved one’s needs are, you may find that assisted living isn’t the best or only fit.

Other options for increased care, safety or companionship are:

  • Home care
  • A retirement community
  • Medical alert service
  • Room sharing or getting a roommate
  • Relocating to live closer to family
  • Moving in with a family member
  • A skilled nursing facility

Each of these options offer different pros and cons. Take the time to determine which one meets the needs of your loved one for right now.

Making the transition to assisted living

The time spent researching, visiting and choosing an assisted living facility can be time-consuming and stressful. Many family members will forget that moving in can also be a very challenging and emotional time for themselves and their loved one. There are some key tips that can help to make the transition smoother.

  1. Settle the paperwork early

    Make sure that all paperwork, contracts, policies, payments and residential agreements have been reviewed and signed prior to the move in day.

  2. Bring personal items

    Bringing personal belongings like furniture, keepsakes and photographs can help the new residence to feel like home. It is important to make sure that furnishings will fit in the new apartment. As well check what will be provided by the facility. You don’t want to haul an antique chest of drawers up four floors only to find it doesn’t fit! Start with small items such as photo albums, favorite wall decorations or a cozy comforter.

  3. Allow for the emotional transition

    A move into assisted living can be hard both for the person moving and the family members helping them. Allow extra time while packing and unpacking belongings to sit and share memories. Talk about the feelings you and your parent are experiencing. Some people may jump into their new surroundings quickly. Others may need time to adjust. Help your loved one to choose a few new activities to be involved in to help ease the transition. Let your parent know you will visit or call regularly.

  4. Address Safety concerns

    When moving into a facility shared by many new people, there may be concerns about safety. Discuss with the community director what policies are in place to ensure your loved one’s safety. Help your loved one to navigate security systems at the front door and throughout the building. The apartment is generally considered a private residence and has a locked entrance for privacy and security.

    Set up a plan for what you will do in case of emergencies. If your loved one is moving into an assisted living facility following a hospital discharge, a wearable medical alert system can encourage them to be active. Medical alerts systems provide 24-hour monitoring that may reassure both your parent and yourself.

    Research has shown that seniors who remain active in assisted living are at a lower risk for falls, functional decline and transfers to a nursing home.

  5. Stay connected with friends and family

    Your loved one does not want to be forgotten! Moving to a new home is a major change. Staying connected with friends and family will be vital to a high quality of life. Plan to call often in the first few weeks. You can consider giving an easy-to-use smartphone to your loved one as a housewarming gift. With your number pre-programmed into the phone, this let’s your loved one know that you are only a phone call away.

    Set aside time to listen to your loved one as they talk over memories and the struggles or successes they are having in their new place.

    Deciding on a move to assisted living, choosing a facility and making the move are monumental life decisions. Prepare yourself by gathering information and remember to move forward with the goal of enhancing your loved one’s quality of life. Take the time to listen and hear what your loved one needs. Then move forward to embrace the new and exciting chapter.

Sources:

National Institute on Aging: Residential Facilities, Assisted Living and Nursing Homes
https://www.nia.nih.gov/health/residential-facilities-assisted-living-and-nursing-homes
Medicare: What are my other long term care choices?
https://www.medicare.gov/what-medicare-covers/what-part-a-covers/what-are-my-other-long-term-care-choices
National Center for Assisted Living: What is Assisted Living?
https://www.ahcancal.org/ncal/Pages/index.aspx
https://www.ahcancal.org/ncal/facts/Pages/Communities.aspx
The Gerontologist: Health of Older Adults in Assisted Living and Implications for Preventative Care
https://academic.oup.com/gerontologist/article/57/5/949/2632052
Gerontologist: Physical Performance Characteristics of Assisted Living Residents and Risk for Adverse Health Outcomes
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3694220/