When Is It Time For Assisted Living?

It’s unlikely that there will be one event that signals that it’s time to move to an assisted living facility.  More than likely, there will be a progression over time of increasing levels of help that are needed to maintain normal every day activities for a senior citizen.

Denial is completely natural for seniors.  The proposition of moving to an assisted living facility can be scary for a senior.  Most seniors want to remain in their home.  Moving to an assisted living facility can be met with resistance because seniors don’t want to admit they are no longer able to care for themselves and they do not want to change their plans.

However, sometimes hard decisions must be made.  The important thing is to realize when a decision is needed.  There are signs that a senior is ready to move to an assisted living facility, even if they may think they are not ready yet.

Sometimes what someone does tells us more than what someone says.  A visit with a senior can speak volumes.  Compare what you currently see with your loved one’s past habits and attitudes.  Look for signs that a senior is having difficulty with everyday tasks.  These include dressing, shopping, cooking, laundry, taking medications, cleaning and driving, among others. We’ve identified major signs that it may be time for assisted living:

1. Changes in Behavior

Changes in mental and physical condition can have subtle changes and sometimes dramatic effects on how we behave.  How is the senior’s attention level?  Are they easily distracted or irritated?

Do they appear to no longer be concerned about personal care?  Are they wearing the same clothes as a previous visit?  Are they wearing clothes without buttons because they have problems with buttons?  Has he decided to grow a beard, despite years of being clean shaven?  These can indicate a change in dexterity ability.

Increased aggression is a common sign of dementia.  Physical, sexual, and violent aggression can harm seniors and caregivers or increase caregiver resentment.

2. Changes in Health

Noticeable weight loss or weight gain are signs.  Seniors might forget about eating or forget that they’ve eaten and eat all day.  Poor nutrition can be detrimental at any age, but it puts seniors at a disadvantage at maintaining their health.

Do they seem frail?  Posture is a good gauge for their strength.  Can they rise from a chair or do they need help?  Being unsteady during walking or standing is a sign of poor balance and mobility.  This is a sign of potential risk of falling and significant injury.  Noticeable bruising could indicate recent falls that they haven’t mentioned.

Are they taking medications correctly?

Are they recovering?  Little things like colds or cuts can be irritating for a couple days, but they should heal.  A senior whose health is compromised doesn’t heal or recover as quickly as a healthy one.

A chronic condition that worsens is a sign that health is deteriorating.  Diabetes, arthritis, or heart problems are common conditions that can be monitored and compared with previous levels of health.  Increased reliance on medication to manage these conditions is a warning sign.

3. Conditions of Home

Loss of attention to detail is a sign of mental decline.  A house and yard that is not clean and maintained is a sign that a senior is no longer interested or is unable to perform the necessary tasks to maintain their home.

The build-up of clutter and unopened mail speaks volumes.  Stacks of papers, unopened bills, overdue bills, unread magazines.  Whether these are signs of cognitive decline and forgetfulness or general lack of interest, these indicate that a senior needs help.

Not everyone has a green thumb, but look for dead or dying plants.  Pet conditions can also indicate lack of attention and interest (luckily, there are numerous pet-friendly assisted living facilities, so a senior never has to leave their pet behind).  Over feeding, under feeding, untrimmed nails, un-brushed or matted pets are easily observed.

Are there hobby or craft areas in the house that have stopped being used?  This could be because of dexterity, memory, mobility, or balance issues.  Lack of interest in previously enjoyed activities can indicate depression.

Is food expired or going bad in the refrigerator?  Are there multiples of items?  No one needs 5 bottles of ketchup.  Buying multiples can indicate forgetfulness.  Lack of fresh food could indicate that the senior is relying on cheaper longer shelf life items to avoid shopping or reduce costs.  It could also indicate that they have degraded their nutrition eating levels.

A freezer full of TV dinners might indicate problems with cooking or a loss of confidence in skills of meal preparation.

Uncleaned spills are a common sign of dementia as well.

Broken kitchen appliances that the senior had previously frequently used could indicate that the senior has forgotten how to use them or lacks the dexterity to operate the appliance.

Look for signs of fire in the kitchen, like charred knobs, pots with singed bottoms, or potholders with singed edges.  A used fire extinguisher or disabled smoke detectors also indicates that there are problems.

A senior might clean the house for guests, but sometimes they do not clean their personal bathroom with the same attention.  Inspecting a personal bathroom can be eye opening about the senior’s true current habits and routine.

4. Signs of Social Isolation

It’s very common for elderly seniors to discontinue social activities.  However, this natural action is counterproductive.  A senior can be trying to hide or deny declining health or cognitive decline.  Memory loss or inability to manage personal care can be embarrassing.  Add to this a nervousness about mobility or driving ability and a senior can naturally choose to stay at home and avoid going out.

Do friends visit?  Lack of visitors isolates seniors, causing loneliness and possible depression.  Lack of visitors and entertaining also gives an excuse for not cleaning or grooming.

Talk to others in the senior’s social circle or family members.  Are there stories or incidents that they’ve noticed?  Sometimes a senior will mention something to one, but not others.

5. Problems Driving

People naturally savor their independence.  Most people note that learning to drive was the start of their independent life.  Just the action of being able to drive themselves provides opportunities and freedom.  Therefore, it can be equally devastating to give up that freedom.  It’s very difficult to admit that you are no longer able to safely drive.  Discontinuing driving can limit access to events and the outside world.  It can mean having to ask others to help seniors and they are no longer in charge of their own lives.

Look for signs of scratches and dents on the senior’s car.  Perhaps there have been tickets or accidents.

Take a drive with the senior.  Notice if they immediately put on their seatbelt.  After years of mandatory seatbelt usage, it should be second nature.  Forgetting this might be a sign of memory loss.

How does the senior drive?  Tailgating, drifting from their lane, driving below the speed limit, slow reaction time, mixing up the gas and brake pedals.  These are obvious signs that driving is becoming dangerous.

A subtler sign is if the senior believes they will be distracted.  Perhaps they turn off the radio while they drive or would rather not talk while driving.  This is a sign that the senior realizes that they need to pay more attention than was previously necessary.

6. Caregiver Stress or Burnout

It’s natural to want to provide care for parents and family members.  These are people who have played important roles in our lives.  Many of us want to be there at the time in their lives when they need us the most.  It’s an honorable goal, but there are times when the senior’s needs exceed our abilities.

Caregivers of seniors with chronic conditions have been known to exhibit symptoms of PTSD, post-traumatic stress disorder.  A caregiver under constant stress with their brain on constant alert can start to demonstrate avoidance behavior, disability anxiety, and hyper-vigilance.

Perhaps caregiver exhaustion is a critical sign that a senior is ready to move to an assisted living facility.  When a senior’s condition worsens, it naturally takes greater effort from the caregiver.  Caregivers naturally respond to this greater need, but no matter how much a person cares, humans have limits to their abilities.

Reaching a family member’s limit in caregiving ability can cause great guilt and grief.  A family does everything available for each other and reaching that limit can cause a feeling of failure.  This can lead family members who are caregivers to be in denial about the senior’s true needs and delay a necessary move to assisted living because they don’t want to feel that they have failed.

It’s okay and beneficial for the caregiver and the senior to consider emotional wellbeing, as well as physical wellbeing.  A caregiver who is stretched past their point of ability isn’t providing the best care and the senior might ultimately pay the price.

7. Being Realistic

Be realistic and objective about a senior’s needs.  Does the senior exhibit any of the mentioned warnings signs that tell you it may be time for assisted living?

At the first sign that there are declining abilities, paperwork should be completed.  Powers of attorney and health care should be executed, as well as a will.  Planning ahead is better than being reactive.  These discussions and making these decisions can be awkward and most families try to avoid them, but it’s important that these occur while the senior is lucid and competent.  Getting the right people involved early can avoid confusion and disagreement later.

Talk to the senior about their activities and their condition.  Broaching the signs that you’ve noticed at this point might come across to the senior as an assault, which could cause them to become defensive.  Instead, discuss their fears about aging and their fears about someday moving to an assisted living facility.  Are those fear realistic or unfounded?

Empathy is valuable in this process.  A senior should be able to retain their dignity.  Understand that a senior might be scared about what they are experiencing and going through.  Considering our mortality is uncomfortable and troubling, being able to honestly discuss their fears is invaluable and can be reassuring for the senior.

With the proper permission, you can have a conversation with the senior’s doctor.  This is an opportunity to discuss your observations and gain their professional insight.  If inconclusive, a doctor can perform a functional assessment.

A doctor’s assessment can provide you with a realistic list of needs for the senior.  If those needs can be met at home, that would be great.  If not, then you have a list of needs when you visit and evaluate possible assisted living facilities.

You should keep in mind that assisted living facilities are not the same as nursing homes.  Assisted living facilities provide assistive services to residents on a daily basis, but resident still maintain some independence.  These are primarily personal care assistive services.  These include dressing, grooming, cleaning, laundry, and helping to take medications.

An atmosphere within an assisted living facility can be beneficial to a senior, despite what they might think.  This is a community of seniors who are likely to be going through the same issues.  An assisted living environment can provide physical services, but emotional and social support.

Quality assisted living facilities provide personal enrichment programs for residents.  This provides social activities for residents to attend.  This can get them out and interacting with other residents.  Keeping social and active is physically and psychologically beneficial. There are also numerous luxury assisted living facilities that provide resort-like amenities that any senior would be happy with. Research carefully to find the facilities that are perfect for the senior’s needs as well as wants.

24-hour staffing allows assisted living facilities to monitor the status of residents and rotate schedules of staff members.  A sole family member attempting to provide care would surely become overwhelmed in those circumstances.  Instead, family can have an enjoyable visit without the stress of being solely responsible for caregiving. It would also help to find senior assisted living near you, so that visiting your loved one is easy and can be done frequently.

A senior citizen has a lifetime of experience and knowledge.  They deserve respect and the ability to maintain their dignity.  Family caregivers must be respectful of the senior’s quality of life.  The highest priority should continue to be to provide the best care possible.

A senior with dementia might not be aware of their condition or situation, and in such case, special memory care facilities should be sought.  Those in the role of caregivers have the honor and the responsibility to provide the best level of care possible, even if that is not immediately appreciated by the senior.