Aging is more art than science. Each person ages at a different rate and may face varying health challenges as the years march on. Because of this, navigating health care decisions later in life isn’t always a straightforward proposition. One of those decisions may be trying to decide when it’s time to move from independent living to assisted living.
Dr. Deena Goldwater, a cardiologist and geriatrician who serves as VP of care delivery at Welcome Health, a Whittier, California-based primary care practice that specializes in aging, says that there’s a distinct difference between independent living and assisted living.
Independent Living vs. Assisted Living
Independent living facilities are geared for older adults who are still fully capable of caring for themselves. These communities feature “planned social events, exercise activities, group travel options,” and other activities that foster “mental and physical engagement to enhance general wellness and quality of life as people age,” Goldwater says.
By comparison, “assisted living facilities are designed to alleviate the burden of daily tasks that might prove challenging to some people due to different life or health circumstances.”
By and large, assisted living communities are designed for older adults who aren’t sick enough for a nursing home or the hospital, but who may have some chronic medical conditions that need monitoring. These residents also often need help with bathing, dressing, housekeeping, toileting and other so-called activities of daily living. Meals are typically prepared for residents and may be served in a communal dining room where residents can also socialize and interact. People in assisted living facilities may have a private apartment or a shared room. Available services and amenities vary greatly depending on the location of the facility and the type of resident it caters to.
The Centers for Disease Control and Prevention reports that as of 2018, the most recent data that’s available, 28,900 assisted living and similar residential care communities were in operation in the United States. Assisted living facilities can take a range of forms and provide various kinds of services intended to support older adults who need a little assistance in completing the tasks of daily living.
Costs of Senior Living
Similarly, the price can vary widely, too. According to a according to Genworth’s 2021 Cost of Care survey, the median yearly cost for an assisted living community is $54,000, up from $28,800 in 2004. Contrast that with the average cost of long-term care by a home health aide, which tops $5,148 monthly or $61,766 annually. And skilled nursing in a private room will set you back an average of $9,034 per month, adding up to more than $108,400 per year.
Some facilities charge a lump-sum rate to cover a set menu of services and amenities. Others use an à la carte pricing model where residents can pick and choose what services and amenities they want to use. There’s an awful lot to consider when attempting to select the right assisted living facility for yourself or a loved one.
But before you even get to the finer details of which community would offer the best fit, you’ll need to decide if and when it’s time for you or a loved one to move into an assisted living facility.
When Is It Time to Move to Assisted Living?
Determining when to move from independent living to assisted living is a highly personal question. “The move to assisted living is often triggered when people begin feeling overwhelmed with tasks that are necessary for independent living, such as grocery shopping, laundry, cleaning the home and cooking meals,” Goldwater says.
In some instances, family members, caregivers or friends might be the first to spot warning signs that independent living may not be the optimal situation, she adds, such as difficulties in the kitchen, challenges keeping places tidy, etc.
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. But it’s a complex concept that many people need some time to adjust to.
That said, there are some clear signals that indicate it may be time to move from an independent living situation into an assisted living facility, including:
- A worsening of medical conditions, an increased number of falls and overall increased frailty.
- Difficulty managing domestic finances or other money problems.
- Difficulty keeping the house clean and a decline in ability to care for oneself.
- Depression or social isolation.
When is assisted living appropriate? One classic example is a senior who recently lost the spouse responsible for taking care of the housework, meals and shopping. The surviving spouse may struggle to cook or clean adequately while also being very lonely after the death of a partner.
Another common situation is when a senior develops multiple medical problems. Progressive or neurological disease such as Parkinson’s disease, often hasten the discussion of when to move to assisted living. As these chronic conditions progress, the senior often needs more help day-to-day.
A third common situation is one in which a senior begins to exhibit signs of memory loss, which may be a symptom of Alzheimer’s disease or dementia. Caregiver burnout is also very high among those who look after people with cognitive impairment, so seeking respite by using an assisted living situation may help the other spouse or primary caregiver enjoy a better quality of life too.
Transitioning to Assisted Living
Moving into an assisted living community can be a challenging undertaking. For older adults with cognitive deficits, such as those that arrive with Alzheimer’s disease or other forms or dementia, or other chronic diseases such as Parkinson’s or diabetes, this is particularly true. Changing routine – indeed uprooting an entire life – can feel completely overwhelming at times.
In some cases, the loss of a spouse may precipitate the need to move a loved one into an assisted living community. This can be a particularly difficult prospect given that grief may be added on top of all the other mixed emotions of leaving the family home for an unfamiliar place full of strangers.
Another issue that often crops up is guilt on the part of caregivers who’ve found they simply can’t handle the burden of supporting an aging loved one any longer. Feelings of guilt may be exacerbated if the decision to move to assisted living is made last minute, in a rush or emergency situation.
“Families are making some of the most important decisions of their life while they’re emotional. They don’t have time to think about it. They’re in a crisis situation, and now they’re faced with the decision of where mom or dad is going to be institutionalized for the rest of their life,” says Roxanne Sorensen, an aging life care specialist and owner of Elder Care Solutions of WNY in Rochester, New York, a case management consultancy.
Making important decisions under pressure or with high emotions can create a panic situation. It typically prevents families from making an informed and thoroughly researched placement in the right community.
Talk to Your Loved Ones About Senior Living
As terrible and sadly common as these situations are, Sorensen says that many of these negative feelings and difficult situations can be alleviated by starting the conversation early and talking often about what’s coming down the road for aging loved ones. Starting the conversation can be difficult for sure, but approaching it a piece at a time and conducting a series of conversations over a span of weeks or months may help.
Some families find that speaking with an expert can help. For example, Goldwater recommends starting by talking with the senior’s doctor, as they can “refer you to a case manager or social worker who can give you options in your area.”
Talking with a financial advisors, an attorney or even a counselor who works with families facing these challenging situation can also be beneficial in deciding when the right time to move is. These professionals can provide insight, suggestions for where to start and a yardstick for how other families have handled similar situations.
“Another way is to leverage the knowledge of local nonprofits that focus on senior care,” Goldwater says. “These nonprofits will often be able to provide a list of communities and facilities.”
She also says it’s critical to “visit each location you’re considering. It’s important that you experience what it would be like to live there, meet the people who live there and the staff. It should feel comfortable and welcoming.”
Do Your Homework
Before you even start the conversation, write down your own concerns and the points you want to get across to your loved one. Do some research on options and what might be a good fit for your loved one so you have some suggestions at the ready as the conversation evolves. Then, start talking.
Some things to keep in mind about these conversations:
- You don’t have to do it all at once. You can make small inroads before you sit down for a really big talk.
- Try to do as much of this sort of communication in person so you can pick up on body language and other nonverbal clues about how your loved one is feeling.
- Be empathetic and try to understand how difficult these conversations can be. But don’t pity them – we should all be so lucky as to reach the age of needing a little extra support.
- Start with a general discussion of what life is like at home for your loved one. Ask about safety issues or challenges they might be having, and if these can be easily remedied, such as by installing extra hand rails around the bathtub. Look into making that happen for the short term, until a more final decision about future care has been made.
- Ask if your loved one feels lonely. One of the biggest upsides to moving to assisted living is the big increase in social stimulation. Things like community dining and activities can be a big help if a senior is feeling lonely.
- Ask if your loved one wants help with housekeeping, laundry, running errands or other daily chores. They might be struggling in silence and hoping you’ll offer or find them some help.
- Listen carefully to the answers. Really listen to what your loved one is saying, and aim to ask open-ended questions that allow them to bring up any issues they may be facing.
As difficult as it may be, begin having the conversation with loved ones about their future plans earlier rather than later. “The best advice I can give anybody out there is to pre-plan,” Sorensen says. This means sitting down and having the difficult conversations about finances, wishes and the legal arrangements that will need to be put in place prior to an advancement of certain health conditions such as Alzheimer’s disease.
Dr. Tanya Gure, section chief of geriatrics and associate clinical professor in internal medicine at the Ohio State University Wexner Medical Center agrees that starting these challenging conversations earlier is always better. “I generally encourage families to think about this with a longer view and a longer-term plan. It tends to be more stressful when these discussions come up when there’s an imminent question of moving.”
There’s no doubt it’s an emotional discussion. Talking about leaving your home that you may have been in for a long time, or dealing with the death of a spouse and leaving the home where you may have last been with that loved one can be traumatic, Gure adds.
Starting the conversation before a medical or emotional crisis transpires allows families to take time. For some families, the longer the time over which those discussions can take place, the better the outcome.
In addition, moving sooner rather than later may ensure better quality of life and better support for seniors, especially as health care needs change later in life. Moving sooner sometimes offers seniors the opportunity to actually get excited about new possibilities. When this is done right, it can be a really powerful experience for the whole family. “Moving to a community that meets your social, mental and physical needs may not only improve your quality of life, it might even improve your health,” Goldwater says.