Aging is more art than science. Each person ages at a different rate and may face varying health challenges as the years march on.
So, 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.
Independent Living vs. Assisted Living
There’s a distinct difference between independent living and assisted living, says Dr. Deena Goldwater, a cardiologist and geriatrician who serves as vice president of care delivery at Welcome Health, a Southern California-based primary care practice specializing in aging.
Independent living communities are geared toward older adults who are still fully capable of caring for themselves. These communities feature social events, exercise classes, 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.
Assisted living communities, however, “are designed to alleviate the burden of daily tasks that might prove challenging to some people due to different life or health circumstances,” she notes.
Residents in assisted living communities often need help with bathing, dressing, housekeeping, toileting and other activities of daily living. Residents may live in a private apartment or a shared room, and meals may be served in a communal dining room where residents can also socialize and interact. Available services and amenities often depend on the location of the community and the type of resident it caters to.
[Read: How to Finance Assisted Living]
Costs of Senior Living
The price of senior living can vary widely. According to Genworth Financial’s 2021 Cost of Care survey (also the most recent data available), 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 $61,776 annually. And skilled nursing care 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 communities 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 or independent living community 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 to assisted living for extra care.
[READ: Safety Measures at Assisted Living Communities.]
When Is It Time to Move to Assisted Living?
Red flags often start to signal when it’s time to transition from independent to assisted living.
“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. These signs may include the senior having difficulties in the kitchen or struggling to keep places tidy.
There are also some clear signals that indicate it may be time to move from an independent living situation into an assisted living community, 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.
[READ: Assisted Living Checklist.]
Sample Scenarios
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. So, when is assisted living appropriate? Let’s play out some common situations.
One classic example is a senior who has 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 lonely after the death of a partner.
Another is when a senior develops multiple medical problems. Progressive or neurological diseases, 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 day-to-day help.
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. Seeking respite by using an assisted living situation may help the other spouse or primary caregiver enjoy a better quality of life too.
Planning a Move
In most cases, moving earlier, while the senior still has some capacity to engage in activities of daily living, is preferable, says Angela Stewart, vice president of clinical services with Touchmark, a Beaverton, Oregon-based senior living company with communities for 55-and-older adults across the country.
“Moving into assisted living earlier can offset higher costs associated with hospitalizations, one-to-one care or the decline that occurs when one doesn’t optimize their best health,” she explains.
It can also keep people more independent for longer.
“For example, a toileting schedule preserves continence. Socializing prevents loneliness, which preserves your brain health. Routine exercise maintains balance and skill to ambulate,” she points out.
Stewart also notes that “a substantial value to living in assisted living is that you enlarge your health care team, improving coordination of care and accurate medication management,” all of which could pay longevity dividends.
Transitioning to Assisted Living
Moving into an assisted living community can be arduous. For older adults with cognitive deficits, such as dementia, or other chronic diseases like diabetes, this is particularly true. Changing routine — indeed, uprooting an entire life — can feel completely overwhelming at times.
One 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, a case management consultancy in upstate New York.
Making important decisions under pressure or with high emotions can create a panic situation. Doing so typically prevents families from making an informed and thoroughly researched placement in the right community.
Talk to Your Loved Ones About Senior Living
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, Sorensen says.
Some families find that speaking with an expert can be beneficial as well. Goldwater recommends starting 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 advisor, an attorney or even a counselor who works with families facing these challenging situations can also be helpful in deciding the right time to move. 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, though, 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 so you have some suggestions at the ready as the conversation evolves.
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 most, if not all, of this sort of communication in person. This way, you can pick up on body language and other nonverbal clues about how your loved one is feeling.
— Be empathetic. Try to understand how difficult these conversations can be. But don’t pity the senior — 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 handrails around the bathtub. Look into making that happen for the short term until a more final decision about future care can 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. Community dining and activities can be a big help if a senior is feeling lonely.
— Ask if your loved one wants help. They may be struggling in silence with housekeeping, laundry, running errands or other daily chores and hoping you’ll offer assistance 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.
The Bottom Line
Keep in mind that 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.
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When Is It Time to Move From Independent to Assisted Living? originally appeared on usnews.com
Update 06/05/23: This story was previously published at an earlier date and has been updated with new information.
