It’s easy to think of our parents are invincible. After all, they are the ones who took care of us throughout childhood years and were often the ones we came to with our questions, victories, and heartbreaks. Even after we leave home and start careers, get married, and have children of our own, it’s hard to see them as anything but unstoppable forces in the world.
It starts as little things: perhaps the streak of gray in your mother’s hair or maybe dad no longer has quite the spring in his step. These little things add up over time, though it may take us a while to realize the truth of it. And even longer to come to terms with what it means. Our parents are aging. As they become seniors, we may have to help them as much as they helped us.
Truthfully, most older adults need little help, especially when they are surrounded by a solid social group and family dynamics. They don’t need to be parented, either. Many people live their lives independently well into their 70’s and beyond!
Unfortunately, as people age into their 80’s and 90’s, that can begin to change. Small tasks that were once easy have become overwhelming. New health issues make mobility a greater concern. And, unfortunately, there is always the risk of dementia and Alzheimer’s that can affect their ability to care for themselves safely.
When that happens, you may find yourself questioning whether they can continue to live independently or need a caregiver. If that happens, what is your next step?
Overwhelmingly, it is the family members who are tasked to step in and help care for an older family member who may experience physical and mental health issues. When you are making decisions for the future of your family, it’s important to have all the facts before you make these crucial choices that have lasting repercussions.
What is the right choice for your family? What do your parents need in terms of care? How do you help them live safely and happily when they need extra care?
There’s no universal approach to senior health care, especially when it comes to living arrangements. With our guide, however, you will be more prepared to handle these difficult moments and make the best choices for your family.
Senior caregiving takes many forms. While we will explore many of these possibilities, we first must take a look at the two most likely senior housing options you will find yourself considering: assisted living and nursing homes. While they may sound identical (or very close), there are some very key differences between the two. Just as importantly, they share many of the same functions that are important to know.
Both assisted living and nursing homes are senior housing communities that focus on keeping older adults healthy, safe, and happy. While assisted communities are typically the best option for older adults who are mostly independent but may require some assistance with certain tasks, nursing homes are designed to handle the needs of seniors who require 24-hour medical care.
However, they both provide a certain level of care, including assistance with basic activities of daily living like bathing and personal care. Here’s the care you can expect from both types of housing.
Managing your medicines – especially if you have many daily prescriptions – can be difficult under the best of circumstances. But for elderly individuals, a mistake with their medicines can have deadly consequences.
One facet of care provided by these residential facilities is assisting residents in safely managing their daily medications.
Staying active is the best way for seniors to minimize their risk of health issues. It’s been well established that loneliness and isolation are often linked to increased cases of diabetes, cardiovascular problems, Alzheimer’s, and even cancer.
One benefit to senior residential living is the inclusion of activities and social aspects that tend to the emotional, physical, and spiritual needs of their inhabitants.
Both types of facilities also offer support in daily tasks like housekeeping services, laundry, and assistance dressing. They provide transportation to doctor offices or, in some cases, shopping trips or social outings.
We aren’t talking about security systems here (though most places do have some type of physical security to make sure residents are safe). In this case, we’re talking about building modifications made to ensure an individual with mobility issues.
This includes handrails, wheelchair lifts, modified showers and tub, and emergency call systems in rooms.
A key aspect of senior health is maintaining good nutrition. This can often be difficult for older people with mobility issues who may be struggling to prepare their food. One major benefit of these communities is that they provide scheduled meal options, as well as nutritious snacks, daily!
Overall, the difference between assisted living communities and nursing homes lies in the level of need their residents require. Specifically, it comes down to the medical care requirements that each is equipped to handle.
Nursing homes, also known as skilled nursing facilities or convalescent homes, are designed to offer the highest possible level of care to senior adults outside a hospital. They offer 24-hour medical care because most of their residents require serious medical care of some kind.
There are on-staff nurses and nursing aides to look after day-to-day treatment. Most residents of these facilities have debilitating, chronic, or severe physical or mental conditions that require this type of medical supervision.
They cater to individuals who may be bed bound, require wheelchairs, or even those who need artificial respiration (like a ventilator).
Nursing homes also generally require a physician’s referral and physical examination before accepting new residents. They offer rehabilitation services such as speech, physical, cognitive, vocational, and occupational therapy. They also may be temporary living arrangements during this time; many are short- term options while someone recovers from an injury or illness.
By contrast, most residents in assisted living communities are seniors who are still largely independent apart from a few minor tasks. These commonly include housekeeping or laundry services or assistance with daily tasks like dressing or bathing.
Additionally, they are great for elderly individuals who struggle with routing cooking or grocery shopping. These communities are not hospitals and as such, do not provide round-the-clock specialized medical care for residents.
They do have full-time staff but doctors may travel to the facility to treat specific patients instead.
These communities are perfect for independent seniors who want to move away from the stress of home maintenance. They’ll no longer need to worry about lawn care or home repairs! It’s especially helpful for those who are no longer able to drive and do not have access to reliable transportation. Most assisted living communities are designed as a place for residents to spend the rest of their lives.
In the most basic terms, nursing homes are medical treatment facilities. Assisted living is considered residential care. This classification contributes to the resident’s lifestyle and options available for each. These will vary based on location, however, so be sure to schedule a tour for a closer look.
While historically, nursing homes have been considered closed, clinical settings, this isn’t the case in most modern facilities! Modern nursing homes have a much greater focus on residential living and providing a safe and comfortable environment.
They are no longer seen as "institutional" or depressing. Instead, current research shows they are often joyful and nurturing environments for their residents!
Since assisting living communities are designed for more independent residents, they may look different by comparison. Instead of residential rooms within one (or several) buildings, many assisted living residents live in single-occupancy full suites or apartments.
Because many assisted living residents have greater independence, their facilities offer additional amenities like barbershops or salons, libraries, on-site restaurants, general stores, and even pubs!
As we said above, there is more on-site medical staff available at nursing homes compared to assisted living locations. They are also more readily available.
In the United States, nursing homes must have at least one registered nurse available for at least 8 straight hours throughout the day, seven days a week. They must also have at least one licensed practical nurse (LPN) on duty 24 hours a day.
The staff-to- resident ratio is much higher in these facilities as well, given that they have nurses and nursing assistances on-call throughout all hours of the day.
By comparison, most assisted living services do have doctors available, with typical offices on-site or to make house calls. If your loved one needs extensive medical care, you’ll want to seriously consider a nursing home as their best option – especially if you see their medical needs increasing soon.
Overall, nursing homes have higher associated costs than assisted living communities. However, the expense can be off-set with Medicare or Medicaid. They will often cover some of the fees and expenses.
There is no universal sign that it may be time for your parent to consider more intensive care options. However, there are several things to look out for in terms of their overall health and well-being that may be indicators of larger issues.
Forgetfulness is most likely one of the biggest concerns you might have as your parents age. Everyone forgets things occasionally (and some of us never know where we put down our car keys).
However, you should be on the lookout if your loved one struggles to recall important or easy-to-remember things – such as their current address or struggle to hold the thread of conversation – then it’s a sign of something much larger. And more serious.
As we age, we generally become less active overall. That said, there’s a difference between no longer working out daily and suddenly becoming lethargic or, worse, bedridden without notice. If your parent seems disinterested in activities, mopey, or disaffected, it could be a sign they need an outlet for socialization or assistance in some other facet of their lives.
As we noted, everyone tends to lose energy as they grow older. Sometimes maintaining the house to the spotless degree they once did might not be possible – or as much of a priority – as it once had been. However, there are also serious indicators of underlying concerns.
Dirty dishes left out for long periods, trash or clutter left unattended or may indicate they aren’t able to take care of their home in the way they once could. The same goes for physical appearance as well. Disheveled hair or clothing and lack of bathing can be a sign they suffer from depression. These are all signs that it may be time to consider senior residential living.
Are they paying their bills? Late on that mortgage payment or forget where they’ve spent money? This is another symptom of forgetfulness. While it may start small, it has the potential to turn into a major issue. Mismanaging money can lead to your parents losing their savings or worse.
It also makes them vulnerable to potential scammers or frauds that can cost them even more money! After all, scams cheat seniors out of at least 3 billion dollars each year. More seriously, it can be a sign that they are suffering from a serious issue like dementia or Alzheimer’s.
No one looks forward to discussing this topic with their parents. Realizing that this can be a difficult, often contention conversation is one of the first ways you can prepare for it. Many families wait too late to open discussions, which can lead to complications down the road.
It’s better to have it early, giving everyone enough time to think about their options and ready themselves for the larger discussion. Readying yourself to have this conversation is a huge first step.
From there, you’ll want to start writing things down. Make a physical list of your concerns. Start with any warning signs you’ve seen and how they’ve progressed over time. Be honest but also be kind when you are forming your arguments. It will only help you make the best case for their healthcare.
Finally, before you initiate this conversation you’ll need to educate yourself on all available options. (Fortunately, we’ve prepared a section of this guide to help you do just that!) Going in with all the facts is only going to help you get your point of view across without fumbling through it but it will also help you prepare your parents for what’s to come.
As we mentioned above, this is going to be a difficult conversation. If you’ve prepared in advance, you’ll likely be in a much better position to help the talk go smoothly. Most seniors initially view the possibility of residential care as a threat to their independence and hold out against hearing even the most logical argument for why it might be time to consider it.
Let’s dive into the tips and tools you can use to make your conversation productive and – most importantly – non-threatening to your parents’ sense of independence and self-reliance.
Undoubtedly, this is the most important thing you can do. We cannot say this enough – do not broach this subject over the phone or, even worse, through a text message.
Important conversations deserve thought and care put into them, especially from the party that initiates the talk. Choose a day you know everyone involved will be well-rested and have several hours to devote to the process uninterrupted.
Don’t try to talk to someone when they are already exhausted or overwhelmed with other issues.
Before you even begin to consider bringing up a topic this heavy, make sure you’ve done your research! We mentioned this above but want to repeat just how important it is to come into this conversation fully prepared. This may be a life-changing moment for your entire family; you’ll want to be ready for it.
Be ready and makes sure you have information to offer such as:
Having your research done well in advance can help you be ready to counter high emotions if your parents seem stubborn or unwilling.
When approaching assisted living or nursing home prospects, remember that you are not planning someone’s funeral. Keep the conversation centered around positive aspects of what this transition will do for them (not what they may feel like they are losing).
Highlight the amenities and social opportunities that are available in these communities. Try to use phrasing like “residential-style living”, “condos”, and “retirement communities” instead of immediately pushing the concepts of a nursing home (which often has negative connotations).
You can also rephrase that as a “skilled nursing facility” to give them a more accurate picture of what it might look like.
While facts and information are important, they aren’t the only thing you should approach your conversations with. You’ll also need empathy and understanding. You’ll never quite know how someone else is feeling unless they tell you.
Encourage your parents to reach out to you during this conversation and let them speak. Don’t talk over them. Don’t focus on your message while they are talking. Really listen to their fears and concerns about this process and incorporate that into your planning as you move forward.
They may be reluctant to uproot everything they know in favor of being shuffled off or abandoned in a strange place. There’s also the very real fear that relocating means they’re setting themselves up for death.
These concerns are undoubtedly the root of any resistance you might face in the conversation. Try to be empathetic to these anxieties and put yourself in their shoes.
It’s incredibly important not to appear as if you are coming in to take over their lives. You don’t want to control your parents – you want to help them. Listening to their concerns is one way you can circumvent that issue before it begins.
Here is a tip that might help. Approach the subject by expressing your feelings as well. How does their situation affect you? It might help them become more involved in the conversation if they realize there is a way to minimize your stress and anxieties as well.
Your parents are far more likely to engage positively in this process if they are involved in every step of this transition. They aren’t pawns in this process; they certainly shouldn’t be treated like their thoughts or opinions do not matter.
It’s important to remember that this isn’t going to be the only time you talk about this. If you’ve broached the topic early, you’ll likely be able to ease your parents into the idea of assisted living.
Starting with the conversation as a hypothetical gives them time to think about the possibilities and perhaps come to terms with the move (or initiate it) themselves!
Handling aspects of the health, wellbeing, and financial management for your own life can be utterly exhausting. When you find yourself suddenly handling these things for your parents as well, it’s easy to get overwhelmed. You are swamped with decisions. Choices seem endless. There’s no immediate “correct” answer to any of them.
It may also be isolating, especially if you don’t feel comfortable sharing intimate details of the situation with your friends or those around you. Many people struggle with this very same thing.
Fortunately, it doesn’t have to be that way. Some many incredible organizations and individuals specialize in assisting you with these tough decisions. Learning how and where to find qualified help can make the transition move more smoothly and with much less stress. Here are several avenues of help you should consider when considering how best to meet your elderly parents’ needs.
A senior living advisor, also known as a senior care specialist or eldercare consultant, is an expert in senior care living arrangements. Their strength lies in the fact that they have the knowledge and expertise your family can benefit from, especially when it comes to navigating whatever local options are available in your area.
Senior living advisors provide specialized, personal care that depends wholly on your family’s needs. They start by gathering information about your loved one and their situation, including any background information, emotional needs, care needs, and their wishes.
They take time to work with you for an extended period and fully investigate your options. It saves you valuable time and effort that can be re- directed into the care of your family.
Using this information, they give objective advice on what best benefits your loved one that takes much of the guesswork out of it for you.
When planning for your parent’s future living accommodations, you’ll need to consider their healthcare needs as well. Because of this, it is always beneficial to include a medical professional in the process. In this case, you will want to reach out to your parents and then speak to their doctors or specialists before you begin the process.
Speaking with their primary care physician may seem like a difficult task at first (especially if your parent seems reluctant or unwilling) but they can provide you with invaluable information that can help you make the best possible choice for them.
One thing you can do in advance is to establish a relationship with that medical professional before your parent reaches a point where independent living is no longer feasible. Even if you aren’t able to do that, you can still reach out when it becomes obvious they need additional care.
Before you reach out to them, make sure you start by discussing the issue with your parent and ask them to sign a HIPAA release form so you are privy to their medical information. Start by assuring them you do not want to control their lives and instead try to see their perspective on the matter.
Focus on how much you’d like to help them maintain independence, not take it away. It can go a long way towards helping your relationship with your parents and their health care professionals.
If you have concerns about possible abuse or neglect in an assisting living facility or nursing home, one valuable resource for you to consider is Long-Term Care Ombudsman programs. An ombudsman, or ombud, is a public advocate charged with investigating complaints from private citizens against businesses, institutions, governmental departments, or other public entities.
A Long-Term Care Ombudsman focuses on advocacy for an elderly individual in long term care facilities including nursing homes, care homes, and assisted living facilities. They protect seniors against potential elder abuse and potential mistreatment within these organizations. They also work with governmental agencies to inform and enforce policies that improve the quality of care for seniors.
For more information about the role of Ombudsman in the health care industry and to find programs in your area, visit the ACL (Administration for Community Living) website for the Long-Care Ombudsman Program.
Additionally, you can locate an ombudsman in your area using the tools at the National Long-Term Care Ombudsman Resource Center.
Just as important as local advocates and assistance programs are the online resources available to you. Many of these can help you find benefits and financial resources if you are struggling to find ways to pay for care, information on medications or treatments your parents may be currently undergoing, ways to increase the quality of senior life, and more. They can also help you find advocacy groups to help with any legal issues you might be facing as part of the process.
Here are some of the best-known resources currently on the web:
Once you’ve had the time to consider your options, one important step to take is taking a tour of each possibility and see how it measures up in person. You’ll never get the total picture for any assisted living facility unless you take a look at it for yourself.
Most facilities offer tours that let you see the buildings, apartments, and grounds. They’ll also show you what other amenities are available, which you’ll want to check out!
Make sure you include your parent in this process as well! You want to make sure you’ll find a place they will enjoy and feel comfortable living. This may be impossible, depending on your situation, but if you can bring them, we strongly recommend you do.
In the age of Google and Yelp, it’s easier than ever to find information about possible care facilities in your area. Once you’ve located one or two that you might be considering, you can always search for them online to see if you can find any review for their quality of care. User reviews are common for all businesses and assisted living and nursing homes are no different!
Nursing Home Rating offers information on several throughout the United States, allowing you to find listings by cities within each state. The Medicare website has a tool called Nursing Home Compare that provides information on all Medicare and Medicaid certified nursing homes in the United States. You can look up specific locations and compare their quality and resident satisfaction before you decide.
Once your family has explored your options and made a decision, it’s time to begin the relocation process. This can be a tricky time for your family, as moving itself often stirs up strong emotions and can lead to further heavy conversations (and broaching topics you might not be ready to hear). Starting this process as soon as possible can help decrease everyone’s stress and lead to a smoother, more comfortable move.
Get a copy of the floor plan – including square footage- of the new residence. This will help you plan for how much space your parent will have so you can begin planning what goes with them on this trip and what stays behind.
Do not purge everything immediately! This is likely to cause anxiety and even reluctance from anyone if their belongings are all just removed within a small frame of time. Perhaps consider the Marie Kondo method as a way to start the downsizing process if you feel inclined!
You can hold a yard sale for excess items, which will also give a little extra money for the moving expenses. If you’d rather, you can also make donations at your local thrift and charity stores.
Before you begin downsizing, talk to your parent and begin making a list of their most important possessions. Having your most cherished positions with you in a new place makes that residence feel like a home, after all.
It’s likely that most of the small items will fit. If there are a large number of oversized possessions, they might need to make arrangements for them.
If there are items on their list that do not fit in their new home, make sure they know they still have options to keep them.
One way can be renting a storage unit (which may help their anxiety over losing important items) or they can consider whether or not they’d like to pass them down to the next generation.
Make sure you are not making all the decisions here; let them be in control through these proceedings as much as possible.
One thing you can do to help this transition feel more natural is simply to create a cozy, livable space in their new community! Help decorate their new room or apartment with their cherished positions and small pieces of furniture.
There are plenty of ways to bring their personality into even the most conventional space. Some ideas might be:
Hang photos or paintings on the walls. Perhaps invest in flowers or potted plants to brighten the room and maybe give your parent a fun new hobby in the process.
Wine or spirits is always a great traditional gift. You can pair with a cheese tasting basket or even coffees and liqueurs and gourmet chocolates are a win.
Consider a gift basket, a digital photo frame to cycle through cherished family photos, or even a new fitness item to help them stay active such as a new pair of sneakers.
One potential memento that you might not have considered is a custom piece of photo engraved jewelry. These allow you to choose a favorite family photo with your parents and have it forever etched into metal, even incorporating a name, date, or even a quote on the back.
For example, this Stainless Textured Round Color Photo Pendant is a small yet memorable keepsake that immortalizes your favorite photo into full- color on the metal surface! You can even feel the textured engraving on the front.
With photo engraving, you can see your memories etched in metal that will last. It gives those captured moments – and the people represented in them – a physical presence that your loved one can take with them to their new home.
They can choose to wear them or keep them on display to remind them that their family is never far away.
As we’ve discussed above, you may encounter reluctance from your parents even when moving is in their best interest. If you find that you cannot come to an agreement with them about their living conditions, you may be able to compromise in a manner that satisfies their desire to be at home but doesn’t jeopardize their safety.
There are ways to prolong their ability to stay in their homes until all of you can sit down and come to a consensus or assist in making a hard decision if there is no other choice.
Elderly guardianship, also known as elderly conservatorship, is a legal position created when a court appoints an individual to care for an elderly person who is no longer able to care for himself or herself. This guardian accepts certain duties and responsibilities for the elderly person.
Guardianship is only granted when a senior individual is no longer able to care for themselves. Indicators of a need for guardianship include the inability to remember to take necessary medications, maintain regular hygiene, or effectively manage finances. We’d consider this a last resort if your parent is exhibiting signs of mental or physical deterioration that leaves them unable to make responsible choices for themselves.
If your parent refuses to move from their current living situation for whatever reason, there are modifications you can make to their home that can help them remain safe (and happier) within it. While these can be an expensive upfront cost, they can give your parents more time to come to terms with the reality of their own aging.
Here are some of the most common home modifications to consider:
What happens when the options we’ve explored are not available for any number of reasons? What if you don’t feel comfortable leaving your parent’s care to a third party outside the familiarity of their home? What if there are financial reasons you are unable to move forward with residential senior care?
These are all highly likely possibilities for many families. Fortunately, you do have other options that may solve these problems for you and your parents.
This option may not work for everyone. However, it’s not uncommon to see an older adult move into a family home with their child or some other family member.
Historically, extended families lived together for much of their lives, often including several generations of a family under one roof. It’s only in the last few decades where this trend began to change, though we are seeing a shift back to these more traditional household dynamics.
If your parent moves in with you, it often eliminates many risk factors! It can also add a needed boost to their daily social interactions and give them a reason to be more active (especially if they help out with chores or attend family outings).
Hiring a companion for your senior parent eliminates the need to take them out of their home. This is a good alternative if they are experiencing some issues living independently but don’t yet need the extent of care assisted living would provide.
Some of these are full-time caregivers that require a standard 40 hour per week schedule while other positions are hired as live-in companions to look after them 24-hours a day. Elder companions are caregivers who help with in-home daily tasks such as cooking, cleaning, bathing, or even running errands.
Coming to terms with our parents aging is never going to be easy. Neither is the inevitability that our parents may not be able to care for themselves the same way they once did. Ultimately, you may have to approach your parents with the hard choice of moving into residential senior housing like an assisted living community or a nursing home.
Knowing when it’s time to consider the option and then preparing yourself (and your family) for this move can help all of you come to terms with these large changes more quickly and without threatening your parent’s sense of independence and self-worth. Educating yourself on your options can help you navigate this trick situation in a manner that will ultimately lead to a better life for everyone.
November 20, 2020 by Frances Kay