Gathered around the patio table on a beautiful early autumn evening, talk with friends turned to caring for aging parents. Jan, whose mother lives independently several states away, related an all too familiar story.
"In our daily phone call, I asked Mom how she was doing. She told me she'd fallen the night before. She wasn't hurt but spent the entire night on the living room floor because she could not get up by herself. It wasn't until her friend came by for the usual morning coffee visit that she was able to get up."
"Thank goodness she wasn't hurt," I said. "But I thought she had a medical alert bracelet." Jan gave me an exasperated look. "She does! But she forgets she has it even though we talk about using it in that exact type of situation. When I reminded her that she should have used it, she said that she probably wouldn't have used it even if she had remembered. I asked her why, and she said then the EMTs would have to come, and that would be too much fuss."
Countless other adult children have had similar calls about issues with elderly parents. Excepting a catastrophic event, it's tempting to avoid the question of whether an older loved one should still be living on their own. Many older adults resist losing their independence, so their children are reluctant to suggest an assisted living option to avoid conflict or feelings of guilt.
However, ensuring health and safety becomes an increasingly high priority as parents age. As Kristi Stalder says in her book, Navigating Assisted Living, "[It] is important to stay focused on your loved one's best interest and to avoid feeling guilty when it's time for assisted living."
How do you know when it's time for assisted living? Here are ten signs that could indicate that the time is right:
Falls result in three million emergency room visits annually. One out of every five of these falls causes broken bones or a head injury. Jan's Mom was lucky, but it could easily have been much worse. Assisted living facilities are built with fall prevention in mind. Combined with rigorous staff training, fall risk is significantly reduced. Even if a resident were to fall, help is close by.
Sometimes older adults keep their falls secret in the fear they will lose their independence. Caregivers need to encourage seniors to be honest about when they've fallen to avoid subsequent incidents that could cause painful and life-threatening injuries.
2. Poor Nutrition
Senior living independently often face problems with adequate nutrition. Many factors can cause this:
- Decline in the sense of smell and taste
- Difficulty using table utensils
- Dislike eating alone
- Memory loss
- Swallowing problems
Caregivers should monitor such things as weight loss, lack of energy, skin color, and behavior at meals. These can be tip-offs that a loved one is not eating properly. Programs like Meals on Wheels can help with both nutrition and social interaction. Also, assisted living facilities provide food services to maintain good nutrition.
Taking medications at the right time in the prescribed amounts presents a challenge to some older adults. The number of medications often increases at the same time cognitive abilities start to decline. The cost of making a medication mistake could range from being a non-issue to being life-threatening. Caregivers need to keep detailed track of medication usage to ensure the older adult can keep track of this essential medical responsibility.
Many families have experienced the unpleasant task of taking grandpa's keys away. Many seniors fiercely fight this since it symbolizes the ultimate loss of independence. However, an incompetent older driver endangers themselves and others.
This situation has, for some, been easier to endure due to the rise of ride-sharing services like Uber and Lyft. In some communities, shared-ride public transportation services are available for those who cannot use other public options due to a disability or health condition. Assisted living facilities often offer transportation services for their residents.
Although the loss of driving privileges is not an immediate reason to consider assisted living, over time, it could lead to less social interaction and loneliness.
Several factors can contribute to loneliness or social isolation for older adults. Loss of a spouse, relatives who live far away, lack of transportation, and shrinking friend groups are examples. A 2020 study from the National Academies of Sciences, Engineering, and Medicine (NASEM) found that over one-third of adults aged 45 and older feel lonely. Almost one-fourth of adults aged 65 and older are classified as socially isolated. Older people who experience loneliness and isolation are at greater risk for both physical and mental illness. Safety becomes an issue as well when other people are not around to render assistance in various ways.
Caregivers often feel obligated to provide social connections to their older loved ones who are lonely. Yet, caregivers can only do so much. There are community resources for social interaction, like senior daycare centers. Assisted living settings have a built-in social interaction component that works well for most residents.
6. Handicap Accessibility
The home layout that worked at a younger age may not serve the needs of an older adult. Health issues may call for homes to be outfitted with special accommodations. Stairlifts or no-threshold showers with seating and grab bars are the types of improvements that may extend the duration of independent living.
Such accommodations sometimes only delay the inevitable. Yet that delay may be the most logical option from both a financial and emotional perspective. The number of contractors that specialize in retrofitting homes with accessibility features has grown in the past two decades. Caregivers should compare the costs and capabilities of at least two or three to find the best combination of value and quality.
You pick up your formerly fashion plate Mom for lunch, and she's wearing wildly mismatched clothing and poorly applied makeup. Or your Dad takes an hour to dress because he can no longer manage buttons, and the whole process exhausts him. These are obvious clues that quality of life starts to slip, and stress levels are going up. Whether from memory or physical issues, caregivers need to be alert to difficulties with basic daily tasks. Assisted living provides support in these areas. The result can be a massive relief for all concerned.
8. Memory Issues
Even the early stages of memory impairment can lead to quality of life and safety concerns. This sometimes is tough for caregivers to assess. For instance, if your loved one misses a monthly payment or loses things from time to time, these may be signs of normal aging. On the other hand, having ongoing trouble keeping up with finances or frequently losing things may indicate worse problems.
Professional screening can provide a better fix on the extent to which memory problems have risen the level where intervention is required. Also, health professionals have the experience to help determine what level of support is appropriate.
Incontinence is a stressful reality for many seniors. It can be caused by urinary tract or vaginal infections, constipation, or weak pelvic muscles, among other things. The good news is numerous treatments, and other interventions can help manage incontinence.
Even so, older adults may be embarrassed to discuss the problem. Caregivers may also be reluctant to broach the subject. It cannot be safely ignored, however. Untreated incontinence can lead to other health issues. Medical professionals will provide clear direction about options for handling the condition.
Assisted living facilities are well-versed in handling incontinence issues. Improved management in well-run senior living settings has virtually eliminated the stereotypical "urine smell."
10. Caregiver Burnout
Even the best-intentioned caregivers reach their limit. The term "sandwich generation" has been coined to describe those caring for their own families as well as aging parents. According to a study by the Family Caregiver Alliance, the responsibility falls disproportionately on women who account for 53 to 68 percent of family caregivers. Men are also involved, but the same study found that females spent 21.9 hours per week giving care versus 17.4 for men.
When considering assisted living options, many caregivers face the guilt factor. Yet, the array of senior living choices has exploded in the last three decades. Assisted living has grown to be a viable alternative for many families. These facilities are skilled at making new residents feel at home. Hence, the transition to a new environment is as stress-free as possible.
How Do You Know When It's Time?
No single sign means someone is ready for assisted living. However, caregivers must use their best judgment to assess when a combination of factors reaches a critical mass. Trusted health providers can help in this assessment.
However, they are not around the patient day in and day out. The caregiver needs to provide detailed information to healthcare professionals. For instance, keeping a diary of when these various signs appear will help the caregiver to provide an accurate perspective about the situation.
Are you ready to start looking at Assisted Living options? Download our Essential Assisted Living Checklist to discover the 129 questions to ask and evaluate facility options.