When to Consider Assisted Living/Board Care vs. Living at Home

Caregivers and family members who are new to residential care options for their elderly loved ones may be unfamiliar with knowing when the appropriate time has come.

For some, the following questions may have already crossed your mind?

  • What is residential care?
  • How does someone qualify for assisted living outside of their home?
  • What signs am I looking for that make assisted living a suitable option for the elderly adult?
  • Where does the line fall between transitioning to assisted living and recruiting assistance for home?

First, one assumption needs to be cleared up:

Just because somebody is elderly does not mean that they automatically belong in an assisted living facility.

Many elderly adults live out the rest of their lives at home safely and efficiently. However, some elderly individuals live with specific circumstances in which assisted living becomes a viable choice.

Now, let’s break down and assess some of the red flags that family members/caregivers should be monitoring.

Three main reasons why the benefits of assisted living would outweigh the benefits of living at home:
  • The elderly adult can no longer complete necessary, functional tasks at home safely and independently.
  • The elderly adult lacks a support system (family, friends, caregivers, guardians, etc.).
  • Professional home health is not working (i.e. not available or not improving the safety of the elderly adult functioning at home).

The following items are observable examples of why an elderly adult may not be able to complete certain tasks independently and safely within their own home:

Poor posture and balance: This only becomes a problem if there is an increase in falls, an inability in getting to other rooms safely (the bathroom, the bedroom, the kitchen, the stairs, etc.).

Severe loss of balance should be a red flag if certain compensation measures have been taken and aren’t working such as use of a walker, a cane, or a wheelchair.

Incontinence: In general, incontinence is a disruption in typical toileting patterns for bladder and bowel removal. This could include medical problems concerning the bowel and bladder, the physical inability to get to a toilet independently, long-term use of catheters or colostomy bags, etc.

Incontinence without assistance leads to filthy living environments, infection, and skin breakdown/wounds.

Memory changes: Increased forgetfulness or loss of memory is common with aging adults. It becomes a safety concern when the home becomes a hazard or when tasks become dangerous: forgetting to turn off the oven, leaving doors unlocked, overdosing on or forgetting to take medication, or wandering off and having no memory of how to get home.

In some instances, standard assisted living care. In more severe cases of memory loss, memory care placement should be part of the discussion.

Vital problems: Persons with respiratory, diabetic, or cardiac-related illnesses may have trouble living at home independently if maintaining healthy vitals (heart rate or respiratory rate) is an issue.

This may include difficult in independently managing blood pressure medication, glucometer readings and insulin, prescribed diets, and supplemental oxygen.

Remember, elderly adults living at home have the option of exploring home health supports as well as increasing those supports when changes arise. Assisted living comes into play when home health supports no longer provide safe living at home anymore.

Note: Residential care or assisted living in California are non-medical facilities, so certain medical conditions that require specific nursing attention may not be allowed.

Assisted Living/Board Care: Starting the Conversation With Your Loved One

Are you part of one of those families in which all of the siblings had to draw straws to determine who gets to take away the car keys from Dad when the time came?

Although this method and storyline often lightens the mood, there is no hiding how scary of an endeavor it is to be solely responsible for taking things away from your aging parents.

Children, grandchildren, and other family members/caregivers of the elderly are frequently, at some point, placed in a position in which they need to bring up that life-changing conversation with their loved ones:

discussing the possibility of relocating to an alternative place of residence including assisted living facilities (residential care centers), memory care centers, or other community-based options outside of their private residence.

Depending on the person and their history, this conversation could be a long time coming and not at all surprising. For others, terrifying circumstances at home may spark an immediate discussion:

an increase in falls or injuries at home, rapid health deterioration, or an unexpected change in caregiver roles (death, illness, etc.).

To merely suggest a transition to residential care outside of the home for some elderly adults is to rip away all feelings and modes for independence.

Therefore, this conversation should be taken with great care if family members/caregivers expect to come out with positive results.

Consider the following tips that could be used in initiating the discussion and to keep the dialogue from shutting down:

Prepare for a role switch: Children of elderly parents have a built-up expectation about interacting with each other, with typically children taking the submissive role even as adults. Now, it’s time for children to take a leadership (but not dominating) role. Be proactive and confident when discussing alternative living options.

Formalize the conversation: Talking about a potential move should be considered a sit-down conversation. Physically sit down with the elderly individual, even if this means scheduling a time to meet in advance. Select a quiet, comfortable room where there are limited distractions.

Have your care center resources at the ready: Have prospective centers and care options in front of you, whether the information is all on pamphlets or on your laptop. Have complete evidence of your research, but avoid making this an overwhelming part of the discussion because elderly adults who are talking about residential care for the first time will need time to process.

Back up your stance with recorded incidences: If you feel like the conversation is going a certain direction, appropriately bring up recent and past safety concerns without sugar-coating the facts. Examples include falls in the home, getting stuck in the bathroom, inability to access food or medication without others, hospital stays that resulted from problems at home, etc.

Re-emphasize your love for the individual: Make sure your tone in the conversation does not come across as demeaning or cold. Admitting that you need help is very defeating for some elderly adults. Consistently reassure them, verbalizing how much you care for them.

These tips are not fool-proof and will not work for every, unique situation. For some elderly adults, coming to terms with a residential change will take several scares and hospital stays.

We can only make our best efforts, which includes having the courage to bring up the conversation not once, but numerous times.