When to Move From Independent Living to Assisted Living

This article is based on reporting that features expert sources including Susann Varano, MDRoxanne SorensenTanya Gure, MD

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 is the right time to move into an assisted living community, and when to begin making plans for such a transition.

What Is Assisted Living?

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A 2019 study from the Centers for Disease Control and Prevention found that in 2016, 28,900 assisted living and similar resident 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.

By and large, assisted living communities are designed for older adults who aren’t sick enough for a nursing home or the hospital, but 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.

Similarly, the price can vary widely, too. According to a 2018 survey by Genworth Financial, the median monthly cost for an assisted living community is $4,000 – totaling $48,000 annually. By comparison, long-term care by a home health aide tops $4,195 monthly or more than $50,300 annually. And skilled nursing in a private room will set you back an average of $8,365 per month, adding up to more than $100,000 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. It’s a common concern. “This is a question that I get every day,” says Dr. Susann Varano, a geriatrician at Maplewood Senior Living, a Westport, Connecticut–based senior living residence company. One of the challenges in answering this question well lies in the fact that “it’s a very personal and at times sensitive topic to bring up at any age.”

When to Make the Move

Most of us aren’t too thrilled how the passage of time might make us a little less able to do the things we used to enjoy so easily – and how it can take a toll on our health. 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.

“There are some classic scenarios,” Varano notes, such as 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 very lonely after the death of a partner.

Another common situation is when a senior develops multiple medical problems. “Even if they have one neurological or progressive disease like Parkinson’s, or pain from osteoarthrosis or macular degeneration, those types of diseases get worse,” Varano says. 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. “Putting that individual in assisted living sooner rather than later can help prevent them from getting hurt,” especially if they develop a tendency to wander, which is very common.

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.

Making the Transition

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, Varano says, 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 can certainly be exacerbated if the placement is made last minute, in a rush or emergency situation. “That’s the worst when you make impulsive decisions,” Varano says. “Guilt takes over, and some families fall apart. Typically, the senior is hospitalized and when they’re discharged, they’re not safe to go home. So the family panics and says, ‘let’s just put them in assisted living,’ and then they feel guilty.” For their part, sometimes seniors who find themselves in these situations feel betrayed or like their loved ones have abandoned them.

“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.

Initiate the Conversation

As terrible and sadly common as these situations are, Varano and Sorensen agree that many of these negative feelings and difficult situations can be alleviated by starting the conversation early and 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 the senior’s doctor, a financial advisor, an attorney or even a counselor who works with families facing these challenging situations can also be very beneficial in determining when the right time to move is and how such a change can best be executed. These professionals can provide insight, suggestions for where to start and a yardstick for how other families have handled similar situations.

Similarly, trying to loop in family members can be both challenging and rewarding, so think carefully about who should be involved in the process, not least of which is the senior himself. In some families, the adult children of seniors think they’re doing the best thing for an aging parent without taking into consideration what the parent actually wants, and that can lead to resentment. Clear and open communication can help alleviate these issues, and the more conversations you can have with all interested parties, the better.

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. “The primary end point (for assisted living) is the social model. The secondary endpoint is a medical component,” Varano says. 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 allows families to take time. For some patients, the longer the time over which those discussions can take place, the better the outcome. Talking about what’s coming later gives you an opportunity to get a jump on finding out what a loved one’s wishes are. It will also help to find the best possible placement for them, so that when the time comes, the transition will be made easier and they can actually enjoy this new chapter in life.

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. “Doing your due diligence will decrease guilt and stress,” Varano says, and allow 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, she says. “It’s just a new chapter in someone’s life that they’re expecting, so it’s seamless.” They can integrate to the new community and find a new life. But it all starts with not being “so afraid of talking about it.”

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