When is Assisted Living the Right Solution For Elder Care?


    My neighbor, Henry, lived in his little bungalow for nearly 50 years. He and his wife had raised a son in that home. Eventually, the grown son moved across the country. Henry’s wife died. Henry’s son wanted him to move to a place where he’d have company and help when he needed it. A place where he’d be safe and have friends.


    Henry would have none of it. He was going to stay in his own home, in his own neighborhood. None of those new-fangled assisted living places where there’s no privacy. He liked his neighborhood where he’d lived for half a century. The trouble was, the neighborhood was no longer the same neighborhood.

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    Henry was the only person there who was a long-term resident. His old neighbors had moved to be closer to kids, or chose assisted living, or needed a nursing home or – died.

    But Henry wasn’t budging. He’d watch TV during the day, or at least have it turned on “for company.”  He’d doze in his chair most of the day and then not sleep at night.


    He’d make a meal when he felt like it, though once he left the water running all night, the sink was stopped up, and the kitchen flooded. Then there was the time he left the stove on and the house got all smoked up. "Almost a fire, but we didn’t have one," he would say with a  laugh. There was something a little frightened in his laugh, however, as he explained away the incident.


    He ate cereal a lot. Sometimes several times a day. He lost weight. He was supposed to take a couple of medications, but he lost track of time, so he either took them when he felt like it or neglected them all together.


    His son tried in-home care, but Henry locked the caregivers out of the house. Finally, his son insisted. Henry was dragged, kicking and screaming, into an assisted living center near his old neighborhood. Who did he find there? Why, it was old Ernie, his poker partner. He and Ernie had lost touch, as Henry didn’t hear well on the phone, and besides, he figured Ernie had sort of betrayed him by moving out of the neighborhood.


    Gradually, Henry’s anger melted away. He ate well. He made friends. He gained weight and took his medication right. Much of his improved health was due to social connections. It wasn’t long before he was telling people that moving to the center was his choice. “Too bad the kid fought it so,” he’d say. His son, a man of good humor, laughed that off. He was just relieved that Dad was in a good place and having fun.


    Some people are a perfect fit for assisted living, and, though it took some doing to get him there, Henry is one of them. So, how do people decide that assisted living is the right option? As with in-home care, adult day services and nursing homes, there are questions to ask and choices to be made.



    Q. Is the elder lonely, even though he or she may not admit it?


    A. Watch for signs of dullness and depression. See if the elder is willing to go out and do things when the opportunities arise, or if there seems to be more and more reluctance to go outside their limited comfort zone.


    Q. Is the elder eating well? Is he or she able to regularly prepare a nutritious meal and eat it? Weight loss is often a clue, here.


    A. While in-home living can take care of some of these issues, often not eating well isn’t a matter of just having a meal delivered or prepared.  Most people, by nature, prefer to share a meal with someone. We are social creatures, and eating is as much a social activity as it is a way to survive physically. Assisted living can provide the company necessary to stimulate a mental response to food and an appetite to eat it.


    Q. Do you notice confusion and increasing forgetfulness?

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    A. While confusion and forgetfulness need to be medically checked out and often signal the onset of dementia, it’s also possible that these symptoms are caused by poor medication control, poor diet or just plain loneliness. Often, when moved to a place where an elder can interact with peers, some of the confusion and forgetfulness falls away. Even if it doesn’t, at least there are people around to help the elder feel safe.


    Q. Do assisted living centers provide help with medication? With transportation?


    A. You’ll find assisted living centers can be very different in what they offer as part of the “basic package.” This is one area to be very specific about. Ask questions. Is transportation provided to doctor appointments? If so, do we pay extra? Is an escort provided? Is there someone who can set up medications? If so, is that extra?


    What you’ll notice about many assisted living centers is that they provide a pleasant place to live, good quality food with many choices, activities and social time, plus emergency call lights and other ways for the elder to get help, if needed. But most other services will need to be arranged for, and they will cost extra. Make a list before you tour places. Ask every question you can think of. Then go home and think some more. What is covered in the basic price and what is extra? That is the big, big question.


    Q. Does the elder seem frightened of strangers or just generally unsafe?


    A. This can happen, especially as old neighbors move away and younger families or “strangers” move into surrounding homes. Neighborhoods change, and an elder can become isolated. Isolation can bring on depression and fear.This is a sign a change is needed.


    Q. What about money? Isn’t Assisted living expensive?


    A. Yes. But so is in-home care and so are nursing homes. When my uncle was receiving eight hours a day of in-home care, he was paying more per month than he paid for assisted living, where he had people on call day and night, meals provided and peers to converse with. All care, at least as our health system exists today, is expensive. There are some long-term policies that cover assisted living, particularly newer ones. But, likely if your elder bought a policy years ago, it was called “nursing home insurance,” and that is all it covers. So, again, yes. Assisted living is expensive.


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    My mother and I toured several assisted living centers. There were different levels of care in them. Many were more like resorts than apartments. Some were quite humble. There are also assisted living homes where a residential type home is set up to care for several elders. The options are endless, and quality can differ dramatically.


    Q. Are assisted living centers regulated like nursing homes?


    A. No. There isn’t, now, a government standard like there is for nursing homes. While you need to be careful about selecting nursing homes even with all of the regulations, assisted living, as it is these days, kind of slid in sideways. They aren’t nursing homes, therefore they aren’t regulated as such. Yet, there aren’t many regulations aimed at how they should function.  Therefore, you need to be extra careful about what you are getting. Check references. Look around. Do all of the investigating you would if you were choosing a nursing home – only more.


    Q. I’ve heard of contract problems. Do you have to sign a lease?


    A. This is one area where, unless the contract or lease is very simple and not long-term, you may want to be specific enough to even have the papers you sign checked by an elder attorney or estate attorney. I, personally, haven’t run into anyone who has had trouble with leases and contracts – at least any more problems than leasing an apartment. But nationally, I know there have been problems.


    I wrote about a Web site and book in a previous article on assisted living here on Our Alzheimer’s. You can find some answers by checking out this site. You’ll also find you have more questions than you thought. However, the questions above are the ones I'm most frequently asked. Take this list along and begin your search.


    You may find you have a “Henry” on your hands, who, with a lot of prodding, may find a new lease on life once he has gotten into a safe, social atmosphere. Do your homework, but don’t write it off because of expense. It may be a better bargain (if bargain is the right word) than an elder staying at home with in-home care.



    For more information about Carol go to www.mindingourelders.com or www.mindingoureldersblogs.com.

Published On: March 18, 2009