Making the Transition from Assisted Living to a Nursing Home

Assisted living centers can often make a good transitional home for elders who no longer feel safe in their own homes, or who are so isolated at home that they are in danger of depression and other health issues.

Alzheimer's organizations consider socialization one form of possible protection against the disease. Since many elders find that their neighborhoods change over time, plus many of their friends are ill or have died, a gradual isolation can overtake them without their even being aware of it.

When that happens, adult children often step in and make an effort to convince their parents to move to an assisted living center. Many elders thrive in these centers if the center is well run. However, a time comes for some elders when the services that assisted living centers offer aren't enough. Then another move, this time to a nursing home, if generally considered.

When Is a Move to a Nursing Home Indicated?

Most assisted living centers do not offer medical care. Many offer memory units, but even then, skilled nursing is rarely part of the service. Some centers contract with a home health agency that has a nurse and can dispense medication, though this service generally has an added fee. Others may offer some nursing care for extra cost, but it's rarely enough for those who need around the clock medical care.

If your elders need constant medical monitoring, then they may need to make the transition to a nursing home. Also, few assisted living centers, at this time, accept Medicaid rates, so if your elders funds have bottomed out and they are on Medicaid, the assisted living center may no longer accept them and a nursing could be their only option.

How Should the Elder Prepare for a Move From Assisted Living to a Nursing Home?

The move from assisted living to a nursing home can be traumatic for an elder - or not. Much depends on the quality of each home. If the assisted living center is very good, and a person moves to a poor nursing home, the change could be drastic. While there would be more medical care in the nursing home, the home may seem more hospital like and less like a retirement center.

However, if your elder moves into a person-centered nursing home, the difference in atmosphere between assisted living and this home may be nearly imperceptible, other than there will be more hands-on medical care. Certified Nursing Assistants will be more abundant in a good nursing home and nurses will be on all floors. Visits form a physician's assistant should be at least a weekly occurrence, and a physician visit should happen monthly.

One of the most noticeable changes for someone who transitions to a nursing home would be if the person went from private pay and a private room in assisted living to a Medicaid bed in a nursing home. Medicaid will rarely pay for a private room, so that means a roommate would be in your elder's future. You'll have to prepare your elder for this room sharing, which is not very often an easy transition.
You can help with this important change.

  • Explain to your elder that you would like him or her to have a private room, but since that is not financially feasible, you will help make their half of the room as personal as possible.

  • Try to find a nursing home that has as good a separation between residents as can be expected. Often, unfortunately, that amounts to only a curtain, such as hospitals use. However, many homes are remodeling to the extent that double rooms are nearly as large as two singles, and a dividing wall goes half-way down the room. Unfortunately, this is still not something you will often see. Therefore, you'll likely have to do what you can to help your elder adjust to a roommate.

  • Use the roommate as a springboard for more socialization. If you are lucky, your elder and the roommate will become friends. I've seen this happen. Then, your elder will have someone to go to lunch with and a friend to share activities with.

  • If they don't get along? This happens often. If the conflict is minor, try to help resolve issues with patience and the help of the staff. If the conflict is major, put your elder on a list for a different roommate. Be persistent, as a switch could take time. Advocate for your loved one. Eventually, a move for your elder or your elder's roommate should happen.

  • Be prepared for complaining, no matter what. Try to be patient and point out the advantages of the nursing home, even if a room must be shared. Note the increased medical care, the added attention of CNAs and the immediate attention if someone falls.

  • If diabetes is one of your elder's illnesses, point out the availability of nursing staff. Repeat as necessary. Do the same if your elder is at risk for frequent falls or has other health issues.

  • Point out daily, if necessary, that the reason for the move is for better medical care and safety. Assisted living service was an option for social reasons and a mid-range type of care. The nursing home can offer far more concentrated medical supervision, but also has social programs and activities. Point out these plusses as often as necessary.

How successful this approach is will depend largely on the quality of the assisted living the elder lived in before the transition, and the quality of the nursing home the elder transitions to. Therefore, you may find that there is little complaining and hardly any change, once the physical move is made. Or you may find a lot of complaining over nothing substantial. If this is the case, you are fortunate, and the complaints will likely be short lived.

If, however, your elder leaves a rollicking good time at an assisted living center and is moved to a poor quality nursing home, you will likely have a harder time helping with the transition. If that's the case, there isn't much you can do but continue to explain the reason for the change and help the elder adjust.

Try to get the best care available, and stick with your elder. Transitions are hard at any age and can be harder as we age. Do your best to help. Be patient. Listen to the complaints and do what you can. In the end, this may be one time when your best has to be good enough, so be ready for it.

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Carol Bradley Bursack
Meet Our Writer
Carol Bradley Bursack

Carol Bradley Bursack is a veteran family caregiver who spent more than two decades caring for a total of seven elders. This experience provided her with her foundation upon which she built her reputation as a columnist, author, blogger, and consultant. Carol is as passionate about supporting caregivers work through the diverse challenges in their often confusing role as she is about preserving the dignity of the person needing care. Find out much more about Carol at