For many years, your parents helped you navigate life. Now, as they age, it’s time for you to help them. It won’t always be easy — who wants to admit they need some help managing their day-to-day life — but if you suspect your loved one might no longer be safe and mentally and physically healthy living on their own, the best thing you can do is get them the care they need. But how do you know when it’s time to start considering making the move into assisted living? The answer isn’t going to be the same for everybody, but there are signs you can watch for.

Introduction

Families go through several stages as everyone grows older. Remember the stage when you used to call up your parents and they were too busy to meet up? Maybe they were traveling or having dinner with friends. Perhaps there were other times when you called and they were eager to babysit your kids. Ah, the good old days.

Your Parents Need Help But Don’t Think They Need Help

Maybe now your parents are at the point where they aren’t able to maintain their house like they used to, but they’re getting by. Perhaps you stop by once a week to catch up. Maybe your brother helps with yard work once a month. Your parents might be getting a lot of help, but they probably don’t think they need it.

Your Parents Need Some Help

Then, due to physical or mental changes, your family arrives at the stage where your parents realize themselves that their lives would be easier if someone came in for a few hours each week. Not every day, of course, but maybe an hour and a half in the mornings a few days a week to help with meals and housekeeping. They want help, but they don’t need too much of it.

Your Parents Need Daily Help

Of course, all families would love to stay in the stages where their parents get the help they need at home. But there will come a time when your parents need daily help — possibly even daily medical help or full-time help. This is often a turning point for families who wanted to stay at home. Maybe someone in the family steps up and provides the care your parents need at home, but that can quickly lead to caregiver stress, which puts a strain on family relationships. Another option is assisted living, the fastest growing long-term care option for seniors. Assisted living communities are a place where your parents can get extra help with the everyday tasks of living while remaining as independent as possible, for as long as possible, yet still have the care they require at a moment’s notice.

OK, So What Now?

This isn’t a linear path. Your parents may experience all of these stages or may skip some stages altogether. Change can be sudden or gradual — but it is inevitable. So how do you know when it’s time to start considering making the move into assisted living? It depends on a lot of things, including how well your loved one is faring in their current home, their present health status, and their future medical and personal needs. The answer isn’t going to be the same for everybody, but there are signs you can watch for.

In this eBook, you’ll learn about:

  • Activities of daily living, how they are defined, and how they are assessed
  • Why activities of daily living are important
  • Signs that indicate it is time to begin considering assisted living
  • Must-know facts about assisted living wait lists
  • What to do if your loved one needs more help than you can give

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1. What Are Activities of Daily Living Anyway?

The phrase “activities of daily living” gets thrown around a lot at the doctor’s office, at physical and occupational therapy appointments — and in assisted living materials. So what are these so-called “activities of daily living” and just why are they so important?

ADLs: The Big 6

Activities of daily living (ADLs) is a term used in health care to refer to a series of basic activities performed by individuals on a daily basis necessary for independent living at home or in the community. The concept was originally proposed in the 1950s, and there are many variations on the definition of the activities of daily living. Most health care professionals break ADLs into six basic categories:

  • Bathing: Bathes completely by oneself or needs help cleaning only a single part of the body, such as the back or an injured extremity, and performs personal hygiene and grooming, including nail care, oral care, and hair care
  • Dressing: Retrieves appropriate clothes from dresser or closet and dresses and undresses
  • Toileting: Goes to the bathroom without help, including getting on and off the toilet, taking off and putting on clothes, and cleaning oneself
  • Continence: Has complete control over urination and defecation
  • Transferring: Moves from seated to standing, gets in and out of bed, and has the ability to walk independently from one location to another
  • Eating: Feeds oneself without assistance (though the food may be prepared by another person)

By assessing whether or not someone is capable of performing these activities on their own, you can more easily gauge their independence.

IADLs: The Big 7

You might be wondering about the things that aren’t on this list, such as meal preparation, housework, managing medications and personal finances, and transportation. These are called instrumental activities of daily living (IADLs).

Although IADLs are important to being able to live independently, they aren’t necessarily required activities on a daily basis. However, they can help determine with greater detail the level of assistance required by a senior. Most health care professionals break IADLs into seven basic categories:

  • Basic Communication Skills: Answers the phone, dials well-known numbers, takes initiative to operate phone on their own, emails, or uses the internet
  • Shopping: Takes care of all purchases without assistance, making appropriate food and clothing purchase decisions
  • Food Preparation: Plans, preps, cooks, and serves all food needed for meals and snack — safely using kitchen equipment and utensils — cleans up, and stores leftovers
  • Housekeeping: Does light to heavy home maintenance tasks, such as doing laundry, washing dishes, dusting, and vacuuming
  • Transportation: Manages personal travel independently, either by driving oneself, arranging rides, or using public transportation
  • Managing Medications: Takes the appropriate amount of medication at the correct time without supervision or prompting, manages refills, and avoids dangerous drug interactions
  • Managing Finances: Handles all or some finances with little to no help, including paying bills, keeping track of income and day-to-day purchases, and avoiding scams

It’s harder to notice loss of functioning when assessing instrumental activities, but the functional ability for IADLs is generally lost prior to ADLs. Knowing what the IADLs are can help determine with greater detail the level of assistance required for your loved one.

Why the ADLs and IADLs Are Important

You don’t need to go home immediately and asses your parents’ ability to wash the dishes or rifle through their fridge the next time you’re home to see if there is yogurt that is long past its use-by date.

That being said, the six activities of daily living and the seven instrumental activities of daily living can be helpful in assessing whether your parents can or should continue living on their own or if some assistance might be needed.

For many seniors, there’s a general progression for these activities. As your parents age, harder tasks, such as bathing, tend to become more and more challenging to do on their own, while feeding themselves might be one of the last ADLs with which they require assistance.

Plus, what someone needs to be able to do to live or function on their own can vary from person to person, from your mom to your dad. A person’s physical and cognitive abilities can fluctuate from one day to the next or decline incrementally over time.

8 Signs It's Time to Begin Considering Assisted Living

So next time you’re at home or on the phone with your parents, just keep an eye out for changes in function. In Chapter 2, you’ll learn about the specific signs that you should watch for that indicate that it is the right time to begin considering assisted living.

2. 8 Signs It’s Time to Begin Considering Assisted Living

For many years, your parents helped you navigate life. Now, as they age, it’s time for you to help them. It won’t always be easy — who wants to admit they need some help managing their day-to-day life — but if you suspect your loved one might no longer be safe or healthy living on their own, the best thing you can do is get them the care they need.

Assisted living communities offer apartment-style living options that allow your parents to live in a home-like environment while receiving assistance with activities of daily living. In addition to the personal care support your loved one can receive in an assisted living community, a variety of activities, programs, outings, and dining options are also available.

So, how can you feel more confident about whether circumstances suggest your loved one should no longer be living alone? Although every situation is different, here are eight signs it’s time to begin considering assisted living.

1. Difficulty Managing Activities of Daily Living

Although difficulties with some of the activities of daily living can sometimes be remedied by having more in-home assistance, a move to an assisted living community may be the best solution. Not only do staff at assisted living communities help with these activities, but they also provide meals, housekeeping, transportation, and a wide range of amenities and activities for your loved one to participate in.

2. Days Spent Without Leaving the House

It’s normal for seniors’ social circles to shrink with age. Whether their friends have died or moved away or your loved one can no longer drive, lack of companionship is associated with depression and heart problems in older adults. Does your mom still get together for lunches with church friends or participate in her book club? Has your dad cut back on meeting his friends at the local restaurant for coffee? There are many reasons elderly adults cut back on activities, but dropping out of everything and showing interest in almost nothing is a red flag for depression. Assisted living communities offer seniors the opportunity to form active friendships and to partake in regular outings that keep them more mobile and active.

3. Unopened Bills and Letters From Banks Pile Up

Sometimes you can find warning signs of cognitive decline in the mailbox. Next time you go to your parents’ house, keep your eyes peeled for unopened personal mail or bills; letters from banks, creditors, or insurers; and thank-you messages from charities. Individually, these might not be issues. However, if you find a lot of mail scattered around and unopened bills, this can indicate that your loved one is having difficulty managing their finances.

4. Drastic Changes in Appearance

A sudden change in appearance can indicate trouble. Perhaps your mom is having difficulties getting to the grocery store or remembering how to cook her favorite recipes, so she’s experiencing noticeable weight loss. Or maybe your father is indulging in meals and snacks all day long or eating a diet of mostly packaged goods, so he’s gaining weight. Other signs include strange body odor or changes in personal hygiene habits, which could be a sign of memory trouble, depression, or other physical ailments.

5. Neglect Around the Home

If you find stale or expired foods in the kitchen and a freezer full of TV dinners, your loved one might benefit from an assisted living community where they can get three home-cooked meals a day. Signs of lax housekeeping also offer a glimpse into how your loved one is keeping up when you’re not around. If plants and animals don’t seem well-tended and the yard looks like it’s been neglected for a season or two, your loved one might need housekeeping help or a living situation where this is taken care of for them.

6. Recent Accidents or Close Calls

Falling can pose some serious health risks. According to the National Council on Aging, every 11 seconds an older adult is treated in an emergency room for a fall. Every 19 minutes an older adult dies from a fall. Watch out for an increased amount of accidents or close calls. Was your mom injured in a fall? Did your dad accidentally leave the oven on? Of course, accidents can happen to anyone at any age, but when accidents seem to be happening at an increased rate, it is time to think about assisted living.

7. Forgotten Medication

Older adults often skip doses out of forgetfulness, and that is especially likely, research shows, when they take three or more drugs per day or when they have dementia or depression. Although a pill organizer can be helpful, it can be difficult for some to keep days of the week straight, especially if isolated or forgetful. In addition to forgotten medications, taking the wrong (or too many) pills can also become a problem. Is your loved one remembering to take their medications correctly, with the right doses and at the right time?

8. No Longer Able to Drive

In most parts of the country, driving is a key predictor of mobility and self-sufficiency. If your loved one no longer drives, it jeopardizes their independence and access to essential services and further puts them at risk for social isolation.

Acknowledging that someone you love needs full-time care is hard. Recognizing that you can’t give them that care may be difficult as well. If you’re concerned about your aging loved one’s safety, health, or happiness, talk to them about assisted living. Involve their doctor and a financial adviser in your conversations so that you and your loved one understand all the choices available.

20 Questions to Ask Your Parent

20 Questions to Ask

Obvious red flags such as a broken hip from a fall or depression due to social isolation may speed up the decision process, but more often than not, there’s no clear sign. Here are some questions you can ask yourself, too, to help determine when it’s time to start considering assisted living:

  • Has your loved one fallen recently?
  • Does your loved one seem to take longer recovering after they are sick or hurt themselves?
  • Does the person suffer from a chronic health problem that is only getting worse?
  • Is your loved one taking all their prescribed medications as instructed?
  • Do they have problems with activities of daily living?
  • Is your loved one eating properly?
  • Have you noticed hygiene problems?
  • Are they having mobility problems?
  • Has your loved one caused a car accident or been involved in a number of minor fender benders?
  • Does your loved one still keep up their house?
  • Does your loved one have to deal with a lot of home maintenance, such as mowing the yard or raking leaves?
  • If your loved one has pets, are they well cared for?
  • Have they left their home and gotten lost?
  • Has your loved one become unusually angry or violent when something upsets them?
  • Are they isolated or withdrawn?
  • When you visit, do you notice piles of unopened mail?
  • Does your loved one seem happy?
  • Do they have a supportive community?
  • Have their friends or neighbors expressed any concerns to you?
  • Can their caregiver continue doing everything necessary?

Assisted Living Wait Lists and Move-in Timing

3. Assisted Living Wait Lists and Move-in Timing

Let’s say the next time you’re home, you notice your mom is a little more socially withdrawn than the last time or your dad has a chronic health condition that’s worsening. You recognize these are signs that it might be time to start considering assisted living, but it still feels too soon.

Actually, this is the perfect time to start looking.

The best thing you can do is plan early for assisted living instead of waiting for a crisis. If you wait for an unplanned event that forces you to make last-minute care arrangements, it will not only cause added stress for your family, but your elderly loved one is also at risk. Rather than finding the best assisted living facility for your loved one, you might have to pay for a community that’s at the high end of your budget or that doesn’t meet your needs.

Key Factors of Move-In Timing

In addition to finding the right assisted living community for your loved one, you might also have to help your parents downsize and sell their home, get your family’s finances in place, and plan the physical move.

Factors that influence move-in timing include:

  • Your loved one’s care needs
  • Who is participating in the search
  • The time of year
  • Your family’s finances

For example, care needs are almost twice as important in predicting move-in timing as all other factors combined. If your loved one needs assistance with daily living now, you’re probably more motivated to find them an assisted living facility than to wait for a crisis. Or if you need to sell a home before your loved one can move, it might take much longer to move in.

Don't Be Afraid of the Wait List

Don’t Be Afraid of the Wait List

Even if you do a bunch of research into assisted living communities, call and tour a few that stand out, and narrow it down to the right one, you might find that it is at 100 percent occupancy. This is another reason why you want to start your search sooner rather than later.

If you find yourself in this scenario, put your name on the assisted living community’s waiting list. Even if your loved one isn’t ready to transition to assisted living yet, it’s often the case that your first choice community will not be available when you need it. Planning ahead can give you more control over your options, in addition to saving you time and heartache.

Even if there is uncertainty about being ready, being on the wait list gives you the opportunity to choose down the road. Things can change quickly as your parents age, and you might be really glad that you were prepared.

What to do if your parent needs assisted living now

4. What To Do If Your Parents Need Assisted Living Now

If after reading this you’re starting to think your parents need assisted living now, don’t panic.

Book a Respite Stay

A respite stay is a great option if your loved one wants to try out an assisted living community without committing quite yet.

Many assisted living communities offer the option for an overnight stay, a few days, weeks, or months. Short-term respite stay residents live in fully furnished suites, enjoy three meals a day, housekeeping and laundry services, personalized care, and medication assistance. They also have access to many of the amenities and programs available to full-time residents.

Schedule a Tour

The best way to find the right community is to visit one and get a feel for the community. Interact with current residents, observe how the caregivers treat the residents, talk to staff members and the director, and look for any red flags.

Discuss Care Options with Your Loved One

You don’t want to have to move your loved one several times, so make sure you discuss the plan with them to ensure that the assisted living facility you have selected meets both of your needs. Remember that if your loved one is happy in their new home, it will help minimize any problems and even the possibility of having to move them and repeat the facility search.

Most importantly, they will be supported in living as independently as possible and encouraged to stay mentally, physically, and socially engaged while also having their daily needs taken care of by specially trained staff in a safe and secure environment.

A short-term respite stay can provide the time you need to vet possible long-term options while giving your loved one the opportunity to try out a community prior to a permanent move.

Call Assisted Living Communities in Your Area

Start by making a list of residences. The state or local Area Agency on Aging, the long-term care ombudsman’s office, and friends and neighbors can be great resources. When you have a selection of a few assisted living facilities, call and ask for a general overview of their facilities. Be sure to ask:

  • What is your staff-to-resident ratio?
  • What kind of experience and training does your staff possess?
  • Do you provide plenty of opportunities for activities and social interaction?
  • How much do you charge? Are all services included in the monthly fee? If not, what and how much are additional services?

Do a Thorough Background Check

Assisted living is regulated at the state level, which means it’s not always easy to find information about the licensing and background of the facilities you are exploring. That’s why it’s important for you to do your homework. Call state licensing to check the facility’s records, complaints, and any violations, or visit their online portal to access inspections reports and other background information.

5. Conclusion

At some point, your loved one may need some extra help with the everyday tasks of living. Imagine how nice it would be to have your grocery shopping and cooking and laundry done for you. Assisted living is designed for these older adults who can live independently but also require some assistance.

It can be a difficult moment when you come to realize that your dad or mom needs to move, but assisted living not only creates an environment that supports those who are in need of assistance but oftentimes offers an environment where one can thrive.

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