Elderly Living Alone: How to Know When It’s Time for Assisted Living
18 questions to ask older adults
The decision to move aging adults out of the family home is a complex one — both emotionally and practically. It requires a delicate balancing act between their safety and their emotional stake in staying put. Each of these is important, and helping them make the right decision (while remembering that as long as they are of sound mind, it’s ultimately their decision) requires care and planning.
The basic questions to ask in considering a change in housing
Everyone is different, and the decision to move is an intensely personal one. But asking yourself, and those in your care, the following questions can help all of you navigate this difficult terrain.
- Have there been any accidents recently — or close calls?
Who responded, and how long did it take?
- Are activities of daily living getting harder?
If the answer is yes, are you able to get in-home help with chores like shopping, cooking, or laundry?
- Are they becoming socially isolated?
Lack of companionship can leave older adults more vulnerable to heart problems and other health conditions. If they no longer see friends or visit with neighbors, moving to a place where they would be around other people could actually be a lifesaver.
- Is the house clean and well cared for, and are basic home-maintenance tasks getting taken care of?
If not, are they open to getting more in-home help, can they afford it, and do you know how to help them find it?
- Can someone check in on them on a regular basis?
If a family member, friend, or neighbor isn’t nearby and available to do this, are they willing to consider a home-safety alarm system or daily calling service?
- What’s the plan for a worst-case scenario?
If there’s a fire, earthquake, flood, or other disaster, is someone nearby prepared to assist them?
- Are they clean and well-groomed?
If, say, an older man has always been known for his crisply ironed shirts but starts looking disheveled, that may be a clue it’s time for another level of support.
- What’s in the refrigerator?
Is the freezer full of TV dinners and the vegetable drawer empty? Has the milk gone sour? A quick look can tell you whether they’re eating well or whether they’ll do better someplace where trained staff could make sure they’re getting balanced meals.
- How are the pets doing? What about the plants?
Their ability to take care of other living things may offer clues to their ability to manage their own care.
- How did those you’re caring for weather the most recent illness (for example, a flu or bad cold)?
Are they able and willing to seek medical care when needed, or did last winter’s cold develop into untreated bronchitis?
- What does the doctor think?
With appropriate permission, talk to their doctor. The doctor may share your concerns about their safety at home but may also be able to alleviate them. Sometimes your closeness to the issue can exaggerate your worries, and a little professional distance (and expertise) is just what’s needed to clarify the picture.
- How often do they get out — especially in the winter?
Are they spending days without leaving the house because they can no longer drive or are afraid to take the bus alone? While many older adults fear being “locked away” in a retirement home, many such facilities offer regular outings that may actually keep them more mobile and active, not less.
- How are they doing compared with this time last year?
The holidays, when families get together after long periods apart, can be a good time to reflect on the previous year and take note of any significant changes. A marked decline from one year to the next may mean it’s time to start looking — and planning — for a more supportive environment.
- How are you doing?
While this decision is not primarily about you — the caregiver — your own exhaustion can be a good gauge of a decline in older adults’ ability to care for themselves. If their need for care is just plain wearing you out, that may be a sign that it’s time to start looking at other options.
- How old are they?
Many continuing care facilities have age ceilings after which they won’t admit older adults, no matter how healthy they are, so if you have your eye on a particular place, find out what its age cutoff is and plan accordingly.
- Are the older adults you’re caring for happy?
Safety is crucial, of course, but so is emotional well-being. If they’re riddled with anxieties or increasingly lonely, then that may tip the scales toward a move that may not be 100 percent necessary at this point for health and safety reasons. On the other hand, if they have a full life, close neighborhood and community connections, or simply enjoy being at home, it’s worth exhausting every option before pushing them to move out of the home they love.
- How do others think they’re faring?
Sometimes it helps to get a second opinion, either from a family friend or relative or from a professional geriatric care manager who visits older adults’ homes and does informal evaluations. While they may initially resist the notion of a “total stranger” checking them out, this one may be worth insisting on (offer to have a family member pay for it as a holiday gift). You may be surprised to find they’re willing to share doubts or vulnerabilities with a sympathetic, experienced stranger that they’re loathe to admit to their own children or family, easing the family conversations that follow.
- What do they want?
This may be the most important question of all — and you may be surprised by the answer. While an initial response may be a knee-jerk “I’ll cross that bridge when I come to it,” many older adults harbor the same fears for their current and future safety and security that their caregivers do, even if pride keeps them from voicing them. Taking the time to sit down with them, draw out their concerns, and find out what they fear most about moving out and what they do want to change about their life — rather than launching into your worries for them, or what you think they ought to do — may give all of you the information needed to make the right decision for everyone concerned.