1. How do I determine which level of care my mom needs?
2. My dad has a progressive and disabling disease and needs to move out of his home. Right now, assisted living would provide the level of care he requires. I’m worried about a year from now when he may need skilled nursing, and yet, I want him to remain as independent as possible for as long as possible. What type of living situation should I look for?
3. What’s the best screening process for finding a caring environment for my mom, who has dementia?
4. Is it more expensive for my parents to move into an assisted living community or to hire a home health aide and age in their own home?
5. My mom refuses to move out of her home, but she’s having trouble with daily activities. Last week she fell. She wasn’t hurt, but it scared me. What should I do?
6. My mom has been caring for my dad who has Alzheimer’s disease. As he has required more help, she is becoming worn out. I am concerned about her health. Although she knows that she might have to move him eventually, she feels that if she had some help during the day, she can continue to care for him at home. I have heard about adult day centers but don’t know what they do or how to find them.
1. How do I determine which level of care my mom needs?
Because each community has their own criteria for accepting residents, and the regulations that govern assisted living and nursing homes vary from state to state, your best bet is to contact individual residential care homes to determine if there’s a good fit. Often this entails a representative from the assisted living community to come to the home for an assessment (or you can take your mom to them).
Generally speaking, residents in assisted living are relatively independent but need help with some or all of the activities of daily living: bathing, dressing, eating, grooming, and toileting. Some people move to assisted living because of mobility problems and are not safe living at home because of the risk of falling. Health services can be limited or non-existence at the assisted living level of care.
Be prepared to share the following information: What your mom can do for herself, in what areas she needs assistance, what medications she takes, and her behavior patterns (agitation, if she wanders, if she becomes angry, sleep patterns, etc.) Based on her needs and the community’s policies, they will determine if they can accept her.
Nursing homes (also known as health centers and skilled nursing homes) are for residents who have medical conditions that require attention or treatment. Some residents in nursing homes moved from assisted living communities because their medical condition or behaviors (often associated with dementia) were more than the assisted living community could care for.
If keeping your mom in her home is a possibility, you might also want to consider hiring home healthcare or homecare services, or combine in-home care with adult day services.
Be sure to ask friends, co-workers, and other caregivers for recommendations. You can read up on all your options here. (finding care overview)
2. My dad has a progressive and disabling disease and needs to move out of his home. Right now, assisted living would provide the level of care he requires. I’m worried about a year from now when he may need skilled nursing, and yet, I want him to remain as independent as possible for as long as possible. What type of living situation should I look for?
It’s difficult to balance what you know now with what might happen in the future. Most families want to give their relative a quality of life that they can enjoy and that they might not find in the nursing level of care. But you also want to try to avoid multiple moves in a short time period, which could be hard on your dad.
Start by looking at the level of residential care that gives him the quality of life that most resembles what he has now. Some assisted living places have nurses on staff. If the progressive disease is physical rather than cognitive, ask if there is a nurse on staff and when – on-call, part-time, or full-time.
Ask how many residents they have with a similar or the same disease, how long a resident is typically able to live there, and what usually requires a resident to move on to nursing home care. Then observe the other residents: How would your dad fit in with them? Do they appear to have similar conditions or require a similar level of care?
Ask what additional services the staff could provide (most likely at an additional cost) that would enable him to stay longer rather than having to move out when his needs change.
Lastly, ask what support and guidance they provide when a resident does need to move.
3. What’s the best screening process for finding a caring environment for my mom, who has dementia?
This depends on what stage of dementia she has and what state she lives in. In some states, assisted living places will accept a person in the early stages of dementia; in other states a person with a diagnosis of dementia can’t live in general assisted living but would be required to move to a memory care unit.
There are many options and resources available. Here are a couple suggestions to get you started:
Start With the Math
What can you afford? Then contact the Alzheimer’s Association for names of places in your area. Call assisted living communities, and your mother to see if it’s appropriate to come and take a visit. (You don’t want to waste time if your mother’s care needs exceed their ability to care for her)
When You Visit
- Take someone with you.
- Visit during activity or mealtime so you can see the other residents.
- Observe other residents; do they appear to be at the same or nearly the same level of dementia as your mom?
- Observe how staff are caring for the residents: are they using caring voices? Are they spending time with the residents?
Do they have smiles on their faces or are they frowning?
This can tell you a great deal about how they feel about their job, where they work and the other residents.
For more information, we recommend reading Moving a Relative with Memory Loss, available in the ICareVillage store.
4. Is it more expensive for my parents to move into an assisted living community or to hire a home health aide and age in their own home?
Typically if a person needs part-time help, it’s less costly to live at home. If a person’s care needs approach full-time help, then the cost is likely to exceed the cost of assisted living. A live-in caregiver may be an option and be less expensive than living in an assisted living community. But there are many factors to consider:
- What are the expenses associated with living at home: taxes, utilities, maintenance, food, etc.
- How many hours is a caregiver needed? Do both parents need assistance or just one?
- How much does the caregiver cost on a weekly basis? Monthly?
- Is a caregiver needed short term or long term?
Another option is combining some in-home care with adult day centers, which provide supervised social activities and sometimes healthcare during the day, and typically have a much less expensive hourly rate than an individual home health aide.
5. My mom refuses to move out of her home, but she’s having trouble with daily activities. Last week she fell. She wasn’t hurt, but it scared me. What should I do?
First, recognize that moving from home at your mother’s age is a big loss. Most people want to remain living in their homes for as long as they can or forever. If your mom has lived in her home for many years, her house is full of memories and collected possessions that have great meaning to her.
Share your concerns and begin a conversation about “when the time comes.” Be sure to ask your mom what she wants. Assure her you will try to respect her wishes but her safety is your primary concern.
Start looking into places in your area, either by yourself or with her. Doing some homework now can relief some of the stress you are feeling. To keep your mom in her home longer, consider hiring help to come into the home or making some adaptive changes around the house, such as installing handrails down and removing throw rugs. A PERS (personal emergency response system) is also a good idea. See Aging in Place and Mobility.
6. My mom has been caring for my dad who has Alzheimer’s disease. As he has required more help, she is becoming worn out. I am concerned about her health. Although she knows that she might have to move him eventually, she feels that if she had some help during the day, she can continue to care for him at home. I have heard about adult day centers but don’t know what they do or how to find them.
Adult day centers (sometimes called adult day services or adult day care) are a good option for your dad and will give your mom some much-needed support. The services vary, but basically you’ll find social activities, meals, and some heath services for adults who need supervised care outside the home during the day. See Adult day services and http://www.nadsa.org/ for more information.
