Guide for Moving to Assisted Living
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Moving out of the family home and into an assisted living community may not be the easiest of transitions. For older adults who've spent decades living at the same address, relocating to a new community can surely cause some angst. But there are ways that loved ones can minimize the stress. Preparing for the event, showing understanding, and rallying around mom and dad with a supportive network of family and friends can help reassure them as they move into this new life chapter.
- Choose the community that's right for your loved one
- Check that facilities meet local and state licensing laws
- Create a plan that details your loved one's wishes related to health care and finances
- Identify which belongings to move to the new living space
- Employ strategies to help a loved one feel safe and supported
What is Assisted Living?
Today, more than 735,000 people live in assisted living communities, which vary widely in the types of amenities and services they provide. Many offer private and shared apartments and rooms. Some assisted living facilities resemble Victorian mansions while others look like small homes tailored to residents' needs. Services can include three meals a day and help with daily living activities like bathing, dispensing medication, paying bills and shopping for groceries.
Many assisted living facilities emphasize social interaction, offering regular activities, outings and amenities like on-site hair salons.
Signs Someone Needs Assisted Living
If you're not certain whether the time has come for a loved one to transition to assisted living, experts say to watch for certain telltale signs.
Telltale Signs Assisted Living Is Needed
- Difficulty with bathing, dressing, taking medications and other daily tasks
- Coping with accidents, especially slips and falls
- Slow recovery from illness or experiencing a worsening chronic health condition
- Big changes in weight gain or loss, along with increasing frailty
- Unkempt appearance or neglecting personal hygiene
- Becoming noticeably less social
Choosing the Right Community
Choosing the right assisted living community is extremely important for a loved one to feel comfortable and welcome. Look for a community that provides a home-like atmosphere with friendly residents and staff, and one that meets your relative's care needs and interests. Assisted living communities generally offer social activities, transportation to medical appointments and shops, and outings for residents.
Typically, facilities offer three meals a day, which are sometimes served in a large dining room with other residents. Some communities allow residents to order from a menu or cater to specialized dietary needs like vegetarian or vegan meals or food for diabetics. Some facilities permit residents to bring their small pets along.
Here are two websites that list assisted living communities in your area.
Provides a list of each state's assisted living options near your zip code. It also reports on facilities' licensing status.
Offers a "home match" tool that matches the facility (independent living, assisted living, and residential care homes) with your care needs and desired location.
7-Step Checklist to Finding the Best Assisted Living Facilities
Use the following tips and questions as tools to decide which places best suit the senior you're helping.
Take a Tour
Visit the assisted living communities that appeal to you. Does it seem homelike? Do apartments, rooms and common areas provide lots of natural light, with grab bars in the bathrooms and adequate closet space? Is the facility clean and well-maintained? Do you notice unpleasant odors? Is the temperature comfortable?
Meet the Staff & Talk to Residents
Meet and talk with residents and staff members. Do they seem friendly? What do residents like most and least about living in the community? Notice whether staffers seem motivated, knowledgeable, accessible and reasonably happy in their jobs.
Observe Staff Behavior
Pay attention to how staffers interact with residents. Do they treat them with kindness and respect or do they seem rushed or bothered by residents' requests?
Watch For Resident Grooming
Look for residents to appear well-groomed. Are men clean shaven and women well-kept? Do they appear active and engaged or drowsy, listless and bored?
Eat a Meal With the Residents
Eat at least one meal with other residents at every assisted living you're considering. Is the food tasty? Ask about dining hours, whether there's a menu to choose from and whether residents can eat meals in their apartments or rooms.
Review Calendars of Events
Many communities post monthly events calendars. Check these out and see if they're appealing to your loved one.
Compare Resident-to-Staff Ratios
Ask about the residents-staff ratio and compare it to other assisted living communities you're considering. Ask how day and night residents and staff ratios differ? When you get home, call the National Long-Term Care Ombudsman Resource Center at 202-332-2275 and ask how many complaints the facility has had, the seriousness of the complaints and how they were handled.
Creating an Effective Legal Plan
Before loved ones' move to assisted living, it's important to make sure that their affairs are in order and that serious matters are addressed in written documents. For instance, who is designated to make decisions if acute health conditions emerge? Who will handle mom's finances if she is incapacitated? Who will make certain that the proper documents pertaining to mom's treatment wishes get into the hands of doctors, assisted living facilities, family members and attorneys?
Your Relative's To-Do List for Managing Their Legal Affairs
Create a Living Will
Also known as a health-care directive or advanced directive, this document specifies your wishes regarding care and treatment if you become incapacitated or otherwise unable to communicate. Most state department of aging offices provide free forms to do this. Long-term care facilities and hospitals are required by law to follow the dictates of living wills. Many states also now have Physician Orders for Life-Sustaining Treatment or Medical Orders for Life-Sustaining Treatment forms as well, which are expanded Do Not Resuscitate orders that apply in non-hospital settings. (See the MoneyGeek page Protecting Your Parents' Finances to learn more.)
Set up a Durable Power of Attorney for Healthcare
Some states have different names for durable power of attorney for healthcare, such as health care proxy. This enables you to give someone you trust (known as the agent) authority to make medical and end-of-life decisions for you, such as Do Not Resuscitate. The agent can go to court to enforce your decisions, if necessary, hire and fire medical workers involved in your care, and gain access to your medical records. A healthcare power of attorney usually has broader authority than that of a living will. (See the MoneyGeek page Protecting Your Parents' Finances to learn more.)
Make a Will
This stipulates how assets are disbursed upon your death. Designate an executor to prevent a court from appointing one. The executor ensures that assets are distributed according to your wishes and handles financial obligations, including final taxes and other expenses for the estate.
Set up a Power of Attorney for Finances
This gives someone else the authority to manage your financial and legal affairs, such as paying bills, managing your real estate, or liquidating investments to pay for care. (See the MoneyGeek page Protecting Your Parents' Finances to learn more.)
Helping Loved Ones Adjust to the Move
The move into an assisted living community can be stressful and even frightening. Many older adults fear that they'll be forgotten and alone. Adult children can play a critical role in helping relatives adjust successfully. First, understand and acknowledge that this is a life-changing move. Reassure your loved ones that they won't be left alone.
When the big day arrives, have family members help pack up mom and dad and move together. Make it a celebration, perhaps with a brunch before the move. Let them know that nearby loved ones will visit frequently and that those living farther away will stay in touch regularly. Make good on those promises.
7 Strategies to Smooth the Transition
Visit the Community Before the Move
Visit the assisted living community as often as possible before moving day to help your relative get to know some residents and staff.
Eat Meals With the Person You're Assisting
Eat meals with your parent at the assisted living community before and after the move. (Assisted living communities often welcome guests for meals, but may charge a fee.)
Throw a Party on Arrival
Throw a house-warming party and decorate your parent's new space with cherished keepsakes, books, family photos, and perhaps some new items like throw pillows, a comforter or window treatments.
Accentuate the Positive
Accentuate the positives of your parent's new home like big common areas, regular activities and outings, and help with chores and daily living tasks.
Encourage Involvement in Activities
Get your parent involved in activities like bingo and movie night soon after move-in. Ask the facility's management to introduce your loved one to other residents.
Indulge Interests if Possible
Talk to the staff about letting your parent indulge her interests, like letting her spend time in the kitchen if she loves cooking or planting flowers and vegetables if gardening's a hobby.
Use Modern Communications Technology
Ask staffers to arrange Skype, Facetime or Snapchat sessions for your parent to help them stay in touch with family and friends.
When Someone You Care for Refuses to Consider Assisted Living
Doctors, loved ones and friends may realize it's time to move a parent into an assisted living community. But it's not uncommon for the parent to reject the idea altogether. Here are five tips to help a reluctant loved one come around to see that the move is in her best interest.
Ease Into the Idea
Don't act as if you made the decision unilaterally. Go easy at first, broaching the idea gently and seek your parent's feedback.
Propose touring an assisted living community together. If there's much resistance, drop it for the time being and return to the idea on another day.
Express Your Concerns
In a non-threatening way, point to reasons for the move — a fall, difficulty keeping up with daily tasks, failing health, for instance — and make it clear that you and others worry about your parent.
Emphasize Positive Aspect of Assisted Living
Emphasize that your parent will make new friends, become involved in social activities and outings, have ready access to transportation but won't have to deal with home maintenance and will get help with daily activities.
Enlist Help From Trusted Friends & Family
Try to get a friend of your parent or a trusted clergy member to help her see the wisdom in moving to assisted living.
Caregiving from a Distance
Caring for a loved one is difficult even when you live nearby. It's much more challenging when you live in another state. You see your parent much less frequently. You may become frustrated over your ability to help, or become embroiled in territorial disputes with siblings over care.
Being a long-distance caregiver doesn't mean that you can't help your parent a great deal. You can provide a fresh eye and insights that might be overlooked by local caregivers. You can help take care of financial issues, insurance claims, and weigh in on services the assisted living community provides. And rapid advances in technology make long-distance communication, including video-conferencing, easier than ever.
But caregiving from a distance also presents enormous challenges: making time and footing the bill for travel to the assisted living when it's not an emergency, balancing the time-consuming tasks with family and work, and dealing with the emotional stress of infrequently seeing your parent.
Four web sites offer information, tips and resources to help long-distance caregivers.
Tips for the Long-Distance Caregiver
AARP, an advocacy organization, assembled nine tips to help a long-distance caregiver be effective from a distance.
Handbook for Long-Distance Caregivers
The Family Caregiver Alliance offers a 31-page no-cost handbook to guide long-distance caregivers, as well as other resources.
Long Distance Caregiving: Getting Started
The National Institute on Aging offers distance caregiving resources, including FAQs, how to split caregiver responsibilities, and simple things you can do to make distance caregiving easier.
Caregiving: Tips for Long-Distance Caregivers
What you can do to help your loved one from afar and how to make the most of personal visits.
Tips for Small-Scale Living
Seniors moving to assisted living must prepare to downsize considerably. It's a good idea to measure the new space and speak with residents and staff about what others bring and what they leave behind. Here's a sample of what to take, but always check with the facility to be sure.
What to Bring to an Assisted Living Facility
a love seat instead of a couch, for example
(if your unit does not come with one)
nightstand and dresser
A few sets of sheets, blankets, a bedspread, and pillows
A computer, laptop, or tablet
and curtains, artwork, houseplants
A few small trash cans
and stereo, radio, and telephone
A laundry basket
and light bulbs
Pots, pans, glasses, cups, and utensils
What Not to Bring to an Assisted Living Facility
Area or throw rugs that pose a safety risk
Expensive and seldom-worn jewelry
Lots of knickknacks or collectibles
Lots of bulky clothing
Lots of mugs, appliances, bathrobes, coats, handbags
Chairs on wheels
Assisted Living Communities & Cost at a Glance
U.S. assisted living communities
Residents of assisted living communities
National median monthly cost for assisted living
Sources: National Center for Health Statistics, Genworth 2019 Cost of Care Survey
The Price Tag for Assisted Living
Costs for assisted living communities vary a great deal depending on the location, whether the resident has a private or shared apartment or room, and the services received.
These 10 tips can help you keep costs under control:
Rent a studio apartment instead of a full-sized apartment. This can reduce costs by 15 percent to 20 percent a month.
Go Suburban or Rural
Living outside a major metro area can reduce costs by up to 25 percent, while moving out of state can sometimes reduce the cost by much more.
Ask for a Deal
Assisted living communities with empty beds may consider waiving some fees or offering financial move-in credits, which can slash your initial tab by up to $10,000. One note: Communities don't provide occupancy rates to potential residents but do disclose them to referral services, and some of these fees can be found at the web site A Place for Mom.
Review the Monthly Bill
Pay close attention to fees for services, including help with bathing, mobility, medications, laundry and housekeeping. Even facilities that say their monthly fees are "all-inclusive" sometimes charge for some of these services. Assisted living costs for the overwhelming majority of residents are paid out of pocket from their own financial resources or those of loved ones. That can quickly eat through savings, of course. But other options exist to help foot the bill.
Buy Long-Term Care Insurance Wisely
Long-term care insurance covers assisted living, but most policies don't pay until you're incapable of performing at least two activities of daily living or are mentally impaired. The cost of premiums depends on age, gender, health and level of care needed.
Review Whole Life Insurance Policies
Whole life insurance policies with long-term care riders or conversion options ensure you — or others — will certainly receive payouts on your premiums, whether in the form of long-term care coverage or benefits to your spouse, children or other heirs at the time of your death.
Look at Assisted Living Loans
Assisted living loans are meant to help families over periods of less than two years while they're awaiting other means of paying for care, like the sale of a home or a veteran's pension.
Consider Annuities With Long-Term Care Riders
Annuities with long-term care riders enable you to make a series of payments or a single payment to an insurance company. The annuity, in turn, will provide you with monthly income over a number of years or for life.
If you lack long-term care coverage and assets to pay for assisted living, Medicaid may be an option. It helps pay for assisted living in a growing number of states. But to qualify, residents must spend down most of their assets and be unable to perform at least two activities of daily living such as dressing, bathing, moving from a chair to a bed, and walking. Not all facilities accept Medicaid. Some non-Medicaid state programs also offer financial assistance to help pay for assisted living.
Check With the VA
If you or a loved one is an aging veteran, check with the U.S. Department of Veterans Affairs about benefits that could help pay for assisted living.
Expert Q&A: Making the Transition to Assisted Living
Barry J. Jacobs is a clinical psychologist, family therapist and the author of the book The Emotional Survival Guide for Caregivers: Looking After Yourself and Your Family While Helping an Aging Parent. He works as the director of Behavioral Sciences for the Crozer-Keystone Family Medicine Residency Program in Springfield, Pa. He is the national spokesperson on family caregiving for the American Heart Association. In July, Jacobs is coming out with a new book he co-authored "AARP Meditations for Caregivers: Practical, Emotional, and Spiritual Support for You and Your Family."
What signs indicate it may be time for older adults to consider assisted living?
Barry J. Jacobs:
It has to do with whether people can manage their activities of daily living. Can they dress, groom and feed themselves? Can they take medicines? Are they falling? If they need some help, that help comes from a home health aide coming to the home, a family member caring for them or going to a facility like an assisted living environment where they get a certain amount of supervision with their care.
What are some of the biggest challenges in making that transition to assisted living?
Barry J. Jacobs:
There's a tremendous sense of loss when people move out of homes that they've lived in for decades. They have to part with all sorts of possessions. They're moving to an environment where they usually know no one, where there are all kinds of rules, where they have to adapt to institutional living.
Sometimes, there's a lot of anger. Many people who are going into assisted living are being arm-twisted into that decision by family members who don't feel their parent is safe living at home on their own. For family members, there's a lot of guilt. They feel that this is the right thing to do, that on balance, they are ensuring their loved one's safety. They recognize that the loved one is not happy with the move, that the loved one is not living the way they're accustomed to living.
And there's the whole issue of dealing with the assisted living facility itself: the staff and how clean the place is. So family members become very hyper-vigilant in going into to facilities and trying to advocate for their loved ones, sometimes very aggressively.
What tips would you offer to help people find the right assisted living community?
Barry J. Jacobs:
For starters, what works best is to know someone who has a loved one in that facility who knows first-hand what the care in that facility is actually like. Some facilities look good on paper, and when you go for a tour, all places are putting a good face on. So I think having that experience from someone you know is important.
It's important to find a place that has a staff that's not having a lot of turnover, that's well-rated, and a facility that has been around for a little while, not necessarily decades, but not a brand-new facility either so the operation has sort of been perfected over time so there aren't a lot of bugs in the system. When you visit the facility, are people active? I'm hoping that most facilities are offering not just a safe place, but are offering a lifestyle people can embrace and a community that they can be a part of.
How should family members prepare for emergencies, including a sudden health crisis?
Barry J. Jacobs:
The most important thing I would say to that is that everybody living in assisted living needs to have an advanced directive or living will. But people need to have some legal documentation of what their wishes are in the event that they are unable to speak themselves so family members have that at the ready in the event there's an emergency. I see that constantly in the work that I do.
What is the best way to persuade a reluctant parent to move into assisted living when the time is right?
Barry J. Jacobs:
I think most people are probably reluctant or fearful about going into an assisted living; they just don't want to go. Many places will allow you to move in for a short time. They'll either let you come in and stay weekends and kind of let you get a feeling for the place or let you move in for 30 days and if you move out within 30 days, you get your money back. That has a lot of advantages because it allows people to not just go by their first impression, to see what life might actually be like there by living there for a little while.
If children can allow parents to do that, I think it gives parents a greater sense of control over what's happening to them and probably eases the transition. The other thing is I think children really need to reassure a parent that they won't be forgotten in this facility, that even though the parent may not be having big family dinners in their home anymore that the children are making a commitment to continue to see the parent on a regular basis, and it's not like the parent is being put on a shelf somewhere. They're downsizing into a home where they have supports, and the children are going to continue to be an important part of their parent's life.
These resources provide advice and information about assisted living and how to make the transition successful.
Offers a resource library for caregivers and other information on the transition to assisted living.
Offers a state-by-state list of assisted living regulations.
National Center for Assisted Living
Provides resources on finding and paying for assisted living, as well as consumer protections for residents and their loved ones.
Life Care Funding Group
Offers expert advice to help people who need funds to cover the costs of senior housing, including assisted living communities.
Find Local Area Agencies on Aging
The U.S. HHS Administration for Community Living contains links to aging agencies in every U.S. state and territory, with plenty of helpful information for long-distance caregivers
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