When to Move to Senior Living: Weighing Your Loved One’s Wants and Needs

The decision to transition to senior living should occur after “a series of conversations” that begin in one’s 50s, says Cleveland Clinic Center for Geriatric Medicine Section Chief Dr. Ardeshir Hashmi. However, when it comes time for senior care, many Americans are forced into making a decision during an emergency.

Keep reading for Hashmi’s advice on how to know when it’s time for senior care, along with what caregivers should look for to ensure their aging loved one remains safe and supported for as long as possible.

The vast majority of older American adults want to age in place. In fact, “76% of Americans age 50 and older say they prefer to remain in their current residence,” a 2018 AARP study concluded

Whether or not your loved one is open to discussing senior living, Hashmi says it’s most important to be observant of your loved one’s living conditions. In a recent interview, Hashmi notes that a caregiver needs to be a “good detective,” especially if their loved one lives alone. This means paying attention to the kitchen, pantry, bathroom, and office — or any area where their parent conducts home business, such as paying bills.

“It can all become very complicated,” Hashmi says. “Errors can start to creep in, when bills are not getting paid, for instance — not just mail, but bills piling up.”

Medication management is another common issue to look for, Hashmi notes. Does your loved one remember to take all their pills regularly? Have they ever taken a medication more than once per cycle? When talking with their doctor, can they answer important questions like how many medicines they take and at what time of day?

Inspecting your loved one’s home room by room

Carefully consider your answers to the questions below. If your answers paint a picture of your loved one’s basic needs going unmet, it may be time for senior care or in-home help.

Top areas of focus

• Are all medications up to date? If your loved one uses a medication management tool, like a weekly pill box, did they skip any days?
• Is the mail piling up either in the mailbox or in a location where your loved one keeps it for inspection? Are bills going unpaid?
• If your parent still drives, does their car show unexplained damage?

Kitchen and pantry

• Is the food in the refrigerator fresh and not past its expiration date?
• Same for the food in the pantry: Is it within its best-by date?
• Are the refrigerator and pantry well stocked, partially empty, or bare?
• Do you see dirty dishes piled in the sink or dishwasher?
• Are the cooking surfaces clean?

Bathrooms

• Do the cabinets and vanities appear properly stocked with essentials, like toilet paper and soap?
• Are tubs, toilets, and sinks clean and working properly?
• Do you see any clean towels ready for use?

Office

• Is computer equipment — like printers, laptops, and monitors — functioning and up to date? (Your senior may not be an adept computer user, but checking in with them about updates and security can help reduce the risk of online fraud.)
• If your loved one is a list maker, do you see signs they are keeping up with their to-dos?
• If a voicemail recorder is in use, does it show unacknowledged messages?

Hallways

• Do you see non-working or missing lightbulbs in stairwells or other high-traffic areas?
• Are nightlights installed and working properly in dark areas?
• Is there a clear, uncluttered path between rooms?

Outside the home

• Do the yard and plants appear neglected?
• Is the exterior being maintained regularly? Is your parent tending to needed repairs?
• If your loved one has trouble walking, are the paths around the home and to exit points like a sidewalk or driveway clear and unobstructed?

Observing appearance and behaviors

Behaviors occur in the moment — they include gestures, speech, and posture — but they can leave a sign after the fact, too. For example, the turned-up corner of a rug could indicate shuffling.

Read related article:10 Signs Your Elderly Parent Needs Help

Let our care assessment guide you

Look out for these key behaviors:

Appearance and hygiene

• Is your loved one grooming as they usually do, or has there been a tendency toward not getting ready for the day?
• Are they showering or bathing regularly? Do you detect any new odors?
• Are their clothes neat and/or clean?
• Have they gained or lost weight suddenly?
• Do they have any cuts, abrasions, bruises, or other small injuries that are taking a long time to heal?

Speech

• Does your loved one mumble or whisper to themselves?
• Are their words harder to make out? Are their sentences cohesive?
• Do they repeat questions or statements over and over?

Gestures

• Do you notice that your loved one is shuffling more instead of walking?
• Are they stumbling, tripping, or steadying themselves more often?
• Do their hands repeatedly search for an item before grasping it?

Mood

• Is your loved one suddenly despondent or depressed?
• Are they suddenly more frustrated, irritable, or even angry?
• Are you noticing more aggressive or irrational behavior?

While Hashmi says aging to the completion of one’s life at home is possible, he notes that doing so comes with “incredible financial expense.” As a person ages in their home and their faculties deteriorate, the upkeep of the home remains a constant — at the very least — and care needs inevitably increase. “To recreate a robust care structure in the home is incredibly financially intensive, and it’s incredibly labor intensive,” Hashmi adds.

Senior living in a group setting also requires a significant financial commitment, but, on average, it costs less than in-home care, or in-home care with added in-home health care. Genworth’s 2020 “Cost of Care Survey” is now available.

Furthermore, in a home setting, the primary caregiver bears a great deal of responsibility, and burnout is a real risk. Self-care is critical, as is reaching out for help when too much is too much. In a communal care setting, caregivers rotate in regular shifts, specialized care providers are either on call or in house, and the community takes on the responsibilities of maintenance, meals, and social engagement.

“If the goal is to promote physical robustness and mental sharpness,” Hashmi explains, “then we know that social connectivity is a huge piece of that. If the goals are to get better and stay better, then a structured environment may help.”

It’s easy to miss what we don’t want to see. A loved one’s declining health surely falls into that category, even if you’re their caregiver and see them every day, and especially if you’re exhausted from your duties.

“Internally, caregivers can experience a sense of denial in the early phase when things are maybe going along nicely,” Hashmi explains. “You don’t want to see that early warning signal because you are afraid of a couple of things: One is that the Pandora’s box might open. Two: You really can feel alone because you might be one of few people who are truly concerned about your loved one. That is the single, most powerful sentiment. People say, ‘Well, there are others in the family, too, but I am the one. I have asked, and I am still the one.’”

If you are “the one,” remember that you have needs, limits, and a life of your own. Sometimes, caring for your aging loved one means trusting the right care team to take over when the demands upon you are too great. It might also mean letting go of guilt in favor of your loved one’s best long-term interests.

A Place for Mom and Cleveland Clinic: Supporting seniors and their families

This article was developed in conversation with Ardeshir Hashmi, MD, section chief of the Cleveland Clinic’s Center for Geriatric Medicine, as part of a series of articles featuring expert advice from Cleveland Clinic geriatricians.

Read more:Aging at Home: Essential Tips for Safe Home Care

Talk with a Senior Living Advisor

Sources

AARP. ARTICLE. “2018 Home and Community Preferences: A National Survey of Adults Ages 18-Plus.”

AARP. STUDY PDF. “2018 Home and Community Preferences: A National Survey of Adults Ages 18-Plus.”

Administration for Community Living. “2020 Profile of Older Americans.”

American Psychological Association. “Psychologists emphasize more self-care for older adults.”

AP | NORC. “Long-Term Care in America: Americans Want to Age at Home.”

Business Wire. “Is 80 really the new 60?”

Evidence Matters. “Aging in Place: Facilitating Choice and Independence.”

Interview conducted with Hashmi, A., by Eason, Haines. September 13, 2021.

Interview conducted with Hashmi, A. July 26, 2021.

National Institute on Aging. “Aging in Place: Growing Older at Home.”

PD&R Edge. “Understanding the Challenges and Solutions to Aging in Place.”

PRB. “Fact Sheet: Aging in the United States.”

Urban Wire. “American Seniors Prefer to ‘Age in Place’ — but What’s the Right Place?”