Signs It May Be Time for Assisted Living

The National Institute on Aging says it is not always clear when an aging parent or relative needs help. Some people ask. Others do not want to cause worry or admit they are struggling. The institute groups the signs into several areas, and suggests that the place to notice them is in the person's home, during a visit long enough to see an ordinary day.

No single item on this list settles anything. Everyone forgets an appointment or lets the mail pile up now and then. What to watch for is change from how your mother or father used to manage, and several signs appearing together.

• Changes at home. Trouble preparing meals safely on the stove, not bathing regularly, clothing that does not suit the weather, clutter or a home that is no longer clean, medications that are missing or not taken as prescribed.
• Health concerns. Significant weight loss or gain, poor hygiene, falls, trouble walking or getting around.
• Mood. A change in mood can signal a need for help. The institute notes that depression in older people is sometimes mistaken for normal aging, and that a person may brighten up for a short call or visit.
• Memory and thinking. Confusion, poor decisions, or changes in personality that go beyond occasional forgetfulness.
• Loneliness or social isolation, which the institute lists among the health concerns.

A phone call or text is not a reliable way to tell how someone is doing. If you live far away, the National Institute on Aging suggests asking your parent's permission to stay in touch with people who see them regularly, such as neighbors, friends, the doctor or a relative nearby, and asking those people to call you with concerns.

When you do visit, look past the tidy living room. Open the refrigerator. Look at the pill bottles and the dates on them. Notice whether the mail has been opened, whether the car has new dents, and whether your parent moves around the house with ease or holds on to furniture.

The family caregiver is part of the picture too. If a spouse or an adult child is providing most of the care, signs of strain in that person count. The Alzheimer's Association suggests caregivers ask themselves whether the person's care needs are beyond their physical abilities, whether their own health is at risk, and whether they are neglecting work, family and themselves.

Occasional forgetfulness is a normal part of aging. The National Institute on Aging says that more significant memory problems, changes in thinking or personality, or poor decision-making could indicate a serious condition that needs medical attention. Only a doctor can say what is causing them.

For a person who has already been diagnosed with dementia, the Alzheimer's Association says that during the middle stages of Alzheimer's disease, 24-hour supervision becomes necessary to keep the person safe. It suggests asking whether the person is becoming unsafe in their current home and whether the structure and social contact of a care setting would benefit them. Our guide to memory care vs. assisted living explains the options.

Start small and start with your parent. If someone is in immediate danger, call 911. If your parent says they feel hopeless or you are worried they may harm themselves, the National Institute on Aging says to seek help right away by calling or texting the 988 Suicide and Crisis Lifeline at 988.

1. 1

   Write down what you are seeing

   Dates and specifics help: two falls in March, lost about ten pounds since the summer, the stove left on twice. A doctor can do much more with examples than with a general worry.

2. 2

   Talk with your parent

   The National Institute on Aging suggests mentioning your worry without sounding critical, then offering practical help that respects what the person wants. Our guide to talking to a parent about assisted living has more on how.

3. 3

   Arrange a doctor's visit

   The institute suggests offering to make the appointment, give a ride or go along. Some causes turn out to have a simple fix, such as a new glasses prescription. Ask the doctor what kind of help and supervision your parent needs now.

4. 4

   Find out what help exists nearby

   Help does not have to mean a move. The Eldercare Locator connects older adults and their caregivers with local services and can be reached at 800-677-1116. Your local Area Agency on Aging can also explain what is available.

5. 5

   Learn the levels of care before a crisis

   The institute says the right time to plan is before the person needs extensive help, while they can still make their own decisions. Our overview of senior care levels in California sets the options side by side.

Not always. Depending on what is behind the signs, the answer might be grocery delivery, a home care aide a few days a week, an adult day program, or rides to errands and appointments. The National Institute on Aging notes that most people prefer to stay in their own home for as long as they can, and that there may come a time when living alone is no longer safe or comfortable.

Assisted living tends to fit when help is needed every day and at unpredictable times. The institute describes it as care for people who need help with daily tasks, but not as much help as a nursing home provides. In California, assisted living communities and board and care homes are licensed as residential care facilities for the elderly (RCFEs). The California Department of Aging describes them as non-medical: they provide care and supervision, and residents should not need ongoing medical assistance from the home's staff.

A home cannot simply accept whoever applies. The state's consumer guide explains that the personal care a home provides is based on a pre-admission appraisal of the person, so the home will ask about health and daily needs before it offers a room. If your parent would rather stay home, assisted living vs. home care compares the two honestly.

Hamssa Benrekia is a senior living placement specialist in Torrance with a background in hospice, palliative care and home health. If your family has reached the point of looking at homes, she can talk through your parent's needs and budget and suggest licensed assisted living or memory care homes in the South Bay and Harbor area of Los Angeles County. She does not diagnose or replace the doctor. To start, contact Hamssa, or read the California Assisted Living Placement Guide from the beginning.