A common worry many adult children express about aging parents is that the parents are alone and it's time they got some help. The kids are worried because of changes in the parent's health, mobility or memory problems. The aging parent may not agree that there is anything to worry about, and this, of course, leads to resistance. Assisted living is something adult children frequently mention as a solution to their worries. But is it? There are pros and cons to consider and the family needs to understand what assisted living is and what it isn't. On a personal note, I have a 96 year old mother-in-law in one and a disabled sibling in another. I have seen many of these places personally in the course of my work. Here's my list of things you need to know, developed at AgingParents.com after answering countless questions about our clients' aging parents over the last ten years.
1-Medicare does not cover assisted living, nor any part of the expense of this option. Nor does Medicaid pay for it except in a few rare experimental programs. It's largely an out of pocket expense.
2-What happens if an aging parent goes to assisted living, stays for a few years, is happy there, but then runs out of assets? They either have someone else to pay the cost or they have to move out.
3-The actual cost of assisted living may not be fully understood when you size up a place under consideration. You may be quoted the price for the rent of the apartment. The cost is usually more than the rent, as your loved one must also pay many other charges. If help is needed with bathing, for example, there is an additional cost for that. Mom can't remember to take her pills? "Medication management" can be a huge cost on top of the basic rent.
4. Assisted living is not a nursing home with nicer furniture. Nursing care is not offered, nor does this kind of facility have legal authority to give skilled nursing care. If a nurse is on staff, the nurse's role is limited to assessment and directing the resident assistants. Some assisted living facilities also have a separate nursing home wing or section, and that requires a different license to be a skilled nursing facility.
5. If there is an emergency, the assisted living home staff will call 911. They will not offer emergency care because they can't. It is not a hospital, nor can it provide medical assistance.
6. If your loved one is difficult to care for, or needs frequent treatment for chronic conditions, the assisted living facility may not accept them. A doctor has to verify that they are suitable by signing a form. On top of that, the facility does its own assessment to see if the prospective resident is a fit for their community.
7. No one is watching over your loved one 24/7. Help is available, but your aging parent will not have a personal attendant noting their every move. Someone will check on them daily and if they don't show up for meals, someone will notice. If medications are being given out by the attendant ("med tech") every day or more than once a day, that person will notice if something is wrong. However, the assistants are not medically trained. They help with basics but should not be expected to diagnose, or offer anything other than exactly the medications on the resident's list. They may ask the nurse to check on a resident.
7. These homes offer an enriched social environment. There are meals in common and a chance to socialize, activities offered, and entertainment of various kinds. Some communities offer classes. Residents have a way to call someone if there is a problem. If they're not feeling well, an assistant can be summoned by either pulling a cord, a call bell, or pressing a button. The proximity of attention to an aging parent's needs is one of the best ways to assuage the worries of adult children. It may not be perfect, but it is far better than an isolated parent being left alone with scarce opportunity to get help short of calling 911.
8. Usually there is transportation on specific days so that residents can get to medical and other appointments. Some people, like my mother-in-law, decided to give up driving when she moved into an assisted living community. This is a relief for family members concerned about an elder's dangerous driving. It eases them out of that responsibility by making rides in the facility's van easy to get.
9. The work of maintaining one's self is reduced. All meals are provided and the need to shop and cook is eliminated. The facility does the laundry. Linen changes are usually included as well. In other words, someone else makes the bed up with clean sheets, so an impaired elder doesn't have to do that. For aging parents struggling with household chores, this is a major benefit.
10. Many elders resist the idea of moving into "an old folks home." However, once they get there and their lives are easier, many make good adjustments and enjoy the positive things. Social isolation is bad for one's health. Assisted living provides protection against isolation if the aging parent is willing to accept community life. It's not for everyone but when it works it works well to keep aging loved ones engaged.