Who Does Well in Assisted Living, Who Doesn't

Who Does Well in Assisted Living, Who Doesn't

When home care is no longer an option for an older adult, the next choice is often assisted living. How would your loved one adjust there?

"It's almost an impossible question because there are so many variables," says Linda Adler, founder and CEO of Pathfinder Medical, a provider in Palo Alto, California. Health status, the level of assistance needed, finances, and the quality of care at the facility all factor in, as does personality.

Expectations matter, too. Since every family situation is different and conditions are always changing, it's best to go into transitions expecting both the best and the worst, eldercare experts say, and taking what steps you can to ease the way.

Here, 6 types who adjust well in assisted living, and how to make the transition even smoother.

Who does better in assisted living?

1. Appreciative realists

Why: Assisted living isn't for everybody. But those who recognize that they've reached a point where they need the added eyes, ears, and strong helping hands of facility tend to make a better adjustment -- especially if they feel grateful for the assistance.

"Some people are relieved to not feel responsible anymore for the logistics of shopping, cooking, and cleaning -- all those things that have become a struggle," says social worker Lisa P. Gwyther, education director of the Joseph and Kathleen Bryan Alzheimer's Disease Research Center at Duke University and coauthor of The Alzheimer's Action Plan.

What helps: Make sure that assisted living is the right fit from a physical perspective. It's a good option for a loved one who needs some help with functional tasks -- dressing, bathing -- but doesn't need constant medical monitoring or care.

2. Extraverts who've become isolated

Why: When you're a homebound older adult, "you're basically incarcerated in your home," says geriatric care manager and eldercare consultant Kay Paggi of Dallas. "A lot of people are very isolated and understimulated at home alone with a single caregiver," adds Gwyther.

Providing a high level of support is burdensome and stressful even for loving family members. And paid caregivers can't always provide the level of stimulation needed, especially if they speak a different language or come from a different social class, culture, or educational background, says Paggi.

"People with a basic social tendency tend to thrive in assisted living," says Gwyther. Social butterflies find it easier with so many peers nearby.

What helps: Look for ways to help your loved one get connected socially, within the assisted living community and outside it. Choose a community with activities that will be interesting and engaging, or one that provides access to off-site events and locations -- cultural outings, shopping, hobby groups, church or synagogue, or a senior center.

3. Adaptable types used to life's transitions

Why: Those who've moved easily in the past tend to fare somewhat better moving to assisted living, says Adler. A military wife who lived in many different houses might find this move easier than someone who lived in the family home for 60 years.

Some people just have more resilient approaches to life. Agreeableness was associated with a positive adjustment to assisted living, found University of Florida PhD candidate Wendy L. Mills in a 2010 study of 64 residents (average age: 86). Those who adjusted well reported that they entered assisted living with the intention of "making it work."

What helps: If your loved one's affect changes dramatically when he or she transitions to assisted living -- from sunny to depressed, or from talkative to withdrawn -- look for possible reasons. Pain and poor care can dampen a strong personality. "Even the most well-adjusted person in the world isn't going to do well if the care isn't so great," Adler says.

4. Those with family nearby

Why: One of the truisms of assisted living, Gwyther says, is that residents with families nearby do better and receive better care. Even though many assisted living facilities try to provide stimulating activities for residents, having family buffers against isolation. Families can take their loved ones out for fresh air or a change of scenery, as well as talk about familiar people and places in a way that staff or new acquaintances can't.

What's more, families play a strong advocate role, which triggers better care. Gwyther says families of those in assisted living generally say they do more negotiating on behalf of their loved one about the type of assistance that's provided, deal with staff more, and provide more physical and practical support, such as financial management and shopping, compared to families of those in nursing homes. This is especially true when a loved one has dementia.

What helps: Interact often. Many studies show that family contact is one of the strongest predictors of life satisfaction, in all kinds of housing settings. In a nursing home setting, family involvement is linked to lower mortality, decreased infections, less hospitalization, and earlier hospital discharge, according to a 2005 critical review of the literature in Aging and Mental Health. These findings are thought to be relevant to other settings as well.

5. People who are attracted to amenities

Why: Older adults of modest means -- who may have been living in small houses -- often feel that they're "stepping up," Gwyther says, when they move to a well-appointed assisted living facility. (Her own grandmother so loved the court of tables with umbrellas in her facility's atrium that, combined with the lack of housework there, she believed she'd upgraded to a swanky spa.)

What helps: Pay attention to the amenities that will matter most to your loved one -- and to you. It's common for families to pick the setting where they can best imagine themselves visiting, Gwyther says. Because these families are then more inclined to visit, they tend to be more active advocates.

At the same time, be careful to choose the setting that's most appropriate, regardless of amenities. Well-appointed assisted living facilities often win out over nursing homes or communities with fewer amenities even when they're not the most appropriate choice, Gwyther warns. Before noticing amenities, be sure to find a place that ticks the right boxes concerning quality of care and best fit for your loved one.

6. Those with mild to moderate dementia (in a dementia-care assisted living facility unit)

Why: People with dementia tend to live in the present moment (or the distant past), so they're often not distressed to find themselves with others who are similarly confused. "They may not actively miss family or feel loss if they're lucky enough to be in a healthy, lovely place with good caregivers," Adler says.

It's critical, though, that a loved one with dementia live in a dementia-care unit, Paggi says. In general assisted living, there may not be enough medical supervision to make sure the person takes medications properly, for example.

What helps: Monitor how well your loved one is doing, perhaps with the expertise of an independent eldercare consultant or geriatric care manager, because the best type of placement depends on the individual's experience of the disease. Some people have what experts call "pleasant dementia" -- a more benign version of their former personality "“ while others turn aggressive and/or paranoid. A high-needs patient will do best in a facility where the staff is trained in dementia care and the turnover is low.