How to Tell if Someone With Alzheimer's Needs Assisted Living

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It can be hard to decide when someone with Alzheimer's disease should no longer live alone. With sufficient lifestyle supports and memory aids, some people with Alzheimer's and other types of dementia live independently for years. The illness usually begins mildly, and progresses at different rates for different people.

Eventually, though, you may have your doubts about how well things are going. Are you overreacting to ordinary problems? Or making excuses so you can postpone tough choices? It can be difficult to know. Confounding the issue is the fact that people with dementia are often able to conceal the severity of their problems, especially if you don't see them every day.

Here are some questions to help you decide whether memory care, a type of assisted living for those with Alzheimer's and other dementias, might be a good option for your loved one. Each "yes" answer is a sign that warrants a closer look.

Changes in communication

  • Have letters and grandchildren's birthday cards slowed or stopped?
  • Does she seldom initiate calls anymore (it's always you calling first)?
  • Does she seem in a hurry to get off the phone, fail to ask you many questions, or seem unresponsive to your comments?
  • Do you get nonemergency calls at unreasonable hours, or hear complaints from friends that they're receiving such calls?

Changes in self-care

  • Is she losing weight inexplicably?
  • Is she gaining weight inexplicably?
  • Has her usual style (hair, makeup, clothing) become noticeably different?
  • Does she dress appropriately for the occasion?
  • Does she dress appropriately for the weather?
  • Have you detected the smell of urine on her clothes?
  • Does she stay up later and later, and then not wake until practically midday?

Unexplained weight loss may signal an illness, such as depression, or may reflect that she's losing the ability to go through the complex steps of shopping and cooking, or is even forgetting to eat. Conversely, she may forget she's just had a meal, and eat again and again. Obvious signs of a change in grooming standards, whether she's just more sloppy or more flamboyant or inappropriate, may indicate these tasks are becoming too much for her. Unpleasant body odors may mean she's neglecting to bathe or forgetting to toilet. Mixed-up hours (day and night) can be symptomatic of sundowning or depression, and tend to fuel unhealthy isolation.

Changes in social life

  • When you pick her up for an appointment, is she routinely not ready yet?
  • Does she forget you said you'd be visiting and seem surprised to see you?
  • Does she berate you for being late when you're not?
  • Does she no longer mention certain old friends, or when you mention them, is she dismissive?
  • Has she quit longstanding social engagements (clubs, card parties, religious committees)?
  • Has she noticeably lost interest in younger grandchildren (she's no longer asking about them, wanting to spend time with them, or sending them notes or gifts)?

A shrinking social life and increased isolation are not natural functions of aging. Unless she's so old that her longtime friends have all moved or died, it's more likely that she's withdrawing because of embarrassment about her dementia or inability to keep up -- or her friends are dropping her because of their own discomfort. Social appointments may also dwindle as her concept of time grows muddied. A person with Alzheimer's or other forms of dementia may forget meetings, anticipate them at the wrong time, and also lose track of recent acquaintances.

Changes in the household

  • Have you ever come to visit and found the temperature of the house inappropriate (much too hot or too cold)?
  • Are cupboards full of multiple units of the same item, more than she could reasonably consume?
  • Is the refrigerator full of expired or spoiled food?
  • Is the refrigerator nearly empty?
  • Do you see any melted pots or pans with burned bottoms?
  • Do you see signs of spills that haven't been mopped?
  • Are there piles of unopened mail or obviously unread newspapers?
  • Can you smell urine?

When you visit, keep alert for these signs that she's not keeping up with everyday home care. Simply buying the same foods over and over (a particular brand of cereal, 20 varieties of vinegar) is a memory problem that may seem harmless, if expensive. But it's a safety hazard if she's forgetting to turn off burners, turn up thermostats, clean spills, or throw out old food.

Additional signs that someone with Alzheimer's needs assisted living

Other more obvious and more ominous warning signs that someone may no longer be able to live alone and may benefit from assisted living include:

  • Having electricity or water shut off because bills have gone unpaid
  • Letters thanking her for her contribution to a charitable organization that you're not aware she has a history of supporting
  • Robbery (because she let someone in the house unsuspectingly or left a door unlocked)
  • Wandering from home or getting lost

Paula Spencer Scott

Paula Spencer Scott is the author of Surviving Alzheimer's: Practical Tips and Soul-Saving Wisdom for Caregivers and much of the Alzheimer's and caregiving content on Caring. See full bio

about 1 year, said...

My Aunt has had Dementia for several years and has been diagnosed with last onset-Alzheimers. Adult Protective Services intervened for possible exploitation from one of her drivers/caregivers, as she was writing large ($450.00 plus) checks weekly and was taken to a bank branch were my Aunt was unknown. APS did pay my Aunt two home visits, and they couldn't prove exploitation, but they were worried about her safety. She was asked if she cooked on the store (she said yes), but was not able to tell them what she would do if there was a fire. The next time APS visited, when asked about what she would do if there was an emergency, she told them that she would go to sleep. I took her to her primary care doctor and gave him the card from the APS investigator. asked him for help for my Aunt and our family. I am named Durable POA if her doctor writes a letter saying she is not able to handle her finances, etc. Instead, he faxed a form to APS, which said she needed 24/7 care. She did not have anyone else on her bank account but my Mama (RIP). I took her to a Neurologist who said Assisted Living, rather than 24/7. The Assisted Living I put her in notes she is at Level 1, but I believe she is a Level 3 or 4. She has not had a bath/shower in almost a year, and she is unable to eat without assistance. I am a caregiver that needs some help, so I can help her and get some relief.

about 1 year, said...

My parents want to stay in there home. I have help 8-4 every day but after dinner and beneed someone to stay at night. They go to Bed By 9 pm every day. Having some one there at night Would be a grease help

about 1 year, said...

My husband is in a nursing home and he has dementia. I called everyday. But now he wouldn't even come to the phone. I haven't talked to him in about three weeks. It is so sad because we were very close and it hurts that he won't talk to me

over 1 year, said...

Are there any Memory Care facilities near the Stone Oak area in San Antonio that accept Medicare to help supplement the monthly rental costs?

over 1 year, said...

My name is Regena Carroll, I am the one who witnessed my sister's first seizure in 2006 and have helped her to be where she is today. She has overcome death numerous times. Currently she resides with my husband and I in our home in Newnan, GA. Recently diagnosed with things that I would like to speak with someone about. Thanks

over 1 year, said...

My dad was on his way to dementia then he had a stroke/heart attack. Now my dad has been diagnosed with dementia and other medical issues.My dad is gone and now replaced with his new self. He repeats himself,has 15 sec memory-maybe. Now after discharge from from hospital instead of home he will go to a SNF.

over 1 year, said...

I have a mother with epilepsy and possible dementia. She has a problem with her eating habits. She would take very little bites of her food and then say she is full or doesnt want anymore . Due to the weight loss, we took her to the hospital. Even the nurses couldnt get her to eat. She has anxiety attacks which it makes it more difficult for me to feed her. It doesnt matter how much the food looks pleasing she still wont eat. She will have a few sips of her boost and ensure. If she doesnt eat, she will sleep. Any suggestions will be great.