Evaluating an older adult's living needs and abilities -- especially living arrangements -- is an ongoing process. And there's a range of options available to meet those shifting priorities and concerns -- from the freedom of living on one's own (perhaps in a smaller place) to the supportive environment of assisted living to the round-the-clock care available at skilled nursing facilities. Each offers something different, so sorting out the options is the first step.
Independent living or aging in place
Sometimes called "aging in place," this is the route that the great majority of older Americans say they hope to take. Your family member is likely to need some support if she chooses to continue living on her own, although how much help she'll need will vary tremendously depending on her health and how connected she is to the community.
A good place to start looking for support is our Local Resources Directory, which can connect you with providers that offer special services to enable older adults to stay in their homes, such as Aging in Place certified Home Remodelers. You may also want to look at simple home renovations, such as adding a railing next to the toilet, as well as the growing list of gadgets that can make independent living safer and more comfortable.
_ Is this the right option for my family member? _ A good candidate has family who are able to check on him every day," says Pat O'Dea-Evans, COO of Paxem, a Chicago-based company that helps seniors who are contemplating a move. Health is a central factor to consider -- one you'll need to re-evaluate periodically as she ages. Older adults who are healthy enough to perform basic functions such as cooking and bathing and who can get around safely may do well living independently.
Also look at the kind of support an older adult has in the community -- does she live near important services like a grocery store, pharmacy, doctors, and a hospital? Is she connected to others in her neighborhood, or has she become socially isolated?
Moving to a new home
As people age, they'll sometimes choose to move into a smaller, perhaps single-story home, sometimes in a different state in order to be closer to their children. If this is something your family member would like to pursue, consider enlisting the aid of a senior move manager, a professional who specializes in the relocation needs of aging adults.
Is this the right option for my family member? If you or another person in your family wants to offer support but lives too far away, relocation may be a good solution. If she's already living nearby and is committed to living independently, it may be wise to downsize as she gets older and a larger home becomes harder to navigate and maintain.
Getting in-home care
If your family member wants to stay in her home but is beginning to need more help, she has a number of options -- from a personal care attendant, who can assist with tasks such as cooking and cleaning, to a certified nursing assistant, who can monitor her medical condition and help with activities like bathing and dressing.
Is this the right option for my family member? If she places a high value on privacy or the familiarity of her home and neighborhood, this may be the best choice. Finding the right match may take some time and effort, however. If she's cognitively impaired, you'll want to be especially cautious before going this route. Although most caregivers are trustworthy, you'll need to make sure she doesn't get taken advantage of.
Moving an older adult in with you
If you have the space and can handle the day-to-day care of your family member, you may want to think about inviting her to come live with you.
_ Is this the right option for my family member? _ Whether to move her into your home is an intensely personal decision. You need to think about the nature of your relationship, as well as her relationship with your partner and children.
The layout of your home is an important consideration: Do you have an in-law unit or even just an extra bathroom that she can use exclusively? Privacy can be very important to older adults, as well as to you and your immediate family.
You'll also need to consider your schedule and her care needs and level of mobility. If you work full-time and she can't get around on her own, she may feel more isolated living with you than she would in a eldercare community where she could socialize with other residents and participate in on-site activities. But if you and she communicate well and enjoy each other's company, and you and your family have the time and ability to care for her, sharing your home with your family member can be a wonderful way to stay close as she ages.
Independent living communities
Usually apartment or condominium complexes, independent living communities generally offer on-site amenities such as beauty salons, banks, fitness programs, and communal meals. They may even have a doctor who makes regular rounds.
Is this the right option for my family member? If she values her independence and isn't in need of daily care -- but perhaps is ready to stop driving, is starting to worry about her safety, or just wants more support and companionship -- an independent living community can be a great choice.
Assisted living communities
Assisted-living facilities cover the middle ground: They serve elders who need more support than they can get living independently but who don't need complex medical care on a daily basis. Most offer meals, housekeeping, and planned activities. Many will remind your family member to take medications but won't do things like give injections.
Is this the right option for my family member? If she is finding daily life increasingly challenging but doesn't have a serious medical condition that requires round-the-clock monitoring, assisted living may be the right choice. As with all eldercare housing communities, assisted-living facilities vary greatly, so make sure you know exactly what a particular location does and doesn't offer before making a commitment.
There's a wide variation in what continuing-care communities provide, but most offer a range of eldercare options as someone ages, from independent living units to assisted living to skilled nursing, all in one place. These facilities can be costly to start -- most charge an entrance fee and may require your family member to purchase her apartment or condominium -- but because many promise to care for residents for the rest of their life, even if their needs change, they also offer security.
Is this the right option for my family member? A continuing-care community is a good choice for an older adult who wants assistance making some healthcare decisions, says O'Dea-Evans. It's also a good choice if you don't feel able to manage her care on a daily basis -- perhaps because you live far away -- as everything she'll require as she ages is generally on-site, and trained staff will help her move from one phase to another as the need arises.
Family homes are usually private homes that have been converted to provide eldercare for a small number of older adults. An alternative to a skilled nursing facility, they generally offer all meals and round-the-clock staffing, sometimes at a lower cost.
_ Is this the right option for my family member? _ If she lives in a small town or rural area without a skilled nursing facility and wants to stay in the area, this may be the best option. Family care homes are also a good choice for people who need lots of personal attention from caregivers who know them well, says O'Dea-Evans. Such people might not thrive in a larger facility with different staff members coming in and out.
Skilled nursing facilities
Skilled nursing facilities provide round-the-clock medical care, usually administered by registered nurses and aides under the supervision of doctors. Your family member may also receive physical, speech, and occupational therapy, as well as assistance with activities of daily living.
Is this the right option for my family member? If she needs help from trained medical personnel on a daily basis -- such as insulin monitoring and injections for diabetes, or intravenous medication -- or if she's unable to feed, bathe, and dress herself, she may need to be in a skilled nursing facility long-term. A limited stay in a skilled nursing facility may be necessary after a medical crisis requiring hospitalization.
Memory care facilities (Alzheimer's care facilties)
Memory care or Alzheimer's care facilities are specifically designed to serve Alzheimer's patients and those with other forms of dementia. They are generally secure, so that a patient who is confused can't wander off the grounds. The staff is specially trained to provide eldercare to seniors with cognitive issues.
Is this the right option for my family member? If she suffers from Alzheimer's, dementia, or a condition such as Parkinson's or a stroke that has caused permanent cognitive impairment, she may well need this kind of specialized eldercare. But be sure a neurological exam confirms that any impairment is permanent before you make this decision. If the patient were to regain cognitive function, as may be possible after a stroke, this kind of setting wouldn't be right long-term.
For more information on eldercare housing options
The National Center for Assisted Living offers the CareInterpreter -- an online tool that asks a few basic questions about your family member's finances, health, memory, and independence, and then helps match her with the most suitable living situation.
Caring.com also provides a comprehensive Senior Care Directory with ratings and reviews from other caregiving families to assist your search for communities and other service providers.