11 Signs It Might Be Time for Assisted Living

The decision to help an aging adult move out of a current home is a complex one -- both emotionally and practically. Above all, you want the person to be safe and well. How can you all feel more confident about whether circumstances suggest that your loved one should no longer be living alone?

Although every situation is different, looking at the following 11 signs will give you valuable information to help make the decision.

1. Big-picture signs it might be time for assisted living

Keep the big red flags in mind. Certain situations make it more obvious that it's wise to start thinking about alternate living arrangements.

Look for:

  • Recent accidents or close calls. Did your loved one take a fall, have a medical scare, or get in a fender bender (or worse)? Who responded and how long did it take? Accidents do happen, but as people get older, the odds rise of them happening again.

  • A slow recovery. How did the person you're caring for weather the most recent illness (for example, a flu or bad cold)? Was he or she able and willing to seek medical care when needed, or did last winter's cold develop into untreated bronchitis?

  • A chronic health condition that's worsening. Progressive problems such as COPD, dementia, and congestive heart failure can decline gradually or precipitously, but either way, their presence means your loved one will increasingly need help.

  • Increasing difficulty managing the activities of daily living (ADLs) and instrumental activities of daily living (IADLs). ADLs and IADLs are the skills needed to live independently -- dressing, shopping, cooking, doing laundry, managing medications, and so on. Doctors, social workers, and other geriatric experts evaluate them as part of a functional assessment, which is one way to get an expert's view of the situation. Difficulties with ADLs and IADLs can sometimes be remedied by bringing in more in-home help.

2. Up-close signs it might be time for assisted living

Give your loved one a big hug. Clues aren't always visible from a distance; especially when you don't see the person every day, you might learn more through touch.

Look for:

  • Noticeable weight loss. Does the person feel thinner? Are clothes loose, or has he added notches to his belt? Many conditions, from depression to cancer, can cause weight loss. A person who is having trouble getting out to shop or remembering how to cook (or to eat) can lose weight; check the fridge and watch meal-prep skills.

  • Seeming more frail. Do you feel anything "different" about the person's strength and stature when you hug? Can your loved one rise easily from a chair? Does she or he seem unsteady or unable to balance? Compare these observations to the last time you were together.

  • Noticeable weight gain. Common causes include an injury slowing the person down, diabetes, and dementia (when someone doesn't remember eating, he or she may indulge in meals and snacks all day long). Someone with money troubles may choose fewer fresh foods and more packaged goods or dried pasta and bread.

  • Strange body odor. Unfortunately, a close hug can also reveal changes in personal hygiene habits. Causes range from memory trouble to depression to other physical ailments.

  • Changes in appearance. Does the person's hair and makeup look all right? Are clothes clean? Someone known for crisply ironed shirts who's now in a stained sweatshirt may lack the dexterity for buttons or may have lost the strength for managing an ironing board and iron. A formerly clean-shaven man with an unkempt beard may be forgetting to shave (or forgetting how to shave).

3. Social signs it might be time for assisted living

Think realistically about the person's social connections. Social circles tend to shrink with age, which can have health and safety implications.

Look for:

  • Signs of active friendships. Does your loved one still get together for lunches or outings with friends or visits with neighbors, or participate in religious activities or other group events? Does he or she talk about others or keep a calendar of appointments? Lack of companionship is associated with depression and heart problems in older adults. If friends have died or moved away, moving to a place where other people are around could be lifesaving.

  • Signs that your loved one has cut back on activities and interests. Is a hobby area abandoned? Has a club membership been given up? A library card gone unused? There are many reasons people cut back, but dropping out of everything and showing interest in almost nothing is a red flag for depression.

  • Days spent without leaving the house. This sometimes happens because the person can no longer drive or is afraid to take public transportation alone and lacks a companion to come along. While many older adults fear being "locked away" in a retirement home, many such facilities offer regular outings that may keep them more mobile and active, not less.

  • Someone who checks in on a regular basis. If not you or another family member, who does this? Is your loved one willing to consider a home-safety alarm system, a personal alarm system, or a daily calling service?

  • A plan for a worst-case scenario. If there's a fire, earthquake, flood, or other disaster, is someone on standby to assist? Does your loved one understand the plan?

4. Money signs it might be time for assisted living

Riffle through the mail. Your loved one's mail can offer an often-overlooked clue to how he or she is managing money, a common early warning sign of cognitive trouble.

Look for:

  • Snowdrifts of mail in various places. Finding lots of mail scattered around raises concern about how bills, insurance, and other matters are being managed. (Piles of mail are also a potential tripping hazard.)

  • Unopened personal mail. Everybody skips junk mail, but few of us can ignore a good old-fashioned, hand-addressed letter.

  • Unopened bills. This can indicate that your loved one is having difficulty managing finances -- one of the most common first signs of dementia.

  • Letters from banks, creditors, or insurers. Routine business letters aren't worrisome. But it's alarming if they're referring to overdue payments, overdrawn balances, recent accidents, or other concerning events.

  • Thank-you messages from charities. Older adults are often vulnerable to scammers. Even those who have always been fiscally prudent are vulnerable if they're having trouble with thinking skills (a common sign of Alzheimer's disease). Some charities hit up givers over and over, and your loved one may not remember having donating the first time.

  • Lots of crisp, unread magazines. The person may unknowingly have repeat-renewal subscriptions he or she doesn't need.

5. Driving signs it might be time for assisted living

Take a drive -- with your loved one behind the wheel, if he or she is still driving. Living independently in our culture often depends on the ability to drive (or the arrangement of alternate transportation options).

Look for:

  • Nicks or dents on the car. Notice the car body as you get in and out. Damage marks can be signs of careless driving.

  • Whether the person promptly fastens his or her seatbelt. Even people with mild dementia usually follow the rote basics of driving. It's worrisome if he or she is forgetting this step.

  • "Tension, preoccupation, or being easily distracted. The person may turn off the radio, for example, or be unwilling to engage in conversation while driving. He or she may avoid certain routes, highway driving, or driving at night and in rain -- a safe kind of self-policing but also signals of changing ability.

  • Signs of dangerous driving. People whose driving ability is impaired are more likely to tailgate, drift from their lane, go below the speed limit, react slowly to lights or other cars, and mix up gas and brake pedals. See 8 ways to assess someone's driving.

  • Warning lights. Check out the dashboard as you ride along. Does the car have sufficient oil, gas, antifreeze, windshield-wiper fluid?

6. Kitchen signs it might be signs for assisted living

Go through the kitchen, from fridge to cupboards to oven. Because people spend so much time in this room, you can learn a lot.

Look for:

  • Stale or expired foods. We all buy more than we need. Look for signs that food is not only old but that this is unnoticed -- mold, sour milk that's still used, or expiration dates well past due, for example.

  • Multiples of the same item. Ten bottles of ketchup? More cereal than can be eaten in a year? Multiples often reveal that the shopper can't remember from one store trip to the next what's in stock at home.

  • A freezer full of TV dinners. Your loved one may buy them for convenience sake, but frozen dinners tend not to make healthy diet. If there's not much fresh food in the house (because it's too hard to for the person to procure or cook), your loved one might be ready to have help with meal prep or delivery services.

  • Broken appliances. Check them all: microwave, coffeemaker, toaster, washer, and dryer -- any device you know your loved one uses (or used to use) routinely.

  • Signs of fire. Are stove knobs charred? Pot bottoms singed badly (or thrown out)? Do any potholders have burned edges? Also look for a discharged fire extinguisher, smoke detectors that have been disassembled, or boxes of baking soda near the stove. Accidents happen; ask for the story behind what you see. Accidental fires are a common home danger for older adults.

  • Increased use of takeout or simpler cooking. A change in physical or mental abilities might explain a downshift to simpler recipes or food choices.

7. Around-the-house signs it might be time for assisted living

Look around the living areas. Sometimes the most obvious sign is hard to see because we become so used to it.

Look for:

  • Lots of clutter. An inability to throw anything away may be a sign of a neurological or physical issue. Obviously it's more worrisome in a neatnik than in a chronic slob. Papers or pet toys all over the floor represent a tripping hazard.

  • Signs of lax housekeeping. Spills that haven't been cleaned up are a common sign of dementia -- the person lacks the follow-through to tidy. Keep an eye out for cobwebs, bathroom mold, thick dust, or other signs of slackness. Physical limitations can mean your loved one needs housekeeping help or a living situation where this is taken care of for him or her.

  • Bathroom grime and clutter. A common scenario: Your loved one makes an effort to tidy up living areas but overlooks the bathroom. Or the guest bath is clean, but not the one the person uses all the time (the one off a bedroom, for example). Here you may see a truer picture of how your loved one is keeping up.

8. Pet-care and plant-care signs it might be time for assisted living

Be sure to check out how the other living things are faring. An ability to take care of pets and plants goes along with self-care.

Look for:

  • Plants that are dying, dead, or just gone. Most of us have seen plants go brown sometimes. Keep an eye out for chronic neglect, especially in a former plant-lover's home.

  • Animals that don't seem well tended. Common problems: dogs with long nails, cat litter boxes that haven't been changed lately, or dead fish in the fish tank. Poor grooming, overfeeding, and underfeeding are other red flags.

9. Home-maintenance signs it might be time for assisted living

Walk around the yard. Yard maintenance -- or lack of it -- can yield clues that your loved one isn't faring as well at home alone anymore.

Look for:

  • Signs of neglect. Look for discolored siding or ceilings that might indicate a leak, gutters choked with leaves, broken windows or fences, dirty windows.

  • Newspapers in the bushes. Are papers being delivered but ignored? Sometimes people pick up those they can see on a driveway but not those that go off into the yard.

  • Mail piled up in the mailbox. Go out and check -- it's an indication that your loved one doesn't even retrieve it regularly.

10. Get help looking for signs it might be time for assisted living

Get the input of others who know your loved one in order to collect a fuller picture of reality. Gently probing about what others think isn't nosy; you're being loving, concerned, and proactive.

Look for:

  • Input from those in your loved one's circle. Talk to old friends and close relatives to get their sense of how the person is faring. Listen for stories that hint that the person doesn't get out much ("She doesn't come over anymore." "She quit book club."). Pay attention to comments that indicate ongoing concerns ("Has he had that heart test yet?" "We were worried the day the ambulance came.").

  • Medical insight. With appropriate permission, your loved one's primary doctor may share your concerns about his or her patient's safety at home -- or may be able to alleviate those concerns or suggest where to get a home assessment.

  • A second opinion. A social worker or professional geriatric care manager visits older adults' homes and does informal evaluations. While your loved one may initially resist the notion of a "total stranger" checking on them, try pitching it as a professional (and neutral) second opinion, or ask the doctor to "prescribe" it. Some people wind up sharing doubts or vulnerabilities with a sympathetic, experienced stranger that they're loathe to admit to their own children or family.

11. Caregivers' signs it might be time for assisted living

Finally, realize that some of the information you collect is intangible -- it has to do with feelings and emotions, and the stress levels of everyone involved.

Look for:

  • How you're doing. While this decision to remain in one's home is not primarily about you -- the son, daughter, grandchild, caregiver -- your own exhaustion can be a good gauge of a decline in older adults' ability to care for themselves. Keeping someone at home can require lots of hands-on support or care coordination, and this is time-consuming. If your loved one's need for care is just plain wearing you out, or if a spouse or children are feeling the collective strain of your caregiving activities, these are major signs that it's time to start looking at other options.

  • Your loved one's emotional state. Safety is crucial, of course, but so is emotional well-being. If someone living alone is riddled with anxieties or increasingly lonely, then that may tip the scales toward a move not solely based on health and safety reasons.

If your loved one has a full life, a close neighborhood and community connections, and seems to be thriving, it's worth exploring as many in-home care options as possible before raising stress levels by pressing a move from a beloved home.

If, on the other hand, your loved one is showing signs that living alone is a strain, it may be time for a talk. Broach the subject of where to live in a neutral way and you may find that your loved one harbors the same fears for current and future safety and security that you do. Find out what your loved one fears most about moving and about staying before launching into your own worries and what you think ought to be done.

For more help starting the conversation about a change in housing, see How to Have "The Housing Talk".

4 days ago, said...

NICE POST..........hotmail sign up

29 days ago, said...

Oh, she is in a wheelchair, and she did it to herself. it explains, why my half brother have become a pain., it was stated that she would move back home, are you kidding,? there is no way to get the wheelchair up the stairs, and very dangerous in the ice and snow, and front door, bathroom is not set up for a wheel chair, etc..

29 days ago, said...

My Half Brothers Mother is still living, and she is a pain to me, as much as I've tried to be polite, she is never appreciated with my answers, if I called, she doesn't give me 2 minutes. my Half Brothers and their half Sisters tend to not admit, yet, one half brother is in HI, while her parents is getting up in their age as well is still living in AL. Thank goodness, they are fine, meanwhile I've ignore my Half Brothers for going on 5 years. does she even notice or care? obviously, if I do see her, she gives me the business, well, I seen you a few years ago, and wouldn't even make a simple appointment, my life is not in your city, my dog gives me more respect. yes, sometimes, distance family are a pain, but your dog loves and respects. you by thanking you and taking care of him and or her, so meanwhile to be back up, I was on the road and stop by to see her, she was sock, like I invited myself. that was always her back-word attitude, so I saw her a yr. later with other local people for a luncheon, and she was fine, a yr., later, she called and asked if I was coming their this summer, typical last minutes, I said a flat NO, I already have my plans and am going west,. she slam the phone with out reasoning, it came to a point just to avoid her, well, she is 90 this yr. if I don't show up, does she care, obviously not,

7 months ago, said...

I need a place for me and 8 cats that are my reason for living. My budget is 753 a month. Please tell me there's options! I'm about to be homeless! I'm 58 and disabled.

8 months ago, said...

My husband has ADHD and memory disorder plus his own chronic back problems and I am his caregiver until I recently left the hospital due to finding out I now have spinal cord tumor cancer. So this is like the invalid leading the invalid .last night our three thousand dollar sleep number bed leg went through one of the risers we have it on and it really hurt my back. There is nobody but my husband to care for me and that is a joke because he can't even take care of himself . We may have great insurance but we make less than 53,000,00 a year. So anyway I asked him to put a new riser under one of the legs, well I went to check to see if they were on right and found out he missed one. It was completely not even on the riser. We both could have really hurt ourselves and the worst part is he always has something stupid to say to save face. I know I shouldn't ever say this to him but he uses his disease whenever it suits him and the rest of the time he is is in complete denial of his disease. This is just the tip of the iceberg!!! WORRIED

10 months ago, said...

Hello I'm 46 years old with Copd also my daughter has sever lung issues !! She is a very sickly child we are from New York State but the problem she is 17 years old and very allergic to the area!!!

11 months ago, said...

I'm writing this about myself. I have problems getting food. I once had nothing to eat but boxes of rice. I was recently told that my problems aren't. real. I made them up. This man who said that is the father of my children. He has treated me very badly for 27 years. Calling me lazy. He is in a nursing home. He has diabetes type 2. Didn't test his blood every day. Now he's recovering from a stroke which left him paralyzed. He blames our son and daughter for the stroke, and he blames me. He is so abusive to the nurses where is that those nurses refuse to work with him. I have epilepsy. I don;t drive so my doctor issued me a placard so I can be closer to where I need to be.. My neurologist told me that I have a condition called Ataxia. I have horrible speech problems.. I need to get away from here. Be near the bus line. Read more. Be near a library. Wish somebody could help.

about 1 year ago, said...

Thats interesting

about 1 year ago, said...

Its interesting :)

about 1 year ago, said...

I am sure everyone deals with this same situation. My mom 91 has lived alone for almost 30 years since my dad died. She has been fortunate to have 2 of her children and a bunch of grandchildren around for support, because except for family she has turned herself into a recluse. For example she will not go to great-grandchildren's birthdays if non-family members are going to be there. So, if you so much as broach the subject of assisted living you get a series of stories (which we have all heard 100 times) about a friend who moved to one and hated it. She recently woke up at 3:00 a.m. with a "nice looking young man" in here bedroom (you would think that might motivate her to move out.). Fortunately he was a nice young man (he took his shoes off (so he must have had a good mother), and nothing happened. But if this story is brought up as to why she might consider moving, all you get is that she is still very concerned about the "nice young" man.

over 1 year ago, said...

I've read the statements from the folks who wrote but am Not seeing any responses to any of these situations. Is that in another place?

over 1 year ago, said...

My best friend is still caring for her husband who has serious Alzheimer's - he is always lost - cannot dress, bathe, or do any care for himself. He walks in circles from room to room, not knowing where bathroom is or if it's night or day. She has to do EVERYTHING for him, his near vision has been affected by this disease and he has accidents knocking things over - doesn't know how to sit in a chair. She must be at his side every moment unless he's in bed. She has medical issues herself - at the moment, she has the flu (she got it from him) - and she is not getting the rest she needs and cannot care for him. Her doctors have been of no help. They are totally on social security ONLY and we are having difficulty trying to get him onto Medicaid. He was classified as "disabled" due to the disease several years ago and they have no pensions or any other income. She is at her wits' end trying to find help and not getting anywhere. I believe he is way past assisted living, and needs to be in a home with other memory patients. The ONLY good thing is he has lots of moments where he seems to know what's going on - but he cannot sit, pickup items, bathroom himself and doesn't know where anything is. She is perpetually doing everything for him and I hate to say it, her health is suffering from this. I do not want to overstep MY bounds as their friend, but I feel like she needs some relief (even if it's just to have him put into hospice or something until she can get rest and recover from her cold and some other medical issues she's suffering from at the moment.)

over 1 year ago, said...

Hello We (my sister and I) don't know how to handle our parent's situation in the upcoming weeks. My father has Parkinson's and has been barely able to walk for a couple of years. He can use a walker but his steps are really for going to the bathroom and bed. My mother used to be the caregiver up until the last few months. My mother was diagnosed with Pancreatic Cancer and has all she can do to bear her pain. She is unable to care for my father. My sister took a leave of absence from work but needs to return in 6 weeks. She has been there everyday taking care of our parents. How are we going to take care of my parents? Who will take my mother to her chemo treatments? My sister lives 8 hrs away, I live approx. 90 minutes but have a very demanding job and family (young 9 yr old boy) My parents are 80 and 83. I hate the idea of a senior housing facility and hope we can work out a plan where help can come to my parents?

over 1 year ago, said...

just joining and all ready I've had a few laughs because I can relate!

over 1 year ago, said...

Thank you for this very detailed list, Paula! There are so many things a child or friend may not catch while observing an elderly loved one's behavior - like checking the mail or plant care - that you've touched upon here. Very insightful. Another thing for caretakers to consider is the safety within the home. From slippery floors and bathtubs to inadequately organized kitchens, the home holds many hazards to the elderly. Keeping safety at the forefront ensures a safer independent experience for elderly, especially in those hours when the assisted living caretaker is not present.

over 1 year ago, said...

My mother is 90 years old. She fell last week and dislocated her right shoulder and was taken to the hospital by ambulance then discharged to a rehab facility. Her doctor is saying that she will not be able to return to her home where she lives alone and has for over years but will need 24 hour care at an assisted care facility. As the oldest of her five children, we have looking for an appropriate assisted living facility in the southeast area of Columbus, Ohio where Mom currently lives. We have toured several places, but some are extremely higher than we had anticipated. My father was a Navy vet. so we want to know if there is a vet program for the surviving spouse of a Navy Vet that could assist with financially assist us with bare necessities for our mother who is a very quiet, respectful, kind Christian woman who is very satisfied with bare necessities, love and care.

over 1 year ago, said...

My mother(82) Has, always been a little on the rude side, but now for sometime she (by the day) is getting so mean. That I can't even have a two minute conversation...before she throws me under the bus. Only negativeness, is all she wants to say and if you don't agree with her well alrighty then she will be done with you. Until the next (same way) different day. I am the youngest of 3 girls. My middle sister(60)has been living with her since 1991. omg they put me in the middle of their crap constantly. My mother is basically an addict with a very nice roof over her head! She blackmails sp? with her money. Can not even be trusted with ANY medication, including aspirin. Didn't know one could really overdose on that. Found out after the 3rd or 4th time to the er. by way of 911. She wouldn't wake up is why, they were called. Now she threathens for aspirin and or BC powder along with her painkillers at the same time, every 4 hrs. Says she never sleeps, does until she starts screaming (IT'S TIME)says who would let their mother hurt like this....I mean she gets legally gets these from her doctor because she has had alot of broken bones and such her whole life. Horses. car wrecks ect. But somewhere along the way ADDICT.Does not care about anything but those naughty little pills.I could go on and on. The skinny of it is my sister won't leave, because of guilt and (money)and all my mother says is get out when she really does't mean it. and won't Let strangers in her house. It's like she is alive with no thinking processing. Oh she know who everyone is and just bad mouth everyone so sad. Can't be around that negative talk never ending. but she's got $. disgusting.................................