Depression is not just moments of sadness or disappointment, it is a mood disorder that requires attention and treatment. Depression can affect a person’s thoughts and feelings, and interfere with one’s motivation and ability to complete daily activities such as bathing, eating, and sleeping. When people struggle with daily life for weeks at a time, it is a diagnosable medical condition known as “Clinical Depression.” While depression is a common health issue among older adults, it is not a normal part of the aging process. The natural changes that come with aging: loss of a loved one, loss of independence, and the end of working years can bring about feelings of sadness, anxiety, and uncertainty. Some older adults regain their sense of balance after a period of adjustment, while others may experience the onset of depression.

According to the Depression and Bipolar Support Alliance, Major Depressive Disorder (MDD) affects approximately 17.3 million American adults, or about 7.1 percent of the U.S. population age 18 and older, in a given year. The Center for Disease Control and Prevention attests that depression among older adults is a serious public health issue. Statistics show that 7.7 percent of adults aged 50 and older report current depression, while 15.7 percent responded as having a lifetime diagnosis of depression.

What is Clinical Depression?

Depression is associated with distress that can lead to impairments adversely affecting physical, mental, and social functioning. Some signs and symptoms include trouble concentrating, remembering details, and making decisions. People with Clinical Depression also struggle with aches, pains, headaches, or cramps that won’t go away. It may be difficult to understand the difference between what many older adults believe is a natural part of aging and the onset of depression. It is important to observe the frequency and intensity of these symptoms and look for the following symptoms:

  • Fatigue, irritability, or sudden mood changes
  • Feelings of guilt, worthlessness, and helplessness
  • Pessimism and hopelessness
  • Insomnia, early-morning wakefulness, or sleeping too much
  • Overeating, or appetite loss
  • Digestive problems that don’t get better, even with treatment
  • Persistent sad, anxious, or “empty” feelings
  • Suicidal thoughts or attempts

Causes and Risk Factors for Depression in Older Adults

Depression in older adults can co-occur with other serious medical illnesses such as Alzheimer’s disease, dementia, diabetes, cancer, heart disease, and Parkinson’s disease. Depression can make these conditions worse and some of these conditions can induce depressive episodes. Sometimes medications taken for these physical illnesses may cause side effects that contribute to depression. All these factors can cause depression to go undiagnosed or untreated in older people. It is important to have an open and frank discussion with a health professional concerning these issues, as they can become life-threatening.

Diminished independence is a major risk factor in the onset of depression in older adults. It can be very difficult for a once autonomous senior to lose the ability to drive or be faced with the fact that they need assistance with taking medicine or getting dressed. The suggestion of assistance may seem intrusive and worrisome, leaving older adults feeling helpless, weak, and despondent.

Assisted living facilities to take these factors into account when they are providing care plans and activity programming for their residents.

What is Assisted Living?

Image of senior and caregiver

Assisted living is a residential care option that provides a continuum of long-term care services. These services are designed to support an individual with normal activities of daily living in a way that promotes independence. Assisted living services can be provided in freestanding communities or a part of nursing homes; some assisted living facilities are located in small residential communities. Accommodations are widely varied to fit a community culture and lifestyle. Individual quarters usually include private or shared rooms, full bathrooms, kitchenettes, and security features inside the rooms.

Assisted living provides support for those who need assistance with activities of daily living that include:

  • Hygiene
  • Toileting
  • Dressing
  • Medication administration
  • Meal preparation
  • Maintenance of accommodations

Also, seniors are given 24-hour supervision and assistance, some health services, and scheduled activities. Assisted living encourages residents to maintain autonomy while having privacy, dignity, and community involvement. Some assisted living facilities offer complimentary transportation to appointments, excursions, and to run errands. This helps seniors to feel a sense of independence. While an older adult may no longer be able to drive, he or she can experience a fulfilling life with this service.

Seniors also benefit from a care management team. This is a group of medical, occupational, and caregiving professionals that develop and design individualized plans that include:

  • Daily activities
  • Social services
  • Health screenings
  • Spiritual care
  • Counseling services

For seniors who struggle with clinical depression, a care team may conduct further assessments and provide a comprehensive care plan that addresses issues such as socialization, nutrition, personal care, and supervision.

Costs of Care

According to the 2018 Genworth Cost of Care Survey, the national average rent in an assisted living facility is $4,000 per month. This cost typically does not include additional services, amenities, or other need-based fees that may accrue. For example, should a resident of an assisted living facility require further mental health treatment, such as memory support, additional costs would apply to this ancillary service not covered under assisted living services.

Benefits of Assisted Living Facilities for Seniors with Clinical Depression

Beyond personal suffering, depression in late life poses a major health risk that includes illness, social isolation, suicide, and non-suicide related deaths. The services and amenities in assisted living help mitigate these risks and give seniors peace of mind. Here are some of the benefits that are a part of transitioning to assisted living:

Prevents Isolation

Seniors living alone are at a higher risk for social isolation which can lead to increased feelings of loneliness, despair, and depression. In assisted living, seniors live in a community environment with friends and staff encouraging participation in social events. These communities prepare diverse activity calendars with the opportunity for residents to take up new hobbies, make new friends, and find new ways to express themselves.

Maintenance-Free Living

For those who struggle with depression, weighting responsibility can hinder emotional progress. Assisted living facilities often offer support in light housekeeping, laundry, and meal preparation. Some assisted living facilities offer resort-style living, which means that they provide activities, social events, and activities to stimulate the mind while serving three meals per day restaurant-style. This helps residents to feel as if they are living in luxury instead of losing independence.

Physical Activities

Getting regular exercise is a great method of keeping a balanced mood. Assisted living communities offer many fitness and physical therapy programs to keep seniors active.

Fitness programs are also catered to seniors and specific medical conditions. Staying active in organized group settings can also help seniors keep their bodies engaged in healthy ways. Opportunities for physical fitness in assisted living go far beyond what family caregivers can easily provide at home.

Ensures a Healthy Diet

Nutrition is a big part of maintaining physical and mental health. A nutrient-rich, flavorful diet can ward off a depressive episode. For seniors living at home, it can be very difficult for a loved one to supervise and enforce nutrition guidelines. As such, many seniors suffer from malnutrition. At an assisted living facility, three meals a day can be tailored to specific medical conditions.

Promotes Self-Care

While these communities are a great place to receive customized care services, assistance is provided with an eye on independence. Caregivers work to ensure residents are doing all that they can to take care of themselves. It is important to demonstrate a culture of care that will help to add quality of life. When a resident sees that he or she has support from the care staff, they can continue to maintain as much independence as safely possible.

Provides Medical Supervision and Assistance

For residents of assisted living facilities who also struggle with depression, medical supervision provides them with the assistance required to manage dosages of medication prescribed to alleviate the symptoms of depression and other illnesses. Additionally, there are some side effects and drug interactions that need to be carefully monitored. At an assisted living facility, trained nurses can oversee and control the administration of medication, monitor side effects, and ensure that a resident is not a harm to self and others.

What to Look for in Assisted Living for Seniors with Clinical Depression

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The mission of assisted living is to help older adults retain autonomy, privacy, and quality of life in a personalized environment. Greater effort should be made to detect and treat depression in this setting, both to reduce suffering and prolong the resident’s ability to remain in their preferred environment.

Aging in Place Community

For some seniors, depression could be just one difficulty that is faced on a long journey of a progressing illness. In a community that provides residents multiple levels of care along the continuum of aging, seniors can remain in the same residence. This service provides seniors with additional support, continuity of community, and a sense of safety and security.

Specialized Caregivers

When exploring assisted living facilities for your loved one, look for caregivers with extensive experience in behavioral health. These specialized caregivers work with family members as the backbone of long-term care services. While your loved one may not have memory issues, these types of caregivers can perform tasks compassionately, with a focus on building mental and emotional strength in their residents.

Physical and Medical Assistance

As seniors age, they may need some help with physical needs, including activities of daily living. This could range from shopping, cleaning, cooking, and looking after pets to intensive help with bathing, moving around, and eating. For residents that have trouble eating due to clinical depression, it is important to find a facility that specializes in nutrition assistance, weekly counseling programs, and visits from a gerontological psychiatrist.

Social and Emotional Support

Social networks change throughout the journey of aging. Friends or family may not be as close by, or neighbors may move or pass away. It is important to find an assisted living facility that provides social networks on and off-campus. Complimentary transportation to field trips, including cultural events, and broader community activities will help fulfill residents and offer a well-rounded lifestyle.

Choosing Assisted Living for Someone with Clinical Depression

Before deciding to find the right assisted living facility for a loved one, there are many factors to consider. Many times transitions such as a loss of independence can exacerbate depressive symptoms while others experience a new sense of enjoyment in a new situation.

Who Should Use Assisted Living

Assisted living is ideal for residents who may feel isolated outside of a community or who struggle with motivation to prepare and eat meals. Some residents of assisted living need assistance to ambulate steadily but can do so with a caregiver. Assisted living is also good for those who:

  • Are socially driven and thrive in a community environment
  • Need care that exceeds the physical capability of the home caregiver
  • Need mental stimulation with activities tailored to their mental health needs
  • May need a little extra help with activities of daily living

Who Should Not Use Assisted Living

Seniors who need 24-hour nursing care are not eligible for assisted living. Residents who are bedridden, unable to utilize their medical equipment, or pose a threat to themselves or others, are not good candidates for assisted living. Additionally assisted living is not a viable option for those who:

  • Refuse physician directives
  • Cannot follow directions in emergencies
  • Residents who have frequent in-patient behavioral health-related hospital stays

Financial Support Options

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Many seniors who once believed they saved enough for retirement find themselves in need of supplemental income to off-set the rising costs of long-term care. Financial assistance helps seniors and their families pay for the expenses related to assisted living. For those who have mental and behavioral health challenges, there are options within Medicaid, Medicare, Social Security, and Veteran Benefits.

Medicaid

Medicaid is a health care program that assists low-income families or individuals in paying for doctor visits, hospital stays, long-term medical, custodial care costs, and long-term care. Medicaid is not a single program, but a collection of many different programs and these programs’ rules and benefits change in every state. Medicaid works on both a federal and state level; it is funded primarily by the federal government and runs at the state level, where coverage may vary. The federal government sets guidelines on how each state must spend their Medicaid dollars. As a major source of insurance coverage for low-income Americans, and as the only source of funding for some specialized behavioral health services, Medicaid plays a key role in covering and financing behavioral health care.

Forty-four states and the District of Columbia now offer some financial assistance for those in assisted living within the Medicaid program, usually through a waiver program.

Financial Eligibility for Medicaid

To participate in Medicaid, federal law requires states to cover certain groups of individuals. For example, a person who lives in a state who has expanded its program under the Affordable Health Care Act and has an income that is 138 percent of the federal poverty level ($12,060/year for an individual), may qualify for coverage. Additionally, Medicaid eligibility for individuals 65 and older, who have blindness, or disability is generally determined using the income methodologies of the SSI program administered by the Social Security Administration. An older adult receiving Supplemental Security Income (SSI) for a disability is an example of a Mandatory Eligibility Group, which means that Medicaid can assist with some of the costs of assisted living.

Medical Eligibility for Medicaid

For individuals with significant health needs, states have the option to establish a program for “medically needy,” or those whose income exceeds the minimum standard to qualify for Medicaid. Medically needy individuals can still become eligible by “spending down” the amount of income earned on the cost of medical expenses, which is also above a state’s medically needy income standard. Individuals spend down by incurring expenses for medical and remedial care for which they do not have health insurance. States typically cover other services provided by assisted living facilities that may include:

  • Personal care
  • Case management
  • Medication management
  • Health examinations
  • Behavioral Health assessments

Medicare

Medicare is a federal health insurance program for people who are 65 or older, others that are under 65 who are earning Social Security Disability Benefits (SSDI), and those with End-Stage Renal Disease (ESRD). The program is funded in part by Social Security and Medicare taxes that Americans pay on their income, in part through premiums that people with Medicare pay, and in part by the federal budget. Medicare Part A is premium-free for those who are disabled Social Security recipients or who have had Medicare-covered government employment. However, many recipients pay a premium, a co-pay, and a deductible, as with other forms of health insurance.

  • Medicare Part A (Hospital Insurance) – Provides coverage for mental health care services during an inpatient hospital stay. Coverage includes:
    • Room
    • Meals
    • Nursing care
    • Therapy or other treatment
    • Lab tests
    • Medications
    • Other related services and supplies
  • Medicare part B (Medical Insurance) – Helps cover one free depression screening per year and other outpatient or partial-stay hospitalization. Other mental health services include:
    • Visits with a psychiatrist or other doctor
    • Visits with a clinical psychologist or clinical social worker
    • Lab tests ordered by your doctor
  • Medicare Part C – Also known as the Medicare Advantage Plan, this is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.

Social Security Disability Benefits

The Social Security Administration provides services for people with conditions that are considered to cause a long-term disability. It is important to note that Social Security Disability Benefits are for Americans who suddenly are unable to work due to an unexpected, long-term disability. To qualify for disability benefits based on a mental disorder, the following criteria must be met:

  • The mental disorder must prevent a person from doing any work performed.
  • The mental disorder must render a person from being trained for any other work.
  • The mental disorder must be expected to be long-term, lasting at least a year.

Affective disorder is an eligible category for coverage. Mood disorders, such as depression and bipolar disorder, fall under this category.

Disabled Widows and Widower’s Benefits

Individuals who are at least fifty years old, but who are not yet 60 years old, who have become disabled within a certain amount of time after the death of their spouse may qualify for Disabled Widows and Widower’s disability benefits. To qualify for this benefit, the deceased spouse must have worked and earned enough work credits under the Social Security program to be insured by the Social Security Administration. There are no income or asset limits associated with this type of disability benefit. The amount of money received each month by individuals who qualify for this benefit will depend on how much money the spouse earned while he or she was alive.

The Social Security Administration’s Benefit Eligibility Screening Tool can assist in helping citizens determine eligibility for all forms of support.

Supplemental Security Income

Supplemental Security Income is available for seniors aged 65 and older who have limited financial needs. This program will evaluate income and will provide a stipend that will help make ends meet. This pre-set amount is determined by the federal government.

Unlike Social Security benefits, SSI benefits are not based on an individual or their family member’s prior work history. As seniors receive payments directly from the government, they or their loved ones are free to apply those dollars towards any need they have, including assisted living.

Veteran Benefits

Some veterans may be able to receive assistance with assisted living services or costs. The following are ways in which the Department of Veterans Affairs can provide support, counseling, services, and resources.

Mental Health Support

There are many options for retired service members and their spouses. According to the official Veterans Affairs website, 1.7 million veterans received mental health services in 2018. For veterans that already receive benefits, primary care physicians can provide a referral to a counselor in your area. For veterans and their spouses who may be home-bound or without transportation, online options are also available.

Veterans Aid and Attendance Benefit

The Veterans Aid and Attendance benefit can help offset rising care costs for veterans with clinical depression who are searching for adequate assisted living care. A wartime veteran or their surviving spouse with limited income may be eligible to receive a non-service connected pension. There are three levels of VA Pensions:

  • Basic Pension: Services provided for healthy veterans over the age of 65 with low incomes.
  • Aid & Attendance Pension: Provides additional monthly income over and above the Basic Monthly pension. To be eligible for this pension, one must also meet the requirements for the Basic Pension.
  • Housebound Pension: For veterans with a disability rating of 100 percent that prevents them from leaving their homes, but does not have to be related to their military service.

General Requirements

The following requirements can be met by a veteran or spouse:

  • Age: Must be 65 years or officially disabled, if younger
  • Period of Service: Veterans must be considered “wartime veterans” serving at least 90 days in the military and one day during the war (non-combat applies).
  • Discharge Status: Veteran cannot have been dishonorably discharged
  • Marital Status: Surviving spouse must have been living with the veteran at the time of death to claim benefits

For more information on Veteran Benefits and assistance with eligibility, you can call 877-222-8387 to find the right resources for your needs. If you have hearing loss, call TTY: 800-877-8339.

Locating Assistance

Locating an assisted living facility that can accommodate the needs of a person with clinical depression can be overwhelming. By turning to the experts at Caring.com Family Advisor, you have access to up-to-date information, resources, and advocacy. Your team will assist you in locating the right assisted living facility within your budget. To connect to a Caring.com Family Advisor call, toll-free, at 800-973-1540.

Resources for Seniors Who Are Struggling with Depression

Find a Therapist

Psychology Today

Psychology Today helps those seeking treatment by providing a directory of board-certified psychologists across the United States. Visit this link to locate gerontology psychologists in your area.

Stay Informed

National Council on Aging Center for Healthy Aging Mental Health Resources

The National Council on Aging will help seniors and their loved ones understand the stages of aging and provide resources that can help everyone navigate the course of mental health.

Get Involved

The Community Guide Mental Health Recommendations

American Psychological Association’s Depression and Suicide in Older Adults Resource Guide

These resources are guides for loved ones to become involved in learning about mental health. Learn the signs of clinical depression, prevent suicide, and seek assistance.