Assisted Living 12 Signs It Might be Time

assisted living

I get by with a little help from my friends.

~Ringo Starr

Assisted Living

Assisted Living is an option for some older adults and knowing when to stay or go is challenging for all parties involved in the decision. As I’ve experienced this scenario there seem to be 3 levels:

Level 1 Most Optimal (This is about CHOICE)

The older adult is ready to downsize and free-up time (opportunity cost) in housework to peruse other interests. Perhaps tackle some “bucket list” items like travel, meet new friends, take a class, or make a change.

They are stable financially, physically/mentally, and ready to make the move to assisted living. There may be chronic medical conditions, but for the most part, their body and mind are available to them and a lifestyle change is desired.

Level 2 Less Optimal (This it is about NECESSITY)

The older adult is isolated and starting to decline in health, both mental and physical. They need some (intervention) assistance with ADLs (activities of daily living) but they are capable with assistance to live Inter-dependently.

Level 3 Least Optimal (This it is about NARROWING OPTIONS)

The older adult is succumbing to chronic conditions and requiring increased levels of care and supervision. ADLs and IADLs (Instrumental Activities of Daily Living) can’t be accomplished on their own fully. 

Aging In Place Works Until It Doesn’t 

Oregon Public Broadcasting Think Out Loud aired a show on the topic of down-sizing a senior. A guest from AARP told a personal story of having to move her mother out of the family home she promised to keep her in. It was heart-wrenching to listen and the anguish was still palpable in her voice.

Her story reminds that for most aging-in-place is preferred—but for some, it becomes untenable.


Sensitivity to Telling Mom She Can’t Stay Home Alone Anymore

A common cry for help from an adult daughter living in Brazoria, Texas, reaches out for advice:

Mom is 82 and slipping in memory…she has recently been recommended to benefit from “assisted living”. I Don’t need ideas on how to keep her in her own home. We have exhausted ourselves providing a company of ourselves which include her children, grandchildren, and great-grandchildren, life-support lines, meals, cleaning and shopping, medical appointments, writing her bills, etc. In-home-health or assisted living is the next best thing…but it won’t come without breaking my heart and her’s. Please don’t suggest she come live with one of us…she did when the hurricane-displaced her, and she was miserable. I need suggestions on how to be kind, but firm that she needs help…more than we can provide with her medical needs at this time of her life. She has CHF and COPD and is down to 70 + lbs. She has a nurse coming weekly and physical therapists, and occupational therapists, too. What do you say?? thank you for listening…

 Another Scenario

This is a compelling story I received as a comment responding to my blog post. A caring son whose experience is all too common in this time of life. This is a cautionary tale of perhaps waiting too long–but loving deeply enough to live with the consequences.


Aging in Place is a fine idea and I completely support it – until it isn’t a good idea, and when it isn’t, it may create real problems, especially for our children.  I know this from personal experience.  My mother was 73 when my dad died.  She was strong, healthy, engaged in church and community, and she continued to live – by herself – in the family home.  The years went by and she gradually declined physically, but we, her children, did all the things necessary for her to remain in her home – accessible bathroom, grab bars and rails, ramps, help with transportation and shopping, etc. etc.

Now 97, she is still healthy, with some mild memory and balance issues, and still in her own home.  But now she needs constant, around the clock care to be dressed, showered, fed, safe and not feel alone at the end.  She is too old to move to assisted living – it would likely be the end for her, and it would be against her wishes, which we are not about to do. And as you know, Social Security has in-home caregiver benefits only for skilled nursing, and most seniors simply can’t afford to pay for care out of pocket, so that means children take on that responsibility. So, her children have taken on the responsibility for her care – I drive ten hours from my home every other month and stay a month, and my sisters leave their families to help out.

My experience has taught me that there is a window of time during which an Elder can – and should – leave her home for a situation that will provide her the services and support she needs all the way to the end.  If we don’t move during that window, well, I am living with the consequences.  And as much as I love my mother, I’m not about to pass this on to my children.  So, while you are providing us with all the tools for aging in place, I would hope you would use some of our Elder wisdom to address the question of planning for and knowing when it is time to leave our homes, and what kinds of new arrangements we can create to nurture and support us in our final years.  I think Elder owned and staffed group homes – Elders caring for Elders – is an exciting idea, one that leaves Elders in charge of our lives, provides us with companionship, and perhaps most importantly, brings real meaning to our final years, as we help each other in the grand experience of conscious dying.

Many blessings and thank you for your work.              

Charlie Landman

12 Signs an Older Adult Needs Help (maybe Assisted Living)

1) Forgetting things: Missed appointments, forgetting where the car is parked, not remembering familiar names, all can be a sign of cognitive decline.

2) Not taking as many trips in the car as before: For example, not going to church or to visit friends/relatives. Reporting they are not comfortable driving after dark.

3) The car has unexplained dents or damage: Often blame others, “I was hit in the parking lot” or “someone must have hit me when I was in the store”.

4) Pulling away socially: Not engaging activities and people as they once did with the community and surroundings. They struggle to keep conversations going; often repeat over and over the same stories as if you’ve heard it for the first time.

5) Hearing loss: Leading to further isolation, often saying “huh?” whenever you engage in conversation.

6) Clothing that no longer fits: Weight loss due to loss of appetite or interest in eating. No longer shopping on a regular basis. Or simply forgetting to eat.

7) Poor hygiene: Body orders (urine, yeast, incontinence), no longer taking care of personal appearance, wearing soiled clothing.

8) Spoiled food in the fridge: Aged freezer burned food, smelly moldy, or decaying food items in the refrigerator, outdated items.

9) Unkept home: Stacks of newspapers piling up, dirty floors, dust accumulating, refrigerator spills, soiled towels, yard neglect, hoarding, mail stacking up, etc.

10) Wayfinding issues: Hanging onto furniture when getting around, wounds on lower limbs in various stages of healing, skin tears, bruising, can indicate balance problems.

11) Medications not being taken: Accumulating bottles with outdated labels.

12) Bills not being paid on time: Can mean a loss of something called “executive function” indicating cognitive decline.

When the Time Comes there are solutions from the best in the business…



  1. What is your staff-to-resident ratio?
  2. What kind of experience and training does your staff possess?
  3. How many staffers are on duty overnight?
  4. Can staff administer medications?
  5. Do you have a nurse on staff 24/7?
  6. Do you have any experience with (issues or diagnosis of your care recipient)?
  7. Do you do an initial assessment prior to admission?
  8. What types of apartments are available?
  9. What is the monthly cost per apartment type?

Other Points to Consider: 

  • If there is a waitlist, how many are on it and what is the policy?
  • Tell me about some of the current residents.
  • Do you have any outdoor space?
  • What is your discharge policy?
  • What additional services are available if the needs of a resident change?
  • What are your billing and payment policies?
  • Are all services included in the monthly fee? If not, what and how much are additional services?

Down Load the list:

~A Place for Mom

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