Assisted Living: Your Complete Guide
Helping an older adult move into a senior living or assisted living environment can be overwhelming, and emotions can easily escalate. This guide will help you start the conversation with older adults about assisted living, provide you with expert tips on managing the flood of emotions, and tips for navigating senior living with a mental health condition.
- How to Support Older Adults Moving to Assisted Living?
- What Are the Different Senior Living Options?
- How to find assisted living?
- Recommendations for finding assisted living for a loved one with a mental health condition
- 6 strategies for moving through guilt and shame when helping your older loved one adjust to senior living
How to Support Older Adults Moving to Assisted Living?
Here are 12 tips for managing those emotions during difficult conversations with elderly parents.
1. Expect that this will be emotional.
Expect that this is going to be emotional. Know that it is reasonable that this is emotional and that there will be some fallout. Everyone is entitled to their feelings about this transition. Starting this discussion with the understanding that this will indeed be an emotional conversation will help you get through it.
2. Prepare for “the Talk.”
Before you have this conversation, take the time to prepare. Here’s how:
- Do a Dress Rehearsal
It can help to talk this conversation through with someone you trust before you bring it up with your loved one (like a dress rehearsal).
This has a couple of benefits:
- It will help you to clarify exactly what you want to say and how to say it.
- It will help you discover some of your own feelings and allow you to begin to process them, which brings us to the next tip…
Work Through Your Feelings First
It’s normal to have all sorts of feelings about your loved one moving AND feelings about having to have this conversation in the first place. Any of these sound familiar?
- Anger: “I hate that I’m even in this position of having to initiate this conversation” (ROAR!!)
- Resentment: “I’m not the only one in my loved one’s life. Why am I the one who has to have this conversation? I resent my sister for not stepping up ”
- Sadness: “Seeing my dad lose his independence makes me want to cry… I think of what else he’ll be losing down the road.”
- Fear: “What if the burden of all of my mom’s needs falls on me?”
- Guilt: “I feel like a bad daughter for not being able to move my loved one in with me.”
Processing your own feelings before talking with your loved one will help you to stay focused, grounded, and empathic when you actually have this conversation.
3. Use Your Empathy Skills.
Just like YOU have all sorts of feelings about your loved one moving, your loved one will have all sorts of feelings about this major transition, too.
If you make the time to work through your own feelings, it’ll be much easier to be empathic when your loved one expresses their feelings. Empathy is the ability to understand and share in another person’s feelings.
Your loved one may have some of these feelings:
- Anger: “Who are you to tell me I need to move!”
- Fear: “How am I gonna do what I need to do? Go where I need to go?
- Sadness: “Losing my independence and my home is a tremendous loss, it makes me think of all my other losses (friends, family, etc)… and all of the other losses to come”
The more steady and grounded you are in this conversation, the more likely you are to have success and come to an agreement.
Here are some tips for being empathic:
Soften your tone and practice listening. Listen for the anger, sadness, and fear. Don’t run away from your loved one’s feelings, instead, move toward them by trying these empathic statements:
- If your aging parent is angry, try saying: “This is so tough and this is a really difficult to conversation to have. I admire you for sticking it out.”
- If your loved one expresses sadness, you might say: “This is such a painful loss. I’m so sorry.”
- If they expresses fear, you might say: “It makes sense to be afraid of what will happen when you move. If you let me, I’ll be here along the way and we can figure it out together.”
WHAT NOT TO SAY:
Don’t say: “I know how you feel”. By saying “I know how you feel”, you aren’t taking the time to understand the feelings and you definitely aren’t putting yourself in a position to share in the feelings. Saying I know how you feel shuts down the conversation, rather than opening the conversation up.
Giving your loved one the room to express themselves with you listening and being empathic will help them adjust to this move AND strengthen the relationship between you.
4. Be Respectful
Acknowledge that this is a difficult subject for everyone and be respectful of your aging loved one. You may have been thinking about your loved one moving longer than they have, so give them some space and grace to adjust to this idea.
Don’t label or call names, like “you’re demented, you have to move”, or “you’re acting like a child”, or “you’re so stubborn and rigid”- this will push them away and make them lose trust in you. Use respectful language, even when you’re frustrated.
Another way to be respectful, is to respect that this is a process and that it will take some time for your loved one to adjust to this change in their life.
5. Be Present! Stay on the Topic at Hand
When talking with our aging loved ones, it can be so easy to get sucked into old relationship dynamics and patterns. Like…
“Ugh, she’s always been stubborn, I’ve never been able to get through to her. She’s never been able to see me- never really listened to me!”
If this happens, all sorts of feelings are gonna bubble to the surface and you may feel the need to protect yourself by arguing or shutting down. Unfortunately, this will likely lead to ineffective communication… leaving you both disappointed.
During the conversation, if your mind (or feelings) shift back to times in your relationship where there has been pain or conflict, simply notice it, and shift the focus back on the conversation at hand. Don’t let feelings from the past derail this conversation.
6. Identify next steps
If things are going well and your older loved one is able, ask them come up with next steps so you don’t have to do all of the work and so that this experience is shared. Be positive and supportive, acknowledging the difficulty of this decision.
You could offer some suggestions for next steps, like:
- “Who do you know who has moved to an assisted living community?”
- “What was their experience like?”
- “Would you be open to talking with them and hearing how they got through this.”
7. Suggest making a list of pros and cons of all the various living options.
Is your loved one on the fence? A list of the pros and cons of moving versus staying put may help to clarify some points and put things in perspective financially, practically, and emotionally.
8. Take a break from the conversation if needed.
Recognize that this will be the first of many conversations. The first conversation should not be the last conversation. When things get heated, take a break and offer to talk about this again at a later date. Let the older adult sit with this for awhile, but follow up at a later time. The second and third attempts at this discussion may well be easier for everyone
9. Keep the older adult involved in the decision as much as possible, even when it’s difficult.
The more you’re able to include your aging parent in this decision, the better. This will set your loved one up for success in adjusting to the new living environment.
10. Be positive and supportive, and at the same time acknowledge the difficulty of this decision.
Try to simultaneously hold compassion for your loved one, the difficulty of this decision for all involved, and your own thoughts and needs.
11. Give your aging loved one and yourself some space and grace to adjust.
This move is a big emotional and practical change and is hard on even the healthiest of families. So, be patient with yourself and your aging loved one.
12. Try to limit other stressful life changes during the adjustment phase (if you can).
Adjustments and transitions take time and energy. Your aging loved one (or staff at the new living environment) may be calling on you more than normal. It can help to limit other big life changes (even positive ones), like a career change, or starting a start-up during this initial adjustment phase. Sometimes, it’s not possible to prevent other big life changes, but if you can limit other stressful changes in your life, do it! This goes for you and your older loved one.
What Are the Different Senior Living Options?
There are a wide variety of senior housing options available, it’s helpful to learn about the differences before you start looking. Here’s a primer to get you started.
Independent Living Community (IL)
A multi-unit apartment community usually available as a rental. Most ILs offer social and recreational opportunities, including two meals a day. Some offer services such as housekeeping, transportation, and home health care services.
Assisted Living Community (AL)
They provide a special combination of housing, personalized supportive services, and health care to meet the needs of those who don’t require full-time skilled nursing care but might need help with activities of daily living (ADLs). They offer apartments ranging in size which may include studios, one- or two-bedrooms, social and recreational opportunities, three meals a day, housekeeping, laundry, and transportation.
Skilled Nursing Facility (SNF)
Rehab or short-term care: State licensed facility that provides 24-hour skilled patient care due to hospitalization, complex physical or complex cognitive conditions, and assistance with multiple ADLs. A patient must be admitted and followed by a physician. The maximum length of stay is 100 days— the first 20 days are paid for by Medicare; days 21-100 require a co-payment.
Skilled Nursing Facility (SNF), Residential Long-Term Care/Nursing Home:
Medicare generally doesn’t cover long-term, custodial care stays in a nursing home. Nursing home care can be expensive, and there are several ways to pay for it. Most people who enter nursing homes begin by paying for their care out-of-pocket. As you use your resources (like bank accounts and stocks) over a period of time, you may eventually become eligible for Medicaid.
Continuing Care Retirement Communities (CCRC)
A community that offers apartments with several levels of assistance, including IL, AL, and SNF home care so residents have the ability to “age in place.” CCRC usually provides a written agreement or long-term contract between the resident and the community and requires a large buy-in fee.
Residential Care Home Assisted Living
A licensed assisted living residence providing a watchful environment and personal services to adults who require varying degrees of supervision and protective care. The homes are smaller with two to eight residents, usually offering a shared or private bedroom, shared bathrooms, and a lower patient to caregiver ratio. The high-quality ones provide home-cooked meals with residents usually eating around a dining room table in a homey atmosphere. These are especially good for individuals needing a lot of care, and not able to socialize much anymore. It’s important to work with a senior placement advisor who is a certified senior advisor (CSA) to find high-quality residential care homes.
Memory Care (MC)
MC offers specialized programs for residents suffering from memory loss. Programs and activities are planned with dementia care in mind. Overall room sizes are smaller because they don’t spend much time in their individual rooms. For residents’ safety, all MC facilities are secured with fences and alarms.
How to find assisted living?
Ready to find senior living? No family has to go through the senior living alone. no family has to go through a senior living transition alone. Senior industry experts can help to guide you in the right direction, take you on tours of communities, answer your questions and be your advocate.
Consider what city the older adult may live in- or be moving to.
Finances and proximity to family play a large role in this decision for many families. For example: long distance caregivers tend to spend more money annually than caregivers who live near their older adult loved ones.
Identify what is available
Once you identify what type of living environment (assisted living community, personal care home, continuing care retirement community, skilled nursing home, etc) and the city, do your homework to identify what is available. Here are some strategies for finding living environments:
- Contact your local Area Agencies on Aging (AAA) and ask for a list of senior living options. Ask if they have senior living advisors available to help.
- Contact an independent Senior Living Advisor: google senior living advisors by city.
- Contact a senior housing locator like Seniorly or A Place For Mom. If you sign up on their website, you’ll likely be called by a Senior Living Advisor. Senior Living Advisors may be non-licensed telephone helpers who help to gather information and advise you on different types of senior living or housing options. This can feel a bit “spammy”
Recommendations for finding assisted living for a loved one with a mental health condition
There are some mental health conditions that are expected in assisted living environments, like depression and anxiety, which often occur with dementia and medical conditions. In fact, one in three residents takes medication for a mental health condition. But when it comes to what we call serious mental illness (SMI), which includes bipolar disorder, schizophrenia, and other psychotic disorders, among other conditions, assisted living communities are less prepared to meet their needs.
With 8.6 million people age 65+ living with SMI and the older adult population on the rise, it’s important for families helping their older loved ones and senior living communities to consider the unique needs of folks with SMI, including helping them find senior living communities that can meet their needs.
1. Stabilize the mental health condition. Many severe mental health conditions are chronic and can be stabilized with a combination of medication and therapy. At times, psychiatric hospitalizations are needed to stabilize a mental health condition. Other times, working with outpatient mental health providers is sufficient. It will be easier to find a senior living community if the mental health condition is stable.
2. Maintain mental health with consistent follow up care. Once the mental health condition is stable, encourage the older adult to continue to meet with their mental health treatment team. The mental health team can help to maintain stability and identify any signs that the condition is worsening, as well as take stock of factors that help to maintain the health and stability of the older adult.
3. Be upfront with the senior living community. Sharing medical and mental health information with the Director of Nursing or Executive Director will allow the senior living community to make an informed decision about their ability to support your loved one. Some senior living communities may not be able to provide the type of environment your loved one needs, and it’s best if this is known upfront so that your older loved one doesn’t have the experience of cycling through many places.
4. Develop a crisis plan. Severe mental health conditions can be episodic, meaning that there can be a period of stability followed by an escalation in symptoms. Thus, it’s important to have a crisis plan in place. This plan might include the older adult’s signs and symptoms of mental health changes and the older adult’s and family’s preferences if there is a crisis (e.g., which hospital to go to, which family member to call, which treatments to use as identified in a psychiatric advance directive, etc).
Setting up a culture of teamwork among the older adult, the senior living staff, and the family when moving into a senior living community will help with communication and decision making should mental health urgencies or crises arise.
5. Maintain consistent communication with the senior living community. The older adult and the family should identify one family member to be the family’s point of contact to check in on a consistent, approximately weekly basis, with the older adult and the Director of Nursing (or another representative) from the senior living community. This will help each party to collaborate and identify what is working well for the older adult in the senior living community and any red flags that a mental health episode may be emerging. This is an important step, as identifying and treating escalating symptoms before they reach crisis level can alleviate a lot of turmoil and suffering.
6 strategies for moving through guilt and shame when helping your older loved one adjust to senior living
Have you helped your loved one move to a senior living or assisted living community only to find that in the midst of experiencing relief that your loved one is being cared for and is safe, you also have intense feelings of guilt and shame?
You’re not alone. Many caregivers struggle with guilt and shame after moving older loved ones into a senior living community. Perhaps you feel that you’ve let your older loved one down, like you’re not being a dutiful spouse, daughter, or son. This can lead to emotional distress and discontent.
To help you navigate the emotionally turbulent waters of caregiver guilt and shame, I’ve prepared 5 strategies for helping you to move through guilt and shame when helping your older loved one adjust to senior living.
1. Be clear about your boundaries and share these boundaries with others.
Identify what your boundaries are. Are there certain caregiving tasks that you do not want to do, or cannot do? Taking time to get clear about your boundaries when it comes to caregiving will help you to identify what sorts of supports you will need to have in place to help your loved one, so all of the tasks do not fall to you.
- I can help my dad with doctor’s appointments, but he cannot live with me
- I can help my mom with bathing, but I can’t prepare meals
- I can take mom to the doctor, but I can’t manage her finances.
Now that you’re clear about what you can and cannot do as it relates to caregiving, share your boundaries with others involved in your older loved one’s care, like your partner, siblings, health providers, and doctors.
2. Be a friend to yourself
When you’re noticing that you’re being hard on yourself, like “I’m a bad daughter for moving my aging parent into a senior living community and not being here for them and the way that I imagined I would be” or the way that my parent imagined I would be. Be a friend to yourself. Respond to yourself when you’re having that thought, like you would respond to a friend.
For example: This is a really tough situation. I’m so sorry that you’re going through this what a dilemma. What a difficult decision that you have to make. I mean, either direction, it’s going to be hard. I’m here for you.
3. Know that you’re not alone
Other people in this situation often have similarly intense feelings of guilt and shame. It may give you a little comfort to know that you are not alone. At some point in almost every caregiver’s journey, caregivers feel that they have disappointed their loved one or let them down in some way.
4. Focus on positive aspects of your relationship and your contributions to your loved one’s care
Guilt and shame are really good at are getting us to focus on negative aspects of ourselves. It can help to counter this with focusing on positive ways that you’re contributing to your loved one’s care or the relationship. For example:
- I call my older loved one every day, or I do a window visit or an outdoor visit with my loved one once a week.
- I call the senior living community daily to get an update on my loved one.
- I was able to take my loved one to the doctor a few times last week, and then we went to lunch. And that was lovely.
Find ways that you are contributing in a positive way and focus on those. Don’t let the guilt and shame have the last word.
5. Practice mindfulness
Mindfulness is essentially holding in your mind’s eye your thoughts and feelings. After you finish a visit with your older loved one, take a few minutes to reflect on what thoughts and feelings are arising for you.
For example: After I leave a visit with my dad in his senior living community, I feel so sad. And then that sadness, jumps to feeling like “I’m a bad daughter”, like I shouldn’t have made this decision.
Taking the time to mindfully recognize your thoughts and feelings and hold space for them, free of judgment, will help you to more compassionately process these intense feelings.
6.Give therapy a try
If you find that guilt and shame, or stress and depression are taking a toll, it can help to work with a therapist.
If you or someone you know is in crisis or struggling with thoughts about harming yourself or others, please reach out to the National Suicide Prevention Lifeline at +1 800-273-8255