When he was in his late 80s, William Cohn, Candy Cohn’s father, unintentionally stopped taking medication for a long-standing bipolar disorder and experienced a significant mental health crisis requiring hospitalization and intensive treatment. It was following this episode that Candy knew that she needed to help her older parents find a senior living community that would provide more continuity and medication management, as well as to offer opportunities for a better quality of life than they were getting at home. But, where to start?
I have witnessed many older adults living with significant mental health conditions, like bipolar disorder and schizophrenia, struggle to find senior living communities.
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.
5 recommendations for finding assisted living for a loved one with mental illness
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.
Candy eventually helped her parents find senior living and used many of the tips described above. She recently shared her story in the Psychology of Aging Podcast and has since devoted her career to helping others caring for aging parents and older adults with mental health concerns to find senior living that meets their needs. You can listen to her story here.