When is residential care the best option for my aging parent?

Laurie Theriot, MD

Geriatric Hospital Medicine

Although most people would prefer to “age in place” at home, a time may come when it’s not safe to do so. Making the decision to move someone into residential care is often emotional and difficult, leaving many at a loss for how to even start.

Geriatrician Laurie Theriot, MD, offered advice about how to talk about residential care with your aging parent, as well as the next steps to take.

When is it time to consider residential care for an aging parent?

“When a caregiver can no longer meet the needs of an older adult without sacrificing their own mental and physical well-being, it’s really time to consider a residential care option,” Dr. Theriot said. “This is definitely a difficult decision, but it should never be viewed as a failure of the caregiver. It’s an acknowledgement that this is difficult, and it takes a tremendous amount of resources to be successful.”

What residential care options are available?

Depending on the needs of the older adult, you may consider a residential home, an assisted living facility or a skilled nursing facility for long term care (also known as a nursing home).

Here’s a breakdown from the National Institute on Aging on what each type of facility offers.

• Residential homes are usually small private care facilities or group homes that have 20 or fewer residents. Rooms may be private or shared. Residents receive meals and help with personal care around the clock, but nursing and medical care is not provided.

• Assisted living facilities are for people who need daily help, but not as much as a nursing home provides. Facilities can have up to 100 residents or more, with residents living in their own apartments or rooms and sharing common areas. This option is more expensive than living on your own but cheaper than a nursing home. Medicare does not pay for assisted living, but fees can be partially covered by some long-term care insurance plans.

• Skilled nursing facilities (nursing homes) offer a variety of medical and personal care services 24 hours a day. Medicare doesn’t typically cover long-term stays, but it might pay for related costs such as doctor services. Medicaid may also pay for some of the costs, depending on eligibility requirements. Long-term care insurance may also provide coverage for nursing homes.

How do you start the conversation about residential care?

These are tough conversations that ideally would happen early on, with input from your loved one before decisions need to be made. Take the time to ask what they would want if they can’t live at home anymore.

“This gives you an idea of what they want should they cognitively or functionally decline in the future,” Dr. Theriot said. “It also allows you to deliver this potentially difficult news in a more gradual manner. Knowing what your loved one wants doesn’t mean you’ve promised to deliver, but at least you know what their goals are, and it allows you to be in a position to possibly meet them.”

You can also talk with your family and other caregivers about options that can help your loved one stay at home longer and agree when a residential option would be considered.

How do you know if a residential facility is good?

Skilled nursing facilities, or nursing homes, are evaluated by the U.S. Centers for Medicare and Medicaid Services, so a good place to start your investigation is their website.

“You can see staffing and past health survey results, including abuse reports, but it’s important that you visit the facility and see for yourself,” Dr. Theriot said. “Look at who is currently living there. Are they out and active? Do they seem to be having fun? Do they remind you of your loved one as far as their functional abilities and cognition? It’s always a good idea to ask for a copy of their activities calendar and see if it’s something that you think your loved one would enjoy.”

Some red flags to look for include:

• Is the facility unusually quiet? Residential facilities are usually active and lively unless it’s a scheduled quiet time.
• Is the facility clean?
• How are the interactions between residents and staff? Do the staff seem to know the residents by name, and do the residents seem genuinely happy when the staff engage with them?

For information about residential care facilities and assisted living facilities, visit assistedliving.org and search for facilities by state. The site includes compiled reviews and star ratings from patients and their family members.

“Also, talk to your friends, coworkers and church members about their experiences with these facilities,” Dr. Theriot said. “But I can’t stress enough how important it is to visit these facilities in person and see if it’s a good fit for your loved one.”