By Tanya J. Tyler


As parents and other loved ones age, a prime concern is finding a place for them to live. There are many senior housing options available, forming a continuum of care that seeks to make the transition to each stage as easy as possible.
You could choose to help your parents age in place in their own home, hiring home care personnel to help with daily living activities such as cooking, laundry, grocery shopping, taking medications and bathing. You might make modifications to the house, such as installing easy-access tubs and showers and grab bars.
You could choose to move them into your own home and take care of them yourself. Or you could find an independent living community where your parents would interact with people of the same age and have moderate supervision. This option is best for those who are still in good shape mentally and physically and who can take care of themselves without assistance. But if their health begins to fail or they suffer a debilitating setback such as a heart attack or stroke, the next option could be an assisted living facility. Here they will be closely monitored by staff, who perform such daily living activities as bathing, dressing and medication administration. These facilities offer apartment-style living and often have amenities to make the residents as comfortable as possible, including exercise rooms, restaurant-quality dining and opportunities for shopping and other off-site activities.
Finally, once the care receiver becomes incapacitated to the point where he or she needs more intensive care, you can choose to place him or her in a skilled nursing home. These facilities accommodate elderly people who have health conditions that require constant monitoring and medical care. Residents receive 24-hour supervision, health management support, physical or occupational therapy if necessary, meals and medication. Patients with Alzheimer’s disease or other dementia can be placed in a memory care facility that is especially supportive for these challenging conditions.
Continuing care retirement communities encompass the options of independent living, assisted living and skilled nursing on one campus, so an elderly person can smoothly transition from one level of care to another as needed in a familiar environment. This option is becoming increasingly popular.
What makes it difficult to choose where elderly parents or loved ones will live is the fact that many people put the decision off until a crisis hits.
“I wish I could say people get proactive, but I’ve learned everybody waits for that crisis,” said eldercare expert Barbara McVicker, author of Stuck in the Middle: Shared Stories and Tips on Caring for Mom and Dad and Before Things Fall Apart: Preparing to Care for Mom and Dad.
McVicker cared for her aging parents for 10 years while raising her children and working as a development director. Her plunge into elder caregiving began when she discovered her father had sent $68,000 to scammers in Canada who told him he had won the Canadian lottery and needed to pay taxes on the winnings. Other events could trigger the sudden need to find an appropriate place for an ailing parent.
“It could be a phone call that says, ‘Mom’s in the emergency room; she’s broken her hip,’” McVicker said. “We encounter that crisis and we haven’t had the conversation about where they will go.”
Without a plan in place, conflict can flare up. “Families sometimes never get over that conflict,” McVicker said. “I know of siblings who have never talked to one another again.”
As difficult as it may be, the time to discuss all the options is now.
“The best gift families can give each other is to talk about it sooner rather than later and let everybody in on the plans,” McVicker said. “By not bringing up the topic, it makes all the aspects of caregiving – financial, emotional, physical – difficult.”
With people living longer, caregiving can easily be a 15-year unpaid job. “Caregiving is a marathon, not a sprint,” McVicker said. She helped her parents stay in their own home for several years, but eventually they moved to a continuing care retirement community. Often the situation deteriorates as the person’s health declines and such a move is necessary. “There’s a point at which you either need to hire skilled people, such as RNs, or move to a place that can provide the level of care that it takes,” McVicker said.
Costs are staggering. The average cost for an assisted living facility is about $3,000 a month.
“If you look at it in terms of how many years most people need to be in assisted living or a nursing home, the national average of actually using those facilities runs around $200,000 from beginning of needing those different options to when the person dies,” McVicker said. “With in-home care, there’s a point when you’re starting to infuse $40,000 a year into helping Mom and Dad.” Geographic area also makes a big impact on costs.
People sometimes hesitate to move a parent into another type of facility because the parent has said, “Don’t ever put me in a nursing home.”
“And we say OK, and as the situation deteriorates, we feel limited by that promise,” McVicker said. “There are so many great options now, but our parents have in their mind the old nursing home ‘warehouse’ model and don’t understand how different and how engaged and how their health can even get better by being in some of these other situations.”
McVicker advises making visits to different care facilities with your parent before he has to choose one. This can help him see what the facility is like, and he can talk to staff and residents about their experiences.
It’s most important to reassure the person that she will be involved in making the decision about where to live and to make sure they understand all their options.
“We should say, ‘I will be there for you. I’m going to listen to you. Out of safety and support and love, we will make those decisions together,’” McVicker said.

Assessing a Parent’s Capabilities
Is it time to move your parents to another level of care, such as assisted living or skilled nursing?
Eldercare expert Barbara McVicker says there are ways to assess an elderly person’s capabilities to determine whether they need more help.
“There are eight areas adult children need to look at and assess every six months or so,” she said. “Look at their financials—can they pay their bills? Assess their own personal care—can they grocery shop? Are they eating? Ask about hygiene—are they bathing and grooming themselves? What about transportation—are there dents in the car? Can they take medications correctly? Can they make doctor’s appointments and keep them and understand what’s going on? What about memory issues; are they getting confused and forgetful, misplacing objects? What about their mental status?”

Other signs to watch for include:
Weight loss
Unpaid bills and stacks of unopened mail
Missing important appointments
Unexplained bruising
Uncertainty and confusion when performing once-familiar tasks
Body odor indicating lack of bathing
Mood swings
Forgetting to take medications or taking more than the prescribed dosage