There are few points in life more guaranteed to trigger feelings of guilt, confusion, and worry than when it becomes apparent that our elderly parents can no longer live alone.  While it is true that older Americans are living longer these days, and often in good health and with a great deal of their traditional independence intact, some are not so fortunate. Even those now doing well may reach a point where it is neither safe nor wise for them to be on their own any longer.  The question that haunts many of their adult children when this point is reached is What to Do?

While there are signs that multi-generational households are becoming more common, having Mom, or Dad, or any other elderly relative come live with you is often not an option for many people.  Many people are confused about what their options are. Depending upon the health, mental alertness, and levels of ability the older person in your life still enjoys, there are generally three options.

For older people who are basically in good health and just need help with daily chores, the first two options are In-home Assistance and Assisted Living.

In-home care, as the name implies, is full or part-time assistance from a nurse or aid that comes to the home. It can be for limited nursing needs, or for non-medical needs such as cleaning, maintenance, and even dressing, cooking and bathing.  There are a number of sources for this kind of help, and the New York State Office for the Aging can offer help and guidance on what to look for and how to select the service that is right for you and your older family member.

An Assisted Living facility, by contrast, offers special housing for elders, as well as a variety of support services. These usually include assistance with day-to-day activities, such as bathing, dressing, grooming, and the like. Meals are often provided in a cafeteria-style atmosphere, and regular activities are scheduled for those residents who might like to attend. Very basic health care, such as reminders to take medication, might be also offered.

Crossing the bridge to either In-Home Care or Assisted Living is often not easy.  Your older loved one may both resent and resist the idea that he or she can no longer get by on their own.  If Assisted Living is the choice being considered, he or she may strongly resist the idea of leaving their home, their familiar surroundings, and “doing things their way.”

The best advice is to start slowly.  Begin with hiring help for basic chores, such as mowing the lawn or running errands. As the need for care progresses, add more in-home services to meet the need.  But if staying at home alone is clearly not a good idea, then start a conversation. Talk to your loved one about what the future might hold. Discuss their medical issues and what their options are for long-term care. Making a decision may not happen overnight, so be patient with them as they sort through their emotions.

However, if your elderly loved one has significant medical problems that require regular monitoring, or mental or emotional issues that need constant attention, then either of these two options might not be best, and you may have to consider a nursing home or skilled-nursing facility. Older people in nursing homes receive assistance related to day-to-day activities, but they are also monitored by a round-the-clock nursing staff. Patients in nursing homes often have chronic medical conditions and require daily medical services, but not the acute care offered by a hospital.

There are several steps you should take when considering a nursing home.  The first is to make sure that you and your older loved one really are at the point where nursing home care is needed.  If he or she will agree to it, speak to his or her doctor about the state of their health and the degree of independence it is wise for them to try to maintain.

If a nursing home seems to be the best choice, then do your homework.  You can readily obtain quality-related information by mining such resources as the new U.S. News & World Report’s “America’s Best Nursing Homes” rankings, which rely on information collected, analyzed, and converted into ratings by the federal Centers for Medicare and Medicaid Service (CMS).

Once you have narrowed the possibilities down to a manageable few, size up the nursing home by visiting. Don’t be afraid to ask questions.  You deserve answers.  If you think it might help, bring the U.S. news checklist with you as a reminder of what questions to ask.  Use all your senses: does the place look appealing; are there visitors with the other patients, do you detect any unpleasant smells?  If the facility you are visiting has been rated by U.S. News or other outside source, do not be afraid to ask how it got that rating. Ask to see the facility’s Form 2567, information about nursing homes in New York State and the quality of care they provide.  The facility is required by law to show it to you.

Finally, follow up to make sure the nursing home does its job.  It is important to remember not to make snap judgments because there is bound to be a period of adjustment during which things may not go smoothly.  During the first few weeks, however, watch for dramatic changes in the health, disposition, or appearance of your loved one.  Be firm, but not aggressive with nursing home staff.  Make your concerns known. And keep an eye on what is going on with the facility itself: without too much fanfare the small, private facility where you placed your older loved one could be bought up by a larger chain of such homes, and the care offered to the patients could decline.  Frequent changes in either staff or management may be a warning sign that all is not as it should be.

In the end, you want to do what is best for your older loved one, be it a parent or relative.  It is never an easy decision to make, and any path you choose is likely to be full of misgivings, mixed feelings, and uncertainty.  If you are facing this choice, we urge you to contact Capital EAP and speak to one of our trained staff.  We are here to help and to assist you in getting the information you need to make the right decision for you, your older loved one, and for your family.