Is it too early to look at assisted living? (Probably not!)
A common mistake I hear when I ask friends about their mistakes is that they wish they had gotten their parent into assisted living earlier.
When my mom’s best friend was sick last year, her son and I got in the habit of taking long walks. (Okay, he was already in the habit of taking long walks, and I simply tagged along.) On one of these walks around Clearwater, looping through palm-lined streets toward the Gulf and back toward the hospital where his mom slept, we talked about her new assisted living apartment.
“They’re probably worried I’ll just stay there after she goes,” he said. “They’ll have to kick me out.”
I laughed. “A two bedroom apartment with a view—stay as long as you can.”
I could see why someone would want to stay—three decent meals a day, no dishes to do, day trips, trivia night, happy hour. It didn’t sound that different from the cruises they used to go on together.
My mom’s best friend didn’t get to participate in much of that, though. No day trips, no chair yoga. She stayed at home, living alone, until she was desperate. She had fallen a few times and was scared to be alone, especially at night. One time, when I went to visit, she asked me to call every neighbor she had a phone number for. She could barely stand to be in her house one more night, and she wanted me to ask them to stay with her.
Once her son got her moved in to assisted living, she was safe, but she wasn’t as mobile, energetic, or social as she had been just a year or so earlier.
Why not just wait?
Since I started this newsletter, I’ve asked a lot of friends what mistakes they felt they made when their parent was sick or when signs of their aging grew harder to ignore.
So many of them have said that waiting until their parent’s situation was dire before moving them out of their house was their biggest mistake. You think you have more time, but when you look back, you often realize just how little time you actually had.
If your parent can afford assisted living, it’s a mistake to wait to move them into assisted living until they absolutely need help.
If you wait, they miss out on getting to know the place while they’re still fairly independent, decently mobile. If you wait, they may not be able to do as many activities, which means they might not make as many friends. If they don’t have friends, the period of time when they are really struggling, unable to participate in anything, might be unnecessarily lonely.
If your parent goes into an assisted living situation before they need daily assistance, they have a chance to acclimate. You are also making it easier for them to tell you if things aren’t right, to make a move, and to participate in the choice of their own living situation. If you wait, most of the research, choices, and logistics will fall to you.
This advice might seem in conflict with the concept of “aging in place.” But I don’t think it is, necessarily. You can age in place up until a certain point, and that point is going to be different for different people. It’s important to talk about your parent’s goals and values, not just about staying at home or not. For my dad, staying at home was more important to him than being safe, because he was more comfortable at home and he bristled at being told what he could or couldn’t eat, how early he had to be up in the morning, and where he could go. The most important thing for him was independence, and I wish I had been able to distill that in conversation. It may seem like a loss of independence when you move into assisted living, but I would argue it’s the opposite—by being in a safe place and having most of your needs taken care of, you’re actually able to be more independent, more able to enjoy that independence, than you would be at home alone.
Having your parent “age in place” might seem like less work for you. After all, you’re not researching facilities, convincing them to move, handling moving logistics, packing, etc. But in the long run, it might be more work for you. When my dad was home alone, I got a lot more late-night calls than I did when he was in a facility. He had a lot more hospital trips than he would have, I think, if he was in a safer situation. And I was his only source of socialization. Over time, you might find that your parent being home is more work for you than them being in an assisted living facility.
But, assisted living is expensive. Not every aging person can afford to make a move into an assisted living facility. Medicare doesn’t cover assisted living. Medicaid doesn’t cover it. The average cost of assisted living in 2024 in the U.S. was $5,900 a month. You can check the median cost in your state here.
If your parent has long-term care insurance, some policies may cover some costs associated with assisted living. Or you may be able to access benefits through the VA or Medicaid, depending on your state. But, for the most part, when it comes to paying for assisted living, your parent will be on their own.
What is assisted living?
A couple of quick definitions: “assisted living” usually means apartments for people who need some help but are mostly, though not entirely, independent. Often, some or all meals are provided. States regulate assisted living facilities, and the regulations vary.
Many of these facilities are set up with three sections: one for those living independently but on property (usually they have a full kitchen and pay à la carte for any meals they eat in the dining halls), one for those who need more assistance (usually they eat all or most meals in the dining halls and may have help for certain other tasks), and one for those who need skilled nursing. Most assisted living facilities offer some supervision of residents but not nursing care. The pitch often is that it’s easy to move up or down the ladder of need depending on your medical situation and ability to be independent.
At most assisted living facilities, a resident has their own kitchen or kitchenette, a bedroom, and a private bathroom. Residents generally have access to common areas and social activities, and they may receive help with various activities of daily living, including medication management, meal preparation, bathing, dressing, housekeeping, and transportation. Services can vary wildly at different facilities.
Okay, how do you start?
Start by opening your ears to conversations about assisted living. Does your parent know anyone who is living in assisted living? Do they like their accommodations? Has your parent ever visited? Hypothetically, how does your parent feel about assisted living? As you drive around, become aware of what facilities are nearby. If you haven’t already, start tracking your parent’s needs and abilities. What are they struggling with? (Here’s a link to my free tracker.)
Next, gauge whether your parent is well-suited for assisted living. This post is about a common mistake—waiting too long to get your parent into assisted living. By the time my dad was willing to go to a facility, he was so frail that he didn’t qualify for assisted living. Specifically, he wasn’t able to get himself from the bed to a wheelchair or to the toilet without assistance. Residents in assisted living need help but they don’t need 24-hour supervision or care.
If your parent has medical conditions and you’ve been attending doctor’s appointments with them, you likely have an idea of the way their conditions will progress and how quickly. If not, it’s smart to have a conversation with your parent’s doctor to get that information. If your parent’s capacity may change rapidly, you may need to look at another living situation or choose an assisted living facility that makes it easy to step up care when it becomes necessary.
How do you vet facilities?
If you’re starting this process early, your parent can be part of the vetting process when you’re looking at facilities. You can bring them on occasional visits to assisted living facilities and let them get a feel for the place that could become their new home. In “The Measure of Our Age,” M.T. Connolly advises:
“Don’t be deluded by chandeliers. A careworn place might have better care and activities than a fancy one. A place with special mattresses might rely heavily on temporary “agency” staff who don’t know the residents. Consistent quality and emotional connection are preferable to dazzling amenities.”
When you’re checking a place out, talk to residents and visitors to see what they like and don’t like about the place. Google the name of the place (add the name of your local newspaper or television station, too, to see if any reporting has been done!), and check out reviews, but remember that online reviews don’t always tell the whole story.
Questions to ask at your visit to an assisted living facility:
What services are available? Are these an added cost? (Ask specifically about medication management, bathing/dressing, laundry, housekeeping, grooming, meals, and transportation to doctor’s appointments and grocery stores. The facility should be able to provide a list.)
My parent needs help with ________. Does this facility help with that?
What are the rules for visitation? What about my parent leaving campus?
Can my parent bring their pet? Their exercise bike? Their collection of 1970s casino ashtrays?
What activities are available? How many residents typically participate?
Does the apartment come furnished or unfurnished? Can we see the exact apartment she would be in, not a model?
What circumstances would get your parent kicked out? How much notice would you get if the facility decides she needs to leave? What happens if she gets more frail or more confused?
What happens if they become ill and go to the hospital? Rehab? How long is their place held for them?
Can I chat with other residents about the facility?
What do residents like most about this place?
What’s the staffing ratio during the day? At night?
Will someone check in on my parent multiple times a day?
Can I eat a meal here with my parent before we commit to the move?
What kind of contract is my parent expected to sign?
Can my parent keep their existing primary care doctor or specialists?
When my mom’s best friend was first looking into moving out of her house, we were lucky—she found a place all on her own. She asked around to friends in her retirement community and visited the place by herself. She could get a two-bedroom apartment, bring her own furniture, and keep her cat. She could have been happy there, I think, for a long time.
Assisted living may not be right for your parent, but don’t close yourself off to the idea prematurely. Getting a bit of help, being around other people in the same situation, making friends, and taking some of the burden off you, might be exactly what your parent needs. Learn from my mistake—start having these conversations far before your parent needs help.
I have been employed in three assisted living/memory care facilities. I agree with most of what you have written. I have seen individuals blossom in assisted living - the combination of community and care has been invaluable. Deep friendships developed within the community, and also with care-givers. The cautions I would offer are 1, no assisted living community is perfect. They all make mistakes and often the same mistakes repeatedly. 2. If the family members are not engaged in the community, are not visiting their loved one at ALL hours of the day, it is possible to miss things. Pay attention particularly to overnight staffing levels. If the facility is consistently short staffed, it is indicative of issues. 3. Assisted Living Communities are businesses and the marketing can be slick. Be sure the staff training is continuous. There is a lot for the staff to know. The assisted living companies can change hands often, and staff turnover can be high. Is it better than isolating at home?? In most cases, yes. In my experience the residents are not passive consumers - they are political and sometimes loud. Their individual voices are strengthened by the support of others. Residents socialize, learn and contribute. Good for them, and for all of us who love them.
My parents did all the right things because their own mothers would not budge. They were in an excellent facility but to be eligible their doctors had to verify that they would not need skilled nursing for an arbitrary period—maybe 3-5 years? I don’t recall exactly. Within 2 years my mother did need that care, so they were fortunate they had been accepted. I have several friends whose parents refused to leave their homes and of course they fell/had strokes/etc and it became an emergency. One friend’s mother is in a substandard place and the other’s mother is still in her home and my friend is having to drive the 3 hours to her town constantly to help out. It’s a shitshow, to put it bluntly.