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June 10, 2024

Transitioning from Home to an Assisted Living, Skilled Nursing, or Memory Care Facility

Alexis Alarcon
The PDF which includes endnotes and footnotes in which this article appears can be found in Bifocal Vol. 45 Issue5.

Transitioning an older adult from their home to a skilled nursing facility or a memory care unit can be extremely difficult for the older adult, their family, and their caregivers. It can be especially hard to know when the right time is to transition an older adult, and how to talk about it with them.

Consider this hypothetical: an older woman, living about two hours away from her children and grandchildren has started to develop dementia. She had a stroke and a few falls, and her old two-story house is not safe for her to live in anymore. Her children also start to notice changes in her mood as her dementia worsens; she wanders and starts to be paranoid of her daughter. Of her five children, two live in the area and three live in different states. The children do not get along most of the time, and they disagree about her care. On top of it all, their mother’s physical health is rapidly declining due to a recent cancer diagnosis, and it has been suggested by her physician that she needs placement in a 24-hour skilled care facility. The search for a nursing facility to meet her needs within the budget is daunting, uncomfortable, and tiresome for family members. The decision to move her into a memory care unit is an extremely difficult one as her savings were rapidly draining and her children fought for every penny Medicare and Medicaid would give them. After two years in the memory care facility, she transitioned to hospice for “comfort-measures-only” end of life care, and she passed away peacefully on the night of her oldest granddaughter’s high school graduation.

The key issues in this hypothetical are emotional (confusion, mistrust, desire for the older adult to be well cared for, stress, sadness, guilt), physical (treatment, declining health), mental (dementia diagnosis), financial (daily battles with Medicare, Medicaid, and private insurance to finance her treatment). This scenario, which many caregivers of older adults can relate to, shows that there are no easy answers to these issues. This article will provide recommendations for family members and caregivers going through similar situations, although every individual situation is unique, and what may work in one situation is not guaranteed to work in another.

The reasons why an older adult may need placement in a nursing facility are numerous, and as seen in the hypothetical above, the older adult needed memory care, cancer treatment, and assistance with dressing, bathing, and eating. There could be dozens of reasons an older adult might benefit from additional care. One of the biggest issues families and caregivers face in this process is knowing when is the right time to move the older adult, and how to tell the individual they can no longer live on their own.

It is important for caregivers to discuss their concerns with an older adult’s medical professional or primary care physician (PCP). Most PCPs wait until a family member speaks up before ordering an assessment of an older adult’s memory, and it can be daunting to voice concerns to a medical professional. It is important for the families and caregivers of older adults to know that they are not alone and to seek out resources to help with their own mental health, (which includes reaching out to family and friends that might be in similar situations or may have gone through this in the past). With the financial strains that are often placed on the immediate family, it is important to fully understand what is covered with by the older adult’s insurance plan. While Medicare often does not cover nursing home or long-term care, Medicaid can cover such expenses depending on your state.  (For more information, go to Caregivers and families should also consult online resources, such as the website for Medicaid’s Beneficiary Resources section, and trusted medical professionals when making the decision to move an older adult to a skilled nursing or memory care facility. Ensuring that this transition can happen as smoothly as possible is essential for older adults to retain their autonomy and dignity, and to ease their caregiver’s anxieties and worries.

There is no “one size fits all” solution to the issue of knowing if or when it is time for an older adult to move into an assisted living, skilled nursing, or memory care facility. To make the most informed decision possible, caregivers should pay attention to the older adult’s physical and mental health. If they notice frequent falls, difficulty performing basic tasks, cognitive decline, increased confusion or agitation, or increased assistance required to perform custodial tasks, it might be time to talk to the older adult’s PCP about available options.

In the hypothetical at the beginning of this article, there were several warning signs that the older adult may be need more care and assistance: the older adult was living on the ground floor of her home because she could not walk upstairs, she frequently could not remember whether she had eaten a meal or not, and was increasingly isolated from her family.  There are many community resources for caregivers of older adults. For example, the National Council on Aging (NCOA) has resources for older adults, caregivers, professionals, and advocates in related fields. The AARP also has a toll-free family caregiving resource line (877-333-5885) for people taking care of a loved one, as well as a free online caregiving community that caregivers can join to talk with other caregivers and get answers from experts in the community.

Many family members, especially spouses, are unable to let go of their role as caregiver. Whether it be out of guilt, sadness, or anxiety, spouses often visit daily to try to maintain as much normalcy as they had before the transition. While Alzheimer’s or dementia patients may not remember if they visit every day or once a week, it is important for caregivers to continue to live their life after an older adult is placed in a nursing facility. This decision is one that most people hope they never have to make, but many do all the same. If nothing else, it is important for caregivers to remember that as long as they have the best interests of the older adult at heart, they will make the right decision.

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Alexis Alarcon

Freshman, American University