Additionally, you may soon find that they need more help than you can give them right now. After all, at this point in life, you likely have your own family to care and provide for.

But how do you know when the time is right to make arrangements for long-term care? How do you which option is best? And how will they be able to afford it? Furthermore, what if Mom and Dad won’t talk about it?

When things reach this stage, it feels like nothing but a flood of questions.

But you’re not alone. While situations certainly vary, these same questions come up for almost any family with elderly parents, whether poor or rich, big or small, close-knit or arm’s length.

It can feel awkward, even difficult, to inspect for these types of issues with your parents, but keep in mind that you’re truly looking out for their best interests, all so that they can best enjoy their later years of life.

 

Here are some signs to consider.

It’s common for seniors to be more susceptible to colds and flus, but when it seems like Dad barely gets over one thing before another hits him, or when you notice Mom has a hard time rallying after a minor head cold, it could be time to bring up the subject. Their health may require more consistent monitoring—especially if you find yourself frequently shuttling them back and forth from doctor appointments. 

While one fall or a troublesome medical test result doesn’t necessarily mean Mom and Dad can no longer take care of themselves, be wary of patterns. Have there been several times Mom almost fell? Are you afraid to get in the car when Dad’s driving?

Trouble with Activities of Daily Living (ADLs / IADLs)

Even if your parents can still bathe and dress themselves, you may notice a decline in how well they’re able to care for themselves each day. Take note of how well they’re handling tasks such as meal preparation, grocery shopping, paying bills, compliance with medications, or even getting from one end of the house to the other. 

Are they ordering take-out for their meals? Do they spend most of the day in just one room of the house? Does Mom avoid walking without someone to stand beside her?

There are two categories when it comes to the activities of daily living. ADLs refer to fundamental tasks an individual must do each day, just to have basic needs met, such as feeding, bathing, toileting, dressing, grooming, mobility, etc. IADLs, or Instrumental Activities of Daily Living, are not absolutely necessary for daily physical function, but are needed to get through a week, or to maintain a reasonable quality of life. IADLs can refer to laundry, meal prep, keeping house, using a phone or a computer, etc. (Find out more here.)

Bottom line, when your parents’ self-care is clearly taking a back seat due to fatigue, weakness, or apathy, don’t wait to start the discussion.

When you visit your parents, do you notice more clutter around their house? Is it obvious that they haven’t kept up with basic tasks of housekeeping? You might even notice a difference in their personal care, wondering if they’re still bathing regularly (or thoroughly). Mom might have trouble styling her hair like she used to, or maybe you notice a faint odor when you get close to them. 

 

Sometimes, when seniors realize they can’t do the activities they love with the same energy or skill, it can be depressing for them. Without even realizing it, they might gradually cut something out of their lives that used to bring them joy—even though modifications exist that could help them continue to enjoy their favorite things. 

If Mom and Dad rarely leave the house, if they’ve become significantly more sedentary, or if conversations have become short and shallow, these are signs of loneliness or depression. There are many options for care that can provide the social support and supervision needed for their mental health.

Even the most financially savvy individuals can suffer a decline in these abilities as they age. It’s not uncommon for seniors to be behind on their utility bills or other regular payments that have been in their budget for years. Or, they might accidentally pay the same bill twice. In some cases, they might even forego bill payments in order to make large donations to various fundraisers, to purchase unnecessary insurances or warranties, or to enter contests or sweepstakes.  

This can take some detective work on your part, but you may have already noticed some signs. Has Mom gone overboard with home shopping purchases? Does Dad ever mention that he has trouble getting the checkbook to balance? Do you notice the mail piling up, untouched?

While not directly related to physical health challenges, this is still a big indicator that Mom and Dad need regular assistance.

Approaching these subjects can be tricky, especially because Mom and Dad might not want to admit—to others, or to themselves—that they’re having trouble with simple tasks of daily life. 

But if nothing else, the best advice would be not to wait until there’s a major, dramatic event to force the issue. The more time for planning, conversation and consideration, the better.

If you’ve already determined that your aging parents need to move, the next step is to consider the right level of care they need. 

You might want to look at an ADLs / IADLs checklist to determine what would need to be provided for Mom and Dad as you choose the right type of community—especially if there are several things they still can and want to do independently. 

However, one rule of thumb can be to answer this question: Can their care be scheduled around their activities, or must their activities be scheduled around their care?

Most elder care facilities can be categorized as custodial care or skilled care. Registered nurses must be present to perform skilled care, while certified nursing assistants (CNAs), aides or orderlies can provide the medical tasks necessary for custodial care—including memory care. 

While in the past these facilities have been called “nursing homes” or “convalescent homes,” they are more accurately referred to as “skilled nursing facilities” because they exist to provide round-the-clock care by registered nurses. The emphasis has been taken off of “home” because in the majority of cases, the lodging at these facilities is temporary. Typically a physician recommends a skilled nursing facility for recovery and rehabilitation after injury, illness or surgery. 

Residents remain at skilled nursing facilities until they are well enough to be released back to independent or assisted living. It is rare that residents stay for the long-term unless they need continual care in the form of injections, feeding tubes, trach maintenance, or if they have severely limited ability in bathing, toileting and transferring. 

These facilities are not designed for residents who wish to maintain some independence, and often residents will share rooms or suites. 

Unless Mom or Dad are in recovery from a major medical event, or if they truly require consistent medical monitoring or are expected to be in and out of the hospital in the near future, you may not need to spend much time researching skilled nursing facilities. 

In addition, unless Mom or Dad have severe cognitive impairment, assisted living can still provide a wide range of care options, including memory care. And on that note, communities that offer memory care have staff specifically trained to work with dementia residents. Skilled nursing facilities prioritize age-related medical care and employ registered nurses—not necessarily mental health specialists (find out more here).

(NOTE: Some families do look at custodial care options in skilled nursing facilities due to insurance reasons, but you don’t have to let this limit your options. Find out more here.)

This remains a popular choice because these communities aim to provide the care seniors require to function while still allowing residents to maintain as much independence as possible. While physicians or registered nurses are not on staff, nurses’ aides are present to provide custodial care, even memory care for those suffering from dementia, Alzheimer's, or other memory or confusion problems.

When considering an assisted living community, Mom and Dad will be assessed to determine the level of care they’ll need. Assisted living provides for most IADLs and many ADLs, such as:

• Housekeeping and linens

• Meal preparation and service

• Transportation

• Laundry

• Medication management

• General health monitoring

• Transferring and toileting assistance

• Ambulation and escort assistance

• Bathing and dressing assistance

• 24-hour staff and security

• Recreation area(s)

Some communities also offer:

• Salon/barber services

• Fitness center

• Classes or programs for nutrition, fitness, etc. 

• Limited respite care after surgeries or hospitalization

• Assistance in financial management

• Massage therapy

• Library or computer area

In addition to providing much-needed care, however, many assisted living communities pride themselves in offering a variety of social activities and resort-like amenities:

• Swimming pool

• Gardens

• Gourmet meals

• Wellness programs

• Social outings to ticketed events or upscale dining

• Weekend entertainment

• Party rooms or home theater areas

• And more!

The possibilities, especially in Southern California, are near limitless!

Also consider the range of options you have in choosing the right assisted living community for your parents, simply in the areas of preference:

If they’re foodies, there are places the pride themselves on their fancy meals. Some may have a fine dining establishment on the property, in addition to the main dining hall. 

If they’re active, several communities have fitness centers, organized walks, outings to the mountains or beach, golfing groups or water aerobics. 

If they have a religious preference, several communities offer onsite worship services or transportation to nearby churches. 

If they prefer a simple, frugal way of living without much noise or fanfare, many communities pride themselves in offering a quiet, relaxing, no-frills atmosphere that can also bring down costs already factored in to other communities’ plans.

As unique as your parents are, there is likely an assisted living community that can care for them as they need while also giving them opportunities to enjoy their favorite activities. 

These licensed establishments are smaller (6 beds and under, in California) and more attentive in their care, though the level of care provided is similar to that of the larger assisted living communities. They allow for a more low-key lifestyle and are often embedded within existing residential neighborhoods.

The goal of board and care is to maintain a more home-like feel. Many seniors consider this type of living if they do not require the skilled medical attention of a nursing facility, but they also don’t prefer to living a large apartment-style community. Board and care homes still promote activity and social interaction, but in smaller groups and a more intimate setting. 

Some board and care homes do not offer completely private living areas, though your parents will likely have their own bedroom. 

If memory care is a concern, it is much lesson common for board and care homes to offer this level of care. Assisted living may be more appropriate.

Many families feel that a board and care facility is a smoother transition for Mom and Dad, especially if they prefer a quieter social scene. They might also appreciate getting more time and attention from the staff. 

If Mom and Dad would prefer more frequent or diverse social activities, however, board and care may not be a good fit. 

If you’ve been reading through these options and think that these arrangements sound like more than your parents need right now, there is still another option.

Also referred to as retirement communities, retirement homes, retirement housing, senior apartments, etc., independent living communities can provide a nice, easy place to live for older adults that can still maintain their ADLs and want to remain active and social. 

“Seniors” as young as 55 often opt for communities like this, drawn to the quiet, safe environment that allows them to maintain a degree of autonomy while also enjoying maintenance-free living. These communities often help with IADLs such as:

• Housekeeping

• Meal preparation 

• Errand-running

• Clubhouse or recreation area

• Laundry services 

• Various onsite conveniences (banking, salons, fitness centers, library, etc.)

Living arrangements can vary from a stand-alone house, an apartment, townhouse, condo, or even an RV. 

If Mom and Dad are still capable of maintaining self-care but would benefit from giving up the day-to-day chores of keeping up a home, independent living can be a great choice.

If you’re still determining whether your parents need skilled medical care or custodial care, it’s best to think in medical terms instead of cognitive. If Dad has both dementia and is also severely diabetic, skilled nursing should be considered. However, if Mom’s Alzheimer’s is serious but she is otherwise in good physical health, an assisted living community with a memory care unit can provide the care and supervision she needs. 

It’s true that many seniors with cognitive impairment do end up in skilled nursing facilities, especially if they are prone to getting angry or violent. However, RNs aren’t required to have additional training in memory care, even though some of them may choose to. 

The difference in training can mean a lot. For example, memory care specialists know how to calm and redirect individuals experiencing an episode of confusion, keeping them from becoming stressed, belligerent or paranoid. Without this type of specialized training, even a seasoned RN might inadvertently cause a resident to become scared or angry, or to decline into panic, which can elevate heart rate and blood pressure.

Fortunately, memory care is becoming more and more common in assisted living communities and with the many locations available in Riverside County, you should be able to find a suitable place for Mom and Dad.

Even if all the signs are there, it’s not easy to bring up the subject with Mom and Dad. Aging takes it toll on emotions, and if chronic pain, depression or anxiety are also in the mix, it makes it hard for seniors to think objectively about their own living situations. 

It’s not uncommon for seniors to hold onto the past, wanting to stay in the house they’ve lived in for decades—even though the yard is overgrown, the carpet is old and worn, and they have trouble navigating the steps up the front porch. 

So what do you do? 

Sometimes it can seem easier to avoid the subject, to just let Mom and Dad stay put and hire a caregiver. 

But there’s more to the equation that just receiving care. To help Mom and Dad thrive during this time of their life, staying active and social is key.

A recent study followed almost 1500 people, age 70 or over, for 10 years. These participants were categorized into two groups—those that stayed at home with family caring for them, and there who were integrated into social networks via assisted living communities or residential care facilities.  

The results revealed a strong relationship between maintaining social networks “with friends and confidants” and favorable survival rates, with more reports of happiness and engagement. 

You just want what’s best for Mom and Dad for the remainder of time you have left with them. Here are some tips for starting the discussion.

If you have siblings that will be sharing this task with you, try to avoid the appearance of “ganging up” on Mom and Dad. Approach the topic gradually, looking for cues, and always acknowledge Mom and Dad’s feelings and preferences before sharing your recommendations. Keep it conversational, so it doesn’t appear like a rehearsed presentation. 

Unless serious health risks are in the equation, frequently let Mom and Dad know that they are still the ones who make decisions for their future. You do not wish to force anything—you’re just speaking from concern, and in attempts to have plans in place in case anything unexpected come about.

One way to demonstrate that you’re not trying to control the conversation is to ask questions throughout, such as, “Would it be helpful if you had someone assisting with cooking and cleaning?” or “Do you think your back pain would improve if you didn’t have to walk down the stairs each day?”

If you anticipate questions about what types of communities are close by, what types of services are available, what will happen to their belongings if they move, what Medicare or MediCal does or does not cover, or how this will affect their budget, come prepared. 

This helps avoid slow-ups in the discussion process from having to say, “Ok, I’ll check on that.” or “I’ll look up some options.” You’ll already be prepared with the answers, and it’ll be easier to refute any misconceptions they may have.

Especially if you are working with a senior care placement specialist, you can compile a lot of information ahead of time. A little insider knowledge and expertise goes a long way.

Many aging adults still picture a drab, white-washed facility similar to institutions portrayed in the movies. Old, unhappy people walking around in robes, coughing and popping pills, finding entertainment only in watching TV, playing cards, or knitting. Even if they know that assisted is supposed to be different, it’s tough to change old perceptions. 

First of all, make your parents are correctly informed of the difference between skilled nursing facilities and assisted living communities

Mom and Dad might need to see some proof that many of these communities can even be quite glamorous! Get them to come on at least one community tour, or have them meet some peers that are enjoying assisted living and can give them an unbiased review. Also,.

Outdated stereotypes, such as those mentioned above, often accompany deep-seated fears like losing independence, feeling confined, or living in close proximity to a large amount of people. In reality, however, seniors often become more independent once they’re settled in assisted living!

Without the daily burdens of housekeeping and meal prep, Mom and Dad can enjoy extra freedom, energy and opportunities. They can start going to movies and restaurants again, or revisit an old hobby. 

They feel like they’re not “sick enough” or “frail enough” to need assisted living

Usually in the interest of saving money or holding onto their old ways of life for as long as they can, many seniors will tell their children that they don’t see the point of discussing assisted living when they’re “doing mostly ok” for the time being—even if it’s clear that their health is declining.

It might feel funny to be planning for long-term care when Mom and Dad are still able to do some of their IADLs without too much difficulty But it’s infinitely harder to make decisions about care or living arrangements when also dealing with the aftermath of a fall, a serious illness, or a sudden turn for the worse. It’s so much easier to plan a move when Mom and Dad are still able to vocalize what they like about one community over another, help with packing, and set up their own living spaces without much assistance.

Additionally, making a move when less care is needed can reduce the price at communities that have a price range based on levels of care.

This will be discussed further in the next section, but it’s important for Mom and Dad to keep in mind that the higher monthly “rent” of assisted living is due to the fact that all amenities, utilities, and meals are included, as well as several other perks such as security, attentive staff, and assistance with ADLs and IADLs. 

Right now, they’re likely paying for several of these things separately—possibly even paying more! It’s worth a thorough look at their current budget.

When looking at the raw numbers of assisted living expenses, it can seem overwhelming. Yes, it’s much more than a rent or mortgage payment, and it may seem like that such a large number can’t possibly fit into your parents’ budget. But consider these points:

This isn’t just a big rent payment, it’s most of Mom and Dad’s expenses in one bundle—utilities, groceries, transportation, medical care...even weekend recreation!

If your CPA or tax preparer is up to date on the latest laws, they’re aware that assisted living costs can be written off on Mom and Dad’s taxes as medical expense if it’s more than a certain percentage of their income. It used to be that only the specific care expenses were deductible, but this has since expanded. Ask your parents’ accountant for more details.

You may see signs or ads for assisted living communities that say things like, “Move in next month a get two months rent free!” or “Move in by August and we’ll waive the initial fees!” Yes, these incentives are time-sensitive... but next month, a similar promotion will be available, even if it isn’t widely advertised. If you’re working with a community your parents like and you express concern about being able to afford it, they can usually pull some strings to help the expenses become more manageable for Mom and Dad’s situation.

They may be eligible for benefits through the Department of Veteran Affairs.

In some communities, rooms on the first floor or closer to the dining area are more expensive. If Mom and Dad don’t need the most accessible room on the grounds, they could find a cheaper room on the 2nd floor near the back of the property that costs less per month.

Especially if you’re placing a single parent who wouldn’t mind this particular form of close companionship, some communities offer suites or larger rooms that can accommodate roommates. There may also be opportunities for couples to share two-bedroom apartments.

If Mom and Dad are in good enough health to be selective of the services they need, they may be able to negotiate a lower rate. Many communities have a flexible pricing structure, even if it’s not listed in their promotional materials.

As mentioned earlier, sometimes aging adults can get their finances confused or unbalanced. Going through things together, you might discover that some payments, memberships, charity donations, frequent splurges, etc., can be reduced or cut.

Senior placement specialists are available at no cost no cost to your parents. They have access to inside information that individual communities may not be as forward about, such as discount programs, a la carte agreements, or various points to use in negotiations. 

There are private insurance options specifically focused on long term care for seniors, but sometimes the premiums are so high (and can get higher) that it doesn’t offer much improvement from paying out of pocket. 

When it comes to Medicare, it usually covers home health or a stay at a skilled nursing facility, based on physician’s orders. Medicare will not cover assisted living costs as a whole. 

However, there may be certain medical costs within Mom and Dad’s care plan that could qualify for coverage. It’s worth speaking with a Medicare representative, especially if there are specific medical needs to be factored into your parents’ care plan.

If your parents qualify for Medi-Cal, there is the option of the Assisted Living Waiver (ALW). Not all communities will be able to participate, and this will not cover the room and board expenses. Similar to Medicare, it will only cover specific medical expenses that qualify.

Important to note, however, is that there are often funding issues with this government aid program, and it’s possible to wait well over a year to receive assistance. Mom and Dad can’t always afford to wait until this is available to make the move.

There are over 200 assisted living communities in California's Riverside County alone. They all provide the bare essentials Mom and Dad need as seniors, but how can you tell which one is right for them?

A simple Google search can overwhelm you in less than a minute. Which websites belong to the actual facilities? Which websites are just another search engine, or an agency collecting leads to get commission after placing your parents? (Be careful before calling 800-numbers or entering your email address!) Which websites let you compare communities side by side, based on the needs and preferences of your aging parents? Where can you find unbiased, objective information?

It’s not much easier if you look in the phone book, or other local directories. You’ll find listings and ads that all claim to be the perfect assisted living community for Mom and Dad. Come visit us, they say. Tour the property! Meet the staff! Taste our food!

While they may be great communities for many reasons, they don’t know your parents. Services and amenities vary widely, as well as the way that are presented, administered or kept up to date. It’s important to do thorough research well before you schedule tours or consults. 

Furthermore, appearances can be deceiving. While some communities might have newly renovated rooms or one of the most top-rated chefs in the area, their staff might be behind on their continuing education. While another community may appear warm and friendly, with several unique activities offered regularly, they might be dealing with state licensing issues behind the scenes.

So how can you tell what each assisted living community is really like?

One way is to check review websites such as Yelp. An abundance of bad reviews is an obvious red flag. Keep in mind, however, that one or two bad reviews may not necessarily mean that community should be removed from your list. Emotional family members, misunderstandings or honest mistakes can cause unfortunately situations that don’t always reflect the standard of care across the board.

Do look for patterns. If more than one unfavorable review says similar things as others, take that into consideration. 

If you’ve done some searching already, you may have come across websites that use your location to present search results for assisted living communities near you. 

This information can be helpful, of course, but there are significant details to be cautious about. 

While you can find itemized listings of nearby communities’ amenities, as well as reviews, related articles, or even the chance to live chat with an agent, these agencies are not always out for the personal touch. Their business model is built around providing leads to assisted living communities in exchange for commission. 

And in many cases, even if you haven’t yet chosen a community, your family’s name and contact information has been passed along to several establishments. And they may soon end up calling you, asking to schedule a visit. (You may not even be ready for this yet, as you’re still in the info-gathering stage!)

How did they get your contact information? If you entered your email address to receive certain information, or even if you called their 800-number once, they are able to retrieve what they need. 

What’s more, the way the community's’ listings are displayed on these agency websites, some families think they are contacting the community itself, but instead their call goes to the agency. The representative who takes the call can talk about the community in consideration and set you up with a contact, but you still have not actually connected with that community. 

This can also cause your parents to miss out on some promotions, as calls that come from agencies are often considered pre-matched and not in need of extra incentive before making the decision.

This is not to say that families haven’t benefited from the resources a referral agency has provided. But this level of service bypasses the personal relationship that can be essential in determining the best community for Mom and Dad.

Fortunately, there’s a widely-available, free resource that not many families know about: Senior Care Placement Specialists.

Senior care placement specialists are different from agencies as they work individually and only within their local area, which they know like the back of their hand. They can provide free assistance in finding the assisted living community that best matches what your parents value. 

This is possible because a placement specialist takes the time to sit down with both you and your parents, getting to know the family dynamics and assessing the needs and priorities of both Mom and Dad, as they each may need different levels of care.

In addition, these professionals have the insider knowledge about each community that you won’t be able to find in a Google search, a Yelp review, or even a visit to the property itself. They’ll know if a certain community has had state licensure issues, or if another has been tented for pests twice in the last year. They’ll also know that while one particular community looks simple or even old on the outside, the residents absolutely love living there.

Placement specialists can also accompany you on community tours, helping negotiate with personnel to achieve the best deal and the most fitting level of care for your parents. It’s having an advocate in your corner, truly looking out for Mom and Dad’s best interests.

These professionals are completely independent, receiving their income as finders’ fees with no bias or affiliation with a particular establishment. And their work is referral-based—they want to make sure your family is happy with the placement decision, and so does the community you chose.

With such a life-altering decision ahead, there is nothing more important than staying informed. 

You’re working with your beloved parents to find arrangements that can allow them to thrive during their later years of life, and getting the right help in your corner can make the difference between information overload and elevated stress, and getting personalized guidance that facilitates the whole family’s decision-making process.