There is no one right decision when it comes to living arrangements for your aging parents. Some parents thrive at home, others do better in a senior living facility. As always, when talking to your parents about their living arrangements and/or making decisions on their behalf, aim for equal parts courage and compassion: the courage to do what is needed and the compassion to understand what a challenge aging, and all of the challenges it brings, can be.
 
Senior Living Options
 
To give you a sense of the options, here is an overview of 8 different types of living arrangements. 
 
Aging in place.
This means your parent remains in their home. In order to do that they may at some point need assistance with driving, household chores, finances, bathing and dressing, and medical needs including transportation to doctor’s appointments, assistance with medication, medical tasks, physical therapy, etc.–either from you, another family member, a home health aide, a visiting nurse, or some combination of people. You may also need to retrofit their home by lowering shelves, removing any trip and fall hazards such as area rugs, lowering toilet seats and widening doors to accommodate walkers and wheelchairs.
 
Independent Living.
 These communities, often an apartment complex or cluster of cottages, allow seniors to live independently but take advantage of shared services such as dining rooms, activities, and exercise programs. If you or your parents are concerned about social isolation, a very real issue for many senior citizens, this could be a solution. Most independent living facilities are pricey, often comparable to the cost of a home, but some refund a portion of the fee after move out.
 
Assisted Living.
Assisted living facilities differ from independent living in that residents can purchase care plans for assistance with tasks like bathing and dressing, housecleaning and laundry, and medication assistance. While assisted living facilities have nursing staff, they are not designed to provide medical attention. These facilities are not covered by Medicare or Medicaid they are private pay. Some have a set number of units designated for residents in need of financial assistance and the subsidy source varies state by state. There is typically a long waiting period for subsidized units.
 
Board and Care Homes.
Board and care homes differ from assisted living communities in that they have fewer residents. Both living options provide similar services.
 
Memory Care.
Memory care is similar to assisted living except these facilities cater to people with cognitive decline such as Alzheimer’s and dementia. They offer a high level of assistance with personal care tasks plus recreational programs tailored to people with memory loss. Residents typically live in a locked area so they won’t wander or get lost.
 
Skilled Nursing Facility.
 A skilled nursing facility is what many of us know as a nursing home. Residents receive round the clock medical care. Most facilities have a mix of short-term and long-term residents. Short-term residents may stay there just while they receive rehabilitation services after a hospital stay. Sending your parent to a nursing home is not failing! Sometimes, they need a high level of care.
 
Continuous Care Retirement Community.
 These communities, usually private pay, and usually at the higher end of the cost spectrum, allow people to move into independent housing and then transfer to assisted living and or skilled nursing as their needs increase.
 
Living With You.
Some people move their parents in with them or move into their parents’ home. If you go that route, try to have separate bathrooms, discuss the financial arrangement first, and establish some boundaries for when you will be in daughter, caregiver, and self mode. You may decide morning coffee is a solo activity but watching Jeopardy is a family affair. Think about, and discuss, these things!
 
A Checklist for Choosing
 
Choosing the right facility takes thought and planning – but you don’t always have the luxury of time. Remember there is no perfect solution nor is there only one right decision. Quality of care is a major factor, but so too is availability, and, quite frankly, affordability. Your job as a caregiver is to make the best possible decision based on your individual circumstances. 
 
Referrals/Research.
Ask around for referrals. Your parent’s primary care physician, friends and relatives, staff at assisted living or a hospital, your local Council on Aging, are all possible sources of information. Then use the Nursing Home Compare tool from Medicare.gov to research safety and quality records.
 
Availability and Cost.
If you can, start looking before you think you need to. Many facilities have long wait lists. Ask if the facility accepts Medicaid as well as private pay. Is there a different wait list depending on your method of payment? Do they require several months of private pay before accepting Medicaid?
 
Proximity.
 Is the facility close to you and/or other family members and friends? Maybe you should choose a place close to your office so you can drop by on your lunch hour or on your way home from work. Familiar faces and frequent visits can ease your family member’s transition to a new home. Can other family members easily get there so that they can visit too and give you a break when you need it? Speaking of visiting, are there set visiting hours or can you drop by any time?
 
Tours.
Visit the facilities you’re considering and note what you see and smell. Are residents sitting in wheelchairs in the halls? Are they dressed or in pajamas? Is there a strong urine odor or strong chemical odor that may be masking other smells? Is there a receptionist watching the front door? Are side doors locked? Does the staff seem energetic or lethargic? Do they make eye contact and interact with residents and family members? If you can, sit outside during a shift change and observe employees as they show up for work. Are they dragging or do they have some pep in their step?
 
Quality of Life.
Can patients follow their own schedules or must they comply with routines? What activities are offered? Can you take your parent out of the facility for holidays and excursions? Do they offer services like haircuts, dental appointments, podiatry, and flu shots? Can your parent keep their doctor or will they see a facility-appointed doctor? Under what circumstances will the staff send your relative to the ER? How do they balance risk of falling with independence and autonomy? How are confusion, wandering and behavior issues handled? What is the philosophy on psych drugs and restraining patients?
           
Gut check.
Sometimes the decision comes down to what your gut is telling you. Trust it.
 
Paying
 
Professional services firm PwC estimates that the average lifetime cost of long-term care is $172,000 per person and that costs are expected to grow “enormously” over the next few decades. Funding for long-term care typically comes from one or more of four sources: personal savings, insurance, financial support from family, and Medicaid. A parent outliving his or her assets is a very real possibility. Medicare, the federal health insurance program for people aged sixty-five and older, does not cover long-term care, and Medicaid eligibility is based on income level. Many people discover that their parents have too many assets to qualify for Medicaid but not enough to sustain them for many years.
 
When it comes to paying for long-term care, I cannot stress enough how useful it is to consult an elder law attorney. Eldercare attorneys can help you understand your options for funding long term care including Veteran’s and Social Security benefits and how to protect your and your parents’ assets. They can draw up the paperwork for power of attorney and guardianship and assist with estate planning. They can explain Medicare, the Federal health insurance program for people age 65 and older.  And they can help you apply for Medicaid.  Many, but not all, nursing homes, or skilled nursing facilities accept Medicaid but often residents have to start paying from their own funds until they “spend down,” or run out of, their assets. A good elder law attorney can assist you through that process.
 
If you can’t afford to hire a professional to assist you, you can still get help. The business managers at the different facilities may be able to help with understanding payment options and financing plans. Also check local senior centers and Councils on Aging as many of them offer free legal and financial workshops.
 
Tips for handling a move
 
Don’t underestimate what a big deal it is to move your parents to a new home. It will take time for them, and you, to adjust.
 
Give it time, and maybe take some time.
It can take several months for someone to adjust to senior living. If you start to think you made a bad move, wait a week or two. Stay focused on the reasons you made the decision (safety, health, security, sanity). Take a personal day or two, if you have them, during and right after the move. Your parents may need a little extra support, and you too, may need some time to come to terms with the change.
 
Visit often, or not for two weeks.
Many experts will tell you to visit as often as possible. Frequent visits can ease any stress your parent may have that they will be abandoned or lonely. It might be easier for them to meet people at activities or in the dining room if they have a companion with them. Other experts will tell you to stay away. If your parent is calling you several times a day, staying in their room, and waiting for you to show up and keep them company, you may need to give them some space in order to encourage them to branch out. Don’t listen to the experts. Do what feels right for you and your parents.
 
Ask others to visit.
Ask nearby family and friends to visit your parent. Then brace yourself for unsolicited opinions about the new facility.
 
Expect setbacks.
Just when you think you are over the hump and your parent is settling in, things will change. They will tell you they are lonely. They will decide they don’t like their new dining hall friends. They will ask to go home. These moments are heart wrenching but knowing that they are normal and that they will pass, can help get you through them.
 
Acknowledge the difficult parts.
Yes you want to paint the new move in a positive light, but don’t talk at your parents about all the wonderful new activities and people and opportunities. Listen to their fears and concerns and acknowledge them. Then help them get through it. They will be more likely to listen to what you have to say if they feel like you’ve listened to what they had to say.
 
Surround your parent with their personal belongings.
Moving to senior living usually means downsizing. The maple dining room table with two extension leaves may not fit in the new apartment. But what does fit are photographs of family and friends, favorite books, a familiar piece of artwork. If you need to downsize the bedroom set, you can still bring a familiar blanket and pillows. The kitchen may be new, but you can pack your mother’s favorite teacup.
 
Limit new things.
You may be tempted to furnish your parent’s new place with the latest and greatest in hopes they love their fancy new home. But limit new items. Moving into senior living is a major adjustment where everything is new – the people, the food, the routines. Don’t overwhelm your parents with a new phone or even a new coffee maker. Limit the number of new things they need to learn how to operate.
 
Be your parent’s advocate.
 No place is perfect. You and your parents may see opportunities to improve something at their new home, but your parent may hesitate to speak up when they move to a new place. Do it for them – with a smile.
 
Build a team.
The staff should be a part of your team. Talk to them about your concerns and your parent’s concerns and actively enroll them in helping with the transition. Don’t assume they will notice what needs to happen – they are very busy. If your parent tells you they are too shy to go to the dining hall for dinner, or they forget when activities are happening, ask if a staff member can knock on their door and invite them. If the staff members know what you need, they should be willing to help out.
 
Set your boundaries.
Try to free up as much times as you can in the first few months after the move to help ease the transition but know that it is okay if you are not available. Your kids may need you. Your boss and coworkers may need you. And you need to take care of yourself. Determine what you are able and willing to do and then stick to your boundaries. Other people will tell you what you should do. Ignore them.