As our population ages and more of our national focus is on senior care, we can find ourselves in a muddle over confusing choices. How do we decide what care our elderly mother or father needs and when do we start looking for it?

Choosing Senior Care

If Mom is still living in her original home, with no one to look in on her regularly, she may be at a turning point. Many people choose to start getting help from in-home care agencies, since Mom can stay in her home longer with this help. Others feel it's time for Mom to move to assisted living. There are several things for you and your mom to look at while you consider the options.

Are there still people in her neighborhood she knows and does she get out and about to visit friends? If she is stuck at home and there's no one nearby, she may become socially isolated in her home. In-home help can alleviate some of this loneliness and isolation, but Mom may be better off in an independent senior living community or even assisted living, depending on her needs.

Companion care may even be enough. This is someone who is paid to keep an elder company. Be careful who you hire, however, since seniors can be vulnerable adults. A good place to find senior companions, and it's often free, is to call your local Retired Senior Volunteer Program, known as RSVP. They offer senior companions, who are healthy seniors who make great friends for more frail seniors. Whether hired or volunteers, people who are only senior companions aren't going to be cooking, cleaning and giving baths. They are there to provide company.

Independent communities are aimed at fairly healthy seniors, but they generally offer more socialization than an elder gets if he or she lives alone in a home where the neighborhood has drastically changed, as so often happens. In a local senior center, Mom would probably find it easy to socialize during scheduled activities or shared meals.

However, if mom is showing signs of needing assistance with her meals and transportation, I'd recommend looking around at assisted living facilities. Assisted living does not generally offer nursing care, and if help with dressing and other activities of daily livings (ADLs) are needed, she'd likely still have to pay per service or have the help of an in-home care agency. The advantage of assisted living over an independent community is one of watchfulness. The staff is on alert for medical emergencies. Plus, they generally serve meals in a central dining room. Often, assisted living centers will make transportation arrangements to doctor appointments, and some of them take groups shopping. Assisted living centers are not all cut out of the same mold, so make sure you understand what services they do and don't offer per contract, and what services may be available, but would cost extra. These centers range in size from community homes with four to six residents, to large complexes.

Many people never need more care than an assisted living center can provide, with perhaps some help from an outside in-home care agency for daily care. However, many people do need a higher level of skilled nursing care.  For example, diabetics often need nursing home care, as they must have their blood sugar checked often and generally only medically trained people can draw blood. People who fall or need help to get from a bed to a chair may also need to make the move to a nursing home. Alzheimer's patients also require the medical care and supervision that a nursing home or other memory care location provides. The line between the two is fuzzy, as some assisted living centers can care for people longer into their frail years than others. However, the day may comes for many when the assisted living center won't be enough.

Senior Housing Decisions

Everyone has their own personal checklist for finding good housing for their elderly parent. We want them safe, well cared for and happy. Happy depends a great deal on the individual, but safe and well cared for should be part of the bargain. So, what do you look for when you tour a center?

  • First, don't just take a tour with an administrator and say, "all done." Yes, you will want a tour with an official guide and you will want to talk about options and contracts.
  • Then, go back at a different time. If you can manage it, go back several times - once early in the morning while they are getting people up, especially if you are looking at nursing home. Assisted living centers will not be hustling people out of bed, but it's still a good time to get a feel for how mornings generally go.
  • Expect to have some unpleasant smells, especially in a nursing home. This is unavoidable, but the home should be equipped to hand these issues quickly and efficiently.
  • Watch how members of the staff treat each other, and the elders. Are they a cheerful bunch, working together and treating each other and the residents with respect? Do the hands-on caregivers in a nursing facility - generally Certified Nursing Assistants - seem to know "their" elders? Do the elders, in general, seem happy to see the CNAs? Please understand that some elders won't be happy - ever.
  • Visit again mid-day. Residents should have meaningful activities. One reason to move from the old home into assisted living or a nursing home is for socialization. Many studies have proven that being socially active is good for the health - mental and physical.
  • If you can, visit again in the evening. Security is more of an issue -- and that is a good thing. But it makes unannounced visits more difficult. Arrange to get past for evening visits.
  • In any setting, are people treated as individuals with their personal likes and needs addressed? Or are they just like a little chain of beads, pushed along to conform to the efficiency standard of the home? This is an important aspect of care that is now called "person centered care." and you want to see respectful person centered care in action.
  • Look for cleanliness. Look for attention to healthy detail.
  • Make sure the facility is licensed and has no history of abuse. Read contracts carefully to see what is covered and what is extra.

You can go to the Medicare Nursing Home Compare Guide and find a ranking for most skilled nursing facilities. This can be useful, but the number of "stars" is only a guide. Most of these categories are self-reported, so many nursing homes may fudge. Also, this is a snapshot based on locality. In some states nursing homes are held to fairly high standards and others are pretty lax, therefore a two star home in one state may be far better than a five star home in another. Certainly, the Medicare ranking is useful, but only as one tool.

Bottom line, go with your gut. Check with families who have loved ones in the home. Don't go by just one recommendation (or condemnation). People have different expectations and even grudges. But do check with families you see who are visiting their loved ones. Several opinions should give you a fair idea of what families think. And what families think is far more important than the fluffy pillows on the couch and the smiling guide. Trust your instincts and word of mouth before you trust glitzy marketing strategies.

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To recap: If Mom is declining, start thinking about whether she is safe in her home. If so, then she may be a candidate for in-home care. I'll throw in adult day care here, too, as an option for her to get out, but that's another article.

If Mom needs more watching than is practical with just in-home care for a few hours, but doesn't need a lot of nursing care, she may be a good candidate for assisted living. If Mom needs quite a bit of nursing care, and an in-home agency that provides nursing care isn't enough, then a nursing home may be the next step.

Your guide to choosing the best of any one of these care options is the same: check references, observe how they interact with elders and use your gut. A quick check with the Better Business Bureau may not be a bad idea either.