When is it time to move?

Nobody can answer this from outside your family, and we won’t try. For many people it comes as a shock: a fall, a hospital stay, a visit home that goes badly. If you’re reading this before that happens, you have something valuable, which is time. The National Institute on Aging says the best time to plan is before someone needs a lot of help, because they can still make the big decisions themselves.

The question to ask

Try this one, and be honest about the last few words:

Can Mom stay safe and reasonably well at home, with all the help we can realistically add?

“Realistically” includes you. The National Institute on Aging puts the turning point simply: it may be time to consider a move when someone needs more help than family or friends can provide.

What to look at

A phone call won’t tell you much. These are the things to notice in person:

• Food. Can they use the stove safely? Is there food in the house?
• Looking after themselves. Are they bathing, and dressing for the weather?
• The house. Is it reasonably clean and clear of clutter?
• Medicines. Do they have what they need, and are they taking it?
• Health. Have they lost or gained a lot of weight? Are they falling, confused, or having trouble getting around?
• Mood and company. Are they lonely or withdrawn? People with depression may brighten up for a short visit, and it’s harder to hide over a long one.

Our self-check walks through this one question at a time and starts with what your parent wants. If memory is the worry, read normal aging or something more. If they seem confused in conversation, check their hearing as well. Older people who can’t hear well are sometimes mistaken for confused or uncooperative.

Try help at home first, if it can keep them safe

Some problems have a simple fix, like new glasses. Many others can be handled by services that come to the house:

The problem	What may help at home
Shopping and cooking	Grocery delivery, meal delivery programs, a meal at a senior center or their place of worship
Housework and laundry	Cleaners, pick-up laundry services, family taking a share
Bathing and dressing	A relative, a friend or a trained aide for part of each day
Being alone	Regular drop-ins from neighbors, volunteer visitors
Medical needs after an illness	Home health care, if Medicare’s rules are met

For a person looking after a parent day to day, respite care gives a break of a few hours to several weeks, at home, at an adult day center or in a facility. It can also show you how your parent does with other people’s help.

The Eldercare Locator at 800-677-1116 can point you to what’s local. Expect to pay for much of this yourselves, because Medicare’s home health benefit doesn’t cover 24-hour care, meal delivery, housework, or personal care on its own. See how to pay for care.

When help at home may stop being enough

These are reasons to have the talk. They aren’t rules.

• They need someone close by day and night, and nobody can be.
• They keep falling, or they’ve wandered or left the stove on.
• The cost of care at home is passing the cost of a move.
• The person doing the caring is wearing out: their health, their job, their marriage.

That last one counts as much as the others. The National Institute on Aging says it’s critical for caregivers to ask for help, and that many later wish they had asked sooner.

The options in plain words

Names vary by state and by company, so ask what a place really offers. This is how the National Institute on Aging describes them:

Board and care home, also called a group home. For people who need personal care but little medical care. Usually 20 or fewer residents, with meals and staff around the clock. Most people use their own money. Medicare doesn’t pay, and Medicaid may pay part.

Assisted living. For people who need daily help, but less than a nursing home gives. Residents have their own room or apartment, with meals, help with personal care and medicines, and staff on site 24 hours. Most people pay the full cost themselves. Medicare doesn’t pay, and Medicaid may cover some of it.

Nursing home. For people who need medical care along with daily help. There’s nursing care, 24-hour supervision, meals and therapy. Many people pay from their own money, and Medicaid may help if they qualify. Medicare doesn’t cover long stays.

Continuing care retirement community. For people planning ahead who want to stay in one place. Independent housing, assisted living and nursing care share one campus. People pay most of the cost themselves, usually an entrance fee plus a monthly fee.

Memory care isn’t a separate kind of building. Some assisted living facilities and nursing homes have special units for people with dementia, and these may cost extra. Ask what’s different about it: the staff training, the staffing level and the price.

Assisted living tends to cost more than living independently and less than a nursing home, and residents usually pay more as they need more. We don’t print national averages here, because the only price that matters is the one in the local contract. Ask each place for the full monthly figure in writing.

Some group homes may not be inspected or regulated, though they can still give good care. Ask your state who licenses and inspects them.

How to bring it up

Start small and start early. You’re opening a conversation, and it will take more than one.

1. Raise the worry without criticizing. The National Institute on Aging offers this kind of opening: “Mom, it looks like you don’t have much food in the house. Are you having trouble getting to the store?”
2. Ask what they want, then try to do it. If they want to keep cooking, offer to arrange grocery delivery. A specific offer is easier to accept than a general worry.
3. Talk about the choices, with pros and cons. Their health, what they can do each day, money and what they prefer all matter.
4. Offer to go to the doctor with them. You can make the appointment and drive.
5. Visit a place before it’s urgent. Lunch and a look around is a smaller step than a decision.

If you and your brothers and sisters don’t agree, start here.

If they say no

If your parent can make their own decisions, this is their life and their choice, even when you’d choose differently. Keep the door open. Add the help they will accept. Agree on what would make you both look again: “If you fall again, will you come and see that place with me?”

If you think they can no longer understand the risks, talk to their doctor, and read our guide to legal papers. Guardianship should be a last resort, because it takes away legal rights.

If they’re in immediate danger, call 911. If you’re worried about abuse or neglect, contact Adult Protective Services in the state where they live. The Eldercare Locator can help you find them.

If you promised you never would

Many people have made that promise, usually when nobody knew what was coming. What you were really promising was that they’d be looked after and not left alone. You can keep that part.

The National Institute on Aging is plain about this: you may feel guilty or upset, but a move could be the best or even the only way to get someone the care they need. Feelings may range from loss and guilt to relief, and it says it’s okay to have all of them.

How to check a place

1. Make a short list. Ask friends, doctors and social workers. For nursing homes, look up each one’s record with our tool, or use Medicare’s Care Compare. If a website or phone service offers to find a place for free, ask who pays it and whether it covers every local option.
2. Call first. Ask how many people live there, what it costs, and whether there’s a waiting list.
3. Visit in person, with your parent if you can. Print Medicare’s nursing home checklist and take a fresh copy to each one. Many of the questions work for assisted living too.
4. Go back without calling ahead. Choose a different day or time, and try a mealtime, so you see other staff. Ask if you can taste the food.
5. Talk to other families. Ask what they think of the place.

What to ask

• How many care staff are there per resident, on days, nights and weekends? What training do they have?
• How long have the director and the head of nursing been here? How often do key staff leave?
• Does a doctor check on residents regularly? How do people get to appointments?
• What’s a typical day? What goes on at weekends?
• Is there a safe place to go outside?
• What’s included in the fee, and what costs extra?
• What would make you ask a resident to leave?

Trust what you see, too: residents who look well cared for, staff who speak with patience and respect, and a place that looks and smells clean.

Before anyone signs

Read the contract carefully, and read it again before signing. Then check these.

The money. How often can the price go up? What raises it? Do they accept Medicaid, and what happens if your parent’s savings run out? Our guide to paying for care covers the questions to ask.

Your name on the contract. The Consumer Financial Protection Bureau says a nursing home can’t require you to pay a resident’s bill with your own money, even if you hold power of attorney or are their guardian. Admission contracts can still use words like “responsible party” or “joint and several liability” that try to make you liable. You can refuse to sign those terms, and you can have a lawyer read the contract first.

That federal rule is about nursing homes. Assisted living contracts are different, so read just as closely who is promising to pay.

Who can help. Every state has a Long-Term Care Ombudsman program, which works to solve problems for people in nursing homes, board and care homes and assisted living. It’s worth knowing the number before you need it.

After the move

It can take time for everyone to adjust. Get to know the staff before moving day. Listen to your parent’s worries, but don’t argue about why they’re there. Check in regularly, watch for signs they’re not getting the care they need, and work with the staff as partners. If you’re carrying a lot, a social worker or counselor can help you too.

What to do this week

1. Do the self-check together, or use the visit checklist next time you’re home.
2. Ask your parent one question: “If you ever needed more help, what would you want?”
3. Add one service, however small.
4. Call the Eldercare Locator at 800-677-1116 and ask what’s nearby.
5. Get a power of attorney in place while your parent can still sign it.