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How to Recognize Signs It's Time for Assisted Living

Sarah Stevenson
By Sarah StevensonJuly 28, 2017
How to Recognize Signs It's Time for Assisted Living

Last Updated: April 22, 2019

Caring for a parent or senior loved one can take a toll on both a family caregiver and their loved ones – especially if a senior has been diagnosed with dementia. Many families consider moving their parent into an assisted living community during this period, but how do you recognize the signs that it’s time for assisted living?

See what a psychologist says about recognizing and understanding these signs.

6 Signs That It’s Time for Assisted Living

According to the Alzheimer’s Association, more than 16 million Americans devote their unpaid energy and time to caring for a parent or senior loved one with dementia. Sometimes caregivers find themselves unable to bear the burden of providing home health care without suffering from illness themselves. This is when the cost of caregiving becomes too high and when it is time to consider moving a loved one into assisted living.

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Moving a parent is never an easy decision, but there are some telltale signs to look for that will help you recognize when it’s the right time for assisted living, says Rita Vasquez, M.A., a Marriage and Family Clinician and Therapist at Quail Lakes Counseling Center in Stockton, California.

These signs include:

1. Aggression.

Physical, sexual or violent aggression frequently happen in people with dementia, and caregivers or other family members may begin to feel resentful or stressed. “I tell people when they’re getting to that state, it’s time to start considering placement,” says Vasquez.

2. Caregiver stress.

Caregiver symptoms like increased stress can be just as telling a sign as the dementia behaviors described above.

3. Escalating care needs.

Ask yourself: “Are the person’s care needs beyond my physical abilities?” or “Is the health of the person with dementia or my health as a caregiver at risk?” If you’re answering yes to those questions, it might be time to have that tough family conversation.

4. Home safety.

Consider your senior loved one’s health and your own abilities to care for them. Is the person with dementia unsafe in their current home?

5. Sundowning.

“Sundowners syndrome” — very agitated behavior that becomes more pronounced later in the day — is a common characteristic of those with dementia. Vasquez says that this can take a heavy toll on caregivers and when it begins to severely disrupt family routines, this may be a sign that the caregiving burden is too difficult to handle.

6. Wandering.

In later stages of dementia, the risk posed by wandering becomes much greater, notes Vasquez. “They can wander even if you just take the time to go to the bathroom,” she says, and the probability of falls and injuries increases as well.

How Caregiver Stress May Indicate a Need for Help

The psychological costs of caregiving and of making difficult care decisions are now being likened to the effects of post-traumatic stress disorder.

Caregivers may experience symptoms like:

  • Avoidance behaviors
  • Disabling anxiety
  • Hyper-vigilance
  • Intrusive thoughts and more

Vasquez attributes these symptoms not only to the pressures of caring for someone with dementia but also to the disruptions to normal eating and sleeping patterns that result when one is spending so much time on caregiving. “When the brain is always on alert, many things are going to happen — you’re not going to eat well, your nutrition is going to go down,” and physical health suffers, she says.

The emotional, mental and physical toll of caregiving can be particularly pronounced for spouses of those who need care. In one of the families Vasquez works with, the wife and primary caregiver is 80 years old. “She’s taking care of her 85-year-old husband and it’s draining her,” Vasquez says. “When he fell recently, she couldn’t pick him up and had to call the paramedics.” In cases like this, it might be clear immediately when the demands of care become too great. In other cases, it might not be so obvious.

“If you are feeling alone or isolated, or if you begin to feel resentful of your loved one, it might be time to examine the source of those feelings, says Vasquez.”

“Anger, resentment, sleep deprivation, all those things will become part of what happens to a caregiver,” she says. “Of course, the guilt, when you think, ‘I’m not doing enough.'” When that happens, it’s important to recognize how much you’ve been giving to your loved one, and perhaps tell yourself, “Okay, I’m not living a life for myself anymore, I’m living for that person.”

What If My Loved One Needs More Help Than I Can Give?

Deciding between assisted living and in-home care is never easy, and caregiver grief and guilt are common reactions to moving seniors out of their homes. As Vasquez puts it, “We lose our family member twice: once to the disease and again when they pass.”

Caregivers may wonder if they could or should have done more; they may feel separation anxiety in moving their loved one to another location. If family dynamics are difficult — if, for instance, a caregiver caring for a parent had an unhappy childhood — that may further complicate the decision process. This is why planning ahead is so important.

“If you know your family member is in the early stages of [illness], first and foremost you want to get all your paperwork together,” Vasquez says. “It’s in our culture that we don’t want to talk about those things,” but before dementia begins to affect your loved one’s cognitive health, it’s important to have someone help them collect the right paperwork and make those critical decisions, whether it’s a family member, friend or physician. Planning ahead and involving the appropriate persons in the decision will ultimately help ease the process when it’s time to move your loved one into care.

The best way to be there for them, Vasquez says, is to know that they are in the proper place for getting the care that they need. Visit communities before choosing one, and make sure they have activities and medical support appropriate to dementia patients. Ultimately, she says, try to remember that if you’ve done that research, “They are going to thrive wherever you send them.”

Ways to Care for the Caregiver

As a caregiver, it can be difficult enough to find time to care for your senior loved one, let alone yourself — even if your family member is in residential care. But staying healthy is one of the best things you can do to provide the support your loved one needs.

Arranging a short stint in respite care is one way to recuperate, especially if you are caring for someone at home. Taking care of your mental health is also critical and there are many benefits to seeking out a circle of support to bolster you when times are difficult. Counseling, support groups and therapy all exist to help family members going through transitions relating to dementia.

Check with the community that your loved one is moving to, suggests Vasquez. Many care homes, she says, offer support groups and other resources for families. These resources can help you come to terms with the idea that sometimes the best decision for the health and happiness of both parties is putting your loved one into care.

“We have to know that as a human being, we can only do so much without taxing our health,” says Vasquez.

What advice would you give to caregivers struggling with the decision to put a parent or senior loved one in assisted living? We’d like to hear your suggestions in the comments below.

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Sarah Stevenson
Sarah Stevenson

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