If the thought of your parents living independently troubles you, or if you find yourself questioning your own suitability for independent living, a change might be on the horizon. In situations where clinical conditions and frailty pose challenges, seniors may reach a point where living alone is no longer feasible. As family members, making decisions about their well-being becomes imperative. How can you recognise when a parent requires more assistance than you can provide? As social gerontologists, we’ll discuss the merits and drawbacks of assisted living, exploring the reasons and timing for its consideration.

  • Roshan J Mundapallil, Sowmya Lakshmi

At 82, Sudershan Verma, retired from SBI after a brief stint in the Indian army, has spent the last couple of years alone in his house in Jeevan Bhima Nagar, Bangalore, following his wife’s passing. Acknowledging the mistake of allowing his strained relationship with his younger son, Vivek, to affect their living situation, Sudershan finds himself in a challenging situation.

His two other children, settled in the San Francisco Bay Area—one a physician and the other a dentist—intervened last year when Sudershan, diagnosed with Parkinson’s, had a fall attributed to a slippery surface. The shock of his wife’s unexpected demise, considering her excellent health and fitness routine, added to his challenges.

With a strained relationship with Vivek, Sudershan’s children from US persuaded him to move to an assisted living home. Despite initial concerns, Sudershan realised the necessity of this change, considering both his family dynamics and the progression of Parkinson’s. Living alone was no longer a viable option for him.

When independent living is no longer feasible for you or an aging family member, prompt action is crucial. Take, for instance, Sudarshan Uncle’s case. His children from the US swiftly arrived in Bangalore, recognising the importance of placing him in an assisted living environment before it escalates into a crisis. While assisted living varies from independent living in several aspects, if you’re curious about the distinctions, refer to our previous article comparing Independent vs. Assisted Living. Now, let’s delve further into the specifics of what assisted living encompasses.

At the core of assisted living is delivering personalised care to adults within a community and residential setting. For seniors like Sudarshan Uncle facing declining health, the need for well-being extends to requiring a helping hand, additional support, and continuous monitoring. The assisted living concept aims to simplify and enhance the lives of aging adults, offering services for limited social engagement and promoting healthy living. Beyond routine Activities of Daily Living (ADLs), assisted living settings oversee medication management and act as initial responders.

Evaluating the required level of care for a senior is most effectively done by assessing their ability to perform Activities of Daily Living (ADLs). Coined by Sidney Katz in the 1960s, these ADLs serve as a valuable tool for professionals to gauge a senior’s proficiency in completing fundamental routines and basic activities essential for daily life.

The Katz Index of Independence in Activities of Daily Living, commonly known as the Katz ADL, serves as a fitting tool to assess a client’s functional status, measuring their ability to independently perform daily activities. Social gerontologists and clinicians commonly employ this instrument to identify challenges in performing daily activities, forming the basis for tailored care plans. The Index assesses adequacy in six functions: bathing, dressing, toileting, transferring, continence, and feeding. Its simplicity allows the aged person to score Yes/No for independence in each function. If the total score is 2 or less, indicating severe functional impairment, institutionalisation becomes a viable option. Additionally, individuals with a moderate impairment (Score 4) should consider assisted living or nursing homes to preempt further deterioration.

A perfect score of 6 on the Katz index indicates a fully functional elderly individual, showcasing a higher level of independence. For instance, Padmaja, a 78-year-old retired Railway employee, scored 4 on this index. Despite her son’s challenges in convincing her for assisted living, it marked the end of her independent living. Conversely, if an elderly person scores one or two out of six, it signals a need for significant care and attention, requiring a more hands-on approach to senior care. Managing such scenarios as a primary caregiver 24/7 is often impractical due to hectic schedules and practical constraints.

Next, we have Instrumental Activities of Daily Living (IADLs), which are more extensive than ADLs but assessed in a similar manner. To address gender bias, the ranges differ, with a range of zero to eight for men and a maximum of five for women. The measurement of IADLs follows a similar fashion to ADLs, and a higher score indicates a greater likelihood of living independently, while a lower score suggests the opposite.

We’ve outlined signs that may indicate it’s time to consider assisted living:

1. Worsening Chronic Health Conditions:

Chronic health issues are prevalent among older adults, leading to weakened immune systems and prolonged illness. If you or your parent faces this situation, opting for an assisted living facility with well-defined policies and favourable staffing ratios is advisable.

2. Becoming Aggressive:

Sundowning, as observed in Balaraman, entails increased aggression and confusion during the evening. Seeking professional care in assisted living becomes crucial for individuals, especially those with dementia, exhibiting verbal or physical aggression.

3. Frequent Falls:

Seniors prone to frequent falls require vigilant monitoring, making assisted living an ideal solution. The home environment may pose risks, and an assisted living setting offers a safer space for those with mobility issues.

4. Forgetting to Take Medicine:

Seniors, especially with chronic conditions, relying on medications need consistent adherence to their regimen. If forgetfulness becomes frequent, it could lead to serious health concerns. Assisted living facilities often provide monitoring services to ensure medication compliance and health stability.

5. Struggling with Daily Life Activities:

Tasks that were once simple now feel overwhelming. If you or your parents face difficulties with basic tasks, it’s time for a change. Assisted living facilities alleviate the burden by handling many tasks, ensuring you can relax without compromising on daily activities. For instance, the challenge of cooking may lead to skipped meals or compromised food habits, risking malnutrition.

6. Isolation and Depression:

Seniors experiencing a decline in social life may grapple with isolation and depression. Vinod shared how his uncle’s vibrant post-retirement life turned solitary, leading to neglect and chronic depression after his wife’s death. If your loved one shows signs of depression and loneliness, discussing the potential move to assisted living, with its diverse activities and social opportunities, becomes crucial.

7. Poor Eating Habits:

Good nutrition is vital for mental and physical health. Transitioning to a long-term care facility ensures regular, nutritious meals tailored to specific needs. Assisted living addresses challenges associated with grocery shopping, cooking, and utensil cleaning, preventing elders from settling for insufficient and inferior food intake. In a quality assisted living home, meals are nutritious and customized to preferences.

8. Poor Hygiene:

Personal hygiene is critical, especially for individuals facing sadness or early dementia. Neglecting hygiene needs, such as bathing, is an early sign of decline. When someone struggles with maintaining proper grooming, considering a move to an assisted living facility is prudent. The staff can gently encourage or assist individuals in maintaining essential hygiene practices.

9. Caregiver Strain:

Despite Ajay’s attempts to avoid moving his father to an assisted living facility due to concerns about criticism from relatives and friends, leasing a nearby flat and hiring caregivers proved ineffective. His father’s aggression led to the departure of all hired caregivers, causing significant challenges. Witnessing this struggle, Ajay’s cousin recommended considering the option of assisted living.

We addressed the issue of ‘compassion fatigue’ in another article, discussing the challenges and stress faced by caregivers like Ajay who, out of love and good intentions, find themselves overwhelmed and exhausted. Many individuals who take on the responsibility of caring for family members may not be fully prepared for the emotional and physical challenges. There’s no shame in acknowledging that you’ve done your best, but recognizing when it’s time for a new path is essential.

10. Wandering Off:

In Sridharan’s case, experiencing the third incident of getting lost prompted Kavitha to decide against taking any more chances. Previously, he was found in a nearby layout by a vigilant auto driver who informed the neighbour. Fearing for his mental awareness, Kavitha convinced her mother to admit him to our assisted living facility. If your loved one lives alone and there are concerns about their wandering off, waiting for a distressing incident is not advisable.

When deciding to enrol your parent in an assisted living facility, thorough research is essential to identify the best fit. Here, we’ve compiled key points to assist you in narrowing down your search.

The first crucial aspect is the management. Inquire about who is overseeing the Organisation, their involvement, and expertise. Verify if the management is hands-on or merely profit-driven with delegated responsibilities. Understanding their passion and commitment is paramount, so delve into the details of the individuals behind the facility.

Another crucial aspect involves the staff. To ensure optimal care for yourself or your aging loved one, inquire about the training staff undergoes in community settings. A well-trained and compassionate staff plays a vital role in creating a satisfying living environment. Delve into the facility’s philosophy, orientation practices, and evaluation procedures.

Additionally, grasp the staffing levels, encompassing support staff, as some facilities might compromise on quality by understaffing to enhance profits. Similarly, probing into the number of residents can raise concerns about the facility’s ability to maintain a quality balance between staff and residents.

Consider whether the staff operates on a full-time or day-night shift. Pose questions about bathing care, dressing, medication management, and nursing procedures. Explore preventive care practices, and understand the crisis and reporting protocols in place. It’s essential to gather comprehensive information about the care practices and protocols followed by the staff.

Is there a privacy policy in place? Many facilities attract new customers by showcasing videos and photos of current residents in their social media marketing. However, our parents are not commodities in a marketplace or models for a video or film. It’s crucial to understand how much the facility prioritises and protects the privacy of their residents.

Moving on to dining options, consider how meals are prepared and served. Are they nutritious and flavourful? Elderly individuals often have specific preferences and concerns about their food. While it might be challenging to cater to every preference, does the facility strive to offer meals that align with their taste buds? For those with special dietary needs, is there someone monitoring their nutrition status to ensure they receive an adequate quantity and stay appropriately hydrated?

Assisted living is an excellent choice for maintaining the safety, social engagement, and overall well-being of older adults. In the first part of the article, we highlighted aspects to help you recognise signs indicating your parent may need institutional care. When contemplating a move to senior living, consider factors like your loved one’s daily routine, health, functional abilities, current and future care needs, and overall quality of life. In the latter part, we explained how to choose a facility and what to look for. Selecting the right assisted living community can feel like an endless search. Hopefully, these questions offer additional insights during your visits and tours, helping you determine the residential environment that best suits you or your aging loved one.