The steps outlined in this article can help you assess your loved one’s situation and determine the right place for him or her to live.

In order to determine the best housing situation for your loved one’s needs, consider the following steps:

1. Do the assessment
2. Have the conversation
3. Match housing to needs
4. If the person can remain independent, look into support structures
5. If semi-independent living seems appropriate, examine choices
6. If the person is dependent, begin to evaluate facilities

1) Do the Assessment

As you assess your loved one’s housing situation, keep in mind that your ultimate task is to find the balance that protects his or her well-being while preserving as much independence as possible.

• FamilyCare America’s Needs Assessment Worksheet can help you make a housing determination by specifying your loved one’s care requirements.
• Have another family member do the same evaluation separately, and compare results to get an objective view.
• Consult a doctor or case management professional for help predicting future needs.

2) Have the Conversation

Getting a loved one to accept help may be harder than finding that help in the first place. Most people, however, are more willing to accept decisions that they’re involved in making. So include your loved one in the process as much and as early as possible.

• Keep in mind that many people will not acknowledge even a small weakness because they dread any loss of independence.
• As you explore alternatives, create opportunities for your loved one to express his or her concerns—and for you to provide additional information that may help overcome resistance to change.
• If you hold a family meeting to discuss this issue, make sure your loved one’s dignity and privacy are respected.

3) Match Housing to Needs

Review the Needs Assessment Worksheet as you consider available choices, comparing the types of services offered by each. This can be a difficult and confusing time, so it’s important to be organized and methodical in your approach.

• Don’t wait until a crisis to gather information. The best decisions are usually made without time pressures.
• Consider your loved one’s desire to continue a favorite activity or hobby, and how a change in housing might affect that ability.
• Take stock of what is most important in the individual’s life and make sure this can be maintained, if at all possible.
• Remember that no choice is going to be perfect or give everyone 100 percent satisfaction. Your loved one’s safety and happiness come first.

4) Support Structures For Independent Living

If your loved one is able to remain independent, repairs and modifications can make your loved one’s home safer and easier to get around in. Consider how even these simple changes can make a large difference in home safety:

• Set the thermostat of the water heater at 120 degrees F or lower to prevent accidental scalding.
• As a reminder to keep the smoke alarm working, change the batteries on daylight saving’s time.
• Locate appliances close to outlets, making sure cords run along walls and away from sinks or stoves.
• Install handrails and non-slip mats in the bathroom and shower.
• Install a ramp to allow easier access to the home.

In addition, there may be services available from the government, non-profit, and for-profit organizations that can help your loved one maintain independence.

• Services like “Meals on Wheels” deliver hot meals to homebound people.
• Local community or senior centers offer companionship, including classes, recreational opportunities, travel, volunteer opportunities, and meals.
• Community groups or even the local police may sponsor friendly visitor programs, where volunteers make scheduled visits to isolated seniors.
• There also are telephone reassurance programs, where volunteers call people to chat or check on their well-being.
• So-called “gatekeeper programs” may be offered through public utilities and the Postal Service. Workers who regularly visit the home are trained to look for changes in your loved one’s condition.
• The Area Agency on Aging can provide the names of local organizations that offer legal, financial, health-care, and other services for older adults.

5) Options For Semi-Independent Living

Sometimes the best choice is to relocate to a residence that is more manageable, or where the necessary care services and support are part of the package.

The distinctions between each kind of facility aren’t always clear, and different states may use the same term to describe very different types of facilities. Generally, however, the categories for semi-independent living and housing include:

Adult Residential Care Facilities. These licensed boarding homes provide room, board, and help with medications and personal care. Residents may also receive limited supervision.

• Most adult care homes are single-family residential units.
• Typical residents include frail elderly persons with chronic physical or mental disabilities, mentally ill adults, mentally retarded adults, or other adults with diminished physical and mental conditions.

Adult Family Homes. These facilities can accommodate couples and are licensed to care for up to six residents. They provide room, board, laundry, necessary supervision, assistance with activities of daily living, personal care, and social services. In most cases, nursing services are not provided, and residents must manage their own care.

Assisted Living Facilities. This has become a catchall term for any boarding home that emphasizes privacy, independence, and personal choice. Services include meals, personal care, medication assistance, limited supervision, organized activities, and limited nursing services.

• Assisted Living is licensed by state governments and is known by as many as 26 different names including residential care, board and care, congregate care, and personal care.
• Services, style, and costs vary widely from facility to facility. Some may have a resort-style ambience while others are geared toward affordable living with few amenities.
• This brand of residential care is not a substitute for a nursing facility.

Continuing Care Retirement Communities. CCRCs are designed to provide seamless transitions as care needs increase. A CCRC accepts seniors while they are still active and independent, and then provides an expanding range of caregiving services—including professional nursing care—as needed.

• These facilities are privately owned. All levels of care take place on one “campus.”
• These communities typically require a sizeable entry fee, plus monthly maintenance fees, in exchange for a living unit, meals, and eventual health care coverage up to the nursing home level.
• Many of these communities make their services available on a month-to-month rental basis.

6) Dependent Care

If your loved one has reached a point where he or she can no longer care for himself or herself. Housing alternatives include:

• Intermediate care facilities for people who are physically and psychologically stable, but need a nurse’s care for medications and other needs.
• Skilled nursing homes for people whose conditions require 24-hour supervision, help with medications, and assistance with daily living.
• If you’re looking at an assisted living facility connected to a nursing home, ask to see the nursing home’s inspection report and examine the administrative structure.

Nursing Homes provide rooms, meals, recreational activities, and protective supervision to residents. Some also specialize in Alzheimer’s disease or have subunits for certain illnesses. Services vary, yet all nursing homes are licensed by states and follow federal regulations.

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