Moving into assisted living or a care home

Things families often notice

• Big changes in weight, or very little food in the house
• Confusion, or memory problems that are getting worse
• Falls, or trouble walking and getting around
• Loneliness, or pulling away from people
• Not washing, or wearing clothes that don’t suit the weather
• Trouble cooking safely, or a home that has become hard to keep clean

Depending on what someone needs, a home health aide, transportation, delivered groceries or a geriatric care manager might help them stay at home longer. Sharing care with family, neighbors or friends can help too.

The Eldercare Locator (call 1-800-677-1116) can connect you with your local Area Agency on Aging to learn what is available near you.

Mention what you’ve noticed without sounding critical, then ask what they would like. For example: “It looks like you don’t have much food in the house. Is getting to the store hard?” Try to honor their wishes as far as you safely can.

Gentle openers

• “I’d like us to plan together, so you stay in charge.”
• “I’ve been worried since your fall. Can we talk about what would help?”
• “What matters most to you about where you live?”

The best time to plan is before someone needs a lot of help, while they can still make important decisions themselves. Talk through the pros and cons of each option together.

Ways to share the decision

• Ask what they would give up last: a pet, a garden, their faith community, being near family
• Invite them on every visit to a possible new home
• Let them make as many choices as possible, like which room, what to bring and when to move
• Write down their wishes so everyone can see them

Also called residential care facilities or group homes. Residents get personal care and meals, and staff are there around the clock. Nursing and medical care usually aren’t provided at the home.

Assisted living is for people who need help with daily care, but not as much as a nursing home provides. Residents usually have their own room or apartment and share common areas. Places range from about 25 residents to 100 or more.

Often included

• 24-hour supervision and staff on site
• Help with personal care
• Housekeeping and laundry
• Meals, up to three a day
• Social and recreational activities

Nursing homes, also called skilled nursing facilities, focus more on medical care than most assisted living. They usually offer nursing care, 24-hour supervision, meals, help with everyday activities, and physical, occupational and speech therapy.

Also called life care communities. Many offer independent homes, assisted living and skilled nursing in one place, so people can move between levels as their needs change. Most charge a one-time entrance fee, which may be expensive, plus a monthly fee.

Some facilities have special units for people with Alzheimer’s disease or other types of dementia. If this might be needed now or later, ask what services the unit offers.

Friends, health care providers, social workers, faith groups and support groups may know good places. When you call, ask how many people live there, what it costs, and whether there is a waiting list.

Medicare’s Care Compare tool lets you find and compare nursing homes and other facilities in your state.

• A clean, fresh-smelling, comfortable, well-kept building
• Access for people with disabilities
• Medicare and Medicaid certification, and a state license
• Residents who look well cared for and dressed for the day
• Warm, respectful interactions between staff and residents

• How do residents get to medical appointments?
• How long have the director and department heads worked here? How often do staff leave?
• How many care staff are there per resident, and what training do they have?
• Is there a doctor who checks on residents regularly?
• Is there a safe place to go outside?
• What activities happen during the week and at weekends? Can we join one?

If residents or visiting family are happy to chat, ask what they like and what they’d change. Ask friends and neighbors about their experiences too.

Things worth asking

• Do staff know you by name?
• How quickly does someone come when you need help?
• What is a normal day like?
• What would you tell a friend thinking of moving here?

• Can I bring my own furniture and photos?
• Can I keep my own routine, like when I get up and eat?
• Can I practice my faith, or get to my place of worship?
• Is there a garden, a library or a quiet place to sit?
• What about pets?

In U.S. nursing homes, federal rules give residents the right to make their own schedule and choose their activities.

Long-term care, also called custodial care, is mostly help with everyday tasks like dressing, bathing and using the bathroom. Medicare and most health insurance, including Medigap, don’t pay for it, in a nursing home or in the community.

This is different from short stays in a skilled nursing facility after a hospital visit. Medicare also doesn’t pay for assisted living or board and care homes.

Medicaid may cover long-term care for people who meet their state’s rules. It may cover some nursing home costs and, depending on the state, some parts of assisted living or board and care.

If the person has long-term care insurance, check the policy. Some cover nursing homes, assisted living or board and care, and some only part of the cost.

Get detailed information about costs and what is included. Once you choose a place, read the contract carefully, ask about anything unclear, and read it again before signing.

Things to check

• Extra charges for more care later
• How and when fees can go up
• Notice needed to leave
• What happens if the person needs a hospital stay
• What is included in the monthly fee

A home holds a lifetime: where children grew up, where a partner lived, where you were in charge. Missing it is love, not weakness.

Ways to honor it

• Make a photo book of each room and the garden
• Plant a cutting from your garden in a pot
• Say goodbye to the house, out loud or in a letter
• Tell the stories of the house to someone who will keep them

If a fall, an illness or family worry pushed the move, it is natural to feel angry or betrayed. Research shows control over the decision is one of the biggest factors in how people settle.

Ways to take back some control

• Ask for a care plan meeting and bring your own list
• Choose your room layout and what goes on the walls
• Keep making your own daily choices, like clothes, food and bedtime
• Tell staff what you want them to call you

Some people feel relief: no more stairs, no more worrying about the boiler, help at night, people to eat with. Feeling relieved doesn’t mean you didn’t love your home.

People settle better when they can keep their independence and meaningful relationships, make new friends with residents and staff, and talk about their feelings and life story.

Ideas

• Keep one role you love, like gardener, storyteller or card player
• Put a short “about me” page on your wall: your work, family and favorite things
• Stay in touch with old friends and your faith community
• Tell staff about your life, not just your health

Many people once promised a parent or partner, “I’ll never put you in a home.” That promise was made out of love, before anyone knew what care would one day be needed.

The heart of the promise was usually, “I won’t abandon you. I’ll make sure you’re safe and cared for.” You can keep that promise in a new way: by visiting, speaking up and staying close.

Guilt says “I did something wrong.” Often what families feel is grief: for how things used to be, and for the hopes they had. Naming it as grief can soften it.

Questions to ask yourself

• Did I make the best choice I could with what I knew?
• What does my loved one need from me now?
• What would I say to a friend who made this choice?

Spouses often find this move the hardest. In one study, almost half of spouses visited every day and kept helping with physical care during visits.

Ways to care for yourself

• Find a caregiver or spousal support group
• Keep one thing each week that is just for you
• Let staff do the heavy care, so visits can be about being together
• Say yes when friends invite you out

Brothers and sisters often see a parent’s needs differently, especially if some live far away. Disagreements are common.

Things that help

• Bring in a neutral voice, like a social worker or care manager
• Give everyone a job that suits them, including those far away
• Keep the parent’s own wishes at the center
• Share facts from the same visits, care notes or doctor appointments

1. Visit together a few times, and join an activity or a meal.
2. Decide together what to bring. Measure the room first.
3. Write a one-page “about me”: routines, likes, dislikes, faith, what calms them.
4. Share it with staff, and ask who will be their main contact.
5. Set up the room before they arrive if you can, so it already feels familiar.

• A favorite chair, quilt or cushion
• A radio or music they love
• Clothes they feel like themselves in
• Photos of family, pets and special places
• Something from the garden, like a potted plant

Some families visit every day at first. Others are advised to give a little space. There’s no single right answer. Talk with staff about what seems to help your loved one.

Helpful in the first days

• Ask staff to introduce one or two friendly residents
• Keep goodbyes warm and short
• Keep one familiar ritual, like a call at the same time each evening
• Walk around together so they learn the way to the dining room and garden

Feeling unsettled early on doesn’t mean the move was a mistake. Building new relationships with residents and staff, and having chances to talk about feelings and life experience, help people adjust.

• Bring photos and talk about the people in them
• Do something together: cards, a puzzle, a walk outside
• Join a resident activity or eat a meal with them
• Listen to music from their younger years
• Read aloud, or look through a newspaper together

• Bring something to do together, like a drawing or a game
• Explain what they might see, in simple words
• Leave before anyone gets tired
• Let them ask questions afterward

• Ask staff to help with video calls
• Get to know one staff member who can update you
• Join care plan meetings by phone or video, with the person’s permission
• Send cards, photos and small parcels

Family and friends can help make sure a loved one gets good care by visiting, getting to know staff and joining family councils.

Small things that help

• Ask staff what they’ve noticed, good and hard
• Learn the names of the aides who give daily care
• Raise worries early and calmly
• Say thank you when care is good

Missing home, tears and asking to leave are common at first. It is worth acting if, after a few weeks, someone stops eating, won’t leave their room, loses interest in almost everything, or says they have no reason to live.

Low mood in older adults is sometimes mistaken for normal aging. It deserves attention wherever someone lives.

1. Talk to the aide or nurse in charge.
2. Ask for a care plan meeting. Nursing homes must make a care plan with the resident.
3. Bring it to the director or administrator.
4. Bring it to a resident or family council.
5. Contact the free Long-Term Care Ombudsman program for help.

Long-Term Care Ombudsman programs help residents of nursing homes, assisted living and board and care homes solve problems about health, safety, welfare and rights. Residents, or someone on their behalf, can contact them.

Needs change, and sometimes a place just isn’t the right fit. Nursing homes must give 30 days’ written notice before a transfer or discharge, except in emergencies, and residents can appeal.