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When a parent can't live at home


If Mom or Dad requires help, an assisted living facility may be the answer.


When the time comes that your elderly parents can no longer live comfortably or safely on their own, there are generally three types of facilities to choose from. Independent living communities are essentially hotels and condos designed for retirees—with added services ranging from meals to full-time medical care. Assisted living facilities are designed for seniors who will need help with some of the activities of daily living: bathing, dressing, eating, using the toilet, getting around, and getting in and out of a bed or chair. The highest level of care is the intermediate-care or skilled-nursing facility.

Don't decide which type of facility is best until your parent has had a thorough medical assessment, preferably by a geriatric specialist, so you're confident about what level of care is needed. Many families have had success using case managers (usually nurses or social workers with expertise in devising, monitoring, and coordinating care plans) to assist in the decision-making process. To find one in your area, go to the Web site of the National Association of Professional Geriatric Care Managers (

Adele Winters, a geriatric care manager in Potomac, MD, recommends adult children check out four or five sites, then narrow the choices to two that the parents then visit. She has an evaluation checklist that she tailors to the family's needs. "For example, if the parent is a diabetic and is looking for an assisted-living facility, I make sure the facility has the staff to do injections. Not all are able to. You have to be sure that whatever your parent's particular needs are, they can be met."

Winters also recommends having a meal at the facility, so you can observe how the staff interacts with the residents. "Is the dining room lively, and are people chatting with each other?" she asks. "If it's dead silent, that's a bad sign."

The staff-to-resident ratio is crucial to inquire about. Some facilities include all support staff, such as maintenance workers, in their ratios. "Bear in mind the residents' acuity level, their cognitive and physical functioning, as well as building design elements such as corridor lengths and location of the nursing station," and look for a minimum of one staffer for every 10 residents during the day, says Winters. (That includes a supervisory nurse.) For overnight coverage, the ratio should be one to 20, at least.

"If you see a lot of private-duty aides supplementing the staff, that means families have had to hire additional help," Winters cautions. Also important: the length of service of key staff, such as the director of nursing in a skilled-nursing facility, and the director of resident services at an assisted-living facility.

Make a follow-up, unannounced visit on a weekend to glean more information. "Hang out in the parking lot, waylay residents' children coming out, and ask them what they think," she recommends.

And finally, try to look at any facility from your parents' point of view. "Is your parent into Bach or bingo?" prompts Winters, who considers what she does to be partly a matchmaking service for clients and residences. "A glitzy place might appeal to you, but your parent might find it cold and intimidating."


When a parent can't live at home. Medical Economics Aug. 6, 2004;81:38.

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