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Allan Schwartz, Ph.D.Allan Schwartz, Ph.D.
Dr. Schwartz's Weblog

Aging and the Question of Assisted Living

Allan N. Schwartz, LCSW, Ph.D. Updated: Jul 12th 2007

We have been running some articles on aging, elder abuse and Alzheimer’s disease. The present log entry deals with the question many adult children and their aging parents face: "when is it time to move into assisted living?" It is a difficult and painful experience for both the aged and their adult children because of what it represents: the loss of freedom and the loss of physical ability caused by aging and disease. Is all of this necessarily true?

If a family is able to afford it the best type of living arrangement for most elderly people is to be at home with nursing and home care assistance made available on a daily basis and sometimes on a twenty four hour basis. Because most people prefer to be at home where surroundings are familiar and comfortable this type of arrangement is best if it is practical. When it is no longer practical the next step is either nursing home or assisted living placement.

First, it is important to understand the difference between nursing homes and assisted living arrangements. It is possible that some senior centers have both nursing homes and assisted living apartments. Assisted living usually refers to healthier older people who may no longer be able to care for themselves but do not need the full medical service of a nursing home. By assisted living what is meant is that elderly people reside in small apartments. Additional care and services are available at a greater fee. The advantage of assisted living is that there is a community of people surrounding those in the apartments that the dwellers may or may not choose to take part in. For example, there is the choice of using the common dining room for each meal or dwellers may cook their meals in their apartment or go out to eat. In other words, in the context of assisted living people can live as independently as they wish or fully partake of community activities available to all.

Nursing homes refer to a more comprehensive type of living and medical arrangement for those most debilitated by health problems. These are institutions that look and function like hospitals. Depending on the health of the resident, they may or may not be able to leave the premises.

When Is It Time to Consider Assisted or Nursing Home Living?

I want to point out that a number of aging adults decide to enter assisted living long in advance of any health problems. That notion should go a long ways towards dispelling any myths about what assisted living apartments are really like. In other words, these are nice places, with the more expensive ones being quite luxurious. There is nothing that distinguishes them from any other type of condominium or cooperative type of building arrangement. Those who decided to enter assisted living arrangements while still healthy are usually betting that they might not remain healthy in coming years and want the added support provided by assisted living.

For those who may not want or be able to make their own decision, family needs to be aware of certain clear signs and symptoms of the need for additional support:

Signs of need for assisted or nursing home living:

1. The combination of weight loss, forgetfulness, depression or lack of energy to cook meals. These may be a sign of dementia whether of the Alzheimer’s type or otherwise.

2. Lack of personal hygiene such as not brushing teeth, dirty and unclean clothes, body odor and failure to engage in basic grooming: for men, shaving and for women, using makeup and for both, caring for their hair.

3. Constantly losing and forgetting things such as the keys to the house, turning off the stove and oven, and any type of forgetting that might seem harmless once in a while but that is more serious because it is repetitive and even dangerous.

4. Not being able to remember common words during the course of discussion.

5. Loss of mobility with the resulting inability to engage in normal self care and care of the home. The loss of mobility also results in falls and injuries at home as well as in the neighborhood.

Therefore, when a number of things occur that cause family and even the elderly person him self to feel unsafe at home it is time to consider moving to an environment where increased support and care are available.

Your comments are welcome.

Allan Schwartz, LCSW, Ph.D.

Readers who live in the Boulder, Colorado metro area, or in Southwest Florida may contact Dr. Schwartz for face-to-face consultation. He is also available for psychotherapy through Skype video for those who are not in Florida or Colorado. He can be reached via email at for details.

Reader Comments
Discuss this issue below or in our forums.

Assisted Living for Seniors - Assisted Living for Seniors - Aug 26th 2009

I have recently been looking into assisted living facilities for my aunt. She is able to do most things on her own but I know that she could use some help as she has been forgetting important things like when to take certain medications and when she needs refills. That is what really made me start searching for alternatives. I know my aunt likes her independence, but I also know she gets really lonely. I think she also gets assisted living facilities mixed up with nursing homes. I've been trying to find resources for her to look at. I have been talking a lot to Sunrise Senior Living. They do a good job of separating the different offerings so my aunt can better understand what type of care she will get. I think in the end, it will be the best solution for her.

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