How to Recognize Signs It’s Time for Assisted Living

Caring for someone with dementia can take a toll on both the dementia caregiver and their family. Many families consider assisted living during this time, but will you recognize the signs that it’s the right time for your loved one?

Read what a psychologist says about recognizing and understanding these signs.

Signs That Your Loved One May Need Assisted Living

More than 15 million Americans devote energy and time to caring for a loved one with Alzheimer’s disease or another dementia, according to the Alzheimer’s Association, but sometimes the cost of caregiving becomes too high. Caregivers often find themselves unable to bear the burden of providing home health care without suffering from illness themselves.

This is when it may be time to consider whether to move a loved one into assisted living if their health needs become too much to handle at home.

Moving a family member is never an easy decision. There are, however, some telltale signs that caregivers can look for in order to recognize when it’s the right time for assisted living, says Rita Vasquez, M.A., an MFTI Clinician at Quail Lakes Counseling Center in Stockton, California:

1. Aggression

Physical, sexual or violent aggression frequently happen in those with dementia, and caregivers or other family members may suffer or begin to feel resentful. “I tell people when they’re getting to that state, it’s time to start considering placement,” says Vasquez.

2. Caregiver Stress

Caregiver symptoms like increased stress can be just as telling a sign as the dementia behaviors described above.

3. Escalating Care Needs

Ask yourself: “Are the person’s care needs beyond my physical abilities?” or “Is the health of the person with dementia or my health as a caregiver at risk?” If you’re answering yes to those questions, it might be time to have that tough family conversation.

4. Home Safety

Consider your senior family member’s health and your own abilities to care for them. Is the person with dementia unsafe in their current home?

5. Sundowning

“Sundowners syndrome” — very agitated behavior that becomes more pronounced later in the day — is a common characteristic of those with Alzheimer’s. Vasquez says that this can take a heavy toll on caregivers, and when it begins to severely disrupt family routines, this may be a sign that the caregiving burden is too hard to handle.

6. Wandering

In later stages of dementia, the risk posed by wandering becomes much greater, notes Vasquez. “They can wander even if you just take the time to go to the bathroom,” she says, and the probability of falls and injuries increases.

Stress May Indicate a Need for Help

An article in the New York Times discussed the psychological costs of caregiving and of making difficult care decisions, which some professionals are likening to the effects of post-traumatic stress disorder. Caregivers may experience symptoms like:

• Avoidance behaviors
• Disabling anxiety
• Hyper-vigilance
• Intrusive thoughts and more

Vasquez attributes these symptoms not only to the pressures of caring for someone with dementia, but also to the disruptions to normal eating and sleeping patterns that result when one is spending so much time on caregiving. “When the brain is always on alert, many things are going to happen — you’re not going to eat well, your nutrition is going to go down,” and physical health suffers.

The emotional, mental and physical toll of caregiving can be particularly pronounced for spouses of those who need care. In one of the families Vasquez works with, the wife and primary caregiver is 80 years old. “She’s taking care of her 85-year-old husband and it’s draining her,” Vasquez says. “When he fell recently, she couldn’t pick him up and had to call the paramedics.” In cases like this, it might be clear immediately when the demands of care become too great. In other cases, it might not be so obvious.

If you are feeling isolated and alone, or if you begin to feel resentful of your loved one, it might be time to examine the source of those feelings, says Vasquez.

“Anger, resentment, sleep deprivation, all those things will become part of what happens to a caregiver,” she says. “Of course, the guilt, when you think, ‘I’m not doing enough.'” When that happens, it’s important to recognize how much you’ve been giving to your loved one, and perhaps tell yourself, “Okay, I’m not living a life for myself anymore, I’m living for that person.”

What If My Loved One Needs More Help Than I Can Give?

Deciding between assisted living vs. in-home care is never easy, and caregiver grief and guilt are common reactions to moving seniors out of their homes.

As Vasquez puts it, “We lose our family member twice: once to the disease, and again when they pass.”

Caregivers may wonder if they could or should have done more; they may feel separation anxiety in moving their loved one to another location. If family dynamics are difficult — if, for instance, a caregiver caring for a parent had an unhappy childhood — that may further complicate the decision process. This is why planning ahead is so important.

“If you know your family member is in the early stages of [illness], first and foremost you want to get all your paperwork together,” Vasquez says. “It’s in our culture that we don’t want to talk about those things,” but before dementia begins to affect your loved one’s cognitive health, it’s important to have someone help them collect the right paperwork and make those critical decisions, whether it’s a family member, friend or physician. Planning ahead and involving the appropriate persons in the decision will ultimately help ease the process when it’s time to move your loved one into care.

The best way to be there for them, Vasquez says, is to know that they are in the proper place for getting the care that they need. Visit communities before choosing one, and make sure they have activities and medical support appropriate to dementia patients. Ultimately, she says, try to remember that if you’ve done that research, “They are going to thrive wherever you send them.”

Ways to Care for the Caregiver

As a caregiver, it can be difficult enough to find time to care for your senior loved one, let alone yourself — even if your family member is in residential care. But staying healthy is one of the best things you can do to provide the support your loved one needs.

Arranging a short stint in respite care is one way to get some time to rest and recuperate, especially if you are caring for someone at home. Taking care of your mental health is also critical, and there are many benefits to seeking out a circle of support to bolster you when times are difficult. Counseling, support groups and therapy all exist to help family members going through transitions relating to Alzheimer’s and dementia.

Check with the community that your loved one is moving to, suggests Vasquez, who has led caregiver support groups and coordinated family services at a local residential care home. Many care homes, she says, offer support groups and other resources for families. These resources can help you come to terms with the idea that sometimes the best decision for the health and happiness of both parties is putting your loved one into care.

“We have to know that as a human being, we can only do so much without taxing our health,” says Vasquez.

Caitlin Burm

Caitlin Burm is an award-winning editor and writer who has written extensively about education, health and senior care, most recently at A Place for Mom and previously at Arizona State University and the City of Tempe, Arizona. She thrives on content strategy and storytelling and resides in Phoenix with her daughter and husband.