For many adult children, there is a desire to keep Mom or Dad safe as their abilities decline. The aging parents have more physical problems. They seem forgetful in a more noticeable way. They struggle at home, especially when living alone. Kids worry and they persuade the aging parent to move. Assisted living seems good and the move happens. Sometimes it’s not a great outcome.
When A Problem Becomes Visible
Assisted living facilities are designed to be an enriched social environment. They are regulated by the state’s departments of social services or equivalent. As they are not in any way healthcare providers, they are not licensed to give health care at all. That includes professionally monitoring residents for mental health conditions. These homes offer a variety of things for social connection with programs, events, entertainment and learning opportunities. It works well for many. It all sounds fine. Except when your aging parent won’t do any of the offered activities. They stay in their room. You know that wasn’t in the plan. What can adult children do?
The Mental Health Issue
In some cases, the elder in their lives had already demonstrated an unwillingness to socialize before they moved into assisted living. The naïve hope of the adult children was that being around other people was somehow going to fix that. It doesn’t. Anyone who habitually resists participation is social events historically is not going to magically change because they move into a new community. For some older adults, being in a community can be a mistake, because the cost of the facility is being wasted on things they won’t do, and they will not adapt to the new place. This personality trait is something to carefully consider before a family plans to move their aging parent from living alone into a community. Social isolation is not good for anyone but a wrong fit in a community isn’t good either.
Considerations Before Choosing Assisted Living
Let’s imagine that your aging parent lives at a distance from you. They are widowed and a lot of their friends have moved away or passed. You convince your aging parent to move closer to you and your family. They agree, even if reluctantly. And you check out assisted living homes nearby, and find a beautiful one that looks nice and has a lot of activities. What you may not be thinking about enough is what would make a good fit for your aging parent, not just a good idea for you.
These facilities vary in size and amount of staff. Some have a memory loss wing, which is essentially “locked” so an elder with dementia can’t wander out and get lost. Some are huge with multiple floors and a lot of offerings. Some are smaller and have fewer amenities. At the small end are homes called “board and care”. These are often in a private home and have only a few beds. They give the same help with bathing, meals, dressing, toileting, walking and passing out medications that a big assisted living place does but they are generally not glamorous or distinguished looking. For a shy or introverted elder, that kind of setting could be a better fit than the larger institutional setting of some assisted living homes.
Depression
And consider this. An underlying and often ignored mental health issue with elders is depression. According to a research study, about 27% of people over age 60, living alone, report suffering from depression. Busy doctors, focused on chronic illnesses like heart disease and high blood pressure, may not look for and consequently not see the symptoms of depression. Withdrawal from social activities, sad mood, difficulty sleeping or sleeping too much, and changes in appetite are some of the symptoms. If your aging parent won’t do anything that looks like entertainment at their new assisted living home, consider that depression may be at least part of the cause.
What Can You Do If You Think Your Elder Is Depressed?
In adults, treatment for depression with standard anti-depressant medications can be quite helpful and is often successful. That’s the good news. The bad news is that in many cases, neither the aging parent, nor their loved ones or caregivers has mentioned the symptoms to any physician and depression goes untreated. Further, the primary care physician may hear about symptoms of depression but doesn’t want to prescribe medication for it and refers to a psychiatrist. Then the elder refuses to see a psychiatrist. Too much stigma is attached to the idea. (“I’m not crazy. I’m not going!”) Or the primary care doctor is dismissive and says, “she’s just getting old” and implies that feeling sad all the time is “normal” when one gets old. But it is definitely not normal. It will take advocacy and persuasion for the adult child to get an aging parent to accept treatment for this common condition.
Making Wise Choices
Look carefully for signs of depression that may be present before suggesting any move. If you see persistent sadness, loss of enjoyment of things they used to like doing, changes in appetite, and withdrawal, ask the primary care physician about this. If so, seek treatment before they move. Someone needs to advocate for this. In our experience consulting with families at AgingParents.com, we learn that when an elder moves to a different state or location, they have to find new doctors and that can take time. If there is a move, and it takes weeks to find a new primary care doctor, depression can grow worse. Older folks may not even be good at describing their own feelings. Family many need to help them in articulating the symptoms to the healthcare providers.
The Value Of Treatment
If depression is present, a move to a new community isn’t going to fix it. If it is treated successfully, which can mean talk therapy and medication, a move will be managed better. The chance of willingness to participate in activities increases, mood improves and the idea of a community being a good thing has a better chance of success.
Look For A Right Fit For Your Loved One’s Personality
How the proposed facility looks and a broad variety of amenities are far less important that trying to decide whether your loved one will adapt there. Give them a chance to give you some feedback after the search for a facility is underway. The move itself, for anyone giving up what they’re used to, is stressful and can be depressing. They may need to be safer but they are losing something important to them at the same time. Grieving the loss of what is familiar is necessary and should be recognized. Having a lot of contact with your aging parent around the proposed major life change and after it happens is essential.
The Takeaways
1. Moving an isolated and unsafe elder closer to family is definitely a good idea. But don’t automatically assume that assisted living by itself is a workable plan if your aging parent is not at all social and withdraws from larger groups as a habit.
2. For the less that socially adaptable aging loved one, find a smaller home, a board and care home or one that fits the personality you’re dealing with. There is no one solution for everyone with assisted living.
3. Intentionally look for symptoms of depression. Advocate for treatment for this kind of suffering. It’s not normal to be sad all the time, no matter what a person’s age is now. Be as persuasive about getting help if you see depression clues as you are about getting your aging parent to move.
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