Decision Quandary: When Do Older Adults Enter Care Facilities?

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The adult children of disabled parents are often asked for advice about their parents’ housing options. When parents need around-the-clock care, a nursing home might be the most realistic choice. A parent who needs assistance with the activities of daily living might remain in her home with the help of family or outside caregivers. When the time is right, she might decide to move to an assisted-living facility. But how do older adults and their children know when it is time to make that transition?

A new study examined the age at which seniors move to a care facility. The study also attempted to determine the level of their disabilities — and how long they had been at that level — before making the move. The study offers insight into the decisions that families must make when an older parent can no longer live independently.

Age and Disability Levels

The study found that the mean age of seniors entering a care facility is 84. Nursing home residents have a mean age of 83 at admission while the mean age of seniors who enter assisted-living facilities is 85. About 64% were women. Almost half suffered from some degree of dementia.

Prior to their admission, half of all nursing home residents have lived with a severe disability for more than a month. The study defined a “severe disability” as one that impaired at least three activities of daily living. 

By contrast, only about 10% of residents admitted to assisted-living facilities had been living with severe disabilities. Dressing, bathing, moving within the home, and eating were the most common activities of daily living with which seniors needed help before they moved to an assisted-living facility.

Caregiving Before Moving to a Care Facility

Almost all residents of care facilities were receiving care at home before they were admitted. Nursing home residents typically received about 27 hours of care per week. Seniors who moved to assisted-living facilities received about 18 hours of care per week before they were admitted. 

Seniors who moved to either kind of care facility generally experienced an escalating need for caregiving before their admission. In most cases, family members acted as caregivers. Only a third of caregivers were paid professionals.

Deteriorating health and an escalating need for caregiving usually drives the decision to move to a care facility. Dr. Kenneth Lam, the study’s lead author, concluded that older adults are typically “dealing with severe disability at home for months or years before these people move into nursing homes.” 

Seniors tend to spend less time coping with disabilities at home before moving to an assisted-living facility than those who move to nursing homes. Dr. Lam speculates that individuals who move to assisted-living facilities are better able to afford a care facility and are positioned to make the move before their disability becomes severe. Seniors with fewer resources may be unable to afford an assisted-living facility and may need to “spend down” their assets before they become eligible for Medicaid. The Medicaid program generally pays for nursing home care but not for an assisted-living facility.


Do Families Wait Too Long?

Dr. Lam noted that he is frequently asked whether families wait too long before moving older adults to a care facility. There is no easy answer. “Too early” and “too late” are relative terms. The “right time” to move to a care facility depends on each individual’s situation.

Dr. Lam conducted his research to obtain basic data that he hopes will answer questions that will guide families as they think about moving their older parents to a care facility. It isn’t clear to him whether moving in early or moving in late makes a difference to the senior’s well-being. He views that question as important and hopes that further research will shed light on the answer.

Dr. Lam plans to follow up his study by interviewing residents who recently moved into assisted-living facilities and nursing homes. He wants to understand why and how they made the decision to enter a care facility, the impact that decision has had on their social lives, and the advice they would give to other seniors who are facing that choice.

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