Independent Living v. Assisted Living ... How to Think About It


In my frequent conversations with clients and families, I find (in all honesty) a great deal of misunderstanding about what constitutes Independent Living vs. Assisted Living, which most communities offer. What kind of “assist” is available? Will it meet our needs? What if we have a significant change in mobility or ability? Will we have to move? 

How do they work?

The “template” of most Assisted Living communities is similar, offering Independent Living, Assisted Living, and Memory Care Units. Some larger facilities offer Skilled Nursing Centers where recovery from illness or surgery is available, as well as Long-Term Care for those needing a more skilled care team and round-the-clock support. Fee structures and monthly charges vary for both, and additional services can be purchased “a la carte.” Often, Independent Living includes one meal per day, housekeeping, access to an emergency activation system (pull cord, wrist, or pendant emergency response devices), and 24/7 access to help. 

Before admission, the potential resident will undergo a thorough assessment to determine the appropriate level of need and intervention. A care plan is created based on specific needs and a calculation of how much “direct care” is built into the monthly cost. Additional care is available for purchase, usually at a 15-minute interval. Most facilities welcome private care. 

Unit setup and accessibility are important considerations, in addition to staffing patterns. What is the staffing on weekends and holidays? Is there a nurse physically present 24/7 or just during office hours? What is the protocol if illness or injury should occur? Are the caregivers able to communicate in your loved one’s primary language? How are things like laundry and housekeeping handled? Some other considerations if a move is on the table: Does Mom still drive? (Perhaps the real question…should she?) If yes, can she have her car? Fluffy needs to come with Mom, for sure. Are pets allowed? Who takes care of the animals? Is it family? How much furniture can we bring? Do we need new furniture to accommodate changes in function or ability? Electric bed? Power Assist Recliner? 

Trust your senses

Keep your eyes, ears, and nose peeled. How do the residents look? Bored, disengaged, asleep, disheveled? Or are they well-groomed, content, and participating? Evaluate the cleanliness of common areas and pay close attention to the “vibe” you get. A tour will expose you to a great deal of information that can feel overwhelming. Rather than deciding based on what those at the facility tell you, make your own assessment based on your observations. 

Exploring such a significant move and lifestyle change can feel overwhelming and stressful.

Begin by taking inventory. Excavating the issues is critically important to identify our needs and expectations. After lots of homework, we can carefully consider the following: 

Is this a proactive move without any real concerns for today, or is the current living situation failing? 

Has there been a change in medical status? Mental status?

Have long-time helpers become unavailable? Has the death of a spouse or other household member created a scenario where living alone is concerning?

Are there functional limitations responsible for a higher risk exposure at home? Is the home no longer meeting the changing needs?

Are there seasonal concerns that you want to address before another winter?

Expect a wide range of feelings.

Yes, those pesky feelings keep getting in the way. You may experience guilt and anxiety even as you find relief in having your loved one out of danger, isolation, and risk. If you are working within a family system making these decisions, sometimes the old unresolved issues find a way to rise to the top and sabotage. It can be helpful to have a trusted third party participate in the discussion at some point, perhaps a Clergy, a member of the healthcare community, or a trusted other with whom the elder is comfortable.

This, of course, is a sentinel event for every family considering this type of move. Undoubtedly, unless you are in the rarest type of family where harmony reigns supreme and everyone agrees all the time, be prepared for a wide variety of thoughts and emotions on the subject. I suggest proceeding at a pace your loved one can tolerate. 

Very few folks will be delighted to move out of their homes. 

If you are among that slight number, count your lucky stars. It generally does not go that smoothly. While caring for my mother, the time came when it became apparent that she needed this type of setting. I did my homework; I toured, interviewed, and compared several options before “pitching” the move to Mom. 

Change is hard. Change is inevitable. 

It can hurt. But it also can be necessary. Moving gently through the process is essential. Be mindful that as we age (all of us, and I know YOU can relate), we find change even more difficult as the years accumulate. I’ve worked with families that have taken a year or longer to make this decision if they have the luxury of going slowly. It’s potentially hard for everyone, and experiences are at varied intensities. Reacting to a crisis is perhaps the worst time to introduce this change. However, the crisis may be the tipping point that reveals the level of risk without intervention. 

The best thing you can do to help increase the odds of a successful transition is to make this major change before it’s too late. 

If your loved one can engage, participate in activities, enjoy socialization, and benefit from the community, that’s ideal. If senior is not seeking engagement, the safety features built into the units, availability of staff 24/7, and reduction of things that “can go wrong at home” might be enough to make this an excellent option. The most successful transition to this type of living arrangement is accomplished by getting there “early enough.”

Many elders I have known (and loved) have flat-out rejected a move out of the home, only to survive the adjustment phase and become content, safe, and well cared for in a way that would have been difficult or impossible at home. Ask the communities you are interviewing if a “trial period” can be provided. Make your list of questions well before the interview tour and include, “What if Mom is miserable and we can’t make it work? What happens then?” 

What can go wrong?

Usually, the lack of success transitioning to this type of community is due to the elder having more needs than the unit or facility can accommodate. Often, families consider this type of move only when a loved one is clearly struggling to manage at home despite intervention. The resident needs far more “assist” than the family was aware of, leading to increased risk in an environment that is not supervised for much of the time. Some communities are “fluid” and can move residents to a more appropriate setting as their care needs change and increase. If you select a facility that cannot offer this, relocation or supplying substantial private care may be your only choice. 

What’s the alternative?

Is there someone available to live with your aging loved one? Can they relocate to a family member’s home? Do you have Long-Term Care Insurance that may pay for or offset private in-home care? Is a daytime program helpful to fill a portion of the day, and then family or caregivers provide the needed support at home? If the set-up of the home is the stumbling block, would moving to elder housing or a more suitable situation be enough with some additional support? 

If you want to start, have started, are overwhelmed, are bewildered, or need to revisit this discussion, ask for help. This is tough stuff. Patience, compassion, consideration, and kid gloves are required. Ask the communities you tour if families are willing to share their experiences. Help is a phone call away. Your local Councils on Aging and Senior Centers are great places to get support, information, and assistance. 

Joanne MacInnis, RN, is the founder and president of Aberdeen Home Care, Inc., of Danvers, a concierge private duty home care agency in business since 2001. With 35 years of nursing practice, management and administration experience focused on home care and hospice, Joanne and her team specialize in advising and supporting families addressing the elders in their lives retain dignity and quality of life. 

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