The Life Transition Blog

Straight to Assisted Living vs. Returning Home

Often, family members are faced with the decision regarding whether a loved one should move directly from a rehab facility to assisted living or whether they are better off to come home for a short time in between.  As with so many decisions involving older adults, it depends.  It depends on the five considerations of safety, cognitive condition, resources, logistics, and psychological needs.

The first aspect of the decision has to do with whether or not your loved one will be safe if he returns to his home after spending some time in a rehab setting.  In general, the purpose of rehab is to help the patient regain strength and skill with balance, walking, and transferring from sitting to standing.  In addition, the patient may have been receiving therapy related to day-to-day tasks in the home such as preparing meals or dressing.  Sometimes despite the best effort of the therapy team, your loved one will simply not be able to safely care for herself at home.

A second consideration is the cognitive status of your loved one.  If she suffers from confusion or frank dementia, she may be unable to manage her own medication administration.  Or, he may be prone to wandering around the neighborhood or getting in the car and driving away.  In addition, transitions from one location to another are always difficult for an older person and this can be exacerbated in the presence of dementia or cognitive impairment.

If your loved one cannot safely manage at home alone or suffers from cognition issues, going home might not be a realistic option unless appropriate help can be provided.  This brings us to the third consideration, resources.  If your family can provide the necessary care at home or if there are sufficient financial resources available to hire appropriate caregivers, then returning home might be feasible.  In this event, you need to familiarize yourself with the different levels of caregiver licensees and the requirements for providing an appropriate living space for the caregiver.  In addition, you will need to determine whether a live-in caregiver is the best option or whether you will require multiple shifts to cover the needs.

Fourth on the list of considerations is logistics.  Is the assisted living residence ready at the time of discharge from the rehabilitation facility or is your loved one on a waiting list?   Is the new place fully furnished or do you have to furnish it?  If you need to supply the furnishings, do you plan to buy new items or use things from the new resident’s former home?   If the assisted living residence is available for immediate occupancy it is often possible to make it comfortable on short notice by using a senior move management service so this shouldn’t be a deciding factor.  You can always move personal items over the ensuing few days or weeks.  It doesn’t all have to be there on “day one”.

Finally, we must consider what is best for your loved one.  Many families feel that allowing the older adult to return to their home “one more time” is beneficial.  Sometimes it is.  This is especially true when the older adult is both physically and cognitively strong and when he is an active participant in the decision making that has led to the conclusion that a move is necessary.  On the other hand, if the older adult is an unwilling participant in the move or is really unaware of his or her surroundings, moving home again might be challenging.

As with so many other issues when caring for older adults, there is a balancing act between preserving independence and decision-making authority and managing safety and resources.  As a family caregiver, you sometimes have to be the arbiter of this tension.
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