In this blog series, we examine the differences between activities of daily living (ADLs) and instrumental activities of daily living (IADLs), and what happens when they become difficult for a person.
Inpart one of our blog series “ADLs vs. IADLs,” we explained what activities of daily living (ADLs) are — the basic self-care tasks such as bathing, dressing, toileting, eating, transferring and mobility that allow a person to live independently. Evaluating someone’s ability to perform ADLs helps clarify their functional status and indicates when extra support or care services may be necessary. But what are the practical options when one or more ADLs become difficult for an older adult? And how does that affect the timing of a potential move to senior living?
Three common paths when ADLs become challenging
When an older adult begins to struggle to perform ADLs independently, safely, and consistently, there are generally three paths to consider:
- Can unpaid family caregivers combined with home modifications allow the person to keep living at home safely? and/or
- Is it necessary to hire a paid in-home caregiver? or
- Would it be safer and more practical to move to a setting with built-in personal care services, such as an assisted living community?
Below is a closer look at each of these options and the tradeoffs to weigh when ADLs become more difficult.
Using unpaid family caregivers
Many families initially rely on unpaid caregivers — a spouse, adult children, or other relatives — when ADL support is needed. Staying at home and receiving care from familiar people can feel comforting and is often less expensive than paid care. Still, there are important drawbacks to consider:
- Stress: Family caregivers commonly face physical and emotional strain, particularly when providing personal care like bathing or toileting. Caregiving can also cause financial strain from reduced work hours or lost income.
- Availability: An unpaid caregiver’s health, job, or willingness to continue may change, leaving the older adult without reliable support.
- Unexpected costs: Maintaining safety at home may require increasingly costly modifications such as grab bars, stair lifts, or bath seats.
Relying on family may work short term, but it’s important to ask how sustainable that arrangement is long term and what the backup plan would be if family can no longer provide care.
>> Related:Family Caregiving Can Present an Array of Stressful Challenges
Hiring paid in-home caregivers
When unpaid help isn’t available or needs supplementation, many older adults hire professional home care aides for ADL assistance. This allows a person to remain at home and schedule help for specific tasks (bathing, dressing, toileting, meal preparation, transfers, etc.). Consider these tradeoffs:
- Cost: Regular in-home care can be expensive. National cost calculators illustrate that ongoing assistance often amounts to thousands per month and is typically not covered by Medicare or standard health insurance, meaning out-of-pocket expense for families.
- Scheduling: In many areas there are shortages of qualified home health aides and varying quality of providers. This can lead to inconsistent coverage and difficulty scheduling reliable care.
- Oversight: Someone usually needs to coordinate care, supervise quality, and provide backup if a caregiver is late or doesn’t show.
Paid in-home care can be a good choice when needs are moderate and stable and home modifications are manageable. But as ADL needs escalate, require more supervision, or are accompanied by medical needs, home care can become less safe, less efficient, and potentially prohibitively expensive.
>> Related:What is a Home Care Provider?
Moving to an assisted living community
When ADL difficulties are frequent, complex, or unpredictable, moving to a retirement community that provides personal care services often becomes the most practical option. Assisted living communities focus on non-medical support for daily activities and typically offer:
- On-site personal care assistance and often 24-hour supervision, which reduces reliance on family or the need to coordinate multiple paid caregivers
- Social engagement, prepared meals, and transportation services that help offset the challenges of declining physical ability
- Greater peace of mind for residents and their families because the community is designed to meet these needs
Moving to assisted living requires touring communities, understanding monthly costs, and financial planning since these fees are generally not covered by Medicare or typical insurance. Equally important are the emotional aspects of leaving a long-time home and acknowledging the need for help, which can be difficult for some people.
>> Related:The Cost of Assisted Living: What You Need to Know
A brief note on proactive senior living moves
Some people choose to plan proactively by moving to a continuing care retirement community (CCRC), also called a life plan community, while they are still healthy and independent. CCRCs combine independent living with access to assisted living and skilled nursing care, allowing residents to remain on campus as needs change.
A proactive move to a CCRC can provide security and reduce the likelihood of a sudden, stressful relocation after a health event. However, many CCRCs require a health assessment for residency, so if ADL assistance is already needed, entry may be limited or require different contract terms.
>> Related:Understanding the CCRC Health Evaluation Requirement: When Is the Right Time to Move?
Thinking through the right time for a senior living move
Many people ask, “When is the right time to move?” Generally, the best time to consider senior living options is before a health crisis forces a decision. Planning ahead gives you more choices and less stress.
Ask yourself and discuss with loved ones or a financial advisor the following practical questions when weighing timing:
- How many ADLs can I complete independently, and which ones require assistance or supervision? Consider listing bathing, dressing, toileting, transferring, eating, and walking.
- Have I experienced falls, near-falls, hospitalizations, or worsening mobility?
- Can my home be modified to remain safe, and am I willing and able—emotionally and financially—to make those changes?
- If I plan to rely on family, are my loved ones willing and able to provide long-term help? What is the backup plan?
- If I consider paid help, can I afford it long term, are quality aides available locally, and am I prepared to coordinate and supervise care?
- Do I want to avoid a sudden, forced move after a crisis and instead choose a proactive relocation to a community that can provide personal care?
- Have I toured multiple retirement communities to compare services, contract terms, costs, and the level of care offered for increasing ADL needs?
>> Related:When “What If” Happens: What to Do After a Health Crisis
Stay in control: Planning ahead, before ADL needs are urgent
Recognizing early signs that assistance with ADLs may become necessary gives you more control and more options: continue at home with unpaid family support, hire paid in-home caregivers, or move to a retirement community designed for changing needs. Planning is especially important for those considering CCRCs, which may have health requirements tied to certain contract types.
Many older adults prefer to make a proactive move while they are still relatively independent so they retain choice and avoid the stress of an emergency decision. Touring communities, comparing services and contracts, and speaking with current residents can create confidence and peace of mind.
In next week’s post, we will further discuss instrumental activities of daily living (IADLs).