Mom and Dad, We Need to Talk: Assisted Living for Aging Parents

"Good Morning America's" new series "Mom and Dad, We Need to Talk" tackles tough topics on aging parents. And few subjects are more difficult to broach than the question of assisted living: When is it time to get your parents help or move them to a senior residence?

Elinor Ginzler, senior vice president for livable communities at AARP, offers advice on how to recognize the signs that your parents need assistance in day-to-day living, and how to talk to them about it.

VIDEO: AARPs Elinor Ginzler explains how to talk to your parents about assisted livingPlay

Bringing your parents to live in your home is one option, but that's a different conversation. If that doesn't work for your family, you have to decide whether your parent needs outside assistance at home or an assisted-living facility.

CLICK HERE for more advice from the AARP on choosing an assisted-living facility.

CLICK HERE for more resources on tackling difficult issues with your aging parents, including driving, finances, family and caregiving.

Signs Your Parents Are Struggling to Take Care of Themselves:

Home in Bad Condition
Poor Personal Health or Hygiene

"There is no one special sign," Ginzler said. "This is something that is a gut-check for you as a child looking at your older parents."

But, she said, there are two things to look for to help determine if your parents are struggling: the condition of their home and their health.

A decline in the condition of their home is a sign that they may need help. Here, you are basically looking at cleanliness and upkeep. Is their house as clean as it has always been? Is there enough food -- and is it the right kind of food -- unspoiled and balanced? You also need to look at safety. Are there too many steps? Are there handrails that are loose? Are there throw-rugs that are worn, posing a serious threat for falls?

The second indication is the physical condition of the person, your parent. Look at how he or she is moving around the house and for how your parent appears to you from a health perspective. You're not a doctor, but you can see if your parent's health is deteriorating. If it is, you should be concerned.

This is a family issue, and there's no hard-or-fast rule but, Ginzler said, the key is to have a family history to go on. And it is best to have the talk about assisted living before things get too bad.

"You can tell if things aren't quite the same as they were," Ginzler said. "It is never too soon to have this conversation."

Tips on Talking to Aging Parents About Assisted Living:

Make Concrete Examples
Use 'I' Statements
Ask Parents to Help You
Make a Deal
Write a Family Contract
Give Gift of Help

Talking about assisted living is one of the hardest conversations you can have with a parent. The most important thing, Ginzler said, is to support your parents and let them know your desire for them to be independent. But balance that with everyone's desire for them to live safely and optimally.

You have to use concrete statements, she said. Be as specific as possible about your fears and why you think they need help, and use clear examples. Say something like, "I couldn't help but notice those steps looked dangerous, and it looked hard for you going up and down them," or whatever the actual case may be.

Also, Ginzler said, it's important to use "I" statements. This lets your parents understand that you're coming from an emotional point-of-view, that you care about them and have concern and worries. You could say, "Mom and dad, I'm afraid you might get hurt; I want to make sure you're safe; I want you to be healthy; I want to make sure you're living well; I want to talk to you about how to make sure you're safe."

These "I" statements express your emotional commitment and your true concern.

And frame things as if your parents are helping you. Say, "Do me a favor and consider getting someone to come in to help you." Or, "Do me a favor, and consider how it might make your life easier to live in an assisted-living community."

This can help keep the parent-child relationship in place and help your parent feel a greater sense of dignity.

Remember, first, that one conversation will never be enough. This will be an ongoing process. One of the best things you can do is to think about negotiation techniques and how to make a deal. You can say that if they don't want to move, at least, they can make a visit.

Say, "I'll show you three residences in your community, and then we won't talk about this for 30 days." Or write a family contract that says if specific things happen -- say, food is spoiling or the house is getting dirty -- then another discussion about assisted living is in order.

Another great idea is to give your parents the gift of help. Hire someone to come in once a week to clean up or get a regular grocery delivery. It's much harder to reject a gift. And if all else fails, hire an objective, third-party professional to come in and assess the situation and mediate.

Taking Action to Get Help for Your Aging Parents

Create First-Floor Living
Make House Senior-Friendly
Use Community Services
Visit Assisted-Living Residences
Let Parents Choose

To decide whether it's best for your parents to stay at home and get help or move to an assisted-living facility, start by asking them what they would like.

"Ask them what their preference is," Ginzler said. "Most people want to stay in their home."

If that's the case, you need to determine if it's possible. Look at the house itself. Does it meet the needs of your parent? Can it be easily changed to meet them if it doesn't?

Look at first-floor living; stairs can be a great hazard. Is there a way to have a full bath and a bedroom on the first floor, either by repurposing rooms or doing an easy remodeling job? Then you can make easy changes such as changing door handles to levers, making it easier to come and go.

You can do the same with the cabinets in the kitchen. Also, you need to make sure there are ample community services for them, such as house cleaning or even medical intervention. And can they get emotional support from visitors? People need that kind of attention.

If staying home isn't an option, then you need to help your parents choose an assisted-living care facility. These are not nursing homes. They are residences that support independent living and provide personal care assistance with, for example, bathing and dressing. They provide meals and social stimulation as well. Let the parent choose which residence best fits his or her needs.

CLICK HERE for more advice from the AARP on choosing an assisted-living facility.

Assisted Living: How Much Does It Cost?

Eighty percent of assisted living is paid for privately. But there are a wide range of price levels available, and there are affordable facilities out there. This choice often means you'll have to sell your parents' home, but it is a reasonable thing to do. Many families also find that they can chip in and pay for their parents' care collectively.

And it's essential that you look at individual residences, because each one has its own flavor and each state defines assisted living differently.

On average, informal caregivers who take care of an elderly friend or relative spend $5,500 a year on the day-to-day expenses such as food and doctor visits, according to a 2007 study by the National Alliance for Caregiving and Evercare, a health care coordination program.

Should that elderly parent need to be put in a full-time facility, the costs rise exponentially. The average annual cost of a semi-private room in a nursing home is $69,715, while the average cost of an assisted-living facility is $36,372 a year, according to a 2008 MetLife survey.