When a senior can no longer live independently, this decision about their care is often made during a time of crisis. This frequently occurs when the senior is ready to leave the hospital after a serious illness or operation, or when the health condition of a senior living at home deteriorates.

This obviously is a decision that has long-term ramifications for the senior and family, so an informed decision is critical.

The key objective is to ensure that a senior is in a safe environment and that their medical needs are addressed. The majority of seniors prefer to live at home, so before considering placement in an assisted living facility or nursing home, family members should consider all available options.

Following are the top five most frequently asked questions that caregivers should address about independent living:

How will I know if a decision needs to be made?

Seniors often do not divulge information about their ability to perform activities of daily living. Often it is for fear of the consequences of admitting their deficits. As a caregiver you need to ensure that a family member is eating properly, is taking their medication, is not in pain, is ambulating safely with a steady gait, is lucid enough for decision making, and is able to live safely in their environment. Major or minor structural modification may be necessary to provide safety. Emergency notification devices may be needed. There are many options and issues in a home that may not be immediately visible to the untrained eye. If you are worried about a senior, it may be worthwhile to engage a professional to visit the senior.

What are some immediate concerns?

Weighing options for care can be stressful and time-consuming for caregivers, especially if family caregivers don’t live nearby. Seniors will often be frightened and bewildered over the dramatic change in their quality of life. Initially, recommendations from discharge planners, nurses or social workers may seem viable, but their expertise is the immediate needs of the senior at the time of discharge from the hospital and does not address the chronic medical, non-medical, legal and financial needs.

The time to make decisions about short and long-term care is before a senior requires such care.

Making this decision has long-term ramifications, so it should be made based on research and conversations with health experts specializing in senior care.

Cost and legal considerations will quickly come into play. What does Medicare pay for? Will the senior be eligible for Medicaid? Who will manage the seniors’ day-to-day financial matters? Rents and mortgages must be paid, monthly utility and credit card bills, and prescription drugs. Can a family member be appointed power of attorney? Is there a reliable and trustworthy family member available that wants the responsibility? It is particularly desirable if a single source can attend to the medical, financial and legal needs.

What are some of the care options available?

Your decision will largely be determined by the health conditions, financial resources, availability of family and the physical environment of the home. Seniors can often remain at home, attended by non-medical attendants, in home nursing support, and family members. Adult day care can also help keep seniors active and address loneliness. More serious health conditions may require assisted living or a skilled nursing facility. Investigate each of the possibilities so you are prepared to make an informed decision when the time comes. Although this decision will be made by the family, it often will be at odds with a senior’s wishes.

Where should I look for answers?

An informed decision is critical, and so is identifying resources to make your job easier. Local health professionals are a good referral source, as are local eldercare experts. Much information is available on-line or through local wellness and senior organizations, but relying solely on feedback from others and on-line sources may not provide the detail and scope of information required for prudent decisions. Each senior and their family have unique needs and require customized options.

What should I expect when a decision has been made?

Expect some push-back or even anger from senior family members. Their loss of independence will be a major source of friction, as will money issues. Seniors often think they are healthier than they really are, and may object to new surroundings or strangers in their home. Even though you communicate frequently and effectively, hostile feelings can present themselves. Expect more phone calls from seniors, health partners and caregivers. The first choice is not always right and the family and senior must be open to looking at other alternatives. If the senior has dementia, these special needs must be factored into the plan. Again, the goal is safety, seeking the right level of medical care, and preserving dignity.


Making decisions about the care of aging parents is highly emotional and stressful. But don’t do it alone. Tap into the available resources and eldercare experts in the community.

Mardy Chizek, RN, FNP, BSN, MBA, AAS
President, Charism® Eldercare Services


  • Mardy Chizek, RN, FNP, BSN, MBA, AAS, is President of Westmont, Illinois’ Charism® Eldercare Services. She has 30 years of professional healthcare experience as a nurse/ nurse practitioner, geriatric expert, consultant in legal and insurance issues, clinical risk management, business and an educator.