Assisted living communities can be the perfect fit for many seniors. They offer a variety of engaging activities and opportunities for social connection, while attentive staff help with daily needs. Such communities can feel much like home.
However, around 60% of residents eventually need to transition out of assisted living to a nursing home. This can be a stressful move, but planning for it makes the process gentler for everyone.
This post highlights the key signs that assisted living may no longer be suitable for a loved one. These signs might be subtle at first, but they are crucial indicators that it’s time to start talking to staff members about next steps and planning a possible transition.
There can be a temptation to stay positive and ignore signs that assisted living isn’t effective, but a timely move to a nursing home is ultimately a good thing that promotes better health and quality of life.
Understanding state and community rules
It’s important to note that state regulations, community-specific policies, and residents’ needs are all contributing factors to determining when an assisted living resident is better suited for long-term care in a nursing home. Due to these variations, families should review their community’s care level definitions and state regulations regularly. Doing so helps ensure you can anticipate when a move might be required due to legal or policy limits.
Assisted living vs. nursing home care
Assisted living communities and nursing homes support seniors who can no longer live independently. Both environments provide activities, social support, and assistance with daily tasks, but there are differences as well.
Assisted living:
- There is a homelike residential style with a strong focus on independence and community.
- Residents are often in fairly good health and only require assistance with some daily tasks. There is minimal medical support.
- Communities are regulated at the state level, so quality and staff training vary considerably by location.
Nursing homes:
- These communities can feel more clinical than assisted living facilities, as they have a greater focus on safety.
- Residents tend to be less independent with serious or complex health care needs, as these communities offer skilled nursing care and considerable health care support.
- Staff include certified nursing assistants, registered nurses, and other qualified professionals.
- Communities are federally regulated.
- Costs are higher than at assisted living, but Medicaid can help eligible seniors pay for care.
These differences make assisted living most relevant when seniors are in decent health and can meet some of their own needs.
Now let’s take a look at signs that it may be time to move from assisted living to a nursing home.
When care needs exceed what the community can offer
Two key factors determine whether someone is best suited to assisted living or long-term nursing home care:
- The resident’s needs.
- What the assisted living community can offer.
The second of these is more complex than you might think.
Each assisted living community has its own internal policies and is also subject to state-specific regulations. These policies and regulations often include highly specific language about limitations to care provided. For example:
- Alabama: Residents of assisted living must not have a wound that requires anything beyond basic first aid.
- Mississippi: Residents cannot remain in assisted living if they require physical restraints, sterile wound care, or intravenous liquids.
- Missouri: Residents may no longer remain in assisted living if their presence endangers the health or safety of other residents in the facility.
- Tennessee: Residents may not stay in assisted living if they need continuous nursing care or have needs that cannot be safely and effectively met.
Most of the time, assisted living facilities won’t support someone who requires skilled nursing services like wound care, needs intravenous liquids or food, or is aggressive. However, you should still inquire about the specific policies for the facility in question, as these may not be what you expect.
For example, some states (like New York) allow facilities to apply for enhanced licenses. Such licenses enable the facility to offer additional types of care, including skilled medical care.
When there are medical needs
Assisted living facilities typically don’t have the scope or staff to provide medical care. Some may be able to provide short-term support in highly specific situations, while others might not. As a result, medical needs are among the main reasons people move from assisted living into a nursing home.
This area matters even if the senior was healthy when they entered assisted living. After all, medical needs become more likely as a person ages, especially as the risk of chronic disease increases.
Families should pay particular attention to conditions like diabetes, dementia, Parkinson’s disease, and advanced arthritis, as these are initially manageable but eventually require medical support.
When high amounts of care are needed
Assisted living isn’t a 24/7 hands-on care environment. Staff members are there to help with needed daily tasks, but there are limits to the amount of time they can spend with each resident.
Seniors certainly won’t necessarily have a staff member with them all day at assisted living. As a result, growing levels of care needs are a major signal that it’s time to consider moving to a nursing home.
When problems are common
Falls, medication issues, and hospital visits are all signals that the current environment isn’t providing the support needed. Staff members may be able to improve processes to support the senior better, but there’s a limit to how effective that approach can be.
Ultimately, if the senior’s care needs are too high for the community, issues are likely to keep happening.
When the senior is bedridden or requires a wheelchair
Seniors who are bedridden or rely heavily on wheelchairs require a significant amount of help. In some cases, this may mean they can no longer remain in assisted living and should move to a nursing home.
Whether this is the case depends on specific state rules. For example:
- In New Jersey, assisted living residents cannot be “bedridden for more than 14 consecutive days.”
- In Ohio, residents cannot be “bedridden with limited potential for improvement.”
- Multiple states simply say the resident cannot be bedridden, such as Georgia and Arkansas.
- Many other states have no specific policies about bedridden residents. However, individual facilities may include this in their own policies.
Rules may also focus on the process of transferring residents from one location to another (like from a bed to a wheelchair). For example:
- In Georgia, assisted living residents must be able to actively participate in the transfer process.
- In Arkansas, residents must not have “transfer assistance needs that the facility cannot meet with current staffing.”
- In Florida, residents must “be able to transfer, with assistance if necessary.”
When the senior has considerable cognitive decline
Whether a resident with cognitive decline can remain in assisted living depends on the facility and the senior’s current cognition. In the early stages, the senior may be able to remain in assisted living and still be relatively independent.
Later, they may need to move to a memory care wing, if the facility has one, or to a stand-alone memory care facility.
Another transition might be necessary when cognition declines further. A nursing home memory care wing is especially relevant here, as this provides a higher level of practical support and skilled nursing care.
When there is regular incontinence
Incontinence accidents require residents to be changed and bathed as quickly as possible. This isn’t a huge issue if such accidents are rare, but the workload increases dramatically with the frequency of accidents.
Seniors with regular incontinence accidents, particularly fecal incontinence, will quickly go beyond the level of support that assisted living can provide.
For example, facilities in Iowa and Kansas can’t support people with “unmanageable incontinence,” while in New York, only facilities with an enhanced license can support such residents. In Wyoming, residents with incontinence can remain in the facility, but only if they manage incontinence-related needs themselves.
Knowing when to move to ensure the right level of care
Recognizing when it’s time to move from assisted living to a nursing home is never easy, but it’s an essential part of ensuring a loved one receives the level of care they need. By paying close attention to growing needs and state or community regulations, families can make decisions that prioritize safety, dignity, and quality of life. With open communication, careful planning, and support from care professionals, the transition can become a positive step toward greater comfort and well-being.
Senior care facility rules and requirements vary based on company-specific policies and state-level regulations. The content above represents common guidelines but may differ from a particular facility’s policies or requirements. To learn the regulations that apply in your state, contact your local Oasis Senior Advisor.
