When mom or dad can no longer live alone

One of the harshest realities an adult child may face is the painful realization that their aging parent can no longer live independently. Sometimes, the signs are present long before they're recognized. Sometimes, it takes an emergency for the truth to become apparent.

But it doesn't have to be that way. Know how to gauge your parent's fitness. Know (and weigh) assistance options.

While such preparation isn't easy, it's far easier than making rush decisions after a traumatic event.

Signs a senior is declining

These are common indicators of a problem. If you see these, get your parent to their doctor for an evaluation:

• Forgetfulness

• Loss of interest in friends and hobbies

• Poor hygiene

• Unexplained weight loss

• A dirty, disorganized home

• Mood or personality changes

• Problems with mobility or balance

Know your senior living options

Fortunately, families have more assistance options than ever, including:

Family caregiving — If a family member has the time and will to act as caregiver, this is one way to keep mom or dad at home. However, caregiving often takes a mental, physical and sometimes financial toll.

Home care — Licensed home care agencies also provide in-home personal care, including help with bathing, hygiene, meals, etc. Costs start at $25 per hour. This usually is an out-of-pocket cost, although it's covered under most long-term care insurance policies as are most solutions below.

Home health care — This is skilled care, provided by therapists and nurses. Costs average $40 to $80 per hour. Medicare may cover it short term following a hospital stay.

Assisted living — Under this model, seniors rent an apartment in a facility where they are supported by nurses and aides as needed. Costs are $6,000-$7,000 per month.

Skilled care facilities/nursing homes — These facilities provide 24/7 nursing care for those whose needs are too complex for assisted living. Costs range from $8,000-$13,000 per month. People who can't afford it can apply for Medicaid, but most facilities expect six to 12 months of private pay first.

Supportive living facilities — Similar to assisted living, but they accept qualified Medicaid patients. Costs average $4,600 per month. (To qualify for Medicaid, individuals must first deplete their savings.)

Memory care facilities — Specifically for dementia patients who need round-the-clock supervision and highly trained staff. Costs average $6,500-8,000 per month.

Continuing care retirement communities (CCRCs) — These tiered communities offer independent living, assisted living and skilled care all in one, so residents can “step up” to more intensive care as needed. A growing number of seniors are choosing CCRCs proactively to spare their children the responsibility. Most pay for this by selling their house.

Yes, these are tough decisions to make. But you don't need to work through this alone. Health care providers, elder care attorneys and patient advocates are knowledgeable resources who can help you find the best solution for your parent, budget and situation. With help, seniors can continue to enjoy quality of life even when they can no longer live independently.

• Teri Dreher is a board-certified patient advocate. A critical care nurse for more than 30 years, she recently founded Seniors Alone Guardianship & Advocacy Services (SeniorsAlone.org), a not-for-profit organization that serves the area's senior orphans. She also is the founder of NShore Patient Advocates, www.northshorern.com.