Question: My father is having more and more difficulty taking care of Mom, not only because of her slow deterioration, but also because of his own increasing frailty. For a long time now, my sister and I have wanted them to move to a nursing home or assisted-living facility where they can get regular meals, etc., but Dad has always refused. Now he says that he and Mom will move so long as they are not put in a nursing home with “a bunch of old people”. They are in their mid-80’s, and while they both require help with some activities, they are pretty self-sufficient, by and large. My sister and I think they will be even more self-sufficient if the stress of maintaining their home is off their shoulders. We are now at first base. How do we get to home plate?

Answer: It is difficult to predict what will and what won’t work from family to family because of varying health, mental, and financial conditions. However, it appears that your Mom and Dad could benefit from an assisted-living facility -- assuming that the option of living at home is out of the question because of safety and financial issues.

In the proper assisted-living environment, your folks will be able to enjoy special surroundings designed for elderly persons whose functional capabilities may be limited due to diminished physical or mental conditions, reduced mobility, or like conditions. Folks in assisted-living facilities require much less supervision and care than those in the “institutional setting” of a nursing home.

As contrasted with the more sterile surroundings often found in nursing homes, where residents are much sicker, an appropriate assisted-living environment can offer a less structured, more residential situation that can include such services as meal preparation, housekeeping, help with personal hygiene, other assistance where and when required, and even transportation. Because the assisted-living environment falls between being at home and being in a nursing facility, continuous supervision and skilled nursing care are generally not offered, but are available in some facilities.

Your parents will be happy to know that most residents live on their own in apartments that have been tailored to meet the requirements of people who have some limitations. Some folks prefer to prepare light meals in their own apartments once or twice a day, and dine with the other residents once a day. Socialization is very important to seniors, and this is also provided at assisted- living facilities, unlike the case at home where a growing number of seniors isolate themselves.

We always recommend hiring a qualified geriatric care manager (www.caremanager.org) to assist families in the assessment and transition phases, including helping to choose the right facility. We would also recommend that the care manager be engaged to continue monitoring your folks on a monthly or bi-monthly basis to ensure that their needs are being met and aren’t exceeding the facility’s ability to provide appropriate care.

While the vast majority of assisted-living costs are private pay, there are subsidies available at certain facilities in some states for seniors with low income. We also recommend that a qualified elder law attorney (www.naela.org) be engaged to make sure that financial and health care documents are in place and that money is available to allow your folks to get what they need for as long as possible.

Taking the NextStep: To our readers who have asked what to do if a hospital tries to discharge a Medicare patient who requires skilled nursing care, but there is no skilled-nursing-home bed available: This discharge would violate a strict Medicare policy requiring the hospital utilization review committee to consider whether or not services are available in the community or area. If not, the patient’s continued stay in the hospital should be covered as being medically necessary. The patient would be entitled to skilled-nursing facility Medicare benefits for that portion of the hospital stay when no skilled-nursing facility bed was available. However, if the patient refuses to transfer once a bed does come open, the hospital will stop billing Medicare.