Nolan Alexander (Host): Today, we're here to answer questions on a difficult topic and give you insight to make informed decisions. This is Expert Insights with the Carle Foundation Hospital. I'm Nolan Alexander. And with me is Dr. Aimee Yu-Ballard from the Carle Foundation Hospital, as we talk about when to consider assisted living. Dr. Yu-Ballard, how are you today?

Dr. Aimee Yu-Ballard: Good. Thank you.

Host: Thank you so much for joining us, and let's try to identify some key words here. Can you explain the differences between independent living, assisted living, memory care, and skilled care?

Dr. Aimee Yu-Ballard: Sure. So, independent living is where most of us live. So, we have our own place, apartment, house, condominium. And basically, we are living and doing all of our activities on our own. At some point in time, people may find it difficult to continue to live in independent living and they may choose to go to assisted living, which is oftentimes a facility that will have apartments set aside for individuals or couples, and they can provide some help with activities. These things are often like medications; testing, for example, blood sugar or blood pressure; food, laundry, cleaning, things like that. So, the next step after assisted living would be memory care, and that provides a higher level of care for patients with dementia. And oftentimes that will include 24-hour staffing. And then, lastly, And the most high level of care would be, extended living facility, which is often known as a nursing home, and that provides 24-hour skilled care, often with a nurse available on-site 24/7 for patients who require that high level of care.

Host: Well, thank you for explaining that. That really helps us understand a little bit more as we start to talk about and use some of these words. With that, what kind of support does assisted living typically provide that home care may not?

Dr. Aimee Yu-Ballard: Assisted living, typically, has a number of apartments depending on the size. It could be as small as 10 apartments and as large as hundreds of apartments. And they would provide some help with the activities of daily living. So for example, they may have meals on site. They may have a van to provide transportation to and from appointments or the store.

They can have help with cleaning, laundry, things like that. And they can also provide assistance with medications. So if patients have to take medications several times a day, they can have staff on site. And the staff oftentimes in assisted living may not be nursing. They may be certified medical assistants that can help with day-to-day living.

Host: How do the activities of daily living, which sometimes are referred to as ADLs, and independent activities of daily living, or IADLs, how do those factor in the decision to move to assisted living?

Dr. Aimee Yu-Ballard: I think, many people, as we all get older, may have some difficulties in doing things such as driving, making our own meals, setting aside our medications and taking it every day. And then, just general household chores such as cleaning, laundry, lawn care. And when we have difficulties doing these things and there's various number of reasons why that may happen, we may think about moving into assisted living just to get that extra help.

Host: Are there some that come to mind more so than others or way heavier than others when it comes time to sit and make that decision?

Dr. Aimee Yu-Ballard: Yeah, I think I have like two groups of patients. One group, they move into assisted living in preparation for the future. So, they may be able to handle their own activities of daily living for now, but they're thinking ahead and they want to be able to move when they are still capable and they feel the adjustment would be better. And then other patients, they move because they have to, because they're no longer able to prepare their meals or do their medicines on their own. I think using the bathroom and showering is a big one that a lot of our patients, when they have difficulty toileting, that often is kind of the tipping point for really considering moving to an assisted living facility.

Host: I've heard a lot of discussions before about social engagement, and it's really important. How do you view social engagement as a level of importance when discussing and deciding on senior living arrangements?

Dr. Aimee Yu-Ballard: I think it's very important. I feel that, as we all get older, it's very important to continue our social engagements and to have friends, and to have groups and to have hobbies and activities to keep our brain happy. And that's something that the assisted living facilities do a wonderful job. Often, they have an activities director on site and they have a planned program every single day. Oftentimes, it starts with some stretching exercises in the morning, and then different types of groups that meet throughout the day, including some exercise groups and walking groups all throughout the day. I think it's wonderful for people to have company.

Host: You work a lot with families, and I'm sure people bring ideas or things that they've heard to you, and you have to sift through what's true and what's not. What are some common fears and misconceptions about moving to an assisted living community that you've heard?

Dr. Aimee Yu-Ballard: When families open the discussion, I like to have it as a long-term discussion because it's very difficult for a person to all of a sudden agree to move to assisted living. Often it includes downsizing quite a bit. Patients go from a full house, possibly two stories with a basement, and then they have to consolidate all of their belongings or what's important to them into a one bedroom. So, I think that causes a whole lot of anxiety for families and patients, like trying to figure out downsizing. And then, the second thing, of course, is the cost, because a lot of assisted livings are very expensive, especially the nicer ones will be quite expensive.

Host: So, how do families plan financially for that transition to assisted living?

Dr. Aimee Yu-Ballard: It takes a lot of forethought. My husband's grandmother, who is turning 97 in May, she has been living in assisted living now for about six years. She was living at her own home until about 90 or 91. And she was lucky to have invested in long-term care insurance, which does cover part of the cost of assisted living. But I would say most of our patients do not have long-term care insurance, because it's very expensive. And in that case, they would be relying on their pension, savings, any kind of investments that they have done in the past.

Host: And that's interesting about that long-term care insurance. Is there anything else that families can look to do now if they feel like this is a long-term discussion and decision that could be on the horizon?

Dr. Aimee Yu-Ballard: I suppose most of our families would use their resources, you know, potentially sell their home and put that money into a fund for the assisted living. When the funds run out, there are some assisted livings in the community that will accept Medicaid.

Host: Dr. Aimee Yu-Ballard joining us today talking about a really important discussion today of when to consider assisted living. And you provided a great breadth of discussion across a lot of important topics within this. Is there anything else that you feel is important for our listeners today?

Dr. Aimee Yu-Ballard: Aging is difficult. I've had many of my patients who are in their 90s or even a hundred years old, and they always tell me that aging is not for the weak of heart. And so, I think, just being able to think about the future, plan ahead, and then have an open mind, because things don't always turn out the way we think they will. I think that those are things that I learned from my patients. And I think that helps people age well.

Host: Well, rarely does life go according to plans from a daily standpoint or through the years. Isn't that right?

Dr. Aimee Yu-Ballard: Right, right.

Host: Well, Dr. Yu-Ballard, thank you so much for joining us today. We really appreciate your time and insight.

Dr. Aimee Yu-Ballard: Thank you.

Host: For more information and to get connected with one of our providers, please visit carle.org. or for a listing of Carle providers and to view Carle-sponsored educational activities, head on over to our website at carleconnect.com. And that wraps up this episode of Expert Insights with the Carle Foundation Hospital. I'm Nolan Alexander.