Assisted Living for Mentally Ill Seniors

Assisted living can be helpful for mentally ill seniors if the community’s staff are properly trained to care for people with mental illness, and when it has procedures in place to care for people who have a mental illness.^[01]

When communities aren’t equipped to handle residents with mental illness, it can result in:^[01]

• Staff who are stressed because they’re unequipped to care for the resident
• Poorer care for all residents as staff becomes stretched thin
• Dangerous situations for all residents and staff members

What mental illnesses are common among assisted living residents?

About 14% of elderly people live with a mental illness, such as depression, anxiety, or dementia.^[02] Less common conditions include:^[01,03]

• Manic-depressive or bipolar disorder
• Eating disorders
• Suicidal ideation
• Medication or substance abuse disorder
• Post-traumatic stress disorder
• Schizophrenia

Is assisted living the right fit?

Many families who have loved ones with a mental health condition appreciate the supportive, structured environment of assisted living. Also, knowing that trained professionals are providing the appropriate support, including medication management, provides important peace of mind.

Here are a few examples of how people who have a mental illness can benefit from an assisted living community:

• Someone who has bipolar disorder will benefit from having caregivers who ensure they take their medication consistently.
• Adults who have schizophrenia can gain comfort from structure, boundaries, and support from a caring staff.

Barry J. Jacobs, a clinical psychologist, national expert in family caregiving, and co-author of The AARP Caregiver Answer Book,notes, “Some communities have a medical director or a consulting psychiatrist who’s providing oversight and, ideally, treatment. That’s a plus.”

When isn’t assisted living a good choice for someone with a mental illness?

While assisted living can be helpful for someone who has a mental illness, it isn’t always the most appropriate setting. Communities without specially trained staff or specially designed procedures aren’t likely to be able to offer the support someone with a mental illness needs, regardless of the person’s condition.

Other situations in which assisted living may not be appropriate include:^[01]

• The person has a history of violent behavior and is physically capable of harming staff and other residents.
• The person has other conditions that require more intensive medical care than the community is staffed to provide.
• The culture of a given community isn’t accepting of people with mental illness.

“There are communities that won’t accept people who have a mental illness,” says Jacobs. “Some communities are concerned that their staff will be uncomfortable working with a resident who has a mental illness. It’s not unlike dementia, which is common in senior living. Staff need appropriate training.”

Residential care options for seniors who have mental disabilities, such as Down syndrome, are like options for seniors who have mental illness, such as bipolar disorder. But there are a few differences.

Generally, assisted living for adults with mental illness tends to focus on medication management, while assisted living for mentally disabled adults focuses on supporting their abilities. Residential care homes or assisted living communities usually specialize in one or the other. Memory care communities, on the other hand, are more likely to support both residents who have mental disabilities and residents who have mental illnesses.

Whether or not your loved one has a mental disability or a mental illness, it’s important to have frank conversations about whether a prospective community is equipped to handle your loved one’s condition. In all cases, caregivers in the best communities provide individualized, person-centered care.

Many of the services and amenities offered at assisted living communities can benefit adults living with mental illness. Jacobs offers these three examples:

• Social support. Social isolation can make preexisting mental illness worse, so being socially connected to caregivers and other residents can help keep the person who has a mental illness from becoming isolated.^[04]
• Medication management. People who have a mental illness often rely on medication to manage their condition. Staff in assisted living communities ensure that residents take their medicine on time, every time.
• Consistent observation. Irritability and agitation are two common signs of mental illness. When caregivers see someone every day, they’re able to note changes in a person’s mood and personality and take action if the person needs more or more intensive help.

According to the National Association of Mental Illness, residential care options that offer behavioral health services include group homes, assisted living communities or care homes, supportive housing, partially supervised group housing, and supervised group housing.^[05] If your loved one requires full-time supervision, you may want to consider one of these options.

Residential communities that offer behavioral health services typically do so through counseling and medication. Residents receive psychotherapy to help them change their behaviors and thoughts as well as how they interpret various situations.^[06] Routines are also important, and residents are taught life skills to support their health and well-being.

Assisted living questions? Get expert help

What requirements do mentally ill seniors need to meet for behavioral services in assisted living?

If you’re considering an assisted living community that offers behavioral health services, it’s likely that your loved one will need:

• A diagnosis from a doctor regarding their illness
• A social worker (if your loved one will use Medicare, Medicaid, or VA benefits to pay for care)

If your loved one isn’t currently working with a social worker, a doctor may refer you to one. Online tools, such as the National Association of Social Workers, can also help you find behavioral health therapists who are licensed social workers.

For practical purposes, and to help ensure your loved one receives the best care, you should fully disclose to the potential community your loved one’s diagnoses, as well as whether they:

• Take medication for their condition.
• Need to be matched with a therapist or counselor.
• Act out physically because of their condition.

Many states operate group homes to support adults who have a mental illness or disability, so check with your loved one’s doctor or social worker about local options. The Administration for Community Living, which receives federal funding, also provides resources to help disabled adults find community housing.^[07]

If state resources aren’t available or aren’t feasible, A Place for Mom’s Senior Living Advisors may be able to help your family find a local care home that caters to adults living with a mental illness or disability.

It’s important to note that assisted living communities that specialize in caring for adults with a mental illness or disability can be hard to find. Many have long waiting lists, so if you think your loved one may need this kind of care, it’s best to begin your search at least a year in advance of a move.

Additionally, to the extent you can show your loved one’s condition is well-managed, they may have a better chance of being admitted to an assisted living community. Jacobs explains that people who can “demonstrate that they’ve been functioning at a high level, have a good treatment team that they meet with regularly” provide a degree of assurance to communities that the person has a pattern of long-term stability, and that their staff will be able to provide the care they need.

It’s crucial to find the right community for your loved one, especially if mental health is a concern. Here are some steps you can take:

• Assess your loved one’s needs. If your loved one receives treatment regularly, their therapist or doctor may have a good idea of their care needs. Such specialists can also make sure your loved one is well-prepared and moving at the right time.
• Educate yourself. Learn about assisted living and your loved one’s feelings about moving into a community. You can also get tips from our guide on what to do when a parent is refusing to move to assisted living.
• Tour communities and ask questions. Speak to several members of a prospective community’s staff and ask as many detailed questions as you need to.
• Reach out to a Senior Living Advisor. A Place for Mom’s Senior Living Advisors have a wealth of knowledge about which communities in your area may be able to accommodate adults with mental health concerns or disabilities.

Regardless of the reason, when staff of an assisted living community feel they can no longer provide the safest, most appropriate care for someone, they may recommend that the resident move to a place that can. In the case of seniors who have mental illness, the next step may be a nursing home or memory care community, depending on the resident’s needs.

Once you’ve chosen a community, set your loved one up for success by following these principles for a successful assisted living experience.

“Familiarizing the person with the new environment, reassuring them of the benefits of that environment, and letting them know that they won’t be forgotten or abandoned” can go a long way toward smoothing the transition to residential care, Jacobs says.

Choose the right time to move

It’s best to move someone while their mental illness is well-managed to reduce the chance of relocation stress syndrome. Maintaining a routine helps someone with mental illness stay grounded, so avoid making too many abrupt changes at once. If possible, work with your loved one’s community to discuss how you can help during any transitions to their routine.

Make a crisis plan

Even people whose mental illness is well-managed have lapses, and when that happens, it’s important to know that your loved one’s community has a plan in place to help. Work with the community’s director to create a crisis plan that includes emergency contact and preferred hospital information. Knowing these in advance will make a tough situation easier to handle later.

Understand how the community handles behavior violations

Certain behaviors may result in the community asking your loved one to leave, such as:

• Violent behavior. Endangering themselves or another person likely means your loved one needs a higher level of care and supervision than an assisted living community can provide.
• Exit-seeking behavior. If your loved one does not want to move to assisted living and tries to leave, the community may refuse them. In this case, a community with a higher level of security may be a better fit.