There are many reasons why someone may be unable to live alone. This could be due to physical disabilities, mental health issues, financial constraints, or simply a personal preference for not being alone. Whatever the reason, not being able to live independently is referred to medically as “requiring assistance with activities of daily living” or ADLs. Some key terms related to being unable to live alone include:
Key Terms
| Activities of Daily Living (ADLs) | Basic self-care tasks like bathing, dressing, eating, transferring, continence, and toileting. |
| Instrumental Activities of Daily Living (IADLs) | More complex tasks like cooking, cleaning, shopping, managing money, taking medication, and using technology. |
| Home Care | Assistance provided in the home by caregivers, aides, nurses etc. |
| Assisted Living Facility | A residential facility providing housing, meals, care services, and supervision. |
| Nursing Home | A facility providing 24-hour nursing care for those unable to live independently. |
Being unable to perform ADLs and IADLs independently means needing assistance with basic daily tasks. This ongoing help allows someone to continue living in their own home, or requires moving to a facility that provides extra support.
Reasons Why Someone May Be Unable to Live Alone
There are many different reasons why a person may be unable to live by themselves without assistance:
Physical Disabilities
Physical disabilities that restrict mobility or limit self-care abilities make fully independent living challenging. Examples include:
- Spinal cord injuries
- Multiple sclerosis
- Cerebral palsy
- Muscular dystrophy
- Parkinson’s disease
- Stroke
- Amputations
Those with severe physical disabilities often need help with ADLs like bathing, dressing, transfers, and toileting. Managing IADLs like cooking, cleaning, and shopping also becomes difficult. Home modifications, equipment like wheelchairs, and in-home caregivers can provide assistance to allow someone to remain living at home. However, sometimes the level of care required means transitioning to an assisted living facility or nursing home.
Cognitive Impairments
Dementia, intellectual disabilities, traumatic brain injuries, and other cognitive conditions can make living alone unsafe. Memory loss, impaired judgment, confusion, and other symptoms mean individuals need prompting, reminding, and supervision for their daily routine. Without support, they may wander, forget to eat, miss medication doses, or have difficulty performing household tasks. Caregivers and structured facilities help provide the increased level of monitoring required.
Mental Health Conditions
Severe mental illnesses like schizophrenia, bipolar disorder, and major depression can significantly impact someone’s ability to care for themselves and live independently. Symptoms like hallucinations, delusions, severe withdrawal, suicidal thoughts, and an inability to perform basic tasks mean daily support is necessary. Depending on the level of impairment, a combination of medications, therapy, in-home aides, adult day programs, and residential facilities help manage mental health conditions so individuals can have an improved quality of life.
Substance Abuse Disorders
Those struggling with dependence, addiction, and abuse involving drugs, alcohol, or other substances often require treatment programs and structured living situations to recover. The compulsion and effects of substance abuse can make it impossible for a person to hold down a job, manage their finances, take care of their home, and perform ADLs without assistance. Ongoing medical and mental health care, group support, and a supervised environment are needed initially. Transitional and recovery housing provides an intermediate level of care and oversight as someone works to achieve and maintain sobriety.
Financial Limitations
The costs of housing, utilities, food, medical care, and other basic needs are prohibitively expensive for certain populations like the elderly and disabled. People with limited income and resources may be eligible for government housing benefits, food assistance, Medicaid, Medicare, SSDI, and in-home supportive services. Low-income senior housing, food banks, Meals on Wheels, and subsidized in-home aides help provide the basics. But even with these programs, some individuals still require the enhanced care and affordability of an assisted living or skilled nursing facility.
Lack of Nearby Family
Many older adults who develop health issues or disabilities prefer to age in place rather than relocate to a care facility. This is only possible with regular assistance from family members or paid caregivers. Individuals with no spouse or children living nearby to help care for them often have no choice but to move into an assisted living or nursing facility. The level of support needed exceeds what can be brought into remote homes. Relocating provides proximity to the 24/7 care required.
Recovery from Medical Procedures
Those recovering from major surgeries, injuries, illnesses or hospitalizations often need short-term care before returning home. Assistance may be required during the recovery process with wound care, medication management, meals, bathing, occupational therapy and more. Acute rehab facilities, skilled nursing facilities, home health aides or family members provide the temporary extra support needed before independent living is possible again.
General Frailty
Advancing age can gradually result in overall decline and fragility. Without a specific medical diagnosis, some elderly experience slow decreases in their mobility, cognition, strength, stamina, nutrition and ability to care for themselves. Their needs exceed what can realistically be managed at home without great difficulty and frustration. Increased care and supervision from a facility’s staff provides assistance with general daily activities as age-related frailty progresses.
Living Situation Options When Unable to Live Alone
Individuals who require help with daily living have options when it comes to choosing an appropriate living situation:
Remaining at Home
Some individuals can safely remain in their own homes with assistance from family or paid home health aides. Caregivers can provide intermittent help with tasks like bathing, dressing, medication reminders, meal preparation and housekeeping. Home modifications like grab bars, ramps and stair lifts also facilitate independence. Advantages of home care include familiar surroundings, flexible schedules and private insurance coverage. But round the clock care is not typically available.
Home Health Agencies
These providers send nurses, aides, therapists and social workers to clients’ homes on scheduled visits. They assist with medical needs, ADLs, rehabilitation and case management. Medicare and Medicaid may cover eligible home health services. But the care is time-limited, and not intended to replace daily assistance. It supplements care by family members and other in-home aides.
Adult Day Programs
Also known as adult day care or adult day health services, these facilities offer supervision and a range of therapeutic activities for elderly and disabled clients during daytime hours. Transportation to/from the center is usually provided. This allows members to receive social interaction and assistance with medications and self-care while living at home or with family.
Independent Living Communities
Also called senior housing, retirement communities, or senior apartments – these provide self-contained, accessible living for seniors in an apartment or condo setting. Limited amenities like meals, housekeeping, transportation and social activities may be offered. But residents still live independently and must arrange for any at-home supportive services needed.
Assisted Living Facilities
These residential housing options provide seniors with private living quarters and access to care staff 24/7. Assistance is available for ADLs, medications, meals, bathing, dressing and mobility. Housekeeping, laundry, transportation and entertainment are also usually provided. Staff are available but rooms are still private. Residents have maximal independence while still receiving care and oversight.
Memory Care Units
Specialized secure units within some assisted living facilities care for those with Alzheimer’s and other types of dementia. Services are tailored to this population with activities, schedules and environmental design featuring routine, supervision and reassurance. Wandering and sundowning behaviors are addressed to ensure safety. Staff are specially trained in dementia care techniques.
Nursing Homes
Also called skilled nursing facilities, these provide 24-hour supervision and nursing care for residents with more intensive health needs. Assistance is provided for ADLs, medications, therapy, pain management and medical needs. Short-term rehab patients and longer-term residents live there. Nursing homes have scheduled activities and communal meals. Care is more complete than at home or assisted living, and tailored to those with greater physical or cognitive impairment.
Continuing Care Retirement Communities (CCRC)
These campuses offer a continuum of care spanning independent living, assisted living and skilled nursing. Residents can move between levels in the same location as their needs change over time.Services expand from minimal help through more involved care without having to relocate. CCRCs allow seniors to have priorities like proximity to family, healthcare, and amenities met in one place over their lifetime.
Paying for Living Assistance When Unable to Live Independently
The costs associated with ongoing living assistance can add up for individuals and families. Here are some options to help finance needed services:
Long-Term Care Insurance
These policies help pay for home health aides, facility care, nurses and other daily assistance expenses. Premiums are paid while still healthy and coverage kicks in if ADL or cognitive impairments develop later and assistance is required. Most plans have a waiting period before benefits activate. Reimbursement is typically issued per day or month up to a set amount.
Reverse Mortgage
Seniors who own their home can access funds from its equity value to pay for in-home care or assisted living fees while still residing in the home. These special mortgage loans do not require repayment until the borrower dies, sells the house, or moves out permanently. Interest accrues over time however, reducing assets left to heirs.
Veterans Benefits
The U.S. Department of Veterans Affairs (VA) offers long-term services and support to veterans and their spouses. Eligible individuals can receive skilled nursing care, home health aides, adult day services, assisted living and more. Coverage depends on military service history, medical need and income thresholds. Contact your local VA to learn more.
Medicaid
Medicaid is a government program that provides healthcare coverage and long-term care for qualifying low-income seniors and younger disabled adults. Requirements vary by state but home and community-based services (HCBS) like personal care assistants, habilitation, respite care and day programs may be included. Nursing facility care is also covered. Asset thresholds must be met for eligibility.
Medicare
Traditional Medicare (Part A and B) provides some limited coverage for home health or skilled nursing facility care following a recent hospital stay. Part A helps pay for recovery care needs in a facility for a temporary period. And Part B covers intermittent home health needs. Custodial long-term care is not included however. Medicare Advantage (Part C) may offer some HCBS benefits that original Medicare does not.
Criteria for Assisted Living and Nursing Home Care
Individuals considering a facility must meet certain functional and medical criteria to qualify for admission. General guidelines include:
Assisted Living
To reside in assisted living, individuals should:
- Require limited help with ADLs like dressing, bathing, medication reminders, and mobility
- Not need significant medical care or skilled nursing
- Have cognitive ability to make daily decisions and summon help
- Be continent or manage incontinence independently
- Be able to transfer, stand, or walk (at least short distances) with limited assistance
- Not be at serious risk of falling, wandering or other unsafe behavior
Nursing Homes
Nursing home eligibility factors include:
- Requiring significant help moving within facilities and transferring
- Continence care and toileting assistance needed
- Must have 24-hour skilled nursing services for serious health issues
- May need physical or chemical restraints due to resistance, confusion, or aggression
- At risk forwandering, falls, or unsafe impulsive behaviors
Admission depends on having deficits in a certain number of ADLs and requiring medical supervision, therapy, or hands-on personal care beyond self-administration of medication.
Deciding on the Best Housing Situation
Choosing between remaining at home or moving into a facility is highly personal based on care needs, finances, family involvement, and personal preferences. Considerations in making the transition include:
Weighing Safety and Independence
Living alone maximizes independence but assistance ensures safety. Consider risks like falls, wandering, accidents, self-neglect, or emergencies when alone. Balance autonomy vs. receiving needed care.
Involving Family in Decisions
Discuss perspectives on care goals and living situation with involved loved ones. However, allow the individual needing assistance to make the final decision on their housing when possible.
Identifying a Manageable Cost
Factor in income, assets, insurance coverage, and financial obligations when choosing affordable options for care. Eligibility for government assistance also determines feasible choices.
Prioritizing Preferred Location
Opt for home or facilities near family and community ties. Staying local aids transition. But be open to options nearby if moving is required to access suitable care.
Visiting Communities In-Person
Tour communities and speak with staff to get a feel for the vibe, amenities and care offerings. Don’t rely on ads and pictures alone when picking.
Comparing Services and Contracts
Review levels of care, activities, transportation, food, housekeeping, staffing, fees and terms. Select the best fit providing necessary assistance while maintaining QOL and person-centered focus.
Conclusion
The many terms for being unable to live alone all refer to requiring help with daily functioning whether remaining at home or moving into a facility. Various housing and care options exist to meet different needs. Challenges like physical or cognitive impairment, mental illness, finances, lack of family support, or simply aging can all make fully independent living difficult. But with proper assistance from aides, community services, adult living or nursing homes, quality of life and safety can be maintained. Identifying when additional support becomes essential, and making the sometimes difficult transition is crucial for health and well-being.