Transitioning from Assisted Living to Long-Term Care

There’s a lot of talk about how to handle transitioning your loved one from home to assisted living—but what about from assisted living to long-term care?

After all, it’s a fairly common transition that many seniors eventually face. As Paula Span writes in an article on assisted living for the New York Times, “however suitable assisted living may be when a resident moves in, the average stay is a little over two years, and the most common reason for moving out is needing more care than it can provide.”

So what happens when your parent needs more care than assisted living can provide? The answer is often a transition to skilled nursing and long-term care.

The Difference Between Assisted Living and Long-Term Care

To understand why a transition from assisted living to a more advanced degree of long-term care is often necessary, it’s helpful to know the difference between the two. Though the two options offer similar services and amenities, they represent different levels of care.

The National Institute on Aging offers this definition of assisted living:

“Assisted living is for people who need help with daily care, but not as much help as a nursing home provides. … Assisted living residents usually live in their own apartments or rooms and share common areas. They have access to many services, including up to three meals a day; assistance with personal care; help with medications, housekeeping, and laundry; 24-hour supervision, security, and on-site staff; and social and recreational activities. Exact arrangements vary from state to state.”

In contrast, skilled nursing facilities provide long-term care to seniors who need more help than assisted living can provide. Long-term care is for seniors who require some form of 24-hour nursing care. It could be that they have a chronic illness or injury, or are simply facing age-related challenges.


Related: 4 Signs It’s Time for Assisted Living


Making the Transition to Long-Term Care

If your loved one decides to move to an assisted living community, they will likely need to submit a medical history and physical. This is to ensure that they are a good fit for assisted living and that their needs can be met at the community.

However, their health needs may change in the future post move-in. For example, if a chronic health issue that led to their decision to move to assisted living worsens, they may need more support than assisted living can provide. Or they may face a new health challenge—while assisted living is designed to keep seniors healthy and active, they may face age-related conditions as time goes by.

If that’s the case, then a transition to a long-term care community that offers skilled nursing services may be necessary. This is why continuum of care is an important factor to consider when choosing an assisted living community. If your loved one is at an assisted living community that also offers long-term care services, then they won’t have to move communities—at most, they’ll have to move to a new apartment so their needs can be better met.

Who Decides When It’s Time?

The decision to move to long-term care from assisted living does not rest on the shoulders of the senior or their adult children. Rather, it’s a collective decision made by the resident, their family members and their care team at the assisted living community.

Assisted Living and Long-Term Care Resources

If you have any questions about assisted living and long-term care, our experts can help. Contact us today and we’ll be happy to help you find the right option for your loved one.


How Long-Term Care Can Help with Physical Fitness

Exercise is vital at all ages. However, for seniors, it often comes with unique challenges. Those challenges can stand in the way of seniors maintaining a healthy level of physical fitness.

But there is help available. Long-term care communities are designed to make it easy for seniors to safely engage in physical activities—here’s how.

Fitness Activities in Long-Term Care Communities

A recent study on seniors and physical activity found that barriers to physical activity for seniors included “physical limitations due to health conditions or aging, lack of professional guidance and inadequate distribution of information on available and appropriate [physical activity] options and programs.”

The advantage of living in a long-term care community is that many of those barriers are removed. Expert health professionals are on staff to assist seniors with physical activities and mobility issues. There are special exercise classes offered that are suitable for older adults with health issues. All residents are kept informed of the different services and activities available to them at the community.

MacIntosh long-term care communities all have a full slate of activities planned each month for residents to enjoy. The activities are meant to suit a variety of tastes and interests, as well as mobility levels.

In terms of physical activities, here are a few examples of what MacIntosh residents have access to:

  • Special exercise classes such as “Sit and Be Fit” or “WHOGA Exercise,” which are designed to allow seniors to complete exercises in chairs or wheelchairs.
  • Wii Sports, which can improve daily activity levels for seniors through interactive gaming.
  • Tai Chi, yoga and stretching exercises.

Residents in long-term care are given the option of participating in activities like the ones listed above and are given the assistance they need to attend them. However, residents are never forced to participate.


Related: A Day in the Life at a MacIntosh Long-Term Care Community


The Importance of Staying Physically Active for Seniors in Long-Term Care

While it can be hard work, staying physically active comes with many benefits for seniors. The activity does not need to be strenuous—for example, something as simple as walking 20 minutes a day can improve overall health.

According to the Centers for Disease Control and Prevention, the benefits of exercise for seniors include:

  • Helps reduce the risk of falling and fracturing bones.
  • Reduces the risk of dying from coronary heart disease and of developing high blood pressure, colon cancer and diabetes.
  • Can help reduce blood pressure in some people with hypertension.
  • Helps people with chronic, disabling conditions improve their stamina and muscle strength.
  • Reduces symptoms of anxiety and depression and fosters improvements in mood and feelings of well-being.
  • Helps maintain healthy bones, muscles and joints.
  • Helps control joint swelling and pain associated with arthritis.

Tips to Help Your Senior Parent Stay Active and Motivated in Long-Term Care

The benefits of exercise are clear. However, your parent may need a little extra motivation, especially if they have mobility issues that have hampered their activity levels in the past.

If your parent is in long-term care but is struggling to find the motivation to participate in activities, there are some things you can do to encourage your senior loved one to stay active. For example, you could:

  • Call them on a regular basis to encourage them.
  • Sit down with your parent and a medical professional at their long-term care community to discuss the benefits of staying active, as well as tips specific to your parent.
  • Help your parent set manageable goals and celebrate when they meet them.


Related: Ask the Expert: Staying Active and Engaged in Long-Term Care


Getting the Most Out of Long-Term Care in Columbus, Ohio

If your senior parent is in need of long-term care in the Central Ohio area, MacIntosh has several communities to accommodate their needs:

Canal Winchester
Mill Run
New Albany
West Park

You can also learn more about long-term care and who it’s a good fit for by reading our guide to long-term care.


Importance of Pain Management

Everyone has a different pain threshold so they react differently. Doctors sometimes have a tough time finding the right balance between too much pain medication and too little. And with addiction rates nationwide on the rise, no physician wants to put a patient at risk.

While it will be very important for you to work closely with your own physician after your surgery, here are a few general tips from pain management experts:

  • Stick with Medication Schedule: Pain medications need to be taken on time every time. You will often hear healthcare professionals say sticking with your scheduled doses is important to “staying ahead of the pain.” What they mean is that if you take a dosage too late, the pain may increase to the point where your prescribed dose can’t catch up.

  • Follow Doctor’s Orders: This one can be difficult to do once you are home. But it is important to follow your doctor’s order with regard to daily activities. When in doubt, call your physician’s office for clarification on what you can and can’t do.

  • Be Honest: Patients sometimes feel like they are whining or being difficult if they call their doctor. It is important to be honest and to communicate with your physician. They will often ask you to rate your pain, if you aren’t sure about how to use the given scale, ask your nurse or doctor to review it with you. Being able to objectively assess your pain will help the doctor decide on the best custom intervention to make you more comfortable.

  • Natural Remedies: Talk with your doctor before the surgery for advice on natural pain management remedies. Sometimes they will recommend hot packs and, other times, cold packs. And there may be occasions to alternate between the two.

I hope these tips help, Steve! And best of luck with your upcoming surgery.

Angela Smith

Laughter – The Best Medicine

Dear Dori:

My father recently moved to an assisted living community. After my mom passed away, he was isolated and lonely. He was even beginning to develop new health problems, most notably diabetes.

While I know these are big life changes to adjust to all at once, I really miss seeing him smile and hearing him laugh. I think if we could lift his spirits and get him laughing again, his mental and physical health would both improve.

Do you have any advice?


Laughter Heals the Body, Mind and Spirit

Dear Steven:

Wow! It does sound like your father has experienced some big changes. The two he is facing now — the death of a spouse and a move to a senior living community — often go hand-in-hand.

An assisted living community will more than likely help improve his quality of life once he settles in. Companionship and life enrichment activities are just two of the many benefits of a move to a senior living community.

And you are correct in pointing out the link between laughter or humor and improved mental and physical health. The old adage, “Laughter is the best medicine,” really holds true. The healing power of humor is one way people can find relief during difficult times.

There are proven scientific reasons to LOL (laugh out loud!). They include:

  • Lower blood pressure: Laughing expands the blood vessels and increases the blood flow through your body. This, in turn, helps lower blood pressure.

  • Pain relief: Talk with any physician involved in pain management and he or she will tell you that a good laugh can help relieve chronic pain. Many believe it is linked to the release of endorphins in the body.

  • Aerobic benefits: If you’ve enjoyed a good laugh lately, you probably felt a little tired afterward. Maciej Buchowski, a researcher from Vanderbilt University, found that 10 to 15 minutes of laughing can burn about 50 calories!

Some researchers even say the need for some prescription medications can be cut by indulging in routine laugh therapy.

So what can you do to help your father enjoy himself again?

Here are a few ideas:

  • Does he have grandkids who can visit? They are almost always good for a few laughs.

  • Talk with the life enrichment staff at his assisted living community. What activities are offered? Maybe you and your father can attend a few together. Or the staff can help partner him with someone he can attend events with.

  • Stock up on some favorite old comedies. Use them to host movie afternoons or evenings with your dad.

  • As corny as it sounds, invest in some joke books. Read a few of them with your dad and leave the books behind for him to enjoy on his own.

Finally, be patient. As you already know, your father has gone through two of life’s biggest changes at once. He will need time to work his way through the grieving process.

I hope this helps you and your dad, Steven!

Best Regards,

Dori Duchin


Why does my husband need cardiac rehab?

Dear Dr. Haas,

After a recent heart attack, my husband was told he needs to go for cardiac rehab. I’ve never heard of such a thing. Why does he need rehabilitation for his heart?



Why Does My Husband Need Cardiac Rehab?

Dear Jean,

In the past, there was no such thing as a cardiac rehab center. However, research has shown that patients who go through this rehab have a 30 to 40% reduction in incidence of repeated events and a significantly lower mortality rate. Check out Cardiac Rehabilitation At A Glance for additional statistic’s.

After a heart attack, patients go to cardiac rehab to prepare for life at homeRehab programs may include:

  • Individualized plan of care guided by a clinical cardiac transition coach

  • Activity tolerance monitoring

  • Cardiac-focused physical and occupational therapy

  • Disease management classes and support groups

  • Comprehensive discharge planning and follow-up care

In addition, your husband will receive a heart-healthy, low-sodium diet and be instructed how to change his diet at home. He’ll be told to avoid NSAIDs, such as ibuprofen. And he’ll be educated about the importance of maintaining optimal cholesterol levels, avoiding obesity, and treating high blood pressure.


How can you live a healthy life with congestive heart failure? Find out here.


Your support is instrumental in maintaining his health and preventing another heart attack. Staff at the rehab center will encourage you to learn with your husband. I hope this information helps you better understand the importance of cardiac rehab.

Dr. Garrie Haas


What is Quality Income Trust?

Dear Crystal:

My parents have both had some serious health issues in recent years. I think in all likelihood, we will need to find a nursing home for them to move to in the very near future. My father is very unsteady on his feet and is falling quite often. Despite telling my mom over and over to call for help and not try to get him up on her own, she continues to try to assist him. As a result, she’s taken a few hard falls herself.

Several years ago, my parents sold their house and moved into an apartment. We’ve used a lot of the money from the sale of their house to pay for in-home care the past few years. While they do have some money left, it won’t last long if they are paying for a nursing home.

When my husband’s dad needed to move to a nursing home, we first had to spend down his assets so he would qualify for Medicaid. However, when I toured a nursing home last week for my parents, the social worker mentioned something called a Quality Income Trust. She explained that we wouldn’t have to spend down my parents’ assets like we did with my father-in-law.

What is this and how does it affect my parents?


An Overview of the Quality Income Trust

Dear Tina,

The Quality Income Trust (QIT) went into effect in Ohio on August 1st of 2016. It was a change to the Medicaid program that means older adults are no longer required to spend down their assets to qualify for aid.

Here are a few highlights of the trust:

  • A Quality Income Trust is a legal arrangement that can help seniors become or remain eligible for Medicaid.
  • As of August 1, 2016, people who receive Medicaid long-term care services and have an income higher than the Medicaid limit are required to deposit excess income into a QIT to keep their Medicaid coverage.
  • The QIT applies to seniors enrolled in Ohio’s Medicaid waiver programs. This includes PASSPORT, the Assisted Living Waiver program, Ohio Home Care Waiver and MyCare Ohio.
  • For seniors like your parents to receive Medicaid long-term care services, their income must be below the Medicaid limit set by the State of Ohio. If their income exceeds this amount, you must deposit the excess income into a QIT to stay or to become eligible for Medicaid long-term care services.
  • Money in a QIT can be used to pay for some expenses, such as medical costs, personal care, and bank fees to maintain the QIT.
  • It’s important to know that a QIT is irrevocable, and the State of Ohio is the primary beneficiary.  The QIT remains in effect until the person passes away. Any money left in the QIT is paid to the state, up to the amount Medicaid paid for the senior’s care.

If you need more information or have questions, there are two different resources you can turn to for help:

I hope this helps, Tina!

Kind Regards,

Crystal Moore

Convincing Mom or Dad That It’s Time

Dear Greg:

The time has come for my brother and me to talk with our father about moving to an assisted living community here in the Columbus area. From falls to car accidents to poor nutrition, he just isn’t safe living in his old house any longer.

We just know it is time to make a change before dad really hurts himself.

I can’t tell you how much we dread this conversation! Our father is very stubborn and won’t go without a fight.

Do you have any suggestions for how we tackle this topic with our dad?


Talking with a Parent about Assisted Living

Dear Diana:

We have had this question from so many adult children! Most say it is the toughest conversation of their life. Even though you know you are doing what is best for your father’s safety, it can still be difficult.

It sounds like your dad is already exhibiting some of the typical warning signs — falls, poor nutrition, unsafe to drive, difficulty keeping up the home — that signal it is time for a change.

Here are a few tips other families have tried and found to be successful in encouraging a parent to make this move:

  • Create a Plan: Begin by sitting down with your brother or communicating with him through a video chat service such as Skype if an in-person meeting isn’t possible. Make a list of both of your concerns (i.e. the falls and car accidents you mentioned) and the tasks your dad seems to be struggling with. A united front will be important when you speak with your father.
  • Research Local Options: It sounds like you may have done some research already and come to the conclusion that assisted living is the best option for your dad. Before you start a conversation with him, it might be best for you and your brother to research local assisted living communities and tour those that seem like a good fit. Once you have narrowed down the list to 2 or 3 options, you can confidently sit down to talk with your dad.

Begin “the talk” by asking your father a few general questions on how he is doing. While it sounds like you think he will resist moving, you might be surprised to find out that he is frightened of change, but also frightened to be home alone when he isn’t safe. Make sure you and your brother allow a whole day for this conversation to take place.

A few conversation starters to consider might be:

  • How are you managing the yard? It seems like a lot of work to keep up.
  • Have you been to the doctor lately? What did she say about your nutrition and weight?
  • When was the last time you had the oil changed in the car? Is the upkeep on the car getting to be too much?
  • Is it hard to prepare meals for yourself?

Two final tips are also important: listen with empathy to what your dad has to say and be patient.

If he is resistant, rushing him or getting angry may make him even more difficult. Remember, this will likely be a series of conversations that you have to have with your dad and isn’t usually something that can be worked out in a single family meeting.

Best of luck to your family, Diana. Please let us know if you would like to tour any of our Columbus area assisted living communities. We’d love to show you around and have you stay for lunch!

Kind Regards,



Intimacy & Aging

Dear Lura:

My mother passed away unexpectedly almost three years ago. Since that time, my dad has been pretty down. In the last few months, however, he’s started talking about dating again.

I have to admit, I’m not wild about the idea. It’s hard to imagine him with someone other than my mom. They were married for over fifty years. But I hate seeing him so lonely and sad.

He wants to find an online dating site that might help him connect with women who have his same hobbies and interests. Any suggestions for how I can help my father safely transition back into the dating world?


Helping an Aging Parent with Intimacy

Dear Ryan:

This is such an emotionally charged issue for adult children! I think you will find many children feel the same way you do. At least initially. Not wanting to see your Dad alone but not wanting to see him with someone besides your mother is a tough struggle to reconcile.

It sounds like your Dad may have been thinking about this for a while now. In all likelihood, it took a lot of courage for him to broach the subject of intimacy with you.

The dating world has definitely changed in the last 50 years since your Dad was single! So it’s good that he has you to look out for him.

What might help is to pull together a few articles about intimacy in later life for you and your Dad to review together. A few good ones include:

If you think it may make him too uncomfortable to talk about these topics in person, you could always print them out for him to read on his own.

Online Dating and Seniors

A study conducted by Oxford Internet showed that 36% of adults between the ages of 40 and 70 met their partner online. So it’s no surprise your father is considering going that route. But there are a few things to caution him about including:

  • Remind your Dad not to agree to meet anyone until they have at least spoken on the phone a few times.
  • Safety experts often recommend talking on a mobile phone that can’t be traced back to his home address.
  • When it’s time to meet in person, choose a public place during daytime hours.
  • Also be sure your Dad lets you know where he will be and at what time. He may feel like you are being a bit overprotective but, as the old saying goes, it’s better to be safe than sorry.

As far as senior-friendly dating sites, Senior Planet created a list of their top five:

  2. AARP Dating
  3. eHarmony
  4. Our Time
  5. OK Cupid!

You can read more about the pros and cons of each at Senior Planet.

I hope this helps you and your father, Ryan!

Kind Regards,


Making Sense of the Medicare Rehab Benefit

When a central Ohio senior you love is hospitalized for an illness or injury or planning for an upcoming surgery, understanding what Medicare will cover for rehab to help with their recovery is important. Older adults and adult children may not have had any experience using their Medicare benefit beyond physician appointments and outpatient testing until now. This quick overview should help give you a basic understanding of the benefit.

Medicare Benefit Requirements for Skilled Nursing & Rehab Coverage

The first requirement your older loved one will have is to meet what is known as a “qualifying hospital stay.” What that means is they have to spend 3 consecutive midnights in the hospital at an inpatient level of care. It is important to make sure they were formally admitted to the hospital and not being cared for under an observation stay.

After the qualifying hospital stay, the next requirement is that their physician feels they need to continue receiving skilled nursing and/or rehabilitation care after being discharged. For Medicare to pay for those services, the senior must go to a Medicare-certified post-hospital rehab and care center, such as Whetstone Garden in Columbus or another of the Macintosh Company’s central Ohio communities.

How Much Does Medicare Pay for Skilled Nursing & Rehab Care?

Once a senior has met Medicare’s skilled nursing and rehab center eligibility requirements, the next step is to be certain you understand what is covered and for how long. Here are the requirements for 2022.

Days 1-60. For the first 60 days of their stay, Medicare Part A will pay for 100% of their expenses. Coverage includes their room, meals, equipment, most supplies, medications, skilled nursing care, and rehab services performed by physical, occupational, and speech therapists.

Days 61-90. If their physician determines they still need skilled nursing and rehab care after day 60, a daily coinsurance fee of $389 will be charged to the senior. This will continue through day 90.

Days 90 and beyond. While most patients have recovered and returned home before day 90, some people with more complex needs may not. From day 90 on, a daily coinsurance fee of $778 is charged to the senior until they reach their lifetime reserve (up to 60 days over their lifetime) for each benefit period. After the lifetime reserve is reached, patients are responsible for the entire cost of their skilled nursing and rehab stay.

The Medicare 30-Day Rule

On occasion, an older adult may return home after a few weeks of post-hospital rehab care and experience a setback. The physician involved may recommend additional rehab. If that happens within 30 days of their discharge from a skilled nursing and rehab center and they still have days remaining in their Medicare benefit period, they may return to the rehab center without being required to have another 3-night hospital stay.

We hope this quick overview provides you with a better understanding of what to expect from the Medicare skilled nursing and rehab benefit. If you are a central Ohio caregiver searching for rehab care for a senior loved one, please contact us. We will be happy to help!


Making Healthcare Decisions for Your Parent

Dear John:

My parents have both had fairly serious health problems the last few months. Until then both of them were active and independent. To be honest, we never really discussed how we would handle healthcare decisions and what their wishes for the future might be.

My brother and I thought, since our parents were in such good health, there wasn’t really a need to worry about having these tough discussions with them. It is quickly becoming apparent, however, that the two of us need to learn more about what we can legally do to help our parents.

Can you explain to us what a Power of Attorney is? How is it different from a durable Power of Attorney? And what are the decisions we can and can’t make with either?



Decision-Making for an Older Family Member

Dear Vickie:

You aren’t alone in thinking you didn’t need to have a conversation like this until a parent’s health was worse. Families often delay these discussions because they feel uncomfortable with the topic. Unfortunately, it often means families are faced to make tough healthcare decisions during already difficult days.

Our best advice is to sit down together and have an open and honest talk with your parents. Explain that you want to make sure you know what their wishes are for the future are and to take the necessary legal steps to make sure their wishes are always honored.

Most people don’t understand what these legal documents like a POA and durable POA are, and what they can and can’t do with one. So let’s try to clear up some of the misconceptions.

First, a Power of Attorney is a legal document that grants someone authority to act on your behalf. The document is usually limited to a specific matter. For example, if you and your spouse are selling a home in a different state and can’t be present for the closing, you can give a trusted family member or legal advisor a Power of Attorney to sign the paperwork on your behalf. The POA ends when the purpose is fulfilled.

A durable Power of Attorney is a legal document that gives someone you designate the right to act on your behalf for specific purposes if you become incapacitated and unable to make decisions for yourself. It must be created before you need it. Once you regain your health, the durable POA would end.

What has led to much of the confusion is that people often use “POA” when they actually mean “durable POA.” And it might also help to know that your parents can grant one family member a POA for their healthcare and another one a POA for their finances.

Because of how complicated these legal issues can be, it is usually best to speak to an attorney for advice. There are many good elder law attorneys in and around Columbus who have experience helping seniors and their families navigate these decisions.

Kind Regards,