This article appears in Senior Care Guide 2018.

Determining when it’s time for a loved one to move to assisted living is a question many families face. It takes research, and possibly some difficult conversations, to find appropriate care.

“Where a loved one should live as they age is a tough decision for families to make,” said Wendy Adlerstein, licensed social worker and director of client care services for FirstLight Home Care of West Suburban Boston. “Most times, people want to stay in the home that they have lived in for most of their lives with all the memories and familiarity around them.

Sometimes, this isn’t always the best option, and families need to make the decision to explore assisted living facilities.”

While nine out of 10 Americans want to age in their own homes, that’s not an option when health and memory changes start to affect activities of daily living, said Susan Scatchell, business development director, Gentle Home Services, a non-medical, private duty home care agency in Deerfield, Illinois. Accessibility is a problem for people who have mobility issues, but safety is also a big concern, she said.

“Safety of living alone with memory changes is an issue as scammers target older adults living alone,” she said.

Safety and security may be an issue if a senior opens the door for strangers or scammers or is unable to remember how to dial 911 in an emergency. That should be an immediate red flag that maybe it’s time to move, Scatchell said.

“Whether it’s your parents, grandparents or even a friend or neighbor, there are warning signs you can look for that may indicate they are struggling with day-to-day care,” said Susan Halpern, vice president of philanthropy at JGS Lifecare in Longmeadow, Massachusetts, which offers a campus of care for seniors, including an assisted living residence.

Multi-generational family vacations or the holidays are the perfect time to assess how a loved one is doing, said Steve Stern, owner of FirstLight Home Care. Look for visual clues indicating signs of decline that you would not be able to glean through a telephone call, such as:

— Weight loss

— Not maintaining personal appearance and hygiene

— Not remembering when to take medication and not knowing what condition each medication is treating

— Not eating nutritious meals or not eating at all

— Food in the refrigerator or on the shelves is past its expiration date or molding

— Not maintaining the home by cleaning bathrooms, washing floors or regular vacuuming

— Not paying bills — unpaid or unopened piles of bills are a red flag

— Not taking proper care of a pet

— Avoiding or having difficulty ascending or descending steps

— Limiting contact with or lacking an interest in the outside world

“If you think your loved one may be struggling with activities of daily living due to age, dementia or illness, several options exist to get them the help they need to remain safe and healthy,” said Halpern. Options include home health care, adult day care, assisted living or a nursing home.

When you start thinking about the issue, begin to make plans.

“Try to talk openly and honestly about their wishes. It’s all about them, not you,” Scatchell said. “Best to start planting seeds before there is a crisis. Decisions based on urgency and emotions are not the best.”