The long-standing question of when is the best time to move an elderly adult to an assisted-living facility is being complicated by the poor economy, say those in the retirement industry.

With plummeting personal investment portfolios and dwindling home values, more seniors are staying put in their homes, where their health might deteriorate to the point that their next move is likely to be to a skilled-nursing facility, rather than to an assisted-living center as they had hoped, sources here say.

Debbie Stapleton, marketing director at Orchard Crest Retirement Community, in Spokane Valley, says economic conditions end up changing long-term plans.

"A family can choose to have a parent move in with them to make assets last longer, but will she get the care she needs? A parent's health can go from bad to worse in a short amount of time," Stapleton says.

Some seniors, she says, need to sell a home so they can afford to move into an assisted-living facility, but have found in today's housing market that they can't get the price they thought they could. "They banked on making three to four times what they originally paid for it," she adds.

Donna Horton, owner of a north Spokane franchise of Denver-based Homewatch Caregivers, says that since the economy tanked, more family members are caring for their elderly parents. The reality may be that unemployed adult children have more time to assist with an elderly parents' care than they would if they were working, Horton says.

Although many seniors prefer in-home care to moving out of their homes, there is a segment who hope to transition out of their homes into a retirement community, but since the recession began, that trend has slowed, says Robert Pierce, Spokane director of the Boise-based consulting service Honoring Elders.

"Those same folks who would be able to go into a nicer facility are choosing in-home care instead," he says. "When they get the right kind of help, they actually flourish, but because of the economy, they don't always get the additional help they need."

Pierce says Honoring Elders' clients who decide to access in-home care services do so to save money. "It's the least expensive way to go," he says.

Those in the assisted-living industry don't necessarily agree with that statement.

"Some prefer to age in-home," says Ann Beyer, community relations coordinator for Providence Emily Court Assisted Living on Spokane's South Hill. "They bring in all services right up to hospice care. The choice is between them and their family." Choosing home health care versus moving into an assisted-living facility is "a real tough decision," she says. "It depends on the quality of life children want for their parents. They need to do the math. It may be more economical to choose an assisted-living facility" rather than full-time in-home care, she adds.

Orchard Crest's Stapleton says it's a lot easier on everyone if a parent can sell their home, invest the proceeds, and appoint a power of attorney to segregate funds for care.

Says Beyer, "People generally don't do long-term planning for retirement. People stay at home and deplete their funds. Then, they don't have the money to move into the facility of their choice when it becomes necessary. It's usually a health crisis that forces an older adult to leave their home. It's best before their health has totally gone south to shop around and pick a facility, then earmark funds so they can move there later."

She advises that families "see an estate planner and set long-term plans," and adds, "Most people wait until a crisis. Then everybody in the family has their own idea of how it should be done."

How a family deals with the situation really depends on their dynamics, Beyer says. It depends on the problem-solving methods they've used in the past. In a large family, each member might have their own agenda, and it's difficult for all family members to agree about meeting a loved one's needs.

Horton says about 95 percent of he clients remain in their own home until their death. She says she thinks the majority of clients who begin using in-home care intend to stay with in-home care, and eventually in-home hospice care, rather than move to a care center.

"The track record has shown that people are far more comfortable in their own environment," Horton asserts. In-home care "can take the stress out of life, knowing they can maintain control over what they want and how they want it," she says.

Family members often see warning signs that care is needed before an older person sees the need, Beyers says.

"There are many different ways to address the issue," she says. "They can hit it head on, saying, 'this is what we're going to do,' or they can take a softer approach," saying of a move to an assisted-living facility, "'just try it for the winter' or 'give it a 90-day trial.'"

At what point the level of care needs to be increased depends on how fast a client deteriorates. Some may need increasing levels of "companion care" to alleviate depression, Horton says.

She says that when a health crisis occurs, the client's need moves beyond the scope of in-home care, but it doesn't have to mean a permanent exit from the home. It may be possible to place the parent in a skilled-nursing facility on a short-term basis, and move them back home when the condition is stabilized, she says.

Another step that could provide peace of mind for an elderly person and family members would be to install home monitoring devices.

One Spokane in-home care agency provides monitoring services through a company that installs one to four video cameras in the home, as well as motion, pressure, and temperature sensors to detect danger or unusual events. These monitoring services can range from $100 to $1,000 a month.

Another agency offers an alert system that involves a button worn as a necklace, bracelet, or belt clip and a console that plugs into a phone jack and power outlet. A client wearing the button can call for help anywhere within 400 feet of the console. The system costs about $30 a month.

Pierce says that how well seniors do in their own home "boils down to their ability to get the additional help that they want." He says a broad range of services is available to improve the lives of the elderly at home, including mobile medical teams, meals on wheels, and consulting.

He says, however, that a decision to place an older person in an assisted-living facility versus contracting for in-home care can be difficult and confusing. Families will hear conflicting opinions from the assisted-living industry versus the in-home care industry about what's best for an aged person. He recommends that families use the services of an independent nurse case manager who can help them decide what's best for their loved one.