Assisted Living and Addiction

Tips for navigating assisted living options when your loved one has addiction

About 1 million adults aged 65 and older in the U.S. have a substance use disorder, according to the National Institute of Drug Abuse. The majority of that addiction (around 65%) involves alcohol. But other types of addiction are on the rise among this segment of the population, including prescription drugs, marijuana, nicotine, and vaping.

Addiction can be a big problem for older adults heading into assisted living facilities. And most people in those cases will hide their addiction upon going into assisted living, says Jennifer Lewis, PhD, a University of Southern California professor and social worker.

“Older adults may be less likely to report substance use issues due to stigma, shame, or lack of awareness,” she says. “They may be resistant to seeking treatment for addiction due to generational attitudes, fear of judgment, or a belief that treatment is not effective or necessary at their age. But also, facilities may have limited training and resources, may not conduct thorough assessments during the admission process, and may mistake addiction for other age-related conditions, leading to misdiagnosis.”

Melody Lynch, CEO of NorthShore Home Care in Highland Park, says that many facilities won’t even consider admitting someone with known addictions because of liability concerns.

“While some end up in such facilities with addictions, it’s not openly accepted,” Lynch says. “Concealing addiction is common in all settings, particularly in assisted living, where individuals can go unnoticed without needing full care.”

It’s rare to find an assisted living facility that offers rehabilitation options. Those are usually available at specialized addiction clinics or treatment centers — facilities that have the techniques and tools to handle the detoxification process. Typically, assisted living facilities expect potential residents with addictions to have gone through a rehab process before transitioning to the new facility.

Loved ones should “ensure [the person] has undergone detox to prevent complications,” Lynch says. “Support services should be in place to reinforce positive behavior. It’s crucial to be aware of potential expulsion if behavior becomes disruptive.” These protocols are often included in the resident’s contract.

Laura Herman is a dementia care specialist at ABC Dementia, which supports dementia family caregivers remotely through resources, conversations, and coaching. She says that it’s essential to have open communication with the assisted living facility’s management, as well as any care providers the person facing addiction deals with regularly. That way, expectations and needs can be discussed at the outset, and you’ll be able to see if the facility offers the care necessary, such as therapists or counselors.

Herman also suggests letting management know the person’s needs, such as not offering them alcohol at social events, or helping them get to their meetings weekly.

Children of the person moving into assisted living should speak up as well. Let management know if there are any concerns, like maybe your mom drinks when she’s stressed.

In that scenario, “Ask what interventions can be put into place to help reduce the stress as much as possible,” Herman says.

You’ll also want to ask about policies in general, particularly regarding alcohol consumption, marijuana use, and other potentially addictive substances. The policy may be that adults can make their own decisions. But it’s important to be extra clear on the rules when addiction is involved.

Still, even if a person entered the assisted living facility without an addiction, one can surface after the person is already a resident. In that case, there are some medical interventions that take place.

“The usual course of action is to involve healthcare professionals, potentially including addiction specialists, who can assess the individual’s needs and recommend an appropriate course of treatment,” Lewis says. “This might involve referral to a specialized treatment center or coordination with external healthcare providers.”

It’s possible, too, that some facilities have existing relationships with external providers and can work in tandem. Ultimately, though, assisted living facilities stay in a lane of supporting and assisting older adults with daily activities — not providing the intensive medical care of a nursing home or a rehabilitation program. And that’s something that experts agree might need to change, for the benefit of each resident’s mental health.

“Older adults with addiction may experience social isolation, as friends and family members may distance themselves due to the stigma associated with substance use,” Lewis says. “Assisted living facilities need to address the social and emotional needs of residents with addiction.”