Recognizing when a loved one needs more care than you can provide at home is one of the most difficult decisions a family will ever face. There’s no single moment, no clear line in the sand — it’s usually a gradual accumulation of concerns that builds into an undeniable reality.
If you’ve been asking yourself whether it’s time to explore professional care, you’re not alone. And you’re probably not wrong to be asking. Most families find that by the time they begin seriously researching options, their loved one has needed additional support for longer than they realized.
This guide walks through the 10 most common and important signs it’s time for assisted living, along with guidance on why the type of care matters just as much as the timing.
1. Difficulty With Daily Tasks (ADLs)
Activities of daily living — bathing, dressing, grooming, toileting, and eating — are the baseline of independent functioning. When a loved one begins struggling with these consistently, it’s a strong indicator that they need hands-on support beyond what family visits can offer.
Look for subtle signs: a change in personal hygiene, clothing that’s worn repeatedly without being washed, or meals that go untouched. These are often the earliest visible signals that something has shifted.
2. Medication Mismanagement
Medication errors are among the most dangerous and underrecognized warning signs for seniors. Skipping doses, doubling up, or taking the wrong medication at the wrong time can result in serious health consequences, particularly for those managing chronic conditions alongside cognitive decline.
If your loved one has a complicated medication schedule and is managing it alone — or relying on you to manage it remotely — professional oversight becomes a safety necessity, not just a convenience.
3. Unsafe Situations at Home
Has your loved one left the stove on? Gotten lost driving a familiar route? Wandered outside at night? These are not isolated incidents to dismiss — they are safety red flags that indicate the home environment has become a risk.
Falls, stove hazards, unlocked doors, and unsecured medications are all situations that escalate quickly when no one is present around the clock.
4. Signs of Memory Loss or Cognitive Decline
Forgetting a name occasionally is normal aging. Forgetting familiar people, getting disoriented in familiar surroundings, or losing the ability to follow a conversation are signs of something more significant.
Memory care for dementia requires a specialized environment — one with trained caregivers who understand how to communicate with, redirect, and support someone experiencing cognitive decline. Not all assisted living facilities are equipped for this. It’s important to ask specifically about dementia training, behavioral management protocols, and staff-to-resident ratios when evaluating options.
5. Social Isolation and Withdrawal
Loneliness is a serious health risk for seniors. Research consistently links social isolation to accelerated cognitive decline, depression, and even increased mortality. If your loved one rarely leaves the house, has lost interest in hobbies they once enjoyed, or seems increasingly withdrawn, isolation may already be taking a toll.
A residential care setting — especially a small, home-like board and care facility — provides built-in community, structured activities, and daily human connection that home life simply can’t replicate.
6. Unexplained Weight Loss or Nutritional Neglect
When someone with memory loss or limited mobility is responsible for feeding themselves, nutrition often suffers quietly. They may forget to eat, lack the energy to cook, or have difficulty recognizing hunger cues. Over time, this leads to weight loss, vitamin deficiencies, and weakened immunity.
If you’ve noticed clothes fitting more loosely, a nearly empty refrigerator during visits, or meals that seem to go unprepared, nutritional support through professional care should be a priority conversation.
7. Behavioral Changes or Increasing Agitation
Aggression, paranoia, repeated accusations, mood swings, and sundowning (increased confusion and agitation in the late afternoon or evening) are common symptoms as dementia progresses into moderate and advanced stages. These behaviors are not a character flaw — they are neurological.
They are also beyond the capacity of most family caregivers to manage safely and consistently. Care settings that specialize in memory care for dementia offer behavioral support strategies, structured routines, and staff trained specifically to de-escalate these situations with dignity and patience.
8. Caregiver Burnout
This sign is about you, not your loved one — but it matters just as much.
According to the Alzheimer’s Association 2025 Alzheimer’s Disease Facts and Figures report, nearly 12 million Americans provide unpaid care for people with Alzheimer’s or other dementias — and in 2024, those caregivers provided an estimated 19 billion hours of care. The physical, emotional, and financial toll of that level of commitment is well-documented, and it accumulates invisibly until it doesn’t.
Family caregivers who are exhausted, anxious, physically depleted, or emotionally overwhelmed are not able to provide the quality of care their loved one deserves, no matter how much they love them. Burnout leads to errors in medication management, shorter fuses, deferred medical appointments, and in serious cases, caregiver health crises of their own.
If caregiving has consumed your life to the point where your own health, relationships, or work are suffering, that’s not a sign of failure. It’s a sign that the level of care needed has outgrown what one person — or one family — can provide.
9. Worsening Hygiene and Living Conditions
A home that has become cluttered to the point of being a fall hazard, or a loved one whose hygiene has noticeably declined, tells a story about functioning that goes beyond forgetfulness. It may mean they lack the physical ability, the cognitive clarity, or the energy to maintain their environment.
Professional caregivers ensure that hygiene support, housekeeping, and a safe living environment are consistently maintained — not just on the days when family can visit.
10. The Home Environment Is No Longer Safe
Sometimes the issue isn’t the person — it’s the physical space. A home with stairs, a bathroom without safety features, or a layout that creates fall risks may simply no longer be appropriate. Add cognitive decline to that equation, and what was once a comfortable home becomes a series of hazards.
When the environment itself has become an obstacle to safety, a purpose-built residential care setting addresses both the physical environment and the care needs simultaneously.
Once You Recognize the Signs: Why the Type of Care Matters
Recognizing it’s time is only half the decision. The other half is choosing where — and that choice has profound implications for your loved one’s quality of life.
Large assisted living facilities can offer amenities and activities, but they often require residents to move between wings or buildings as their needs change. That means new rooms, new faces, and new routines at exactly the moments when familiarity is most important for someone with dementia.
A board and care facility takes a fundamentally different approach. With a maximum of six residents per home, care is delivered in a true home environment — not an institutional one. Caregivers get to know each resident deeply, families feel genuinely welcome, and as care needs evolve, the level of support can increase without requiring a disorienting move to a different wing, building, or facility.
For families in the San Fernando Valley, Royal Garden Board & Care has served as a trusted alternative to large institutional care since 2000. With locations in assisted living in Tarzana, Valley Glen, Burbank, and Thousand Oaks, Royal Garden specializes in memory care and dementia support — including care for residents with challenging behavioral symptoms that larger facilities often cannot manage. Our services are built around the idea that familiar caregivers, familiar surroundings, and a consistent daily routine are not luxuries — they are clinical necessities for someone with dementia. Families who choose Royal Garden don’t have to worry about forced relocations as their loved one’s needs change. That continuity of care, in the same home, with the same people, is something large facilities simply cannot offer.
You Don’t Have to Make This Decision Alone
If several of the signs above are familiar, it may be time to have a serious conversation with your family — and with a care professional who can help you assess next steps.
We welcome families to tour any of our homes, ask hard questions, and take the time they need to make a decision they feel confident in. There’s no pressure — only the honest information you deserve. Contact Royal Garden Board & Care today to schedule a visit or speak with our team. You can also explore more resources and guidance on our board and care blog.
Royal Garden Board & Care has provided specialized residential memory care in the San Fernando Valley since 2000, with homes in Tarzana, Valley Glen, Burbank, and Thousand Oaks.