Every day, untold thousands of American families are faced with tough decisions about caring for senior loved ones. Indeed, navigating senior care is a challenge for which few of us are adequately equipped.
That’s why our attention was recently drawn to this article from US News, which first appeared last April. The article, written by reporter Annika Urban, describes the results of a comprehensive survey conducted by US News involving more than 400 respondents. About half were seniors living independently but starting to plan for eventual long-term care needs.
The other half were adults whose elderly loved ones were presently living at home but starting to show signs of needing greater levels of care.
The survey answers some important questions about what the article calls “the challenging process of determining, selecting and committing to the right level of senior care.” The survey clearly demonstrates the need for families to plan for care well before the need becomes urgent. It also outlines the criteria people use to evaluate caregivers and living options.
Survey Shows the Challenges Families Face in Care Decisions
US News conducted their survey in January of 2026. For anyone who has navigated elder care, the core finding of the survey should come as no surprise: as the article states, “The survey found that family members often struggle to determine which level of care is needed for their loved one.”
Given how tough that struggle is, the survey also showed an encouraging outcome: seniors appear to be getting the message about planning. Almost two-thirds of respondents specifically said they had begun the long-term care planning process in order to keep their families from having to make emergency decisions during a crisis.
But how do families decide what level of care is appropriate? For that, let’s look into Urban’s article in greater depth.
Journey into Enhanced Care is Complex and Emotional
With aging comes a basically inevitable need for extra support, says Urban, whether it’s medical, social, or even just with simple household tasks.
With this transition comes “critical questions” about long-term care planning, and finding one’s way through the “vast landscape” of options can be dizzying. “Navigating this continuum of care, from assessment of needs to selecting a provider, can be difficult and involves decision-making at every turn,” notes Urban.
To this end, US News conducted a survey of 203 independent senior participants, currently living on their own but considering their future plans for care. The survey also questioned 208 family members with loved ones experiencing “an increasing need for additional care.”
Urban presents the following results of that survey, along with expert advice to help those of us navigating these decisions—whether for ourselves or a loved one.
The Drive for Support: Crisis Prevention and Trigger Points
The first vital question is: when does someone need additional care, and how do you know?
According to Urban, it’s not always clear: “Adult children may see their parents start to become forgetful but not know whether that warrants professional assessment. Older adults themselves may notice they have balance and mobility issues but think that’s a normal part of aging.”
The survey first explored the reasons why seniors and families are choosing to think ahead.
Most Independent Seniors Want to Ease the Burden on Families
According to the survey, a significant majority of the participating seniors—65 percent—said that they are making plans mainly to ensure that their loved ones won’t be saddled with “emergency decisions” at a later date. “Often, family members are forced to make decisions about senior care after a loved one is hospitalized, falls or has another emergency,” Urban writes.
Dr. Ellie Fishbein, a geriatric primary care physician and assistant professor at Washington University School of Medicine, puts it this way: “Crisis-driven decision-making places families in a position of making consequential choices under time pressure, with limited information and significant emotional burden.”
For Many Seniors, the Goal is to Choose for Themselves
Following closely on the heels of the first choice, 62 percent of seniors in the survey reported that they want to make these plans while they can still do so independently. Fifty-six percent added that they wanted to make informed decisions, fully understanding the financial options and costs.
“Paying for senior care can be complex and is often more expensive than people initially realize, which means that planning ahead can save time and money,” Urban writes, and adds, “Nearly 1 in 5 independent seniors noted that they were planning ahead because they wanted to secure a spot in a specific senior living community that they liked.”
Families Tend to Seek Help When They See “Trigger Points”
On the family side, a few common “trigger points” were noted that made them realize that their loved one needed additional support while aging at home.
“Most commonly,” Urban writes, “the older adult needed more help with activities of daily living, such as grooming and dressing. This reason was closely followed by older loved ones exhibiting signs of cognitive decline and experiencing a recent fall.”
Kelly Cheung is an internist and geriatrics and palliative care fellow at UCLA Health. She observes, “If your loved one is falling repeatedly at home, struggling to bathe or struggling to cook, then that’s a signal. Then the conversation becomes: Are we willing to accept the risk of continuing to live at home independently, even for just a short time, knowing that just one fall could end that independence anyway? Or would we rather move to somewhere with more support, adapt and find other ways to support their independence?”
Self-Assessment and Professional Guidance are Both Important
While many senior respondents say that they’ll assess the need themselves when the time arrives for more support, in order to determine how much help they’ll need, experts say that self-assessment can only go so far.
“Self-awareness is a meaningful starting point,” Fishbein says. “Trust instincts, but don’t rely on them alone. Gradual decline is frequently normalized over time, which makes objective evaluation important.”
Urban tells us that only 25 percent of the survey respondents said that they would rely on the advice given by a primary care physician or even a specialist. An outside opinion can be a valuable asset in determining a person’s true level of need.
“A professional assessment, whether through a primary care physician, geriatrician or structured geriatric assessment, can identify concerns that are not always apparent to the individual or family,” Fishbein explains.
These clues can be subtle, including cognitive changes, side effects from medications, risk factors for falling, and even the stress and strain on the caregiver.
“To arrange an assessment, start with a primary care doctor,” Cheung advises. “If there’s access to a geriatrician, even better. Unless someone is moving into an independent living community, a physician assessment is actually required before a resident can move in.”
The Challenge in Determining the Right Level of Care
Family member respondents noted that they had difficulty determining which level of care was needed for their aging loved one, and they struggled to find information about certain aspects of care, too.
“In fact, two-thirds (67 percent) said it was moderately or very difficult to determine which level of care their loved one needed,” Urban writes. “As a first step, you’ll want to learn about the different levels of care available. When independent seniors were asked what options they knew of in their area, they were least knowledgeable about CCRCs and memory care options and most knowledgeable about independent living and nursing homes.”
She adds that only about one-quarter (27 percent and 24 percent, respectively) responded that they were “very knowledgeable” about independent living and nursing homes.
Rely on a Geriatrician to Help Make the Right Recommendation
While plenty of options can be researched online and through other local resources, Cheung suggests that seeing a geriatrician can really help to clarify how best to meet your loved one’s needs.
She explains, “When an older adult sees a geriatrician, they will be asked what matters most to that person, what their goals are, and then look at the full picture – the medical complexity, their day-to-day functioning, the social and financial supports available – to figure out what level of care actually makes the most sense for that person.”
Why Trust is the Deciding Factor in Choosing a Care Provider
There are many different factors that play into choosing a care provider, says Urban, but the survey results showed that trust is critical. “About 83 percent of seniors said staff trustworthiness was very or absolutely vital to their evaluation of future care options, whether that’s a home health provider or a senior living community,” she writes.
What are the factors that build that high degree of trust for seniors and families choosing a care provider? According to survey respondents, the list of key trust-builders isn’t surprising.
When it comes to personal interaction, more than half, or 55 percent, said they trusted a provider based on positive, professional experiences during initial tours or phone consultations.
Staff retention is another key indicator. Just over 40 percent based their high degree of trust on the provider’s track record of high staff retention and training, noting that the higher the retention, the better.
Finally, online ratings make a strong impression. For just under 40 percent of respondents, the key deciding factor was positive online reviews or other positive online ratings.
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