Before bingo games began at the Gainesville-Hall County Senior Life Center on Wednesday, staff and center attendees talked about what they were thankful for this year.

After Gloria Wilms, senior programs coordinator for the center, encouraged the aging adults to stay positive, 74-year-old Hazel Reash remembered something else to be thankful for.

"We've got Medicare, too," she offered.

While the government program aids some of Reash's health conditions that come with age, it's been Reash and her family making the tough choices about the level of independence she can provide for herself.

Four years ago, Reash moved in with her daughter and son-in-law, Wanda and Randy Golub, after the family decided she could no longer live alone in her Pennsylvania home.

Reash's family is one of many making tough choices for the well-being of an aging relative — and that number will continue to increase.

From 2010 to 2020, the population of adults reaching the age of 65 is expected to increase by 36 percent and the population reaching 85 or older will increase by 15 percent in the next decade according to the U.S. Administration on Aging.

That means more aging adults and their families will reach similar impasses when they will choose where and how they can live.

With the holiday season now in swing, many families are visiting out-of-town, aging relatives, pushing health-related issues to the forefront of their minds.

"If family members haven't seen them for a long time, they may be surprised about the conditions of the home.

They may get more involved in a really short period of time," said Pat Freeman, executive director of Legacy Link, a nonprofit agency in Gainesville that offers senior services throughout Northeast Georgia.

Legacy Link's Gateway hotline allows seniors and their families to ask questions and get in contact with resources that offer help.

Diane Dodgins, the health programs manager for Legacy Link, said there are some red flags families can look for in determining whether their loved one needs assistance.

"The first thing they need to consider is their safety at home," Dodgins said.

When safety is an issue, looking for supervision, supplemental care or alternative living arrangements become necessary.

For Reash, a fall at home, resulting in a hospital visit, preceded the decision to move in with her daughter in Flowery Branch.

"One fall, that's all," Reash said, as if it were a marketing slogan for the condition.

Her daughter said the reasons Reash could no longer live alone were more complicated that.

"She couldn't keep up with her pills. We had to take away her driver's license. It was difficult for her after her husband died (five years ago)," Wanda Golub said.

Events that lead to hospital stays can force these kinds of decisions. However, Dodgins said some warning signals can prompt families to consider options before it comes to that.

Keeping daily routines, food preparation and keeping a tidy house can be indications that aging adults are capable of living alone.

Personal care like maintaining hygiene and taking medication are activities to keep an eye on, Dodgins said.

The options when families or the adults themselves decide they cannot live completely independently can range depending on the condition of the individuals and the family's flexibility.

Even if relatives are having problems with some of these issues, Dodgins said there are ways to keep loved ones at home.

"Everyone wants to stay home if possible," Dodgins said. "There is no place like home."

Other than avoiding the ordeal of moving, staying home has advantages both for the residents and the state, she said. It's less expensive for both, and it gives the adult more time to see family members.

Some adults have family members, nurses or social workers check in on them periodically, but still get assistance for some activities.

Others, like Reash, may be able to move in with families members.

Yet it's not always easy. Wanda Golub said there are challenges having her aging mother live with her.

"At this point, we're hanging in there," she said.

The dutiful daughter is working part time to help support the family, while her husband runs a business, Just Repair Roofing. Golub said she's concerned her mother tries to do things beyond her capacity.

Still, putting her in a nursing home, she said, "was not a option."

For her part, Reash said she's been fairly happy since moving in with her daughter.

"It's fine," she said, before adding with a smile: "They don't shop as much as I want."

However, bringing home a relative who needs assistance is not an option for everyone. Some have to work; others don't live in a home conducive to their relative's conditions.

The decision to move into a nursing home or an assisted living facility can be tough for the adult and the family.

"I think guilt and frustration are two of the most common things with their families," Dodgins said.

Legacy Link's Gateway hotline, Dodgins said, can direct families to programs and services to fit their needs and income levels. The number is 770-538-2650 or 800-845-5465.