Client Education

Care Planning

Planning for Dad or Mom Moving In

By: Andrea Stein, Special to AccentCare

Gail and Lee Shapira had little time to prepare for Gail's parents moving in with them in 1993. Her mother, 64, had never fully recovered from a stroke she suffered at 58. Her father, who had been his wife, caretaker, received word from doctors that he had a brain tumor. Within days of the diagnosis, they moved in with the Shapiras and their 3-year-old son.

To accommodate Gail's parents, the family moved into a larger home and installed two hospital beds. Gail left her job as a school nurse to help care for her parents and still have time for her husband and son, and she continued as caregiver until her father's death in 1996 and that of her mother two years later.

Today, the Maryland couple say wish they had had more time to assess the situation and available support.

"Generally, when the decision is made, it's in reaction to an urgent situation," Lee says. "You don't have time to think clearly, to evaluate or to take a position."

Eileen Goldman of Seniors·At·Home of Jewish Family and Children's Services of San Francisco, the Peninsula, and Marin and Sonoma counties in Northern California, agrees.

Goldman, who counsels families in these situations, says, "I think the first question that really needs to be discussed is, what are the expectations? In other words, if a parent is moving into his or her childs' home, what are the child and the parent expectations and what that is going to mean"?

Expectations need to match, says Goldman, director of Seniors·At·Home, which provides services such as meals and assistance at all levels for seniors and others at home. It also helps people move into other housing if they cannot stay in their home.

It's also necessary to consider the impact on the adult child when he or she takes on the responsibility of caregiver, adds Dr. Samuel Durso, director of Johns Hopkins Geriatrics, an outpatient facility in White Marsh, Maryland.

That can be a very tough burden on caregivers either because a situation was unanticipated or people thought they wanted to do it and didn't appreciate the responsibility. And that can lead to a lot of stress-related problems.

Ask Yourself Important Questions

Planning for elderly parents to move in may seem like a daunting task, but there are steps you can take now that will make it a more manageable one. You should also examine the possibility that your parents may want to and be able to stay in their own home with your help or that of a professional. You might consider asking yourself — and your family — several questions:

• Do I want my mother or father to live with me?
• Does he or she want to live with me?
• Do I have the time, energy and resources to care for Mom or Dad?
• Are there other options? You and your parent may choose to consider personal in-attendant & personal care, an assisted-living facility, home health care, or another alternative.

Planning can be broken down into two categories:

• Financial and legal implications: You need to deal with some of these issues whether or not a parent moves in. These actions can serve as a starting point; your own situation may require other such considerations.

David Pessin, an attorney in Baltimore, Maryland, and member of the National Academy of Elder Law Attorneys, recommends that adults "make sure they have an advance medical directive, which designates health-care agents and sets forth the scope of medical decision making. And every adult should have a very comprehensive, very current general durable power of attorney, so that we can manage financial affairs."

If Mom or Dad does move in, Pessin suggests formalizing the financial situation.

"I always recommend that if the arrangement is going to involve finances that there be a written agreement in advance that delineates the rights and obligations of the parties." If the parent makes payments to his or her child for care, the financial agreement can help clarify how these payments will affect the disposition of assets in the parent's will, Pessin says.

• Expectations, yours and theirs: Consider lifestyle, personalities and basic questions of day-to-day living. Arlene Saks, a licensed certified social worker in Maryland and president of Social Work Associates Inc., a residential-services agency providing care-management services to the elderly, mentally ill and those with medical problems, stresses the importance of evaluation prior to a parent's moving in.

"What is your lifestyle and how will it mesh with an elderly parents' "lifestyle", are a couple of issues Saks says should be considered.

Others, Saks and others suggest, include:

• Do your teenage children have friends who visit often?
• Is the room in which your parent will occupy next to the baby's room — and does the baby still need to be fed several times during the night?
• Look at the layout of your home. Would it be difficult for your parent to maneuver? Are children's toys routinely scattered all over the floors? Would your mother have trouble finding her way to the bathroom during the night? Durso, of Johns Hopkins Geriatrics, suggests having an occupational therapist examine the house for safety concerns.
• What if Dad has an emergency? Who will take care of him while the family is at school and work?
• If Mom has arthritis and it worsens, can she stay at home with the help of family or paid caregivers? Should assisted-living facilities or other alternatives be considered?
• Does Mom or Dad have friends in the area? Are there any groups they can join or activities in which they can participate?
• If you have family in the area, discuss their expectations of how your parent will be cared for. You may assume your brother or sister will cheerfully lend a hand, but they may have other plans.

Solutions Aren't One Size Fits All

Considering the above is just a starting point. Keep in mind that every situation is different, and some creativity may be needed to determine what will work best for you and your loved one. Durso says he finds that there are a lot of idiosyncratic formulations that people have figured out that work for them that wouldn't necessarily work for someone else.

Seek out and talk to others who are or have been in a similar situation. Peter, a media consultant in New York, cared for his 92-year-old father off and on at his home for several until his father moved into an assisted-living facility. Taking into account his father's memory problems, Peter programmed his home telephone with his office number, and posted the speed dial number near the phone to guarantee his father would successfully call Peter's office.

When his father wandered off unexpectedly one day, police were able to locate him with a current photo Peter was able to provide.

With the help of a cleaning woman and neighbors who kept an eye on Peters' dad, Peter was able to look after him several days during the week for five years. Before his father moved into an assisted-living facility, Peter consulted with a lawyer and a social worker to help him in his search for an appropriate facility.

When Harold Youngman's in-laws moved in with his family in 1999 after his father-in-laws illness, he helped them maintain a sense of independence with gardening. He set aside a small area and had them choose what was to be planted. His in-laws contributed what labor they could with the family pitching in the rest.

Youngman also recommends time apart. "Remember to take time for your family away from the parents. It doesn't have to be long — maybe an hour or two — but you need that time away and the parents need time to themselves as well."

During the time Gail Shapira's parents lived with her family, Gail was struck by her mother's enjoyment of life and her young son? empathy and understanding.

Gail's husband, Lee, says, "It came as a surprise to me that by going through this process — so much of which was frustrating and painful and tedious — there was also a lot of enriching personal growth. It's kind of like parenthood: It opens up an experience that you simply would not know otherwise. You become more whole as a person."

It might be difficult to start talking to Mom or Dad about advance medical directives, legal details, their money, your money, whether they want to live with you or another child when they can't live independently and whether you want them to. You may want to include a third party such as a geriatric care manager or other geriatric professional in the discussion. Yes, it might be tough to the subject beforehand, but it would be even tougher after an emergency.

Whatever solutions you work out for you and your family, keep in mind that life won't always run smoothly; there will still be emergencies and disagreements. If you sense that the arrangement isn't working on any level, talk — and then talk some more. And listen. Perhaps circumstances have changed and everyone needs to reevaluate. Keep in mind that caregiving is not an exact science.

As Lee Shapira puts it, "Sometimes we handled things very well, other times very poorly. That's all part of the experience and has to be accepted."