You and Your Aging Parent

First published in 1976, You and Your Aging Parent is a classic–the first book to shed light on the challenging relationship between adult children and their aging parents, illuminating the emotional, health, and financial difficulties that elderly parents and their children face during the senior years. The 30th anniversary edition addresses the changes that have taken place in the last three decades, but it still embraces the authors’ fundamental insight–that the difficulties and challenges of the aging process are as much a family affair as in any other phase of life. The excerpt below focuses on how to relocate your parents if they can no longer live alone.

Should They Live Near You?

Many adult children prefer that their parents live near them in anticipation of the time when one or both need help. Over and over again, the story is told of a son or daughter, whose parents have moved away from them to a warmer climate, having to commute long distances to help out when the parent becomes ill or disabled. Yet in this mobile society, it is often the children who must move, and who subsequently urge the parent to move near them.

In questioning whether parents should settle near you, many of the same issues about their ultimate welfare, such as community, medical, and social supports, apply. In particular, would it be wise to uproot them from their familiar surroundings? Undoubtedly, having them near you is preferable to traveling long distances to see them or arranging for care from afar. One solution is inviting them to move to a retirement community or long-term care facility near you.

Sarah moved from California many years ago and lived near her children and grandchildren in a New York suburb. Her own parents, now in their late 80s and growing more frail, were still living in their California home of 50 years. The anxiety of being so far from her parents and the wearing trips back and forth to California led Sarah to investigate a well-regarded retirement community near her home. However, she ran into a stone wall when she began broaching a possible move to her parents. Her mother was eager to move, but although Sarah pointed out all the advantages to her father, including pleasant apartments, meal service, and activities, he refused to discuss the matter any further. Finally, Sarah gave up and dropped the subject. But several months later, her father indicated that this ‘‘community living business’’ might not be a bad idea, and a plan was made to visit the residence.

After Sarah’s suggestion was rejected, she stepped back in frustration. But this move gave her parents the time they needed to consider their options.

Another solution, if you and your parents want to live near each other, but not with each other, is an ‘‘in-law’’ apartment attached to a home or located over the garage. You have the advantage of both proximity and privacy. Modular homes that can be attached to your home or placed on your property are also a possibility. Known as ECHO Housing (Elder Cottage Housing Opportunities), these units cost about $25,000.

Should They Live with Others?

Those unfamiliar with the problems of old age automatically assume that when elderly parents can no longer live alone, there are only two choices for them—live with a child or enter a nursing home. That assumption is wrong. As Sarah’s situation illustrates, there are other options. Special housing for the elderly is becoming increasingly available throughout the country. Sponsored by church organizations, community groups, and private investors, these facilities admit the relatively well and ‘‘independent’’ elderly and provide them with easyto-care-for living units. Most also offer meals, housekeeping services, and recreational activities. Most important, perhaps, is the fact that they provide safety, companionship, and recreation. In some instances, assurances of care in the case of illness and disability are included. Advanced planning for special housing—when a parent is relatively healthy and active—is essential. A very disabled or ailing older person usually will not be admitted to these types of residences, which include:

Continuing Care Retirement Communities. In these communities, older adults can live independently in their own quarters, but available to them are recreational programs, at least one meal a day, and health care and assistance if illness occurs. A skilled nursing facility home for around-the-clock care is part of the community or located close by. Those that include both skilled nursing and assisted living accommodations are usually referred to as ‘‘three-stage’’ retirement communities. The guarantee of continuing care as an elder grows older and increasingly frail is a significant advantage of these communities. However, they are not inexpensive and thus are limited to those with financial resources. The older adult usually pays a significant upfront fee and monthly rent, or turns over his or her assets for long-term arrangements. Some of these facilities are located near residents’ former homes, enabling them to age in place to some extent. Facilities under religious auspices may have significance for your parents if religion has played an important role in their lives.

Assisted Living Facilities. These facilities are intended for the older person who can live in his or her own private quarters, but requires some supervision and help in managing. One or two meals a day in a congregate dining room are provided, as well as recreational programs. Monthly rental fees can range from $600 to over $4000. There is no guarantee of continuing care if an older person’s condition deteriorates to the extent that he or she requires intensive or around-the-clock care. Some facilities maintain a home health care service, the costs of which are added to the monthly rent. Separate nursing home care may be required. Of benefit to older people and their families is the Continuing Care Accreditation Commission (CCAC), which sets standards for and accredits continuing care and other aging services. This accreditation helps ensure that a retirement community or other facility provides quality care. CCAC recently became a part of the long-standing Commission on Accreditation of Rehabilitation Facilities (CARF), which has available a list of accredited continuing care facilities (www.carf.org). The accreditation of assisted living facilities is expected to be implemented soon.

Subsidized Housing. Subsidized housing (or ‘‘senior apartments’’) under charitable or government auspices is in short supply and only available to low-income elderly. Some services are available, but the waiting lists are long.

Shared Housing. These arrangements are proliferating and include two or more unrelated older persons who decide to live together and share expenses, or more formal group living arrangements sponsored by community organizations. Akin to these arrangements are older couples or singles who live in proximity to others their age and share services as well as look after each other.

ECHO Housing (Elder Cottage Housing opportunities) are temporary homes placed on the property of a single family house. Designed specifically for older adults, these homes allow for both privacy and close proximity to family members. Information about subsidized housing, shared housing, ECHO Housing, or other housing arrangements for older adults in your (or your parents’ community) can be found at your local or area office on aging. You can locate this office at www.eldercare.gov or call 800–677–1116.

Naturally Occurring Retirement Communities (NORCs). NORCs are housing developments, apartment buildings, or neighborhoods in which residents have lived for many years that now have a high concentration of older adults. Targeted health and social services are now provided to low-income elders in some of these communities as a result of public and private partnerships. You are fortunate if your parent lives in a NORC that is targeted for these services. You can read more about NORC supportive service programs at www.norcs.org. Some older persons choose not to live in housing that includes only their own age group. They prefer to live near old and young alike. Yet a move may still be wise for them for reasons of safety, accessibility to services, social stimulation, and ease of housekeeping. When one member of an aging couple is debilitated and the other is not, the safety and supports mentioned earlier can relieve the active partner of constant concern, and give him or her more freedom to enjoy life, while still remaining at a spouse’s side. Certainly, the pros and cons should be weighed when considering any move. After you have found a perfect retirement community near your home, have you stopped to wonder whether the place will be equally perfect for your parents if it forces them to relocate from their familiar surroundings? The director of a retirement complex in a large midwestern university town reported that the majority of the residents made good adjustments, enjoying the range of activities and new friends. The poorest adjustments were made by those who had moved from a different state to be close to a son or a daughter. Having left homes, friends, and longstanding routines far behind, they had nothing familiar in their new situation except their children. Their children replaced the burden of long-distance worry with a different burden—boosting their parents’ morale. This is why the ideal time for such a transition is when parents are active enough to make new friends and enjoy the offerings of the area—one reason why retirement communities have mushroomed near college towns.