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When a Parent Can No Longer Live Alone

By Chuck Yanikoski

This is only the briefest of introductions to what is usually a very complicated problem. But it is a very common one: a parent or other elderly person in the family has become increasingly infirm, or else has had an accident or medical emergency after which living alone just isn't feasible any more. What can you do?

The primary options are:

1. Letting the elder stay home, and enlisting outside help. You might find a friend or relative to live with him or her, or advertise for a living companion who will help out in exchange for free rent, or some similar arrangement. You might find government, charitable, paid, or other services to help with the elder's needs.

2. Moving the elder somewhere else that would be easier - perhaps an apart-ment or condo that doesn't need as much care, or a place that is on one floor instead of two, or that is handicapped-accessible.

3. Having the disabled elder move in with you or some other relative or friend. You might even locate a stranger who would take him or her in as a boarder and help take care of things, if your relative is mostly self-sufficient.

4. Signing up for an assisted living facility where people live as independently as they can for as long as they can, but where services (whether medical or non-medical or both) are available.

5. Entering a nursing home, where 24-hour supervision and/or intensive nursing care is available (or a hospice, if the person is mortally ill).

If the situation is not already an emergency, start considering options at least six months before you expect to make a change, if you can. If you have to make an emergency decision, you will have fewer choices (many facilities have waiting lists).

Meanwhile, here are the main questions that should be asked on the behalf of the person(s) who need to make a change:

  • What level of medical care will be needed, and what kind of help with daily living will be needed? Are there safety issues to take into account?
  • Are lifestyle issues important? Should certain activities still be part of the elder's life? Is it important that they live with or near certain people, or near a certain place or organization (church, club, hometown, etc.)? Is a certain level of comfort or privacy or a certain amount of space needed to make life enjoyable?
  • How important is personal independence? In what areas can it be given up or compromised?
  • What are the financial issues? What does each option cost you or others out of pocket? Which options are subsidized by outside parties, or offer tax advantages? In what ways might a change actually save money?
  • What is likely to happen next? What if the person becomes even sicker or more infirm? If an elderly couple is involved, what if one or the other or both becomes more infirm and the other doesn't - and would it affect your plans if you knew which would die first? Conversely, what if they live a long time - which options are sustainable and, for those that would work only temporarily, is there a plausible next step?

If the person who needs help lives far away, or even if not, you might want to get the advice of someone who has done this many times before. The Aging Lifecare Association website can help you find someone suitable (http://www.caremanager.org), or you might ask doctors or other professionals you know if they would recommend someone in particular.

If you have a social worker or care manager you trust, consult with that person, too. The Federal Administration on Aging (http://www.aoa.gov) will help you locate the nearest local Area Agency on Aging. These offices have been set up specifically to help people in this situation. This should be one of your principal resources.

The U.S. Dept. of Health and Human Services also sponsors the Eldercare Locator Service. By answering a few simple questions at http://www.eldercare.gov, you can find out which state and local agencies help with elderly services in your area (or call 800-677-1116).

And of course, check with family members and others you know who may have personal experience with the facilities in your area.

Families sometimes are too eager to make decisions on behalf of their elderly members. As much as children do care about the welfare of a parent, for instance, they can be too quick to "solve" the parent's problem at a time and in a fashion that the parent is not really comfortable with. In the end, the decision properly belongs to the person whose life is changing. Although this can be frustrating for others who might want to "get things settled" faster or differently, those feelings should not be given too much rein.

It is important to remember that this is often a difficult time for the person who can no longer live alone. The whole experience is likely to be disturbing, even depressing. It is important that family members not make it worse.

But at the same time, this is almost certain to change your life, too. And if you have siblings, it will probably change their lives as well - and may affect relationships among you, especially if some are helping more than others (and especially if they are not being compensated for it).

So take a deep breath, consult with everyone involved, find outside help, and anticipate that this will be a long and difficult path. Your parent's life has just changed dramatically, and so has yours. So approach this as a lifestyle change for you as well as for the parent, and try not to get frustrated, angry, or short-sighted when making these decisions, or living with them.