Fact Sheet - Home Away from Home: Relocating Your Parents

Family Caregiver Alliance

As you've watched your parents age, perhaps you have struggled with situations such as these:

You've traveled to visit your mother for the holidays, and found her refrigerator nearly empty, her checkbook misplaced and her finances in complete disarray.
Or a neighbor calls you to report that your father was wandering in the street, unable to find the home he's lived in for 30 years.
Or your mother has neglected to take her diabetes medications, severely compromising her health.

If there is a decline in cognitive abilities as a result of Alzheimer's disease or a related dementia, or a shift in a medical condition that requires increased care, there is clear cause to be concerned about your parent's welfare. The need to relocate your parent to a safer environment may become apparent.

But where should he or she live? Often your first inclination is to move Mom or Dad into your home?but this major life change deserves thoughtful examination, and there are many alternatives to explore. This Fact Sheet offers helpful advice and summarizes the issues to consider before making the important and challenging decisions regarding relocating your parent.

Open Discussions

Open and honest discussion with your parent and other family members becomes an essential first step when you are trying to decide whether relocating your parent is the right thing to do. Family meetings with your parent, spouse, children, siblings and other key people will help everyone share their views and will help you decide how best to proceed. Active communication among all family members is the building block to a strong support system for an older parent and all family members involved.

Although some of these discussions may be very difficult and emotional, several topics require attention. Together, the family, including your parent, will need to talk about all possible residential options, each person's role in the transition, the type of care to be provided, changes in lifestyle, finances, and the physical setting of the new home. Clear expectations must be defined. The following topics can help guide your discussions.

Level of Care Needed

As your parent gets older, his/her care needs will change, and in most cases become more challenging. Consider what you will and will not be able to do for your parent. Developing a strategy for how the care will be provided is essential and requires practicality and planning.

Evaluate whether your parent needs constant supervision or assistance throughout the day and consider how this will be provided.
Determine which activities of daily living (eating, bathing, toileting) your parent can perform independently.
Determine your comfort level for providing personal care such as bathing or changing an adult diaper.
Evaluate your health and physical abilities and decide if you are able to provide care for your parent.
Expect changes in your parent's medical or cognitive condition.
Explore the availability of services such as a friendly visitor, in-home care or adult day services.
Investigate back-up long term arrangements and options if living with your parent does not work or is not your choice.
Determine the type of medical care that will be needed for your parent, and whether appropriate physicians and services are available in your community.

Family Dynamics

Families are rich in historical experiences, and many of your positive and negative feelings about your parents and other family members will play a role in your decision to relocate or live with a parent. Be honest with yourself and do not allow unresolved conflicts or feelings of guilt or obligation pressure you into taking on more than you can manage.

Be honest with yourself and others about the significant life changes that relocating your parent will mean for you, your parent, your siblings, your spouse and children.
Try to come to terms with past disagreements between you and your parent.
When deciding whether to relocate or move your parent into your home, consider the opinions of your spouse, children, siblings and other family members.
Come to an agreement with your siblings regarding how much and what kind of help you will receive from them.

Consider Various Living Arrangements

Moving your parent into your home is one option, but you and your family should take some time to consider other living arrangements as well. The type of housing and living arrangement will largely depend on your parent's care needs, finances and available options. Also, when deciding where a parent should live, family members need to discuss, understand and accept the benefits and drawbacks of living close to one relative versus another.

Often, the choice of location can cause conflict between family members because those living near the parent bear most of the responsibility for the parent's care, and may feel that those living further away do not help enough. On the other hand, family members who live far away can feel frustrated that they do not have the opportunity to participate more in providing care. An open dialogue and an agreement on how to share local and long distance caregiving is essential.

The following list outlines different types of living arrangements that may be appropriate for your parent. Each community offers different choices. Remember that Medicare does not usually cover these expenses. A fuller discussion of living arrangements can be found in Family Caregiver Alliance's Fact Sheets, "Out-of-Home Care Options" and "Assisted Living and Supportive Housing."

A nearby apartment, house or retirement community: Your parent may still function happily and safely in his/her own independent environment with a little assistance. In this case, renting a nearby apartment or small home will allow your parent to maintain his/her independence and enable family members to provide consistent monitoring and support. Independent retirement communities may offer individual units with group meals and social activities. Sharing an apartment or house with a friend or relative may be another option. There are also agencies in some cities that arrange for shared living situations.
Assisted Living Facility: Individuals who are fairly independent but require some daily supervision and assistance with house chores and personal care may consider an assisted living facility. Assisted living facilities may offer rooms or apartment-style accommodations and, often, social activities. Meals are provided. Staff is also available to assist with different care needs, such as bathing, grooming, eating or using the toilet, and care is arranged as needed by the individual. The monthly charge for assisted living is determined by how much care a person requires.
Residential Care Facility: These facilities are small group homes that provide constant supervision, meals and care for people who cannot be left alone but do not require skilled nursing care. Residential care facilities provide assistance with bathing, grooming, eating, using the toilet and walking, and they also provide socialization and recreational activities.
Intermediate Care Facility: This type of facility provides round-the-clock care for those who require help with bathing, grooming, going to the toilet and walking. Individuals in these facilities cannot live independently and require nursing care, although the nursing care is not offered 24 hours a day.
Skilled Nursing Facility: Skilled nursing facilities provide continuous nursing services and are designed to provide high levels of personal care and medical care, such as administration of injections, monitoring of blood pressure, managing ventilators and providing intravenous feedings to individuals who cannot function independently. People in skilled nursing facilities usually require help with the majority of their self-care needs, and such individuals would probably not be able to live in a home environment.

When Your Parent Moves in with You

Change of Family Roles Living with a parent will lead to a change in family roles. A once-authoritative parent may no longer act like a "parent"?you may become the guardian who gives direction and controls many aspects of your parent's life. You may need your child/children to help with more household responsibilities and with a grandparent. These role changes are hard adjustments for everyone.

Determine your ease with becoming the decision maker and the person with authority.
Be prepared for resistance from your parent if they feel that they can no longer set the rules, control their situation or fear losing independence.
When possible, allow some negotiation in decision-making activities so that you can have a win-win situation.
Decide on what you expect from your parent in terms of completion of chores or financial contributions.
Think about your spouse's and children's readiness to help with caregiving.

Lifestyle Changes You and your parent probably have very different lifestyles. Sleeping cycles, eating patterns, social calendars and daily activities may need adjustments in order to guarantee a smooth transition.

Talk about and plan how to accommodate bed times, nap schedules and sleeping habits of all family members in the house. Discuss what types of food you eat, when meals are prepared, and if special diets are required and how they will be accommodated.
Assess whether smoking/nonsmoking or drinking/nondrinking practices are compatible.
Consider how you can support your parent's continued participation in social networks such as visiting friends and attending a place of worship and how transportation to these and other activities will be managed.
Encourage your parent to keep enjoyable and safe hobbies.
Consider whether your parent will be fully integrated into your family's activities or whether he/she will maintain an independent social life.
Consider how the household noise level and general activity pattern will affect your parent.

The Loss of Time

Caregiving requires a significant amount of time and is very likely to impact your work, family time, personal time and sleep.

Determine the amount of time you can devote to your parent's care needs. When will you make phone calls for appointments or to set up needed services? When will you be able to take your parent to medical appointments?
Evaluate whether you will need to make adjustments to your current work schedule.
If you will reduce your work hours, determine the implications for your financial picture, career advancement, health insurance and retirement benefits.
Consider whether you will have time for your spouse, children and friends.
If your parent requires full-time supervision, who will provide it while you are at work?
Consider the reduced amount of private time you will have to pursue your own interests or hobbies or what your need is for time alone on a daily basis.
Expect that you will, at times, become exhausted and will need to find a way to rest.
Investigate how to arrange for some time off from caregiving duties ("respite") and enlist the help of your family members, close friends or an aide.

Your Home

Physical living arrangements must be adequate if your parent is to move in. There must be enough room and a layout that is adaptable to an older adult who may have mobility or vision problems. A home may require special adaptations to make it safe. Many of these changes are inexpensive but need time and planning to implement.

Evaluate the amount of available space and whether there is enough privacy.
Think about where your parent will sleep. How will a child feel if he or she has to give up a room for a grandparent?
If possible, locate your parent on the first floor in order to avoid stairs.
Consider major changes that may be needed in order to accommodate any disabilities or mobility problems, e.g. wheelchair accessible bathroom, shower, etc.
Determine what assistive devices may be needed such as grab bars in the bathroom, raised toilet seats, handrails and a ramp.
If your parent wanders, consider special locks, door chimes and other devices that will help keep doors and windows safely secured.
Look through your home for hazards such as dangling cords, toxins, slippery surfaces, unsteady chairs, throw rugs.
Install bright non-glare lights above all walkways, and low-cost adhesive strips on steps and other potentially slippery areas such as bathrooms and showers.
Adjust temperature controls so that the house is not too hot or too cold. Be aware that older people often like their environment warmer and this may affect both your comfort and your utility bills.
Discuss how you might incorporate your parent's furniture into your home.
Review how existing or new pets will be integrated into the new home situation.

Financial Arrangements

Individual financial information is not usually shared among family members. However, if you are caring for a parent it may become necessary for you to become more involved in his/her personal finances including paying bills, monitoring accounts and managing investments. This could create problems with your parent or siblings who may question how you are handling your parent's money.

Agree upon how much, if any, financial payment your parent will provide towards their living expenses. Will they pay for rent, food and other costs?
Your siblings may be resentful of any money you might receive. Openly discuss financial arrangements with siblings to keep them updated on new expenditures and apprised of accounts.
Come to an agreement between your parent and siblings regarding payment of out-of-pocket expenses.
Investigate the option of automatic payment of recurring bills.
Look into free or low-cost services that assist with Medicare paperwork for older adults.

Difficulties with the Move

It is likely that your parent has lived in his/her current home for many years and has developed strong ties to community, family, friends, healthcare providers, social life and daily routine. Packing and moving out of a house is a significant chore for anybody, but for the older adult who has decades' worth of memories and possessions, moving can represent a tremendous emotional challenge. Moving away from this familiar and comfortable setting is diffcult and can cause great sadness. Furthermore, leaving one's own house represents a decrease in independence and signals a new life stage.

In some communities, there are specialized companies that will help organize a senior's move to a new location. But for most families, the adult children perform that task. Again, open communication will help ease the way.

While you help your parent pack, talk through the difficult feelings, acknowledge the loss that your parent is experiencing and reassure him/her that you are all making the best decision possible. Allow time and opportunity to reminisce. Your parent will need time to adjust to his/her new living environment and role with your family. Your patience and support will help make this transition smoother. An outside counselor may also be helpful.

Rewards

Despite the challenges, many adult children find that providing support and care for their parents is one of the most rewarding experiences they have ever had. Parents can contribute to the family through sharing their past and become an integral part of your household. Grandchildren have the unique opportunity to learn and absorb family history. Caregiving carries with it the extraordinary opportunity to give back what your parent once provided to you.

Resources

Family Caregiver Alliance
180 Montgomery Street, Suite 1100
San Francisco, CA 94104
(415) 434-3388
(800) 445-8106
Website: www.caregiver.org
E-mail: [email protected]
Help is availble through FCA's online support groups. Use http://caregiver.org/caregiver/jsp/home.jsp to view options for online support.

Family Caregiver Alliance (FCA) seeks to improve the quality of life for caregivers through education, services, research and advocacy.

FCA's National Center on Caregiving offers advice and information on current social, public policy and caregiving issues and provides assistance in the development of public and private caregiver support programs.

For residents of the greater San Francisco Bay Area, FCA provides direct family support services for caregivers of those with Alzheimer's disease, stroke, ALS, brain injury, Parkinson's and other chronic health conditions that strike adults.

AARP
601 E. St. N.W.
Washington D.C., 20049
(202) 434-2277
www.aarp.org

Administration on Aging
3033 Wilson Blvd. Suite 700B
Arlington, VA 22201
(703) 228-1700
www.aoa.gov

Alzheimer's Association
225 N. Michigan Ave., Ste. 1700
Chicago, IL 60601-7633
Phone: (800) 272-3900
Website: www.alz.org

Assisted Living Facilities Association of America
11200 Waples Mill Rd., Ste. 150
Fairfax, Virginia 22030
Phone: (703) 691-8100
Fax: (703) 691-8106
www.alfa.org

Children of Aging Parents
1609 Woodbourne Road, Suite 302-A
Levittown, PA 19057
(800) 227-7294
www.caps4caregivers.org

Eldercare Locator
To find local Area Agencies on Aging throughout the U.S., as well as state Long Term-Care Ombudsman offices for nursing homes, call: (800) 677-1116
www.eldercare.gov

Medicare and Medicaid
Phone: (800) MEDICARE
www.medicare.gov

The National Center for Assisted Living
1201 L St., N.W.
Washington, D.C. 20005
Phone: (202) 842-4444
www.ncal.org

U.S. Department of Housing and Urban Development
Housing Counseling Agency
451 7th St., S.W.
Washington D.C. 20410
Phone: (888) 466-3487
www.hud.gov

Prepared by the National Center on Caregiving, a program of Family Caregiver Alliance. Reviewed by Linda Velgouse, Director, Home and Community Based Services, American Association of Homes and Services for the Aging. Funding provided by the California Department of Mental Health and the Archstone Foundation. ?2003 All Rights Reserved.