If you’re not already in the caregiver ranks, the thought must have crossed your mind: There will come a day when at least one of your parents won’t be able to take care of his or her basic daily needs. What then? There’s a good chance Mom or Dad will move in with you.
Twenty-three percent of people between the ages of 45 and 64 provide unpaid care for an older person (age 65 and over), according to the 2012-2013 American Time Use Survey conducted by the Bureau of Labor Statistics. And a 2013 Pew Research study found that 68 percent of people ages 40 to 59 expect to care for an aging parent in the future.
“What I see most often in the office is stress in caregivers,” says Anne Vanderbilt, a clinical nurse specialist at the Center for Geriatric Medicine, Cleveland Clinic, who works with elderly patients and their families. “One of the things I always say is to really have a good sense of what the older person’s needs are going to be. What are her physical needs, mental needs and caregiving needs?” Even if you have enough space in your home and time in your schedule to accommodate another person, the effort it costs may be prohibitive. Assessing the situation thoroughly before the move will help you get ahead of conflicts and stress that may arise, Vanderbilt says — so ask yourself these questions:
1. Why are you considering having her move in?
First things first: Figure out whether this decision is based on your parent’s physical or cognitive limitations, on her emotional well-being or on other considerations, like finances or loneliness from the loss of a spouse. Once you identify why your parent needs to move in, it will become clear whether it might make better sense to employ home health care instead, Vanderbilt says .
“You have to look at the preference of the older person, as well,” she says. “If the older person does not want to move into your home — that’s common. If the ‘why’ is because the parent is losing weight and falling, but she doesn’t want to move in, can you meet her needs with supplemental home care, home health aides or senior care?”
Your parent’s health insurance plan — whether they have Medicare, Medicaid or a private plan — may offer reimbursement for in-home skilled health care. To find Certified Home Health Agencies in your area, visit your state’s Department of Health website.
2. What are the caregiving needs?
Before taking the cohabitation plunge, figure out what your parent will need on a day-to-day basis, Vanderbilt says . “One need might simply be that the parent is suffering a time of loss, such as when a husband dies and the wife is living by herself. What she really needs are companionship and transportation — that’s a common scenario.”
But then there are other, tougher situations, like when a parent’s health is starting to fail and she is experiencing confusion or weight loss, or her vision or hearing are going downhill. “That person will have much greater caregiving needs,” Vanderbilt says .
To get an accurate picture of your aging parent’s health status, Vanderbilt recommends visiting a geriatrician or primary care provider for a medical evaluation. “As you’re making this decision, I would definitely start by taking them to get a medical evaluation to identify their needs,” she says. If your parent will require some medical familiarity or caregiving knowledge you don’t have, then you can seek help from various organizations. “There are lots of resources and training out there,” she says. “The Alzheimer’s Association is fabulous — they can help you identify your needs and get the training that’s necessary.”
3. Are you going to be able to meet those needs?
If your parent falls in the companionship-and-transportation category of caregiving, you will probably be able to host him in your home without too much difficulty, provided you have the appropriate living space. But if dementia or certain other circumstances are involved, the road might be too tough for an untrained family member to undertake.
Vanderbilt identified two situations that can create immense difficulty for people who are thinking about having a parent move in. Your parent has:
- An erratic sleep schedule
- Cannot take care of his own toileting needs
“If the loved one does not sleep at night and is up and roaming around the house and you have to supervise, or if the person is incontinent, that is often a deal-breaker for families being able to care for them at home,” Vanderbilt says .
One more consideration to keep in mind early on in the decision-making process is your personal relationship with the parent in question. “You need to carefully reflect on own relationship and dynamics with the parent moving in,” Vanderbilt says. “If getting through Thanksgiving dinner has been tough, the conflict and stress will probably get worse” once you’re sharing a roof, further complicating caregiving.
4. How does the rest of your family feel about it?
Speaking of personal relationships, other family members living in your house also will be affected by this decision. “If you have very young grandchildren in the house, it can be a conflict,” Vanderbilt says. “Caring for young children has a lot of demands, and young children won’t be able to help. If you have older children in the house, teens or college age, sometimes they can be very helpful, and it can be good experience for the kids. They’re not going to be just living with you — it’s the whole family. It’s not just about space.”
Additionally, you’ll want to talk to family members who don’t live with you, but are intimately involved — namely, your siblings. Vanderbilt advises having a conversation with your siblings to define your roles and avoid resentment on all sides. “This should be a family decision,” she says. “If there are other adult children, sometimes they’ll go ‘Phew, she’s gonna take care of Mom!’ But you have to be assertive, and say, ‘Yes, Mom lives with me, but I need you to be the one who’s responsible for handling finances or taking Mom out on the weekends, or come here and stay for a week each year while I go on vacation. You need to be very up front.” Establish what help you’ll need from your siblings, so they can’t plead ignorance.
5. Is your house arranged properly if your parent’s mobility decreases?
Is there a bedroom downstairs? Do you have additional steps up or down on the ground floor? Is there adequate space to maneuver around the furniture if agility and balance are a concern? Are your floors slippery? Can you install safety grab-bars in the bathroom? “You need to examine how physically frail the older adult is,” Vanderbilt says. “One floor is always better. They may be able to walk up the stairs today, but may not be able to next year.”
If your house can be modified easily to accommodate your parent’s potential safety concerns, you’ll likely live together successfully longer. If your parent is affected by dementia, visit the Alzheimer’s Association website for more home safety tips.
6. How do you know when the responsibility is too much?
Caregiver burnout is real. According to the Cleveland Clinic, “caregiver burnout is a state of physical, emotional and mental exhaustion that may be accompanied by a change in attitude — from positive and caring to negative and unconcerned.”
Before the move, think about what your life will realistically be like. “If your family’s life is going to drastically change when they move in, they probably shouldn’t move in,” Vanderbilt says. “It won’t be good for you or your parent.” After the move, keep an eye out for changing behavior in your parent and any rising stress you may feel as a result. “If the older person is very irritable or having disruptive behaviors, maybe they should move out,” Vanderbilt says. “Sometimes older people get very restless and are always trying to leave the house, which is stressful for everyone. I always tell people, ‘Don’t wait until you get completely exhausted.’ You won’t be able to provide the best care for your parent at that point.”
Vanderbilt also recommends that caregivers allot time for themselves. “Make sure you’re getting your own physical activity, going to your own doctor’s appointments, having your own social interactions,” she says. “Finding that time is really key, and you might need to rely on siblings or on private-duty caregivers. Caregivers absolutely need to take care of themselves, too.”