In spite of the apparently unconditional nature of Dad’s announcement, I knew that eventually I would bring my parents to California. It was the only responsible way for me to continue doing POP. I found I had an unusual sense of clarity, confidence, and determination in that moment.
My initial task was calming Mom down. I knew that when she was calmer, she would agree with what had become apparent to me, Florence, and their doctors—and, I presumed, to Dad as well. POParental rationality would need to take precedence over my parents’ fears, concerns, or any other “good” excuses they might offer to avoid leaving home.
The near unanimity of opinion that moving to California was their wisest option fueled my feelings of competency and confidence. That was especially important because I would somehow have to override my parents’ decision. By now, since the day I first confronted my father at his door and stepped up for POParenting, I also had plenty of practice utilizing those feelings. If this had been the first time, I might have been more reticent to challenge my parents or more concerned about their reactions. Perhaps I would have backed down.
I knew that I must not personalize any aggressive or hostile-sounding remarks I might receive when I was “forcing” people to do what they didn’t want to do. Jack and Lillian didn’t want to accept the truth that they needed more help than Florence could offer. But it was the truth nevertheless.
All things considered, that meant they would need to come live in California. The move wasn’t only for Mom. I’d also seen Dad decline, getting weaker psychologically as well as physically because of the stress of caring for and gradually “losing” his fading beloved.
Lillian and I would talk many times before she was finally convinced. I knew I’d need to allow her to express herself as best she could for as long as she needed. My mother shared her fears about moving and how it evoked her long history of loss and abandonment. She told me of her concern that moving to California would alter her relationship with Dad and with me. I tried to reassure her that those changes could be wonderful, better than she could imagine, and I meant it. When she saw I was listening to her and, thankfully, she was cogent enough to get my message, she softened.
In spite of my own lingering hesitations, I reassured myself that their moving closer to me was the most intelligent, prudent, and loving POPlan for all concerned. All right! I’d just pack up their remaining stuff and we’d be on our way. Done with partial caregiver coverage and done with long-distance POParenting! At last!
As we all settled into the idea of the move becoming reality, I noticed an old twinkle return to Dad’s eye. I hadn’t seen it there for far too long. Jack was excited. He was relieved to be leaving the apartment and his heavy responsibilities in New York City. He looked forward to living closer to me after all these years and to my sharing his burden. In fact, Dad looked lighter and younger than I’d seen him in years. I thought I heard him whistling a tune that sounded like “California, Here I Come. . . .”[1]
If my parents had lived closer, I’d have first gone to scope out a bunch of places, narrowed my favorites to the top three or so and produced a short list for us to visit together. But since I wanted everything to be ready when they got off the long plane ride from New York, I had to make all the choices without any input from them. I had to figure out where they might like to live and that was not necessarily where I might have chosen were I choosing for me.
My goal was to find a facility where Lillian and Jack would do best—that is, feel at home, remain content, and maybe peaceably pass away some time in the very distant future. Their level of care already mandated some caregiving, so the purely Independent Living (IL) model for seniors was too unstructured for them. Nor did my folks yet require the more serious medical care available in a skilled nursing facility (SNF), where people need nurses.
Thus, my search became focused on finding them either an intimate, pretty homelike setting where they would get some personal attention—a six-bed board-and-care facility (B&C)—or an assisted-living facility (ALF), a larger structure where the senior residents live in their own apartments and share meals and activities.
Which type of setting would my parents fare better in—a small, six-bed B&C or a more populous and private ALF? In a B&C, residents live in a quaint converted home. Most of the time, each resident has a separate room, but all share meals, facilities such as a garden and a reading room, and much of their time together every day. Everything about a B&C, including the number of staff, residents, and size of the facility, is smaller.
An ALF sounded more like what my parents had known and loved in New York. I liked that. But I wondered if they might not prefer a more traditional California bungalow-type setting? Maybe they would enjoy living in a small B&C facility with just six bedrooms, where they could walk outside and read in the garden on a warm winter’s day.
Either way, I had to imagine that I knew my parents’ current tastes and preferences in location, type of residence, décor, and furnishings. Eventually I chose their residence and most of their furniture and furnishings as well. I bought many things to make it homey for them when they landed at their new place, since hauling a lot of their heavy items cross-country didn’t prove to be a great idea. In a way, my “nesting process” before their arrival was another symbol of our role reversal—my doing for them the equivalent of what they’d done for me when they’d first brought me home, their newborn baby girl, all those years ago.
To narrow my search for the most suitable facility for my folks, I found help in the form of a geriatric placement agency. Happily, using their services didn’t cost our family anything. Senior residences pay these firms, which function much like employment firms, offering interested families a menu of prospective residential choices. I chose this particular firm based upon recommendations I’d received and upon my intuitive sense of the woman who ran the company. I liked her questions, the way she posed them, and her professionalism. Like earlier on in the POPcycle when we’d needed a geriatric care manager (GCM), now it was the placement person who needed to understand a lot of background information concisely expressed to best counsel our family.
When the placement woman and I spoke, she reminded me of several significant criteria in settling aging parents into suitable facilities. Later, when I had to resettle each of my parents, I’d return to speak with her and I’d be reminded of the validity of her basic points. One key was to locate my parents near enough to my home and/or work so I would visit them frequently and oversee their care. Another key was the facility’s having a good and caring staff—if possible, a stable staff of long-standing, so that Mom and Dad could avoid some of the separation feelings I anticipated they might have without faithful Florence.
Regarding proximity, I was well advised to be realistic. Longer distances do discourage even the most diligent and loving of POParents from visiting as often as they might like. When seeing my parents added a lot of drive time to my schedule at the end of a particularly challenging workday, I might end up not going. Moreover, if they lived close by me, visiting would be far more accessible. Not only could I be more casual and spontaneous but dropping in on my parents unexpectedly could prove useful. If some of my visits to my parents were “unplanned,” I might obtain a more accurate view of how they really were or how the facility actually attended to them.
Many other factors came into the mix. I tried to put myself into the heads of my parents. What did Mom and Dad like to do? Who did they wish to get to know? How did they spend their time? What would Jack most enjoy in a new home? He had become far more introverted than my memory of him when we were both so much younger. What did he like? Unless I turned the radio or stereo on, he rarely listened to music in New York. Maybe he just enjoyed the quiet? Dad read a lot and watched his TV shows. Jeopardy and The Tonight Show were his favorites. He ate, did some stretching at home, meditated, and talked to Mom and to me. That’s basically what I’d seen when I’d visited in New York, and I expected he’d be similarly quiet once he’d settled into the West Coast lifestyle.
Lillian was far more outgoing. She had previously enjoyed crossword puzzles, listening to music, taking drives through Central Park and watching plays. Still beautiful at age eighty-seven, she could be gracious and friendly with others. Much of the time she still appeared engaged and very affable. But she could become hostile, haughty, demanding, aggressive, and unreasonable—sometimes without any apparent triggering events. I suspected Mom’s discovering that her mind was increasingly beyond her control resulted in much of her frustration and bad behavior. Although I sympathized with her pain, her condition made it challenging to predict which type of senior facility might be best.
During our New York POP years, I came to witness Lillian’s dementia manifest in volatile temper tantrums manifested in pinching, punching, bullying, demeaning, and scratching Dad. She repeatedly threatened him that she’d jump from her fourteenth-story bedroom window. It was painful to watch. Dad had become frailer and never acted aggressively with her. On a few occasions when Mom’s disorders would overcome her, I had to intervene between my parents. As the emerging disciplinarian, it was now becoming my job to set the limits of my parents’ acceptable conduct. That definitely felt like role reversal gone wild.
So far, most of Mom’s aggressiveness had been directed at Dad, but I wondered if she might act out with others in her new place, particularly when the dementia would further take her over. Telling the placement professional this history was important so we could find a facility that would most suit all my parents’ needs, emotional, physical, and mental.
I had concerns about placing them in a smaller B&C facility with my mother’s history of being a difficult patient. I’d seen her blow through a series of hard-core veteran caregivers in those early 24/7 care days in New York. I questioned how soon her fellow residents and the small number of caregivers in any B&C might become a problem for Lillian. I kept returning to the notion that such an intimate setting as six beds could provide too many opportunities for Mom to become upset and/or to upset others.
With this in mind, I turned my sights to locating a serene, nice-looking larger ALF. With the list of ten in hand that my placement professional had given me, I drove from one to the next, checking out all of them. None proved quite right for Lillian and Jack. Nonetheless, while visiting one on my list, someone there recommended an eleventh place that I liked immediately.
This ALF seemed to offer the right blend of serenity and activity and was geographically pretty attractive in its proximity to my home and work. And, as I would soon discover, it had the additional element I sought: a caring and longtime staff. I respected the people I talked with who worked there and liked their attitude toward “their” people. The staff I met seemed genuinely interested in expanding the quality of life, not just babysitting the residents.
The more I heard about this independently owned and operated ALF, the better it sounded. Mom and Dad would be provided much on-site in terms of exercise, recreation, holiday celebrations, and even health monitoring. A van took interested residents daily to the local mall for shopping, banking, and sundry errands. I even saw other transplanted New Yorkers, whom I imagined might become friends with my parents.
To do my due diligence, I visited the facility a number of times. I went at different times of day. I tasted the food, smelled around a lot, and asked a lot of questions. I wandered about, talked to the residents, their families, and to more of the staff. I questioned people I knew in the community about the facility. It all sounded quite fine.
Although I went about the tasks methodically and as unemotionally as I could, I mistakenly thought I’d become inured to the sadness and other emotions that got stirred up while I looked for a place for my own parents. This was how they would end up living their final days. I guess I’d convinced myself that my clarity about the decision to move them to California and my extensive professional background would “simplify” my feelings.
I soon found that choosing a residence for my own parents was very different from visiting similar facilities for my patients. Even walking into the first senior residence felt emotionally wrenching for me as I contemplated what it meant to be “institutionalizing” my own Mom and Dad. I plagued myself with unanswerable questions about where I would end up. What would it be like when my turn to move out of my home came?
POP provided me the chance to ask myself questions about how I wanted to age. There was longevity in my family on both sides. I began to recount the list of my aunts and uncles who lived into their nineties. Even my maternal grandmother with Parkinson’s had lived until seventy-eight, and that was over fifty years ago! My relatives had been healthy people with little obvious dementia and few physical disturbances. I could see that being ill while old could deplete much of the joy of being alive. Looking down the road ahead, I recommitted to my own healthy living.
It would be a good life for them, I assured myself. I made the decision and filled out the application on their behalf. Before I could seal the deal, I needed my parents to be accepted by the AL. I understood that different facilities have varying requirements, and I was relieved and thankful when they told me my parents met theirs.
The apartment I chose for them had a small balcony where Mom and Dad could sit on comfortable patio chairs with blankets and gaze over magnificent oak trees. Or so I envisioned. Next, I went around town furnishing their new home, right down to purchasing their favorite toothpaste and bedside books. I so wanted it to feel like home when they got there after their long plane ride and, more importantly, leaving their home in New York.
I was elated that I had found a suitable and attractive place for Jack and Lillian. It was the answer to my POP prayers that we could finally end our long-distance POParenting. However, as their move became a reality and was actually upon us, I was surprised to discover that I had some mixed feelings that weren’t all positive. On the one hand, I was reassured that I could better monitor my parents’ well-being from up close. But on the other, I felt clueless about how it would be to have them living so close and, as a result, I became anxious.
When I get anxious, my mind starts feeding me questions. How would we all do living in such close proximity at this time in our POPcycle? How often would I see them: once a week or every day? Would they or I want visits to be more frequent? How would I find them decent physicians? Would I take them to their every dentist and doctor appointment? And if so, how would I afford the time? Would they even want that? How would they get to the drug store to buy toothpaste? Or would that task and so many more now become mine?
I was full of unknown speculation and unanswerable questions. I even had some fears that, doing POP up close and personal, I might “fail.” Although I intellectually knew that time would answer all these questions, sometimes it was particularly difficult to replace my anxiety with the faith in myself and the universe’s goodness I usually experience.
Most of the time I was able to use my thoughts constructively—to support me in dealing with knotty POP challenges such as unnerving instances of role reversal. I defined those as when I was “being the grown-up” instead of the child in my relationship with my parents. At this stage of our POPcycle, being the parent meant taking care of all the physical details of finding their new place and helping them settle in, much like when they’d taken me to settle into summer camp or college.
Being the POParent also involved securing a solid emotional base for my aging folks to lean on. One way I was seeing I could use this role reversal to all of our benefits was to remember what I had craved from parents when I’d been the child—and then shower it on them. I’d wanted my parents’ unconditional love, acceptance, permission to lean on them without shame, and a spiritual rootedness. And whether or not they’d been able to give me all of that back when I was young, I saw this as my chance to offer those very qualities to them, now that I was being the grown-up.
There were other times when I was less the consummate adult, times my mind created unnecessary problems for me. For example, when I attributed a fearful meaning to this stage of the POPcycle, I found myself succumbing to a deep sense of loss. Similarly, I’d make myself upset when I obsessed over thoughts of my onetime protectors needing a protected environment or my beloved parents descending a winding road toward increasing attendants and then death.
Lawyer Jane would even try to argue me out of my sinking sadness. I tried to convince myself it wasn’t logical to be upset now, since I’d long accepted that my folks needed a fair amount of help from Florence, and now they just needed more. Psychotherapist Jane jumped in and encouraged me to observe my fearful and sad thoughts, rather than allow myself to get drawn into or paralyzed by them. Sometimes that was hard to do, since my feelings seemed to want to “run me.”
POParenting required me to pull myself back into the present as quickly as I could because it was in that authentic present—and without drama—that I made my most sensible and wise decisions. And right now, my parents were not leaving the planet or me but just New York, and they needed to live in a place precisely like the one I’d worked so hard to find.
Doing POP is, by definition, bittersweet. My folks seemed so vulnerable now, not the invincible figures they’d been years before, when they’d been “the parents.” I was POParenting older parents whose aging genetically programmed them to become less capable of independence and ultimately more childlike. This is strikingly opposite to the experience of parenting children, who are genetically programmed to do the opposite—they become more independent and less infantile. When we launch the children we’ve raised and fallen in love with, we’re shipping them off to (presumably) bright, shiny careers, schools, and marriages to fulfill what they learned originally when they were with us. But when we launch our beloved parents, we’re sending them off to apparent emptiness and the big unknown.
Anticipating their moving closer, I recognized that proximity would also allow me to observe my parents’ day-to-day declines. It seemed to make the time we had left together especially poignant. None of these times could ever be recaptured, but I most often noticed the bittersweet taste when my parents seemed most like their old selves again. It was as if I could see through the old people they’d become to the individuals I used to know. Those remembered parents sometimes seemed more real than the aged couple in front of me.
In the early 2000s I trained under the direction of Dr. Martin Seligman and his expert network of researchers and clinicians I named the “Happiness Scientists.”[2] Their rigorous studies validated some conclusions I’d also reached while working with patients in my office. Doing certain practices regularly and repetitively can and will retrain a brain’s connections. I learned that we can expand our capacity for real joy in life by consistently engaging in three activities—being grateful, granting forgiveness, and savoring the good in our lives. As a result of doing so, we can reset the level of our “happiness thermostat,” that internal mechanism that operates to regulate our emotions much like a thermostat regulates the temperature in our homes. One thermostat raises our environmental temperature and the other our internal happiness level. It was apparently up to me to move that dial, and I could indeed raise it!
Once Mom and Dad moved into my world in California, I reminded myself that I could—and probably should—practice this happiness formula for myself specifically in relation to doing POP. On a daily basis, I made the determined practice to invoke all three: gratitude for having them as my parents and being able to share that appreciation by joyously POParenting; forgiving my parents, and myself, mainly for being human; and delighting in the gift of this moment. I promised myself to focus on the sweet side of the bittersweet, savor the present and its many good times while doing POP.
While not denying my real sadness, especially when I anticipated the future of our POPcycle, I didn’t see much utility in bathing in that grief either. I would remind myself: Live in the present, Jane! Your parents are very much alive! After thirty-five years of living apart, I now had the chance to become closer and more loving with my family and to accentuate the positive in all of that would add to its sweetness.
The three of us needed me to be enthusiastic and to share with Jack and Lillian how attractive the move and their new place would be for them. I’d be no good for any of us if I continued to concentrate my thoughts on their “inevitable descent” or talk about this upcoming phase as “institutionalizing” my folks. Those words sounded very dramatic but didn’t really represent my truth.
Instead, I could more accurately and helpfully coach myself by applying a tool from cognitive research called “reframing” my thinking. Reframing involves examining our thoughts and noticing how else we might think about the same topic, perhaps more neutrally and less emotionally. What I’d been telling myself was that moving them to the ALF was “putting them in an institution.” When I applied the tool of reframing, I could envision that same activity as “picking out my parents’ next home.” How much more positively I could—and did—feel, and how much more energized I was to complete the task, with that new point of view!
Simply shifting my way of thinking about their move helped quite a bit. Afterward, I was far more comfortable settling my parents in, even making decorating choices for them with more ease and confidence. Reframing became a reliable technique and POP coaching tool that I was happy to teach so many of my clients. And, it was a tool I would return to myself often during my time of POParenting, especially when I found myself feeling stuck in repetitive unwanted feelings.
The ALF I chose for Mom and Dad was only a few short miles from my home. The eucalyptus trees just outside their patio provided beauty, shade, and a distinctive aroma I’ve come to associate with Southern California. Downstairs, the food smelled great and tasted even better. Mom would soon be looking forward to a sitting yoga class while Dad would enjoy reading undisturbed in the quiet library.
I wondered: “Is there a minimum age to move in?”
Most families will have many options for elderly parents to safely live out their final days. If your parents need to move from their current location, hopefully you can choose a place that will remain a viable residence through the course of their illnesses and declines so you can avoid moving them multiple times. Multiple moves add to everyone’s turmoil and they present particular challenges for those with cognitive limitations. Moving away from familiar settings is disorienting and sometimes appear to trigger the final decline and death of seniors. Moving from home to an ALF to one SNF after another, as my mom’s conditions eventually required were traumatic each time. It’s stressful for any of us to have to move our stuff and ourselves from our home, and then to readjust and have to learn many new things. But for seniors with dementia, it is best if we can POPlan in advance for as few moves as possible.
It should come as no surprise that most Americans over fifty would prefer to remain living in their own home than have to move. My parents did, and yours may too. Certainly, one reason people don’t want to move involves the series of upsets associated with it: the loss of familiar people, places, and activities and the anxiety of the unknown ahead. Experts claim that moving is one of the highest stressors in life. It’s also hard physical work to prepare, sort, pack up, cart, haul, unpack, and replace things in new places. If moving is hard on a healthy adult, you can only imagine how much more traumatic it might be to your parents. They rarely have the mental or physical energy, stamina, and level of recall that younger people do.
Essentially, your POP choice comes down to three approaches: aging in place; moving to a relative’s home, or choosing a senior “institutional living” facility. None of these is inherently superior to any other. Each type of living experience is very different, and each has its advantages and disadvantages. In deciding, you face the uncertainty of not knowing the number of years your parents have left. If you have limited resources—and who doesn’t—you’ll need to consider price as you look over these alternatives. Other costs, such as your own emotional, physical, or cultural demands, may be even harder to calculate.
If your parents want to “age in place” (stay in their home with extra measures taken to protect them) and your TEAM POP agrees they can do so without much apparent risk, that may be your best option. There are some great advantages for your parents if they can stay living where they’ve resided for a long time. By staying where they have long actively engaged in life and everything is familiar, your parents may enjoy stability and community that are irreplaceable. Having to adjust to a new home, to new neighbors, new routines, and to so much else that is unknown can be taxing at any age. During their senior years, such a move can be overwhelming.
But neither should you underestimate how upsetting, sad, or depleting moving your parents may be for you. Some of you, like me, will be packing up homes where you grew up. During this process you may find yourself caught up in nostalgia and other emotional memory jogging. It may bring tears to your eyes to watch your sweet, maybe shorter, loved ones go to their favorite haunt together one last time. I choked up watching Jack and Lillian at their local deli savoring their last New York corned beef sandwiches on corn rye with sour pickles. Seeing your parents leave behind friends or siblings with whom they shared both happy and tougher times, knowing they’ll never see each other again, can wrench you apart. Many of these moments can be avoided if your parents stay in their home.
Should your parents be able to age in place, you will find a growing industry to help you create in-home environments that support staying at home as a decent and safe alternative to institutional life. Unlike the POParents who will need to find a new setting, your challenges will be to help make your parents’ current housing become even better. If you can avoid having your parents move late in life, their successfully aging in place will also necessitate more work for you. You may need to make modifications to their environment so they can access sufficient safety and hygiene methods as well as obtain good nutrition, stimulation, and social interaction. Then you will also need to see that those things actually are happening and, later, also check that they are working well.
Those who advocate aging in place remind us that many senior parents can stay happily and safely living in their homes, even living alone, provided certain modifications are made and/or certain technology is available. Others point out that aging in place may also require assistance from occasional or full-time help. If one or both of your parents served in the US military, they may qualify for a program called Aid and Attendance (A&A) Pension. It provides benefits for veterans and their surviving spouses who need another person to regularly attend and assist the person in eating, bathing, dressing, and undressing, or taking care of the needs of nature.[3]
Another group of modern geriatric professionals, certified aging-in-place specialists (CAPS), is available to help your parents remain at home. Their offerings can be particularly useful if your parents’ need for modifications is a result of a traumatic event (usually a fall) or a more progressive decline in their function or mobility.
Falling is the leading cause of injurious events to older people. The two major goals of suggested home modifications are to prevent falls and to allow seniors better access to their possessions and daily activities. Some repairs involve taking steps that are as simple and inexpensive as removing clutter and dangerous throw rugs. Other modifications may include installing handheld flexible shower heads, grab bars, and nonskid flooring in appropriate locations. Increasing lighting, railings, and accessible light switches near stairs are also often recommended measures. In general, adding more light to the environment of our seniors is very helpful—whether by replacing bulbs with stronger ones or adding additional lighting and lamps.
Other modifications may be costlier and require hiring a skilled person, perhaps a contractor, electrician, plumber, or a handyman. You may need help if you wish to create sliding shelves and drawers, build walk-in closets and showers, or widen entryways or build ramps for wheelchair access. Your out-of-pocket cost for these installations is likely to be well worth the long-term savings to life, limb, and everyone’s stress levels. Perhaps there is also a program where you live that will help pay for such fixes.
Technology’s contributions to your parents’ ability to age in place grow with every moment. Smart houses are being developed to address the variety of hazards associated with the cognitive and physical declines of older adults. “Elder cams” run on the same surveillance premise that “nanny cams” offer concerned parents watching their children. Even now, apps on your smartphone can allow you or your parents’ keyless entry and cashless payments for needed POP items. In all likelihood, all sorts of new tech tools will come along to help your parents remain as independent as possible in their own dwelling.
If your parents are fifty-five or older and meet certain conditions, they may be eligible
to stay living in their community and receive comprehensive care at home rather than
in a skilled nursing home under a federal program entitled Program of All-
Inclusive Care for the Elderly (PACE).[4] This began as a pilot project and because it was so well received, it has been
expanded to many American communities. Over time, we may see other programs that support
aging in place becoming even more accessible.
But like the other options, aging in place has its disadvantages too. There is a toll that having your parents’ stay in their home may take on you. As I have said, when my parents were aging in place, I had numerous long-distance POParenting concerns and distressing weekends until their conditions left our family without that option. Aging in place is complicated when all the adult children (or the only child) live at a distance or when those who live close by are already occupied caring for their children, homes, jobs, and lives.
Another problem with your parents remaining at home is the danger of their becoming socially isolated there. As your parents age, several factors coalesce to make this period a potentially lonely one. If your parents no longer go out to a job or senior day care, they may spend many days or much of every day sitting alone in their homes, having no contact with other people. Your parents’ closest friends and relatives may have died, moved, or divorced. Now there may be few if any of them left in the neighborhood. As caring POParents, we cannot overlook the growing data of the great toll loneliness has on our isolated seniors and the real advantages of some well-cooked meals spent in the company of peers.
Your parents’ diminished senses of sight, smell, hearing, and/or taste may affect their interest in and enjoyment of other people’s company. Being in pain or having little energy similarly makes socializing a strain. Some of your parents will even experience shame or embarrassment if they have become forgetful or can’t easily learn new things. All of this has the potential to have your parents further insulate themselves and remain within the so-called safety inside their homes.
At this point in their development your parents may have little inclination to leave home to meet new people or make new friends. If they remain living in their own home, your parents are likely to relate to fewer and fewer people and live in a smaller and smaller world over time. Exceptions exist and perhaps your mother attending her years-long Tuesday-night canasta game with “the girls” might be one. Or something unexpected and wonderful may happen in their lives, like your parents becoming best friends with a couple who happened to be seated near them in a restaurant. However, your parents will likely have diminishing social support and engagement if they age in place.
A part of your POParenting responsibilities will be to discover how to encourage your parents to get out of their homes, hang out with their friends, and attend activities they enjoy. It is part of your job to be keen to symptoms that may look like depression. Loneliness and isolation can lead to clinical depression and even suicide. If they will allow you to, your finding interesting local activities or arranging the equivalent of senior “playdates” might just lift your parents’ spirits.
If your parents can stay in their home, you may be able to undermine some of this loneliness by staying in better communication with your parents, maybe better than I was. Skype, the internet, FaceTime, and the many other communication developments since my parents were long distance can help you mitigate the potential danger of your parents becoming too cut off. Sharing family events they cannot attend and keeping up with their grandchildren on the computer can bring your parents immediate pleasure and keep them involved in your life and vice versa.
The second major approach for where your parents can age comfortably is for you or your siblings to offer them a place to live in one of your homes. If you’re thinking you might be willing to step up for that, stop and ask yourself: is it optimal to bring my parents to live in my home? And if your answer is a clear “no,” whether immediately or after much soul-searching, consider whether your sister or brother’s home would be any better. If you or your siblings answer “yes,” you will need to assess whose home would be best for your parents and why. If you and your siblings have responded affirmatively, all of you should read these next paragraphs carefully. If your answer is “no,” for all your homes, you will need another alternative altogether and can read below about institutional options.
But just because you and your parents can make it work, to bring an aging and/or ill, disabled, and demented parent into your home doesn’t mean it’s really the best choice for any of you. You need to discover if POParenting in your home is viable for you and whether it is the optimal place for your parents over the long haul. Realistically evaluate your parents’ current and imminent needs. You may think you can watch your parents more carefully if they live in your home than in theirs or in a residence but maybe not. I believe it is crucial to search your heart and mind before you answer, perhaps in the way you did before deciding to bring a child into your home.
Analyze all the elements involved before committing to a potentially life-altering transition for everyone living in your home. Look at the many different aspects of your current life, including your employment, relationship with your spouse, your health, and your home’s configuration. Recall your long-standing history with your parents and how you’ve all fared more recently together.
If you work full-time or part-time, would you have to sacrifice your job or its benefits to care for the parents in your home? What if your parents’ disabilities eventually require two to three aides to transfer them from their beds to the bathroom commode, as my Mom did, toward her end? If your parents’ cognitive declines require increasing hours of professional care or even more caregivers, would your home still be optimal or even an acceptable location? Would that be affordable in your home or would you need to move your parents again?
Consult a variety of family caregiver support programs, such as AARP and other organizations focused on family caregivers and their special needs. Find out the costs, financial and emotional, and learn about the benefits. Talk with others who brought their parents into their homes and listen carefully to what they have to share. Go online to the POP website and communicate with other POParents who are doing that in real time at the POP website, www.ParentingOurParents.org. You may be exposing yourself and your family to the rigors of living with chronic disease and/or dementia. Hearing details of how doing that affected other families may provide you with very useful insights. Even if your spouse, your children, and your siblings all believe that “everything will be just fine and we’ll help too,” listen carefully to your own wisdom!
As you assess your own limitations and those of your parents, you want to think in detail and be alert to the most likely possibilities. For example, is there enough security in your home for your dad with Alzheimer’s? Such patients often wander off without securely locked exits. How will your parents negotiate the steps in your home if they need a walker and have to go to the bathroom in the middle of the night? Will they be waking you?
Can your marriage survive if it’s already in a stressed state and your parents move in along with your “boomerang” adult children? If everyone ordinarily is away from 8 a.m. until after dark, can your parents prepare their own lunches, go to their doctors unaided, and be alone all day? Will they need a caregiver for some hours in your house? Will you be able to “hold your head up” in your family if you refuse the traditional dictates of your culture that “require” you to bring your parents into your home?
If no relative’s home is right for your aging parents, where will you and your family look next? Your third approach for today’s senior residences is the wide range of attractive institutional options. Although the term “institutional life” may sound off-putting, like you’d be shipping your parents to the back ward of some old, dank hospital in the 1950s, quite the opposite is true today. At one end of the spectrum, some institutions are simply private apartments in buildings or communities with other seniors. At the other end are locked settings where the residents’ mobility and care are provided by staff.
What type of out-of-home experience is most suitable for your parents? The first step, which you’ve already begun, is to become clear about what level of care your parents require for their safety. Since you hardly want to see them as weak or needy, beware not to underestimate the extent of your parents’ disabilities or their need for assistance.
The institutional setting for seniors with the fewest needs is termed IL.[5] These facilities permit “as needed” caregiving services to be added to your parents’ bill or allow POParents to hire outside assistance. If your parents were able to care for themselves fairly well in their own home, this might be a good choice. However, if they need more care or you envision that happening in their near future, your parents may be better off living at the next level of caregiving, an ALF and avoiding the necessity for multiple moves.
Some ALFs and IL facilities have very specific restrictions. Most won’t admit a resident who has a gastric feeding tube and require a resident to be able to evacuate the building without assistance in case of an emergency. Some offer flexibility by having different levels of care provided residents on different floors in a single building. If your parents become more needy, one or both of them can stay in the same facility but move to a different floor. This allows for continuity in location and staffing as well as permitting couples to have much contact in spite of being at different levels of aging. A Continuing Care Retirement Community (CCRC) is an option that offers families a contract that allows for continuity of residents at a single location during the entire POPcycle, with fluidity in the resident’s housing and needed nursing care.
Your TEAM POP can meet to clarify and prioritize the desired characteristics of the new residence that meet your parents’ specific needs and desires. You can use a POP Family Coach to help you and your parents sort out the various choices and parameters of this critical decision and help you be better equipped to find precisely what you’re looking for and know when you’ve found it. You’ll also need to check out which facilities have space available and what is affordable for your family. Cleanliness, the number of residents, proximity to family, privacy, and accessibility to your parents’ doctors, churches, transportation, and stores are certainly likely to be relevant features in your evaluation. It will be helpful for you to consider the attractiveness of the setting; size of the rooms, closets, and bathrooms; the extent of the recreational activities; the attention you observe that is given the residents by staff; and, of course, the quality of the food.
You will want to inquire about their professional people. I liked to hear that the staff remained working at a facility for a long time, since that longevity probably represented satisfied employees and my parents could feel assured that the staff would be there with them over time. In some states, such as California, senior facilities are required to maintain and make available to consumers a book in which all problem situations and their fixes are noted. If you have that advantage, you can look at any remarks or history and are likely to find it highly instructive. You can see if governmental authorities issued any orders or negative reports and ask lots of relevant questions. Consider moving on if you’re not okay with their answers.
Your POP role will be evaluating the alternatives and making your parents’ transition as seamless as possible. It will begin with your helping them accept that their leaving home is necessary and end after you’ve settled them into their new home. As you begin to look at these residences, you will develop a nose—often literally—for one that is likely to work best for your parents. And where else can you go to find your parents’ new home? Fortunately, there are lots of methods to locate senior living facilities. Word-of-mouth, online searches, governmental reports, and professional referrals can each prove helpful to you. Increasingly, online entities provide their take on what will be good for your family, but beware that many websites are commercially sponsored or supported.
Your parents may protest and not like your choice. They may believe and wish you to believe they need less attention than is really warranted. Many will be concerned about the cost of all of this. Maybe your parents are embarrassed at the loss of some of their faculties or mistakenly see that as a weakness to be hidden. I always recommend that you treat your parents’ aging limitations with respect and kindness and that you honor your parents’ intelligence even in their last days. However, if your dad repeatedly can’t remember to turn off the water when he runs his bathtub, you will need a facility that makes sure that happens, either by requiring you to hire additional help or providing it.
Professional placement agencies, such as the one I used, are another link in the geriatric service industry. They will need to interview you or your family’s representative and maybe your parents as well. They will be discovering your requirements and hearing your preferences. After that, they will generate a list of maybe ten facilities for you to visit. Similar to how employment agencies work, their services are generally paid for by the residential facilities and are therefore complementary to the families. They can help you see where on the POPcycle your aging loved ones really are; clarify your priorities; and provide up-to-date information on charges, availability, and facility requirements.
As with other “real estate” decisions, the three watchwords for your POP housing choice may be location, location, location. When you start visiting your parents often, it will be clear why it’s easiest to do POP locally when they live close by. It also might be advantageous to find a facility near to a freeway or on your route to work. Proximity to public transportation for your parents who may not drive can also be wise.
Our government regulates today’s senior facilities. Most you will find are respectable and some are so elegant, you’d bet you were in a boutique hotel. Nonetheless, there are still some institutions that have significant problems that can pose a concern for POP families. How will you be able to know which is which?
In addition to the ways already suggested to check out facilities, you now have two specific websites to help you learn about their defects and governmental inspections. The Centers for Medicare and Medicaid Services surveys and certifies the nation’s roughly fifteen thousand nursing homes. It has made available online the full text of reports that nursing home inspectors have filed for each of these facilities, a step many have urged for years. By going to https://www.medicare.gov and navigating your way to Nursing Home Compare, you can access this useful data. You can also do POP research at http://projects.propublica.org/nursing-homes, a website set up by a nonprofit organization of journalists. This site allows you to specifically discover nursing home defects in a simple, state-by-state manner.
There are always scary stories when people with some vulnerability, like our elderly loved ones, are living in institutional settings. And you must always stay vigilant when your parents are living in such places, but few are anything like what my mother had dreaded from the 1940s and 1950s. These days, most senior residential facilities pose few hazards and the majority of people who live there are grateful for the companionship, care, and activities afforded them in these residences.
See, for example, the Time magazine, January 17, 2005, special issue, “The Science of Happiness.”
To check if your parents qualify for this program, no matter if they are living in their own homes or in an assisted-living facility, go to https:// www.veteranaid.org.
Check online at http://www.Pace4you.org for those conditions and the benefits available.
Although this term also represents a philosophical position about people with disabilities, when we’re speaking in this eldercare context, IL is a step on the continuum of care requirements with assisted living—help from others—being the next rung up of care.