Your parents are healthy, live independently in their own home, and seem to manage well on their own with little help or oversight. But how can you be sure, and what can you do to make sure nothing changes? If you live nearby, visit frequently, occasionally without advance warning–that way you can see how they are really doing, without giving them a chance to tidy up, do the dishes, or make sure they are wearing clean clothes. If they are having trouble and could use help, they may want to keep it from you. They may not even want to admit it to themselves. Enlist friends and neighbors to help with this and report back to you if anything seems amiss.
If you do find a problem, you need to fix it. Will a part-time housekeeper help? What about finding someone to help with shopping and meal preparation? Or maybe someone to drive to doctors’ appointments and take them shopping?
But fixing a problem, or problems, where aging parents are involved, is tricky. A problem needs to be addressed, but it needs to be done in such a way that your parents retain as much dignity and independence as possible while their needs are safely addressed. In other words, it requires a delicate, and tactful, balance.
Where, and How, Should They Live?
- If they are independent, live in their own place, and can take care of themselves with little oversight and help, find ways to make that work. Can family members, friends or neighbors who live nearby check in–casually and unannounced is best–frequently to assess the living situation and check for changes in health, hygiene, and behavior and report to the caregiving team?
- If they need help with some tasks–paying bills, shopping, preparing meals, laundry and cleaning, taking care of the yard, and transportation to doctors’ appointments are examples–can these responsibilities be delegated to members of your team, can you do them yourself, or do you have to hire someone to help out? If you need to hire someone, can your parents afford it, will the family have to chip in, or are there community programs that will help?
- If physical safety is a concern, you might have to “parent-proof” the home. Among the changes you should consider are installing grab bars in the bathroom and eliminating obstacles–like throw rugs, electric cords, even tables and chairs–that might cause someone to trip and fall. Arrange frequently used kitchen utensils and appliances so they are easily reached, without climbing, and since statistics show that most accidents and falls occur in the bathroom, pay extra attention to safety-proofing there.
At some point, it may become clear that your parents’ care needs cannot be met in their home and you will need to consider different living arrangements. Again, this kind of change needs to be discussed in detail and in advance with your parents and members of the team.
Your parents may simply refuse to move, maybe because of longtime fears of being “dumped in an old folks’ home.” It will require consummate tact and a convincing argument for why a move is in their best interests. Financial situation and costs often are part of that discussion. It may help if you take them around and show them the options so they can decide where to move. Any transition will be smoother if your parents don’t need different kinds of living accommodations–if, for instance, one doesn’t need Alzheimer’s/dementia care and the other doesn’t need 24-hour nursing supervision.
Choosing a facility, one that has space, is another hurdle. Friends, family members, your parents’ physician and other health care providers may offer some guidance, but your local long-term care ombudsman may have suggestions. (The National Long-Term Care Ombudsman Resource Center at can connect you with a local ombudsman.) You need to visit the most promising–not once but several times–to get a sense of the atmosphere and ambiance. Ask lots of questions. After the all-important cost question, you need to know what services are covered and what costs extra, as well as about openings and any wait list. For additional information on choosing the various types of facilities and level of care, read our articles on Assisted Living and Nursing Homes.
Different Kinds of Moves
If one of your parents is hospitalized and ready to be discharged, things can happen rapidly and you need to be prepared with a “post-care” plan before discharge (The Assisted Living Federation of America provides a checklist of questions to help plan for a safe discharge). A hospital discharge planner will craft a plan for discharging your parent either back home or to a facility that will provide the appropriate level of care, and then coordinate the movement of your parent from the hospital to a skilled nursing facility or rehabilitation facility, or provide for home health care. If the planner recommends a skilled nursing facility or a rehabilitation center, you should visit the facility before the move and also be available to help with the actual move.
If one (or both) of your parents is mentally confused because of Alzheimer’s disease or another form of dementia, you are looking at a different kind of move, this time a facility that specializes in dementia care. Ensuring the parent’s safety is a key concern. Wandering is the main reason for placing a parent in a facility that protects the parent should he or she roam.
If your parent has a terminal illness and needs continuing care, you may want to consider hospice. Hospice care is a service, and that service may be provided at home or in a nursing home. Whether Medicare coverage or other types of insurance will help cover the costs depends on the situation.
Other Potentially Useful Resources
There are a number of organizations and community resources as well as disease-specific organizations that can help family caregivers with information on finding local home health care services, nursing homes, hospitals and other resources (see our Resources for Family Caregivers page for online links to various organizations and community resources). If your parents belong to a faith community, many may offer services (i.e., Catholic Charities and Jewish Family Services). If one of your parents served in the armed forces, the US Dept. of Veteran’s Affairs has information on medical care and long-term care options.
As with all the fact-finding investigations, again, communicating regularly with all team members and friends about what local communities offer for aging adults is critical to carrying out your basic plan of care.