The Dreaded Dilemma:
To Move or Not to Move Frail, Aging Parents?

by Dr. Sara H. Qualls, Kraemer Family Professor of Aging Studies & Gerontology Center Director at the University of Colorado at Colorado Springs

Colorado Springs Senior Magazine, Spring 2009

We’ve all been there or we will be there soon. A parent or other loved one becomes so frail that we worry about their safety at home. Do we move them to senior housing that offers more support for their independence and safety, or do we add support services to them in their home?

Below is a recent email I sent to a friend who is faced with that situation (details changed to protect anonymity). Robin’s father recently suffered from a fall in which his hip was broken. After surgery and rehabilitation, he still faces risks of reduced activity and falls for a while. Also, he is showing some signs of cognitive impairment that may be a short-term reaction to the fall and medications or may be a longer-term problem. Robin’s mother shows more serious signs of cognitive impairment that suggest she might be in the beginning stages of dementia. So far, Robin has helped her parents stay home with assistance from professionals, but now they need 24-hour care, which is not funded by insurance. Robin wants to know whether to move, and if they move, should it be to independent living, assisted living, or memory care?

“Dear Robin—
I think the first concern is the level of assistance your mother needs while your father is in rehab. Although her memory problems are a concern, they do not inevitably mean she needs a memory care unit. If your mother wanders and needs a secure environment, a memory unit might work best. If she simply needs to have supportive care and activities appropriate to her abilities, then assisted living (AL) may be sufficient. Your mother may require the top level of services offered if she goes to AL. If your father leaves rehab with good mobility, then I would guess that he may require only the lowest level of AL services. They could possibly share an apartment in AL. If the AL has a memory unit, your mother join in those activities to provide your dad with his own time and social network.

The option of keeping them at home offers plusses and minuses. Sounds like your parents’ in-home caregiver arrangement has worked well so far. Many older adults value staying in their long-term residences, and there are many ways to modify the home environment so they can “age in place.” Home care also has risks to consider. Families always need to monitor home-based care services. Costs for round-the-clock care are high. The main limitation of in-home care is that it provides no social connection (other than staff) and limited activities to maintain mental and physical stimulation.

Moving your parents also has pros and cons. The pros include reduced effort needed to maintain a smaller living space along with built-in supportive services and social networks. If his impairment grows after rehab, then they will both require increasing amounts of care and structured activities. The cost for 24-hour services in AL is less than home care. The cons of moving into senior housing are the sense of loss, giving up a familiar home. Elders are often daunted by the very thought of the effort it takes to move. Families thus have to structure that process, which is very challenging. Multiple moves are even more challenging, so I always encourage families to think proactively. What if your dad dies? What if your mom dies? How would either of them do on their own? Another consideration is the role that families play during these transitions. Inevitably, persons with cognitive impairment resist change. They misjudge their abilities so they resist leaving home long past the point where they would benefit from a different environment. The caregiver has to consider his or her own stamina, and which site of care will support family as well.

How do you deal with parents who resist any change in care? Families need to guide the decision when cognitive impairments limit the elder’s ability to understand the ramifications of any decision. Families need to offer options that are useful, and remain firm on options that are not. Firm statements like "When dad leaves rehab, you will need to have a different living situation for a while because he can't climb stairs. I have looked into some options that I want you to visit.” Use statements that are respectful and supportive of independence. If you ask, “Do you want to move?,” inevitably the answer will be “No.” It is helpful to leave the future open ended. “If Dad gets better and you all want to return, we can discuss that then. We won't get rid of your house—we'll just move what you want into your new home.” This simplifies the entire concept of moving so it seems less dramatic and final. After all, there is the chance that it may not be.

I wish you the best in your decisions. Let me know if you need further information or an ear for listening.

All My Best,
Sara”

In this day and age, the one thing that we have an abundance of is choices. Our communities are full of choices for how to handle situations like these. Whether your situation involves an aging parent, spouse or loved one, the challenges require a spirit of resourcefulness and open-mindedness. Ultimately, our goal is to seek the best solution for a healthy, happy and thriving life for those about whom we care most.