Four out of ten American adults provide care for an aging relative, a figure that is projected to rise dramatically in the next decade. If you are among these adult caregivers, you are intimately familiar with the myriad of issues you face and the enormity of the challenges that accompany your role. Whether you are caregiving now, or know that it is only a matter of time before you will be, a threshold issue that may well arise during the caregiving period is where the person for whom you are providing care will live.
The issue of an elder’s possible move is complex and laden with layers of emotion. It is not uncommon for an elder to have lived in their home for thirty, forty, or even fifty years. Their home is the place where they metaphorically “grew up, ” where they raised their children, where the family congregates, where the stories of their lives are shared and displayed. Many cannot bear to even consider, much less discuss, leaving the place that means everything to them.
Consider these common scenarios:
** Now eighty three, Mom lives in a 3,000 square foot colonial in Wayland, MA that she purchased in 1963; Dad passed away two years ago. Mom recently had a stroke. Although she is progressing nicely in rehab and will soon be released, she is no longer able to climb stairs, and has partial paralysis on her left side. Her son, Eric, lives in Philadelphia and her daughter, Myra, lives in western Massachusetts. Both Eric and Myra are insisting Mom sell the house and move to an assisted living facility. Mom says the subject is closed and that she will sleep downstairs on the living room couch if necessary.
** Dad just celebrated his seventy ninth birthday. He and Mom live in a modest cape near the beach in Scituate, MA. While they do not have any major health issues, both parents are slowing down considerably and find themselves unable to adequately maintain their home. Mom desperately wants to sell the house and move to one of the lovely apartments in a nearby continuing care community. She is excited about the lifestyle there. Dad and Jason, their only son, won’t hear of any such move.
** Aunt Bess has terminal cancer and is unlikely to live more than another eighteen months. She wants to die in the home she has lived in for forty years; however, the doctor recommends that she be placed in a nursing home where she can receive skilled medical care when necessary. Mindy and Michael, her niece and nephew caregivers and only surviving family, are terribly concerned about the costs of nursing home care, recognizing that Aunt Bess’s resources are minimal. She has been able to remain in her home only because the mortgage was paid off years ago.
In each case:
- An elder wants to remain in the place they consider home.
- A spouse, adult child or other caregiver believes it is time to consider a different living arrangement.
- Conversation has stalled, family tensions are on the rise and no decisions are being made.
In the silence that ensues, Mom, Dad, Aunt Bess and each of their caregivers are likely to become further entrenched in their positions, perhaps straining or fracturing the close bonds each family has shared.
Through mediation, families can have the discussions necessary to work through critical residential and continuing care decisions. Neutral mediators help ensure that these confidential conversations are productive and search for the common intersections among participants’ goals. As various options are explored, some of the many questions that may be asked may include:
For the elder:
- What would remaining in the family home enable you to do?
- What would change for you if you were to move?
- What is most important to you about remaining where you are?
- What types of alternative residential living options are you familiar with?
- Have you had an opportunity to visit any continuing care communities?
- If there were an understanding that you were not making any commitment, might you consider gathering some information about or taking a look at some options?
For the caregivers and/or family members of the elder:
- What are your most significant concerns about (Mom, Dad, Aunt Bess) remaining in the family home?
- Are there ways to address those concerns that might allow (Mom, Dad, Aunt Bess) to remain in their home?
- What kinds of assistance and/or care might be required?
- Are there ways to modify the home to make it possible for (Mom, Dad, Aunt Bess) to continue to live there, and to address each of your concerns?
And for all involved:
- What are the costs associated with each option? Who will bear the financial responsibility?
- How might nursing home care be financed?
- Have you met with an elder law attorney regarding eligibility for assistance?
These are but a sampling of questions that a mediator would help a family explore in considering the important issue of where an elder will reside moving forward. To be productive and inclusive, discussing a loved one’s current and future living situation requires having a collaborative family discussion. Often, these discussions are not easy. With the guidance of an experienced mediator, you can consider these and other questions, ensuring that each voice at the table is heard and that each participant’s perspective is understood. Mediation provides the opportunity to make thorough and thoughtful informed decisions, while preserving family relationships.