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When Mom and Dad Can’t Live Alone

Rachel Bachrach

Few realities are more daunting than parents’ inability to care for themselves. Devoted children want to offer the best possible arrangement —but often don’t know what would be ideal. Here, a candid look at the pros and cons of the three most common eldercare set-ups

Wednesday, April 25, 2012

grandfather and granddaughterGitta Neufeld was concerned. On Seder night, when the grandchildren announced, “Time for karpas!” Gitta’s father just held the vegetable, looking at it with confusion in his eyes.

That was in 1997. Unfortunately, Gitta’s father’s behavior became increasingly forgetful and erratic since then. Eventually, he was diagnosed with Pick’s Disease, a neurological illness characterized by dementia, poor social judgment, and loss of language. As time went on, Gitta’s mother, who is in good health, needed help managing both the household and the care of her ailing husband.

Gitta’s father is one of many elderly people who can no longer live unaided. Once these seniors lose their independence, the question that plagues their spouses and children – and sometimes the seniors themselves – is what type of living environment will meet their needs? Should they stay at home and hire assistance, move into a child’s house, or relocate to an eldercare facility?


Home Sweet Home


The Neufelds could have welcomed Gitta’s parents into their Far Rockaway, New York, home. Gitta’s mother-in-law had lived with them for a year before she died, so they were set up for it, but they opted to keep her father at his home; Gitta’s mother wanted to stay in Brooklyn, and they assumed her father would fare better in a familiar environment.

Even with her parents in their own home, Gitta and her three younger siblings have much to manage, and they spend a significant amount of time caring for their father. There are the smaller details, like arranging for someone to assist their father with his tefillin and read him the Yiddish paper daily. For larger, overarching tasks to run smoothly, each child is responsible for a different area. One sibling takes charge of medical issues, communicating with doctors who wouldn’t appreciate getting four calls about the same concern. Another helps their mother handle the finances. The third manages the legalities, and the fourth oversees social care aspects, like the aides. Gitta’s mother has the final say, but the fact that her children pitch in alleviates some of her burden.

The sheer amount of time Gitta’s family commits to her father’s care isn’t unusual. According to a Gallup-Healthways Well-Being survey last summer, caregiving for an aging family member cam be very time-consuming. Caregivers spend about 13 hours a month on administrative tasks (e.g., researching care, coordinating appointments, and managing finances), five hours daily supervising or providing companionship, and 13 days a month on errands like shopping, providing transportation, and laundry.

Gitta and her siblings, who take turns going to their parents for Shabbos, continually reassess the situation. For example, after their father left the house one Shabbos on his own and was found by a cousin wandering the block, they childproofed the house with kid locks. Early on, part-time aides provided sufficient care, but as their father’s condition deteriorated, he needed someone round-the-clock.

Fortunately, living at home allows Gitta’s parents to remain together. Gitta feels that keeping her father out of an institutional setting has delayed his deterioration.

Of course, keeping a declining senior at home works only if it’s a safe environment with adequate care, explains Batsheva Schreiber, president and CEO of New Jersey-based CareManagers, a healthcare management company for the elderly or infirm. CareManagers’ philosophy is that the least restrictive environment – usually home – is best. Through a variety of assessments, the company’s certified workers help people determine what it would take to keep their loved one at home. For example, many seniors rely on adult children to help manage their situation, but their children may have difficulty managing two households. “The ability to oversee what’s going on is crucial,” says Batsheva. “If you don’t have that ability, you’re not doing a service keeping your parents in their home.”

CareManagers also helps evaluate how well the physical layout of the home accommodates the elderly parent’s needs. Is there space for his wheelchair to maneuver? An extra bedroom for her aide? Stairs – even small flights – can hinder mobility. Safety is another key concern. Will she wander off and place herself in harm’s way? Is he prone to violence, posing too great a threat to others to live at home?

The impact on the senior’s spouse has to be taken into account as well. Living with a sick spouse who is deteriorating is tough. “Much as we children are going through mourning and grief of our own, we still come home to our husbands and our children and oureineklach,” Gitta admits. “My mother is home with a man in a hospital bed.”

While her mother still prefers this arrangement, others may find it too much to bear, even if they feel it’s what the sick spouse would prefer. With the constant presence of aides in the house, the well-spouse may feel an invasion of home and violation of privacy.

Finances are another important consideration. Homecare can be costly, especially if you’re paying privately. “Sometimes the family doesn’t have the dollars,” Batsheva explains.

These factors all affect the outcome, which is why Batsheva stresses that deciding how to care for an elderly parent varies from family to family. “It’s not one-size-fits-all,” agrees Gitta. Her parents’ setup works because they can afford private care and one sister works part-time and is on-call for emergencies.


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