The decision about when it is right to place an aging parent with Alzheimer’s into a care facility is always challenging. After all, no one wants to go to a nursing home. Many adult children have even made promises to their parent to never place him or her in a nursing home.

Yet, as Mom or Dad’s need for care increases as their dementia progresses, how do you keep your fiercely independent parent safe? Over the years, I have sat down with hundreds of loving families who have been faced with the very same challenge. I certainly understand your struggle.

The purpose of this article is to examine the pros and cons of some of the more popular solutions that many of these families have tried. I’ll preface the article by stating that there’s no one solution that’s right for every family, i.e., each family has its own unique set of circumstances and family dynamics.

Solution #1: Adult child lives with parent. This is actually quite common. Usually, this is because the adult child never left the home in the first place. The “pro” is obvious — the aging parent gets to remain in the home (provided the adult child doesn’t get sick or pre-decease the parent).

Unfortunately, the “con” is that the adult child literally has no life outside of the parent. Quite often, they have no job since caring for the parent is “full-time.” Almost always, the adult child is not married, has no prospects of marriage, and has no children. I often wonder how that adult child will cope after losing the parent.

In return, the parent does all he or she can do to make sure that the child has, at a minimum, a roof over his or her head after they are gone. If you have more than the one caregiving child, it may mean changing your will or trust to give the caregiving child 100% of the home.

“But Judd, I want to give to all my children equally.” Most parents do. The problem is that if you have three children, and they all inherit the home “equally,” the non-caregiving child(ren) could force a sale of your home after you are gone, leaving the caregiving child without a place to live.

“But Judd, can’t I give the home to all my children equally subject to a lifetime right to occupy for the caregiving child?” Perhaps. You need to see your estate planning attorney. While you’re there, make sure the home is protected from a future Medi-Cal estate recovery claim in case of long-term care.

Solution #2: Aging parent moves in with adult child. This usually happens after the loss of a parent. The surviving parent would sell the home and move in with a child. To make sure the aging parent still has enough independence, some of the proceeds of sale from the home are often used to build an “addition” to the adult child’s home.

The “pros” are that the aging parent doesn’t need to go to care facility, and the adult child gets a built-in babysitter. Quite often, this can work out just fine. But be careful with this one. The “con” is that this can also be a disaster for the adult child’s marriage.

Studies show that caregiving can strain a marriage as the caregiver tries to do too much and the spouse feels neglected and burdened. Even if your spouse is fully supportive as you become a caregiver for your ailing mom or dad, the strongest relationships can still be affected by the stress, lack of privacy and financial pressures that come with caregiving. (Source: AARP, May 22, 2012)

One senior come into my office after she had moved in with one of her three sons. The daughter-in-law broke down in tears as she explained how her mother-in-law verbally abuses her and accuses her of stealing. “That’s part of the dementia,” I said, but I don’t think it made it hurt any less.

I have also seen siblings rotate Mom from house to house, i.e., Mom spends one month at each child’s house. It seemed to be working for this family, as no one child takes on 100% of the care. If things start to get “unbearable” for any child or spouse, at least there’s hope that things will get better next month.

Although it’s quite rare to get that kind of cooperation between siblings. More often than not, getting siblings to agree will an uphill battle. For example, one child will say “Mom and Dad’s home should be used for their care. Let’s look into a reverse mortgage.” However, another child would be dead set against it.

Solution #3: Professional home care. If the parent (or the child) can afford it, bringing in professional home care has many “pros.” First of all, the parent gets to remain at home. Second, when you visit, you can spend your time with Dad or Mom as his or her son or daughter, rather than as the caretaker. Third, the parent doesn’t need to feel guilty about having to trouble you.

The “con” is professional home care is so expensive that it really isn’t an option for most families. The 2011 average cost for a home health aide was $20 hourly (John Hancock’s 2011 Cost of Care Surveys). For 24-hour live-in care, it is between $150-$350 per day. That’s as much as $10,500 per month!

I am constantly getting people coming into my office wanting to get Medi-Cal to pay for home care. “Sorry,” I would say, “Medi-Cal will not pay for home care.” I go on to explain that there is a county program called In-Home-Supportive-Services (IHSS) that will pay for some home care, but usually not too much (if at all).

In summary, if Mom or Dad can’t live independently any longer and: (1) there is no adult child living with Mom or Dad; (2) and if it’s not possible for Mom or dad to move in with an adult child; and (3) providing 24/7 home care is out of the question, there are not a whole lot of options left.

Remember, nursing homes exist for a very good reason. Many loving families end up having to put relatives in nursing homes because that is the best place for them to be. Keep in mind you are not looking at putting your mom in a warehouse. I’ve had plenty of families tell me that their loved one actually got better once they were receiving 24-hour care.

Don’t allow your guilt to get in the way of making the best decision for your parent; you are doing him or her (and yourself) a disservice. Furthermore, if you wait too long, his or her memory will be so impaired that the facility will never become familiar and he or she will never feel at home there.

To be continued …

Judd Matsunaga, Esq., is the founding partner of the Law Offices of Matsunaga & Associates, specializing in estate/Medi-Cal planning, probate, personal injury and real estate law. With offices in Torrance, Hollywood, Sherman Oaks, Pasadena Fountain Valley, he can be reached at (800) 411-0546. Opinions expressed in this column are not necessarily those of The Rafu Shimpo.

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