When David Ruttan's father died, his 78-year-old mother's plight worried him. "She was very isolated. They had very few friends," said Ruttan, a California resident. "We were concerned about her driving abilities, and you could tell that she wasn't quite mentally there. She was becoming repetitive. We weren't sure if it was part of the grieving process or something else."
Eventually, Lois Ruttan was diagnosed with Alzheimer's disease, and her son had to face the truth: the mother who once cared for him was no longer able to live on her own.
It's often painful for adult children to talk to an aging parent about loss of capabilities, even when the signs are everywhere: stove burners left on, medication doses missed, wandering, getting lost, being unable to reach the toilet in time.
"They don't want to see the change in their parent. They don't want to make their parent angry. They don't want to offend their parent's dignity," says Suzannah Chandler, LMSW, executive director of Search and Care, a New York nonprofit organization that helps the elderly live at home.
But Chandler says it's important for both parties -- parents and children -- to plan for the day when parents are no longer able to live independently.
In Ruttan's case, discussions about his mom's future went smoothly -- almost. "There was only one bump in the road. She became ballistic when I took away her car," he says. "It was really heart-wrenching."
When he and his mother decided on an assisted-living facility, he fretted. "When I first walked into the place, I was so scared. Is this the right place for my mother? Am I incarcerating her? All these questions were flying through my mind."
While home-care aides can come into an older person's home to assist with housekeeping, shopping, cooking, and other tasks, it's not always enough. Sometimes, aging parents need a new living arrangement with more care and companionship. Nursing homes, with their round-the-clock, comprehensive care, are hardly the only option.
In between, you and your parent have many choices to investigate, from temporary housing set up on your property to continuing care communities that will house your parent through all stages of old age.
Your home or somewhere else?
Some people consider moving an older parent into their own home. Is this right for you?
Quiz your parent about needs and preferences. If your parent welcomes the idea of moving into your home -- and not all do -- think hard about how the new proximity could affect relationships: Will it destroy a good bond, help a distant one, or be a neutral factor?
Critique your home, too. Do you have enough space? Are any stairs a danger? Can you add grab bars to toilet and tub areas?
What about you? Are you healthy enough to take on caregiver duties? Are you comfortable with the idea of helping your parent bathe, dress, and toilet? Do you still work outside of the home? Would your parent be better off in a living arrangement that provides more companionship?
Would too much closeness pose a problem? If so, consider ECHO housing, or "Elder Cottage Housing Opportunities." You can add these small, manufactured living units -- also called "granny flats"-- to the side or backyard of your house. When you no longer need the unit, you can remove it. With ECHO housing, your parent will enjoy both privacy and ready help.
What about an assisted-living facility?
This may be a good option for a parent who craves some of the independence of a retirement community and doesn't need much medical attention, but could use some daily assistance. For example, assisted-living facilities provide help with bathing, dressing, and taking medicines. Seniors often live in their own room or apartment, with meals, house cleaning, activities, and perhaps transportation to the doctor or shopping center provided. Assisted-living facilities, which range from a small home to a large, apartment-like building, may offer some nursing care or none at all.
Nowadays, many assisted-living choices have sprung up to cater to individual tastes. Among the more unusual: ones that enable residents to make wine and go crabbing, or university-affiliated ones that offer classes and discussion groups.
Or a skilled nursing facility?
A skilled nursing facility or nursing home delivers 24-hour nursing care and higher levels of medical and personal care, a good choice if your parent is frail or dementia has worsened. A nursing home also offers supervision to prevent a patient from wandering away, for example, if he or she has Alzheimer's disease.
If your parent enters a senior living facility, be sure to visit regularly. Not only do you offer your loved one companionship and comfort, but you can also keep an eye on quality of care. If you're a regular presence, you'll also develop a better relationship with the staff.
Maybe you're loath to put your parent through more than one major move. If so, look into a continuing care retirement community, sometimes called a CCRC or life-care community. These centers include housing for seniors who can live independently, as well as assisted-living facilities and nursing homes. That way, your parent can move from one type of housing to another as needed.
What's next in elderly housing?
A new wave of communal housing may emerge, especially as baby boomers age in large numbers. In Davis, Calif., a group of 12 friends, average age 80, pooled their resources to plan and build eight townhouses clustered around a courtyard. (The better to keep tabs on one another as they grow older.) Now that they've moved in, they plan to rent a studio apartment to a skilled nurse who can provide health care. No institutional living for this independent bunch -- they still want to call the shots.