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My grandparents, who are both in their nineties, ended up in assisted living about a year ago. They had slowly been sliding toward this for years, as the stairs in their house got harder and harder to navigate, as falls became more frequent, as they ended up in the emergency room again, and again, and again. In addition to the physical difficulties, there were emotional ones: in particular, my grandmother, once an incredibly productive, high-energy woman, was getting really lonely and bored. They had in-home help (to whom I am incredibly grateful), but as the crises grew more frequent, the limitations of that system became more visible. They toured assisted living facilities, collected brochures, but never made the leap.
And then, all at once, there was a final crisis: It started when Grandpa got injured and had to be in the hospital for an extended period of time, followed by rehab. While he was in the hospital, something happened to Grandma, and she needed to go to the hospital too.
When it all ended, neither of them was really in a condition to go home without 24-hour care, so my father’s brother, my uncle, found them a place in an assisted living facility. It was about a 30-minute drive from their home of 30 years, but it was only about 5 minutes from my uncle’s house.
Record scratch. Wait. Don’t values and conservatism mandate that we, as children and grandchildren, take these people into our homes and care for them ourselves?
These were the values I grew up with. My dad, who inherited his productivity and high energy from his mom, once had serious plans for his basement. The basement in that house is a walk-out, with one side having south-facing windows. He told me that we could put an apartment in the basement for Grandma and Grandpa. This was probably around 2009, when they were just entering their eighties and still full of energy. As a preteen, I couldn’t really comprehend why these people would want to live in our basement. After all, we were talking about the man who still helped my dad build sheds, and the woman who made maple cakes, packed them into plastic cake holders, duct-taped them securely closed, and mailed them to us along with some Cracker Jack and clippings from the newspaper she thought we would be interested in. What would they do in our basement?
But the cozy basement apartment never materialized. By the time the first serious health hurdle appeared, in the mid-2010s, I think it was clear to everyone that Grandma and Grandpa didn’t want to move. Additionally, the still hypothetical basement apartment was a fifteen-hour drive or a 1.5-hour flight from the town they had called home since the ‘60s. Why would they go live with the branch of their family that had settled in the middle of the woods, when their other son and a few of his kids were just a few towns over?
But it wasn’t like they could just move into Uncle Tim’s basement. For one, that basement was totally unsuited to them in a number of practical ways: It wasn’t a walkout, required stair use, and was already occupied by Tim’s daughter. No, Tim’s house didn’t make sense, nor did the houses of either of Tim’s sons. The place most suited for my grandparents was still their house. Unless they went into assisted living, a possibility brought up anxiously by my grandmother over a plate of Subway sandwiches served at a “family meeting” she had called. My dad found a brochure for assisted living in a lakeside resort town near our house, essentially introducing Move Them Into Our Basement Plan 2.0. Probably for the same reasons that Basement Apartment had been rejected, this was never discussed as a serious option.
Well, why didn’t somebody move in with my grandparents? There were two people living in a four-bedroom, two-story house. Surely someone could take up residence in their basement?
I can’t answer for my cousins, but I do know they were older than me. By the time this was really a question, their stages of life were incompatible with moving into a small basement bedroom: they had families of their own. What's more, my grandparents were fond of their space. They regularly used their two vacant bedrooms: They occasionally had family stay over, the closets were full of off-season clothes, and they kept a treadmill in one bedroom. Every room in their house got regular use. Of course, had someone moved in to support them, they would have gladly made space, but asking an adult to wedge themselves and their life into a basement bedroom was a lot.
Which left my sister and me. Multiple times during the latter part of my grandparents’ long, slow series of crises, I found myself faced with a transition and considered moving into my grandparents’. I considered schooling there, but my own state has low in-state tuition, while their state has high tuition, and I would be paying the out-of-state rate. Later, as I searched for my first professional full-time job, their city was on my location list, but I ended up tumbling into a vacancy in my hometown. I was never in a transition long enough to even seriously consider moving--the doors God opened were always in my hometown or the nearest college town.
Since I work as a speech therapist for the public school system, I get summers off. I usually go see my grandparents at the beginning of the summer, and a few summers ago it was suggested to me that I stay with them the entire summer. I declined, in part because my hometown was more than just my place of employment, but also because their neighborhood was really no place for a young woman to live. The very things that were suffocating my grandmother would also suffocate me, who had also inherited her energy and need for stimulation. I, like my grandmother, would be friendless, churchless, vocationless, if only for a summer.
This was the other side of the “aging in place” coin. Simply moving in with family, or having family move in, would probably not address my grandmother’s loneliness, and certainly not her boredom. All my grandparents’ children and grandchildren worked full-time, my summers off being the exception. My grandparents’ house was in a neighborhood barren of community — their neighbors also isolated and aged, or young and busy with their own lives. The house prices kept going up while the signs of neighborhood decline continued to drag the atmosphere down: Yet another lawn died, yet another barking dog was chained up in a front lawn, yet another maintenance issue was left unaddressed. The summers were unbearably hot, and the winters were too cold for old bones. Something had to change.
My grandmother adjusted to their small two-bedroom assisted living apartment more quickly. Things to do, people to talk to, reassurance that there would be people around if she or Grandpa fell — this had been what she had needed for years.
My grandfather is less content there. He had liked his den, his TV, his office, his space, and now he was cramped, much of his privacy gone.
Both of them find solace in their long-term assistant, Amy, coming over on weekdays. She started working with them as their in-home assistant a few years ago, and even when they no longer “needed” her, when they had moved into assisted living, it still made sense for her to keep working with them. For both of them, she provides company. She sits with my grandmother and chats, which my grandmother needs. She drives them to local restaurants to eat lunch, which my grandfather loves to do.
Shouldn’t this be a family member doing this? Well, again, everyone needs to work full-time. Uncle Tim and a few of my cousins visit my grandparents frequently. My dad drives out several times a year. My sister and I try to get out every summer, and once in a while we will make it out in the winter, too. Several of us more distant relatives call nearly daily.
I love my grandparents, but it often feels like a narrow escape once I get home, which speaks to the life and community that has been cultivated in my hometown, but also how barren and dry I find their home and the urban area that has grown up around it. Perhaps part of the problem my grandparents faced was how empty their community had become. Or maybe they feel the same way about their home that I do mine. I have no answers, only stories.
I felt such a sense of relief and welcome when we landed in rain, fog, and forty-degree weather after our last trip to my grandparents’ assisted living in June. Even though their assisted living is in a much nicer area than their house, coming home felt really good.
Discussion (20)
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This solution makes sense to me. I think it is the best for everyone involved, once staying in the their own home became impossible.
It's how I see my future, eventually. In fact, I want to move to a continuing care community before it becomes necessary.
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I have definately taken notes for my own future. Seeing my grandparents' once frequent hospital visits plummet has made me realize that these oft criticized elder care facilities can really do a good job.
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"It depends."
It depends on many factors.
My parents divorced when I was in middle school. My mother remained single for almost 20 years before finding her second husband. They moved into a basement apartment in a house my mother's new husband built for his widowed daughter. Worked fine for many years. But when my mother's husband had a stroke, my by-then-blind mother could not stay by herself safely in that apartment. And even after her husband recovered from his stroke, he also was no longer capable of living by himself, or with my mother, in that apartment. They had no interest in moving 450 miles to the town where I by then lived, a town with which they had no connections or history. My brother's immediate family was having its own internal challenges with affording housing in an expensive area and with their challenging daughter, so he was not in a position to house them, even if they were willing to move 1500 miles to where he lived.
My wife's parents were very fortunate to find, via a referral from a neighbor, a person willing to move into their house and to provide 24 hour care for them in the last year or so of their lives. My father-in-law was an "old school" "my home is my castle" type guy who could not even conceive of living in space he did not own and over which he had complete control. An assisted living facility would have driven him bonkers. So would moving in with a child. My mother-in-law was very much a "nester" who had made their home what she wanted. Moving to any other place would have been terribly disruptive for her. By the time they needed serious help in their 90s, all of their children, grandchildren, and great-grandchildren were well entrenched in their own lives, often at considerable geographic distance from where they were.
We did have some friends for whom Grandma moving into a spare bedroom in the house was very successful. The grandchildren loved having Grandma around (Grandma was reasonable self-sufficient, and could still drive a car and thus help with errands and child transportation). But, my experience is that is rare.
I know that in our case, our two children both live 650 miles away from us. Our daughter and son-in-law do not have space for us to move in. Our son and daughter--in-law do have space, but they live on a relatively isolated property (they own a lot of large animals) that would leave us without contact with other people unless they took us somewhere.
In late 20th / early 21st Century America, it is unlikely your children and grandchildren, nieces and nephews, still live very near to where you live. And they have busy lives of their own. The theoretical ideal of children taking care of parents in parents' old age is becoming harder to do on a practical level.
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Our conundrum with my father-in-law and my mother-in-law was that continuing to stay in their long-time house was not as "safe" as being in some other setting. The person who provided 24 hour care was not formally trained in medical procedures. But, by the time the question arose, they were well into their 90s. They had been married 70 years. They knew they were in their last months. Moving them into another setting would have made them miserable. For what benefit?
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You just summarized my point!
I think planning for the next step is important, but unfortanetly I don't think people always know what will be feasible in the future. My grandparents kind of tried to go with the 24-hour in home care/someone moving in route (And did have a family member in their basement for about a month when he was between apartments), but it ended up being cost-prohibitive. Before they could find a workaround or a creative solution, they hit the crisis of no return and ended up in assisted living.
A lot of the factors you mentioned were also factors in my family's story: the sad part of this was that both of them did find the move to be very disruptive, and my grandfather still hasn't seemed to adjust super well (although his health and energy hasn't bounced back to where it used to be.) But blindness and what you refer to as "internal challenges" made assisted living the only available option last year, and they've stayed put ever since, even though they could have made a change at this point.
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