“Don’t wait for a crisis.” How many times have those of us with elderly parents heard that refrain? All around me my friends are taking heed. They’re moving their parents, usually a widowed mother, into retirement villages, independent living units, and low-care nursing homes. They’re cleaning out the family home, and putting up For Sale signs. The elderly parents have seen the light and are moving to smaller places that are potentially more social, with more care, or a path to care, attached. Agreement is almost universal: it’s better to take sensible, pre-emptive action before a crisis hits.
But not my mother, not me. We’re not being sensible. She’s 85, a widow, and lives in her own small house on the other side of the country. We’ve talked on and off since my father died 16 years ago about whether she should move. The time’s never been right. In Perth, she has her friends, her independence; in Sydney it’s me and my brother and four adult grandchildren. My other brother lives in London. She’s a bit frailer, a bit slower now. But she still drives, goes to the gym, the movies and the theatre. She likes her little garden. She manages quite well. But my friends say: “Why wait for the crisis?”
When is the right time for parents to move? Unless a parent has dementia, or some other mental impairment, the decision is theirs to make. Some are recalcitrant and cling to the unrealistic belief they can care for themselves for ever. Even when they can’t manage, some will say, “They’ll take me out of this house in a box.” But children often can influence the decision. After her mother fell for the second time in the family home and waited 40 minutes for help, Heather Hill said to her: “You’re killing me. I feel you aren’t safe.” It was another two years before her mother would sell the house her husband had built and move into something safer.
I turned to Heather for her opinion on the right time for parents to move. She runs Heather Hill Pathways, a business that provides advice on aged care from immediate needs to long-term planning. I’d expected the “Don’t wait for a crisis” mantra. But being a woman who can’t imagine leaving her own two-storey house, her advice was much more nuanced. “You don’t want your mother to move until she has to,” she said. But it’s important to plan. It’s important to have a conversation that explores the “what ifs,” Heather said. It’s important for all adult children to know what parents want should they have a serious fall or a stroke or lose their licence. Often parents will have an aged care residence picked out. “You have to have that discussion,” she said. “It’s important parents understand how much stress and anxiety they can put the family through if their wishes aren’t clear.”
Barbara Squires, an expert on ageing and housing, was even more emphatic about parents’ rights to make their own decisions. Barbara, who’s head of research and advocacy at the IRT group, an innovator in aged care, home care and seniors’ communities, said: “Children have to be brutally honest with themselves. If they’re putting pressure on a parent to move, they have to ask themselves for whose sake are they doing this. Is it for their parent’s benefit or to reduce their own anxiety?” Moving parents prematurely “can tear apart their social network, independence, control and all the things that make life worth living,” she says.
Barbara is supportive of the early discussion and the planning for the “what ifs.” But she cautions against over-romanticising the alternatives. Bitter experience taught her that her own mother was not safer in a nursing home. Three days after she entered a high quality home, she fell on the vinyl floor, fractured her hip, lay undiscovered for one-and-a-half hours, and died shortly after from pneumonia. “An aged care facility can no more guarantee a person won’t fall than fly to the moon,” she said.
When you think about it, the mantra about acting pre-emptively sits oddly with the philosophy of “ageing in place.” Federal governments led by both major parties have in recent years poured money into home care and home nursing packages to keep elderly people safe in their own places for as long as possible. There aren’t yet enough of these government-funded care packages. But private companies also provide these services for elderly people who can pay a bit more.
And where should parents go if they do sell up? Unless parents are assessed by an Aged Care Assessment Team as needing high or low level aged care, they can’t be admitted to a nursing home. If social isolation is a problem, they can go into a retirement village but access to government-subsidised care packages is no better there than for a person living at home; and Heather Hill urges people to get legal advice on the exit rules that can make it difficult to sell out of retirement villages if nursing home care is eventually needed.
In the case of my friends, it’s early days for some of the mothers who are still settling in to their new abodes while others have been happy they moved. For me, it’s still difficult but my mother is now visiting us and we’ll definitely have that “what if” conversation.
What are your thoughts on acting before a crisis? Please Comment.
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