March-April 2012 | Features in Bethesda Health

The Parent Trap

Meet members of the sandwich generation: raising children, dealing with elderly parents-and sometimes feeling as if they've bitten off more than they can chew

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Where elderly parents end up—whether in an adult child’s guest room, a nearby apartment, a senior community, a group home, an assisted living facility or a nursing home—is an intensely personal decision, experts say. And finances play a big role.

In 2010, half of those 65 and older had incomes of less than $22,000 a year, and half had less than $53,000 in savings, according to the Kaiser Family Foundation. Meanwhile, the average annual cost of nursing home care today is $72,000; assisted living, $38,000; and home health care services can total $30,000 a year, according to LifePlans, a long-term care insurance services, risk management and research company.

More than 10 million Americans currently need long-term care, according to the foundation, although few people purchase long-term care insurance. Medicaid, the health care program for the poor, pays for 40 percent of all long-term care. The 2010 health law will expand Medicaid coverage beginning in 2014 so that individuals with annual incomes of roughly $14,000 or less will qualify.

Medicaid, which is financed jointly by the federal government and individual states, used to pay only for nursing home care, but now sometimes covers care in assisted living facilities and in the home.

Adult children taking care of aging parents also incur significant expenses. The annual cost to long-distance caregivers is $8,728, compared with $5,885 when they live under the same roof, according to a 2008 AARP report. Caregivers who spend the least—$4,570 a year—live close to, but not with, their parents.  

Finding the right situation can be a matter of trial and error. St. Clair moved her mother in with her, but with a full-time job, she found it difficult to keep up with the elderly woman’s needs. Her mother had high blood pressure, high cholesterol, glaucoma and moderate Alzheimer’s.

Before long, St. Clair was looking for another situation. She called Seabury Resources for Aging, a nonprofit organization in northwest Washington, D.C., that helps locate geriatricians and housing and financial planners, in addition to driving seniors to doctors appointments. It charges on a sliding scale, anywhere from $3 to $110 an hour.

Seabury connected St. Clair with Mary’s House, an assisted living community in Rockville. That’s where her mother lives today.

Across the street from St. Clair, Annie Hayes is taking a less conventional approach. She and her five siblings move their 88-year-old mother from house to house, but it has been harder than Hayes imagined. Her mother needs to have someone with her full time. She’s unstable on her feet and began suffering dementia after her husband died two years ago.

For five weeks at a time, Hayes’ retired brother lives with their mother in a retirement community in Lewes, Del. Then he heads home to Michigan for five weeks, and their mother starts making the circuit. She spends a week with each of her five other children. Then it’s back to Lewes.

She was with Hayes and her husband earlier this year. Because they both work, they explored bringing in a companion during the day. “She was lonely,” Hayes says. “It doesn’t turn out to be what you expect. Your life is organized, and you think Mom will fit into that, but it’s a whole new puzzle you have to figure out.”

Now the siblings are considering spending their designated weeks with their mother in Lewes. They think she will need an assisted living facility at some point, but there are financial challenges. “Right now, everybody is pitching in,” Hayes says, “but when it comes to writing checks—and it hasn’t gotten to that point yet—that’s going to be very tough. Everybody has money problems right now.”

Several years ago, Maria Jimenez moved her own family across town and into her now 80-year-old mother’s house in Bethesda. Jimenez no longer works, but she used to be responsible for quality assurance at the Kensington Nursing and Rehabilitation Center. She recalls a Cuban woman with dementia whose daughter moved her to the facility from Florida. The woman couldn’t communicate easily with the English-speaking staff, and she missed the foods to which she was accustomed.

“When people reach that age, everything is simplified,” Jimenez says. “What makes you happy are just the simple things, like making sure they get the cuisine they love, seeing familiar faces, like the mailman or the lady across the street.  

“That’s what some of these families are struggling with—plucking the loved one out of the environment that they chose to live in. This lady had gone to Florida to retire there, to be closer to friends, and here they are having to pluck her back out. It was for the right reasons—to care for her—but for the senior, it wasn’t always, ‘This is a great thing that they’re doing to me.’ ”

Eventually the family found her a group home nearby with Spanish-speaking staff. The food isn’t Cuban, but it is Hispanic, and the atmosphere is homier.

“The longer you can keep older adults in a homelike, natural environment, the better it is for them,” Jimenez says. “It doesn’t matter how you sugarcoat it, these are institutions, and there’s a lot that you lose.”

That’s why Jimenez packed up her husband and two children and moved in with her mother after her father died suddenly in 2005. At the time, her mother was healthy, but “the idea of being alone horrified her. …My mother was someone who had grown up in a big family, the more the merrier. ”

Her mother’s house was formal and filled with porcelain—not exactly kid friendly. Moreover, the flooring was slippery, which was unsafe for Jimenez’s son, who has cerebral palsy. Her mother agreed to install hardwood floors and switch out some furniture. “Everybody had to give up something. We were giving up our neighborhood,” Jimenez says.

But they’ve gained something, as well. “It’s definitely a different childhood when you have a grandparent involved,” Jimenez says. Since her mother is active, “the kids have positive views on aging. It’s not always about someone who’s completely dependent. I love the idea of my kids growing up seeing a smart, vibrant, sassy grandmother.”   

For St. Clair, life is easier since her mother moved to Maryland. Her hope was to keep her job, maintain her family life and still help her mom. She believes she has accomplished that.
Instead of spending time making quick trips and arrangements for her mother’s care, St. Clair can enjoy quality mother-daughter time now. She sees her several times a week, and her mother particularly looks forward to their trips to CVS. “She likes the fact that someone is checking on her,” St. Clair says.