Housing options for couples when one needs help and the other doesn’t
Housing options for seniors have been the subject of many articles and
I have myself made it the subject of columns many times. One subject that has not received much attention, however, is what to do when long-standing couples find that one of them needs additional help and the other does not.
The need for additional assistance is always relative — a husband might experience physical difficulties while his wife might struggle with dementia, for instance. However, there are cases where one parent is perfectly healthy and the other needs some serious care and is likely to remain so. There are some alternatives.
Assisted living/ personal care
Assisted living communities (known as personal care in Pennsylvania) tend primarily to those who need some help with activities of daily living such as bathing, dressing, toileting, transfer from bed to wheelchair, for instance. They are not suited to couples as such and the healthier spouse then needs to visit. Aside from the cost of care and the effort involved in travel, the effect of separation can be devastating to the partner who remains at home and may worry. This is not at all a criticism of assisted living/personal care, since the need is definitely there but can be recognition of difficulties. The way our care continuum is structured it is difficult for couples to be together. Whether some future approved living arrangements might help so that the healthier spouse might “visit” more often or for longer periods of time is unknown and might be worth exploring.
Continuing care retirement communities
Continuing Care Retirement Communities or CCRC’s are another possibility for senior living where one needs help but, generally speaking a CCRC anticipates that both husband and wife are reasonably healthy on admission and often requires medical evaluation to confirm this.
The typical CCRC agreement involves a sizeable deposit on admission, admits at the independent level, and has available to its members both assisted living/personal care and skilled nursing later if needed at a later date. The agreement needs to be examined closely to know what is and what is not provided and also the cost and circumstances where a resident would move to a higher level of care. We review these agreements all the time. The arrangement can be helpful since, if one spouse needs to move to a higher level of care the other is close by although they may not be together.
More often today I see the circumstance where the couple pays to have additional non-medical health care coming to their apartment to assist. Couples in long standing marriages often do everything reasonably possible to stay together and this is certainly understandable.
Care at home or move in with other family
The most commonly used arrangements to deal with problems to avoid separation are either to continue to stay at home and hire outside non-medical care to come into the home with or without frequent visits from family members, or to move in with family, often adult children.
It probably should be noted at this point that there is no perfect answer. For instance, remaining
at home with outside help may involve significant cost where the need is great and you are, after all, still in the house which has probably not been retrofitted to meet current needs. This latter problem can be addressed. There are contractors who can add stairlifts or another bath on the first floor, grab bars for showers and other accommodations. Staying at home also can mean that the caregiver spouse needs a break and often does not take one.
It is essential if a wife or husband is caring full time for her or his spouse with serious disabilities that the caregiver spouse have communication with others — usually their children but it could be close friends also. On meeting with families I ask who their caregiver support system is. It can matter for the long term. Visiting family members also need help with stress.
If the answer is moving in with family, the new additions to the household
may require structural modifications to the house — a new bath or inlaw suite, an addition to the house and so on. If this is the preferred answer then I strongly recommend a legal family agreement. It defines who pays for what and, if desired, can make modifications to estate plans.
Janet Colliton, Esq. is a Certified Elder Law Attorney (CELA) by the National Elder Law Foundation recognized by the American Bar Association and the Pennsylvania Supreme Court and limits her practice to elder law, retirement, life care, special needs, guardianships, and estate planning and estate administration with offices at 790 East Market St., Ste. 250, West Chester, 610-436-6674, colliton@collitonlaw.com. She is, with Jeffrey Jones, CSA, co-founder of Life Transition Services LLC, a service for families with long-term care needs.