What’s the best way to deal with an aging couple with different needs?

My friend's parents moved into an AL when her dad needed memory care and mom only needed a bit of assistance for mobility issues. I don't know if he lived in memory care and she lived in AL, visiting him every day or what. He thought he was living in a hotel for 5 years!

I know of other married couples who have lived in such facilities. I've observed it at a facility; the wife in memory care, the husband in AL. Every day he'd bring their dog in to see her. They went to entertainment together at the facility, and he usually pushed her in her wheelchair. They had meals together, watched TV together. It seemed that they enjoyed as much as they could together as long as they could.

The pricing might be negotiated, depending on whether one spouse helps with the other and what size room they have, if they share a room.

In my case, my mom refused assisted living. She was the first one to show signs of dementia in the form of memory loss. Both my parents were 90 and living in the house where they raised their children and had been living in for 40 years.

We thought my mom would pass away first. She declared, "I will die in this home" (instead of a nursing home).

But soon dad fell a few times, and then got covid, resulting in lasting weakness no one was prepared for at all. So dad was catching up to mom in terms of dementia.

We decided--for them--that they should move near one of my brothers, their main POA. It wasn't easy. (I've written a few posts about it on this very helpful forum under DaughterofAD, and then DaughterofAD3 when spam locked me out.)

After moving our parents, we started out with a caregiver from Care.com twice a week for four hours, and we used our parents' savings to pay for it. My brother and I supplemented their care and other expenses in many ways.

Soon my dad was declining even faster than my mom. This caught us all off guard.

Over the course of two years, they had gone from 8 hours a week of care to 24 hours of in-home caregiving. Three shifts, 7 days. Still paid for from their savings.

My dad had intended to leave money to his four children, but we all agreed that in-home care was the best solution for my parents. It just made sense for our family.

So, we kept my parents together. Moved them closer to family in a smaller home. Used their savings to pay for in-home care.

After about two years both declined so much that they both qualified for hospice. The decline was steady, especially my dad's, and luckily we had a plan in place.

Its a tough situation when both parents decline at the same time. Everyone said to me, "It's so odd that both your parents have dementia--usually it's just one." I didn't know how to respond to that.

I'm not suggesting you take the path we took, and it may not work for everyone, and no path is any easier than the other. I just wanted to share how our family did it. I hope you can find what works best for you and your parents.

Would part time help coming in the home be enough respite time to give Dad a break ?
Or are Mom’s care needs too hefty all the time 24/7 ?
If help coming in the home is not enough,
Then at least Mom will need to go to assisted living. FYI. Most say they aren’t ready for assisted living despite the need.

Some couples move into assisted living together even if only one needs it. That’s expensive though . Sometimes one is in memory care and the other can walk over and visit from either assisted living or independent living . Look for a community with all levels of care .
At some point Mom needs to be told she needs more help than her husband can provide, whether Dad remains living at home or not.

Most people, perhaps especially couples, will automatically refuse IL or AL facilities. They want what they are comfortable and familiar with, and most people are not open to going into the unknowns -with strangers.

- You do not 'ask' a person with dementia what they want to do. You do what they need for their own best care / welfare.

One situation may work for everyone now although you 'all' need to be ready to change / adjust as both your parents change. All you can do is decide what to do and see how it goes.

If your dad is 100% capable, why not get a caregiver in to help him out, relieving some of the responsibilities he can no longer manage on his own?
- Is he open to this kind of support?
- Discuss the situation with him first, alone. I do not know how much your mother could understand although you do not want to upset her. A lot depends on how your dad feels and what he is willing to do.

If you decide on a care provider, I would suggest:

* consider whether you want someone from an agency or an independent person (as I am). Agency personnel provide ins and are supposed to do thorough background checks (criminal and references).

IND CONTRACTORS:
Ask for references (both work and personal) and verify.
Ask to see DL and insurance (make a copy)
Require background check (fingerprinting) - usually at their expense.
- Ind Contractors may charge less then hiring through an agency

Everyone's skills and experience is different. My background is like a social worker and I manage care; most caregivers' skill sets may be cooking, cleaning, laundry, which is what you will want right now.

However you proceed, write up a contract
- fees
- duties
- schedule
- You might want to try a 2-week 'try out' period to see how things are going before committing to full time (however that is decided / ongoing work). Everyone involved (you and caregiver sign the contract)

Wherever you hire, ask:
- List of their experience and education/training
- How they would handle a specific situation (give them a scenario)
i.e., your mom starts screaming or refuses to go to the bathroom or is afraid to get in the shower - you want to see how they think on their feet
- assess how compassionate and patient they are,
- how they set needed boundaries (and many have difficulties with this) altho it is essential
- how they see and handle safety measures

What about your mom going to a day care 1-2 x / week?
- Has she done this? She may not be willing to go if you ask her (fear of the unknown, confused thinking, afraid to be w/o husband).
- Go and find out what they offer. This would give your dad a huge break, perhaps as long as someone else drives your mom.

YOUR DAD:

Sounds to me like your dad would benefit greatly from a caregiver - who can support him with compassion and understanding, as well as step in to do what is needed for your mom.
- Your dad may find he has some more free time so consider discussing this with him as things change - keep an eye on him.
- He is losing his wife and likely is grieving now and will continue to.
- Encourage him to share with you how he feels, and support his interests.

Lastly, it isn't too soon for you to go to facilities to get a tour and speak to the administrator. Tell them your concerns and see what they say.
- Depending on finances, may facilities are booked years in advance. The time to do some research is now. Get references if you can.

Gena / Touch Matters

Their finances will determine what care they can afford. It’s all expensive but can be catastrophic and life changing for sure.

Your question is loaded with possibilities. You’ve given a glimpse of health issues but finances are just as important in guiding your choices.

On one end of the spectrum, based on your info, you might hire a caregiver for a few hours per day and see how it works out for dad.

Ask him what chores are the hardest for him, he might need a housekeeper or someone to prep meals or just to get away for a few hours. Everyone’s situation is different.

If they have Original Medicare insurance with part B he can ask her primary to order home health care for mom. This would get a nurse coming in weekly for medical oversight and an aide to help with baths. I used this for years for aging loved ones.

Look up ADLs on line and see which ones mom has trouble with and to what degree. These are questions you will need answers to for evaluation by facilities.

As they age and health declines, you will need to adjust their care plan. No one knows when these things will happen. A fall by either can change everything overnight.

If moms care needs are too great for ALF and she needs skilled nursing, then Medicaid could be in your parents future.

I would see a certified elder care attorney well versed in Medicaid for your state to help understand how to separate their assets so mom could qualify for Medicaid and dad would not be left w/o enough funds to live in the community. Then, if needed, you would be prepared for that step. Medicaid is for those who are both financially and physically at need. One can arrive at both these points and not be able to access Medicaid w/o penalty due to mistakes in managing their assets/income.

Of course, each choice comes with challenges. Their level of acceptance will be important to the success of any choice and please know that a strong advocate for their care is priceless.

Then Dad needs to hire Caregivers for Mom. If he doesn't want to, then AL seems their only choice. Some have apartments. Three meals a day. The ability to have socialization and activities and know Mom will be watched out for.

You may also consider a day program for your mother a few days a week. There are senior centers/dementia programs in many towns that are about $100-$200 day and typically cover snacks, lunch, various programs and light exercise and provides helpful socialization. Some towns offer these programs for free. Look into your county “Center for Aging” or other type of Senior Care to see what may be available. It can be respite for your father during the day and less expensive than hourly care while you are in this interim phase. As others have stated, typically 24/7 hour care will be necessary in the future (possible near future) and for many, it is not affordable. Out of pocket in my area is $500-$600 per day.

For now, your parents can benefit from having an aide come in to the home regularly to take some of the burden from your dad. That allows them to continue to live together in their own home.
It really is time to sit down with them and have some tough discussions about planning for the "what if's". What if mom needs more care than can be managed at home? Are they strongly opposed to moving to an assisted living community with continuum of care? What are their oppositions/fears? It might be a good time to start downsizing and cleaning out the home if they have a lot of accumulated stuff. Preparing for a simpler life as they age.
Perhaps if they toured a few assisted living communities, it would remove some of the hesitation.
You are already considering separate living for the two of them, I assume meaning mom goes to a memory care facility while dad stays on his own at home. How will dad function at home alone? As he ages, he too may weaken and find it more difficult to manage a home and his own self care - think of all the maintenance, cleaning, preparing meals, paying bills.
Better to move into assisted living as a planned move before it becomes an immediate necessity!
While he is still able, start thinking about selling their home, reducing their belongings, where would they want to live that would be easier for them?
In the meantime, they can hire housecleaners and personal care aides to help manage living at home independently.
If your dad is young and spry and still has a lot of good years left and wants to continue living in his home, with your mom going to a memory care facility, remind him that he will be able to spend a lot of time there with her, he just won't be burdened with her care needs. It sounds like home care for now will suit their needs, just have them prepare for the next step in this plan.

Try to keep them together. They have two basic options: caregivers to help them in their home, or moving to a senior facility that can accommodate different needs, for example a continuing care facility. Much depends on their finances and also their preferences. Continuing care facilities are set up so that most people (or couples) start out in Independent Living and as their health declines they move to Assisted Living or Memory Care. One or both can move as needed. If one moves, they live in separate apartments, in the same facility. There is also a Skilled Nursing section for people who need a higher level of care. If they move to a facility, try to find one near you so that you can visit often and oversee their care. This becomes more important if their health declines further as they age. All the best to you and your family. Make sure their paperwork is in order while they are still able to sign legal papers. They each need a will, a living will with their advance medical directives, and they need to set up Powers of Attorney for medical matters (health care proxy) and financial matters (durable POA). They may need an attorney for these legal papers.

CJDB80: Perhaps they can opt for managed care.