Review Helps Adult Children Care for a Parent in Their Home

Laurie Barclay, MD

August 23, 2011

August 23, 2011 — A review reported in the August 17 issue of the Journal of the American Medical Association describes a living arrangement checklist for clinicians to guide adult children in the decision to care for a parent in their home. The review also discusses the prevalence and epidemiology of adult children living with an aging parent, and the clinician's ongoing role in providing care and advice during common stages of multigenerational living (before the move and during coresidency and subsequent care transitions).

"In the United States and globally, increasing numbers of older parents are living with their adult children," write Christine S. Ritchie, MD, MSPH, from the Birmingham-Atlanta Geriatrics Research, Education and Clinical Center, Department of Veterans Affairs Medical Center and University of Alabama at Birmingham, and colleagues. "Making the decision to live together requires careful thought and planning; particularly when the decision means the children will be responsible for their elder parents' care, the physicians of all parties should be consulted. More than one-third of caregivers state that they seek advice from their physician or other clinician when information is needed about this transition."

Specific measures that clinicians can implement to lessen the potentially negative effects of these transitions include keeping the health record updated with current measures of function and cognition, helping older parents and adult children to evaluate the pros and cons of different living arrangements, and referring patients to professionals who are expert in the financial and social implications of any such move.

When an adult child cares for an aging parent at home, the clinician must be vigilant to recognize caregiver stress and possible elder mistreatment, and to provide modalities for caregiver support. Should different living arrangements or healthcare services be needed, clinicians can help the older parent and adult child in planning and making the new transition.

Specific Areas of Checklist

The Living Arrangement Planning Checklist covers the following specific areas:

  • Medical needs of the older parent(s) should be addressed by the adult child or children selected by the parent and provided by the primary care clinician, geriatrician, geriatric care manager, and social worker. These providers should maintain an up-to-date health record including active conditions, current functional and cognitive status, medications, physicians and other healthcare professionals involved in care, advance directives, and records related to key hospitalizations and diagnostic procedures.

  • On the basis of current functional and cognitive status and observed rates of recent decline, medical providers should help determine whether the new living arrangement can accommodate functional and cognitive limitations and has adequately qualified healthcare personnel to meet the older adult's healthcare needs. Future environmental and functional needs should also be estimated, and appropriate proxy signatures obtained for Health Insurance Portability and Accountability Act–related disclosure.

  • Legal and financial needs of the older parent(s) should be addressed by the adult child or children selected by the parent and provided by the elder-law attorney, accountant, and geriatric care manager. Specific goals include clarifying preferences and needs for living arrangement, such as the type of long-term care setting, and preferred distance to specific family members if applicable. The costs associated with a particular living arrangement should also be determined.

  • Spiritual needs to be addressed by the older parent(s), the parent-selected adult child or children, and their spiritual advisors include identifying whether relevant religious services or communities are available in the new location being considered.

  • Social needs to be addressed by the older parent(s), the parent-selected adult child or children, and the social worker are to identify the important activities and social interactions in which the older adult(s) currently participates, and how these will be affected by a move.

"The decision by older parents and an adult child to live together is rarely a straightforward one," the review authors write. "It can be both mutually enriching and also serve as a source of isolation and stress for the older parents and the adult child. Given the increasing prevalence of this living arrangement, physicians can expect to be called on for guidance with greater frequency."

To overcome resistance of the older parent about changing the setting of care, the review recommends that clinicians ask open-ended questions, provide affirmation by pointing out strengths and building rapport, engage in reflective listening by showing respect and allowing for creative problem solving, and summarize to maintain direction and momentum toward consideration of a change.

"Using the tools of motivational interviewing may facilitate more of a willingness to change," the review authors conclude. "The physician and supporting team can assist the adult child and the older parent with the transition by inquiring about what ground rules have been set up between the adult children and parents related to family and personal boundaries and privacy....Physicians should advise patients that adult parents who move in with their adult children are at risk for social isolation—especially if they are far from their community of origin. Identifying avenues for community engagement through social groups, faith communities, or the Internet should be incorporated into the transition plan."

The Care of the Aging Patient series is funded by The SCAN Foundation. Dr. Ritchie has disclosed board membership with the American Academy of Hospice and Palliative Medicine, consultancy with the University of Puerto Rico, employment with the University of Alabama at Birmingham and the Birmingham VA Medical Center, and lecturing through the Annual Lectureship at Macon State College. She has also received support from a Geriatric Academic Leadership Award through the National Institute on Aging (NIA), grants from the National Institutes of Health (NIH), Agency for Healthcare Research and Quality, Health Resources and Services Administration, and the Donald W. Reynolds Foundation. The other 2 study authors have received support from NIH grants; the Centers for Disease Control and Prevention; the NIA; the John A. Hartford Foundation; the National Center for Research Resources; the National Heart, Lung, and Blood Institute; and/or a Veterans Administration Career Development Award.

JAMA. 2011;306:746-753.

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