Helping Your Parent to a New Life

My father wouldn't move to Washington. "I hate D.C.," he said, when I suggested that he and my mother move near me. He had lived there as an ornery adolescent and hadn't been impressed. At 78, he was still ornery.

But my parents knew they would eventually have to move somewhere. They lived 25 miles from Charlottesville, Va., the nearest city. Their home and 30-acre property in the Virginia countryside required upkeep. My father had undergone cancer surgery that affected his speech, and he worried about making himself understood by phone in an emergency. They would certainly move

to town or close to one of their four children . . . someday.

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In procrastinating, my parents were in good company: "Most of us are staunchly independent. We want to stay at home," says Larry Minnix, president of the American Association of Homes and Services for the Aging. "Plus, it's a dang nuisance to move." The average age of people who move to a community that includes care is 78 to 85.

Four years after my parents began the conversation, my mother did move to the D.C. area -- alone. The circumstances that led her there included a devastating heart attack, her children's insistence that she stop driving and, sadly, my father's death. As events unfolded, our family not only confronted a series of financial and logistical decisions but also discovered resources that helped us at each stage. Here's what we learned.

Looking Around

At first, Mom and I, and sometimes Dad, would duck out during my weekend visits to look at retirement communities in Charlottesville. The places we saw represented three models. Independent living provides housing and some services but no health care. Assisted living offers residents help with basics, such as dressing and bathing. Continuing-care retirement communities combine independent housing, assisted living and nursing-home care on one campus.

Assisted living was out. My parents were nowhere near that stage. The continuing-care retirement community was attractive but a little formal for my mother's taste, and the independent-housing prices were high -- currently almost $6,000 a month for a two-bedroom cottage with no deposit and $4,325 a month for the same model with a $270,000 deposit. That left independent living. We warmed to Branchlands, an apartment development with a communal dining room, social activities and bus service to grocery stores, pharmacies and banks. The monthly fee, now $1,500 to $2,500, includes rent, two meals and the other amenities.

Branchlands would mean leaving behind the yardwork, the long drives to doctors and stores, the balky furnace -- and the lavish garden, the glorious views, the delightfully quirky house. Surprisingly, Dad was willing to go for it. Mom said maybe -- but not yet.

Suffering a Health Crisis

My husband, Chris, and I came home from a Friday-night movie to phone messages stacked up like planes on a runway. My 77-year-old mother, so vigorous that she had climbed Old Rag in the Blue Ridge Mountains the previous year, had suffered a massive heart attack. By the time Chris and I arrived at the University of Virginia Medical Center two and a half hours later, the doctor's prognosis couldn't have been bleaker. His exact words: "There is no hope."

He was wrong. My mother survived the night, the week, and bypass surgery 12 days later. My brother and two sisters, who had rushed to Virginia, and I took turns camping in her room in the intensive-care unit. As she inched her way back to life, we realized with joy and trepidation that we would be planning not for her funeral but for her homecoming. Shortly before she was discharged, the doctor said, "This is the time to bring in all the troops."

Talk about feeling daunted. My siblings -- Julie, Genna and Champ -- live respectively in Oregon, North Carolina and California. We all have families and busy lives. Mom was so weak she could barely walk, much less climb stairs, and she was taking 14 medications; a few weeks earlier, she had taken none. Dad wanted to help, but he was undergoing chemo and, frankly, he wasn't much of a nurse.

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Muddling Through

Long-distance care means family members either travel the distance to provide the care, or they hire help. We did both. The hospital discharge planner assembled a home-health-care team that included a nurse, an aide to help Mom bathe, a physical therapist and an occupational therapist to show her how to navigate her home safely. Each one visited several times a week, offering much-needed expertise and reassurance. Because Mom met the criteria for services under Medicare Part A, their fees were fully covered.

We still had the other 20 or so hours a day to fill. All four siblings, plus Chris and our 21-year-old son, Bennett, took one- or two-week turns staying at the house. Brenda, my parents' housekeeper, signed on for extra hours. By midsummer, three months after her heart attack, Mom was back on her feet, shakily, and we had resumed our lives. In December, besieged by the cancer that had spread to his lungs, Dad died.

When You're Alone

Amid the sadness and confusion of the following weeks, we didn't have time to consider Mom's future, but later, reality hit. Not only was she without the love of her life, but also she had no one to help her up if she fell and no one to call the rescue squad in an emergency. Her stamina and balance had yet to rebound. She could have ended up on the floor for a day or longer before being found.

There were other worries. Mom had given Dad her durable power of attorney so he could make legal and financial decisions on her behalf if she became incapacitated (see the box on page 54). Her advance medical directive gave him the right to make health decisions for her, including decisions about life support. He had been joint owner of their accounts and co-signer of their equity line of credit, which meant he could pay the bills and cover any unusual expenses, including medical costs. Such dire eventualities suddenly seemed all too possible. With him gone, who had my mother's back?

In fact, my parents had anticipated that question several years earlier, when they had assigned Champ and me their successor durable power of attorney. As such, we already had the ability to sign documents, pay bills and gain access to my mother's accounts if necessary. We were also given her durable power of attorney for health care, allowing us the right to make medical decisions for her if she couldn't speak for herself.

As for her safety, Julie insisted that Mom subscribe to the LifeStation Medical Alert System. For about $30 a month, she could wear a device that let her summon help at the push of a button. Mom figured it gave her license to climb the steep, narrow steps to her attic and struggle down the long, icy drive to the mailbox. "No worries. All I have to do is push this button," she often said.

Stepping Up the Search

In the spring after Dad's death, Mom and I started looking at communities in the D.C. area. Much as she loved Virginia, it seemed increasingly impractical for her to move into Char­lottes­ville, which was even farther from me than her current home. Mom knew several people who had moved from one retirement community to a second to be closer to an adult child. Why move twice?

This time, we restricted the search to continuing-care communities, where she could move seamlessly, if she had to, from independent living to assisted-living or nursing-home care. We narrowed the choices to Riderwood Village, a sprawling community then still under construction in Silver Spring, Md., and a much smaller community in D.C. Both required a deposit of $200,000-plus for a two-bedroom apartment in the independent-living area, plus a monthly maintenance fee that covered one meal a day, transportation and other services.

The two communities had one major difference. At Riderwood, owned by the Erickson Retirement Communities, the monthly fee -- now $1,329 to $2,168 -- covers only independent living. You pay more for assisted-living or nursing care, but you get a refund, minus a fee, when you move or die. The other community offered the same pay-as-you-go option, but it also let you make a nonrefundable deposit in exchange for future care.

Yikes. We had no idea which was the better deal or which my mother could afford. For help, we consulted Laurie Duncan, a now-retired geriatric-care manager in the D.C. area. Such experts can guide families through the myriad decisions involved in elder care and housing (see the box on the facing page). Duncan charged $100 an hour to review Mom's finances and advise her on the choices.

Mom liked the idea of the full refund, but the decision wasn't that obvious, Duncan said. If you buy health care upfront, you lose the deposit but preserve any remaining nest egg against future costs, and they can be significant: Nursing-home care averages $78,000 a year; assisted living, $36,000. If you pay as you go, you run the risk of depleting your resources over the course of a long illness. (Like many CCRCs, Erickson taps your deposit if you run out of other assets and draws from a fund to pay your expenses if you run out of money altogether.)

Duncan ran the numbers and concluded that my mother could probably afford either place. Of the two, Mom preferred Riderwood for its size and scope of activities. We visited the community repeatedly over the following months and pored over apartment layouts. Finally, Mom put down a $1,000 refundable retainer to reserve a place in the next new building.

Facing the Inevitable

When Mom visited Riderwood, the move seemed doable, even fun. When she returned to her beloved home, she wondered how she could possibly leave. But events seemed to conspire against her staying. Brenda mentioned that she wanted to retire. The man who mowed the lawn and plowed the drive gave up his yard business for a construction job. The brothers who cut her hay told her it would be their last season to do so.

My siblings and I delivered the coup de grâce when we asked Mom to give up her car keys. It was a painful but, in our minds, necessary conversation. Neither her eyesight nor her reflexes were what they used to be, and she had already been involved in several minor accidents. She acquiesced, reluctantly. If she had harbored any doubts about the move, this sealed the decision. Without driving privileges, life in the country simply was not in the cards.

We still had to find a way for her to cope until she sold the house, which was now on the market. I called Home Instead Senior Care, one of several national franchises whose employees deliver nonmedical care. For about $18 an hour, we could hire someone to take Mom to the supermarket and doctor's office, fill her prescriptions and do other errands. But Mom preferred to enlist her own team. She asked Brenda to take on more hours and hired another local woman who wanted part-time work.

The Move

In February the house sold, and we raced against an April closing date. Julie and Champ, with his young daughter, Sarah, flew out on separate trips, and Genna drove up on another. We had our work cut out for us. The house was packed with furniture, papers, dishes, heirlooms and junk, plus several thousand books. And after suffering so many losses, Mom was understandably loath to give anything up. (Let the record show that she has yet to find a need for the turkey roaster.)

Nonetheless, we sorted, tossed, took stuff home and gave stuff away. The Salvation Army declined our offer of a 20-year-old couch, but a local minister agreed to sell the overflow at a church yard sale. Mom gave Dad's choicest books to family and friends. The regional library carted away the rest.

A week before the move, Champ, Mom and I sat surrounded by boxes of old papers, letters and pictures. We still had packing to do, but on that one afternoon, we read the letters, marveled at the pictures and savored Mom and Dad's wonderful, fun-filled life. The interlude set us back by hours. It was worth every minute.

Moving day: Not ready. The movers packed the trucks while Champ, Mom and I, and dear Brenda, tossed, packed and shoved things into the shed for the minister to pick up. At 6 p.m., the movers announced that the trucks were full and they were leaving. "But look at all this stuff!" I sputtered as they hastened out the door.

More tossing and shoving. At eight in the evening, the house was finally empty. Brenda hugged Mom good-bye, and the rest of us piled into two overloaded cars. We were all exhausted. When we drove down the driveway for the last time, none of us looked back.

Three and a half years later, Mom is settled into her lovely -- and furniture-filled -- apartment. She misses her old life, but her new life is full of friends and activities, including Spanish class, book club and brisk walks on the treadmill at the fitness center.

Riderwood is safe, comfortable and well run. I truly believe we made the right decision, and I'm glad we took the time to make it deliberately. As always, I'll let my irrepressible mother speak for herself.