FCRP Policy Statement

When older persons can no longer manage to live alone, even with the help of family caregivers who live in different households, their families face two choices: either establish shared living arrangements or institutionalize to a nursing home or adult foster care facility. In a recent study in which 172 adult children caring for functionally impaired parents participated, the factors associated with changes in living arrangements following hospital discharge of an older patient were investigated. Due to the transformations of the health care system, the length of hospital stays of the chronically ill elderly are shrinking as are the financial resources, primarily fixed incomes, of our elderly population. With this in mind, decisions by older persons and their families regarding living arrangements will likely present themselves.

The results from this study reported that care demands -- as expressed in the overall levels of (partly) new caregiver involvement in bathing, dressing, toileting, walking, getting in and out of bed, and eating and cooking, transportation, grocery shopping, other shopping, laundry, housework, money management -- are also strong predictors of establishing joint living arrangements among parents and their child caregivers right after hospital discharge. Although supportive services like home health care assist in the overall caregiving, families may be faced with a secondary decision point concerning a change in residency if home health care is needed beyond the customary postdischarge periods of service provision.

Adjusted family income is an important factor in predicting the likelihood of moving together after a hospital stay. As expected, higher income is associated with a lower tendency toward joint living arrangements. To some degree, this finding provides support for the notion that many families try to avoid shared living arrangements, if possible. When higher incomes provide the option (through the use of more services, for instance), child caregivers and their parents tend to maintain separate households.

The analysis from this study indicated that decisions about joint living arrangements following hospital discharge appear to hinge both on parental need and resources of the adult child. This appears to confirm that the decision to move together is largely need, not preference-driven.

Policy Implications

• Alternatives to joint living arrangements must be accessible and affordable for families.
• Legislators should ensure funding exists for supportive community services such as chore , or home-delivered meals to allow independent living.
• Reverse home mortgages must be available to older people, allowing them to remain in their own homes and free up funds needed to purchase formal health care services.
• Family members must have access to community-based services to prepare them to care for older loved ones.
• Families need to be supported to delay long term care institutionalization to nursing homes.

From: Mickus, M., Stommel, M., & Given, C. W. (1997). Changes in living arrangements of functionally dependent older adults and their adult children. Journal of Aging and Health, 9(1), 126-143. Research supported by Caregiver Responses to Managing Elderly Patients at Home, Grant#RO1 AG06584, funded by the National Institute of Aging, U.S. Department of Health and Human Services.