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The superb, recently-published book, Being Mortal, by Atul Gawande, discusses numerous end-of-life issues from the author’s various points of view as a doctor, a family member, and the child of an aging parent. One of the important concerns he discusses is: when it is appropriate for a senior to move to an assisted living facility, and what will they find when they get there?

Dr. Gawande points out correctly that children are often worried about their parents’ physical safety. Falls in particular can be life-altering or fatal. When adult children are not living close by their aging parents, they often think of an assisted living facility as the best way to provide for their parents’ safety.

The problem is that assisted living facilities know that their residents are there because their children want them to be kept safe. As a result, the residents are over-protected, or at least they often feel over-protected, and may feel unhappy about being removed from their life in their community.

The alternative is one the writer of this article has seen in person. A senior with a strong will but very limited mobility, who had previously fallen and badly broken her wrist, had a fall in her home. She was bruised and injured, and needed rehab. Her daughter wanted her to go into assisted living at that point. At the last minute, after all the work had been done to arrange the move, the senior refused to go. A few months later she fell again, and needed more rehab. A few months after that, another fall. She is now at the point of accepting the need for assisted living, but her insistence on remaining at home resulted in additional worry for her daughter, plus a lot of time and effort spent helping her mother get the care she needed. The stress of the situation created a strain in their relationship.

A client of our firm who is in her 90’s, still lives in a house with many stairs. She is alone in the house now, as her husband needed nursing home care. She is still vigorous and loves her home, and doesn’t want to leave it. Her only child lives about an hour away, and worries about her a lot. Yet moving to assisted living would take her out of her community and the house she has lived in for several decades. She doesn’t want to go. Does she realize she is in danger? It’s hard to say, but she doesn’t seem to care.

For seniors and their children, the decision about whether to stay in one’s home or move to assisted living is a trade-off that needs to be negotiated. Seniors need to understand that remaining in their homes will put them at risk sometimes high risk of being injured or even dying from a fall or accident. Their children need to realize and accept the fact that, until things get really bad, their parent(s) may understand but choose that risk willingly.

There is no right or wrong answer but honest communication is key to finding the solution that best fits everyone’s needs and goals. Even if you worry about your parent’s safety, by not overruling their decision to remain in the community, at least you are leaving them with the important feeling that they are still in control of their own lives.

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