In a perfect world, couples in happy, loving relationships would be able to stay together for as long as they wanted — in excellent health and side by side. Sadly, this isn’t a perfect world, and people age at different rates; while the number of days you’ve spent on Earth may match closely with your spouse, your health care needs might vary widely from your partner’s. And therein lies a potential difficulty as you continue to age and need different levels of care and assistance later in life.
This reality raises an important question for some older couples: How can we stay together for as long as possible? Here, we’ll look at three strategies that can help you keep your lifelong commitment to be with your partner, no matter what specific challenges you may be facing:
1. Start the conversation early, before health concerns become too difficult to manage.
2. Get an assessment of your current and projected needs for each spouse.
3. Look for assisted living facilities that can cater to those varying needs.
1. Start Planning Early
Mary Sue Patchett, executive vice president of Brookdale Senior Living, a senior living company with communities across the country, says that “people are living longer and longer and staying a little healthier for longer.” This means that increasingly, couples are making it to their golden years together. But it’s not always an easy path, and asking important questions early on can lead to a better, less stressful experience when it comes time to move into an assisted living facility. She says many couples who move in say they wish they’d moved earlier. The social interaction is one major reason they cite. It’s nice to have each other, but sometimes having other people to enjoy activities and meals with is nice, too. Others say they wish they had moved while they had better ability to take advantage of all that’s offered.
Another major reason couples tell Patchett they wish they’d moved sooner is that it relieves some of the burden on the more physically and cognitively able spouse to have the assistance that these communities can provide. They tell her “I don’t have to worry about whether my spouse needs care. That’s all taken care of.”
Therefore, Patchett urges older couples to explore their options sooner rather than later. “Think about it in advance. What do you want as a couple? What if something happens? Would you want to stay together as long as possible?” She says it’s important to talk through the possible scenarios to determine what makes sense for your relationship and expected level of care needs.
2. Conduct a Careful Needs Assessment
Dr. Tanya Gure, section chief of geriatrics and associate clinical professor in internal medicine at the Ohio State University Wexner Medical Center, says that carefully assessing both partners’ requirements prior to making a decision about moving into a specific assisted living community is important for making sure that each person’s needs are met appropriately. “The spouse pair may have different levels of functionality,” so ask “how the services may need to differ for that partnership so there’s not too much burden on one spouse trying to take care of the other. That’s often the reason for moving into a more supervised setting anyway, but if there’s not a full consideration of those differences and needs, the transition may not go very smoothly.”
Visiting a geriatrician or asking your primary care doctor for a full assessment of current status as well as projected needs may be a good way to get a solid understanding of what services and care you and your partner need most. This can help guide your selection of the right assisted living community for your specific situation.
If one partner in the couple is experiencing cognitive issues, such as dementia or Alzheimer’s, it might be possible for the other partner to live with him or her in the memory care part of the facility, but more commonly, the less impaired partner will live in another part of the campus more appropriate for their level of need and visit with the other partner in the memory care section as often as wanted or needed. “They’ll still go meet for a meal or activities, but each partner is in an environment suited to their level of independence,” Patchett says.
Sue Johansen, vice president of partner services with A Place for Mom, a senior referral service based in Seattle, says the question about how to handle different levels of need, or acuity, between the two partners in a couple will require an individual answer; there’s simply no one-size-fits-all answer to how to get the care both partners need while maintaining as much connection between the two as they need emotionally. For example, in the case of a partner with memory care issues, “it’s not really right for the person without memory care issues to be in the memory care community because you want to make sure everyone is around people engaging at their level. That means oftentimes couples will have different apartments in a community at different levels, and so they can spend as much time together as they want. But it just depends on the physical and emotional needs of each member of the couple.”
To address these issues, “senior communities deal with that in different ways. Oftentimes the memory care person can’t be in the assisted living area of a community if it’s a blended community. Understanding how to approach that and considering what’s most important in light of the couple’s needs is important to help them live their best life,” Johansen says.
Another important thing to consider as early as possible is the financial aspect of how you’ll manage your care needs later in life. Assisted living facilities can be expensive — a 2017 survey conducted by Genworth Financial found the median monthly cost for an assisted living community is $3,750, totaling $45,000 annually — and paying for one person to live in assisted living while the other spouse maintains the family home could pose a financial challenge. “Once you compare the cost of one person to live at home and one person to live in an assisted living situation, in some cases,” it may end up being cheaper for both to move to the assisted living facility, Patchett says. Plus, then the spouse who might have remained in the family home doesn’t have to “deal with repairs and separate utilities and other issues. Both living in the facility might be a reasonable expense versus one living at home.”
Not every couple will find the same solution, and that’s OK. Patchett says the important thing is to consider your particular situation carefully and ask a lot of questions as early in the process as possible to get the best solution for you.
3. Look for Communities That Can Help
Figuring this all out might take a little research to find out which communities can handle the varying levels of care needs you might require at a price you can afford. But keep in mind that one upside of moving a spouse who needs more care into an assisted living situation is that it may take a lot of pressure and responsibility off the other partner. “If they’ve been a caregiver for a long time, chances are they’re depleted in some way as well,” and it may take a concerted effort to restore the caregiver’s health and happiness.
But just ceding lead responsibility for caregiving to someone else isn’t always as easy as it sounds. Some people take a lot of pride in caring for a spouse and the role of caregiver becomes an important one that offers purpose. “If one spouse has been the caregiver for the other for a long time — and often it goes too long before that transition — how is that person who’s the caregiver going to relinquish those responsibilities? Because they will have to, to a certain extent,” Johansen says.
Therefore, it’s important to talk with the staff at the facility to understand “what does that transition look like?” This can help ease the transition to assisted living for both partners, while being mindful that changing roles can be stressful, even when it means less work or effort on the part of the caregiver spouse. In these cases, it’s often very important for the caregiver spouse to make sure the less healthy spouse is well enough taken care of before “the caregiver spouse can feel confident about engaging themselves and getting back some semblance of a life.”
Still, it’s not like the caregiver spouse will lose all involvement in the other spouse’s care. Johansen says “they can be the advocate, which is an important role.” This can provide a sense of control and self-importance the caregiver may still want to experience.
Some communities can also help in smoothing this transition by connecting couples dealing with similar transitions as a sort of support group. “Many communities have a resident ambassador for people transitioning into the community to see what the options are. Maybe there are four or five other couples that are in the community where the spouses are dealing with that transition as well. We’ll hook them up with a resident ambassador who’s gone through that.”
She says “having someone who’s been through it is often a great way to understand the fears,” and can help the caregiver spouse get comfortable with how life is changing so they can now focus on their own needs a little more. “Getting a healthful life back means your spouse is OK and being taken care of. You’re being an advocate but it’s not your hands-on responsibility any longer. They’re well-cared for, so let’s take the time to focus on you,” Johansen says.
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