In the last two years, my mother has had numerous surgeries and been in four rehabilitation facilities for physical therapy. Between hospital and facility stays, I've taken care of her either at our house or hers. But following her most recent surgery and care facility rehabilitation program, my husband and I made the decision to move her to the facility's assisted living area. Our decision was based on several factors: complicated, fluctuating medication management for chronic conditions and physical frailty. We've reached the point where home care isn't the best care. We realize that and so does Mama.

In general, the level or amount of care provided by a primary caregiver increases along with the age of one’s parents. Some periods may offer a bit more reprieve than others, but as aging continues, the challenges increase, so be prepared.

Perhaps your parents have been living independently in your hometown and doing just fine. Maybe a health scare or temporary condition caused you to begin thinking. Initially, many of us ignore this indicator of the need for future change in living arrangements, but now is a good time to investigate. The more you know about the services available before you need them, the easier necessary decisions will be later. Tour communities near your home or near the home of the ones in your family who will provide the majority of support care.

Whether or not you’ve tackled the subject with parents yet, you can scope out potential alternate living arrangements before a change is warranted. Constraints on the primary and supporting caregivers, level of assistance needed by a parent, or a parent’s long-term prognosis may all contribute to the decision that home care for your parent isn’t the best option, even if you wish it were.

There are more distinguishable levels of care offered by outside sources. The majority are scaled or rated based on independence of the patient. “Retirement Community” is the term often used for multi-level care facilities. They often encompass a large campus, offering different levels of care, usually in multiple buildings, and with a wide variety of staff. You may see independent living, assisted living, and skilled care (nursing) centers or any mixture of these in any one community. The amount of care given at each level varies and depends on the management. Many communities are owned by large corporations, so it is important to check the stability of the parent company when considering such alternatives.

Things to Consider When Deciding Home Care Isn't Best

· Is it more costly to remodel your house to accommodate your parents than to consider a care facility? (Our house has no bedroom and no full bath on the ground floor and would require an addition. My mother's house is too small to accommodate our family, too, and would also require an addition. With the soft real estate market, selling both and buying another house isn't currently an option.)

· Do your parent's medication dosages constantly change, either daily or weekly, and require a physician to manage?

· Does your parent suffer from dementia?

· Is your parent too frail to perform everyday tasks without assistance?

· Does your parent require round-the-clock skilled care? (It may be more expensive to hire sitters and provide food and other necessities for your parent and sitters than to house your parent in a care facility.)

When There Is No Money

While skilled care and assisted living are wonderful options, unless your parent has long-term care insurance, money can become an overwhelming issue. If your parent doesn’t have much in the way of liquid assets, you may find locating the cash to cover a $5500/month semiprivate, skilled-care bed or a $3000/month semiprivate, assisted-living bed a major problem. (These costs vary greatly, of course, in different parts of the country and often do not include medication costs.)

So what do you do when your parent has no money? If you’re not careful, you’ll quickly deplete your own savings, so now is the time to begin searching for hidden assets. You should consult your parent’s tax preparer before doing anything, but here are a few options to consider with your parent or your siblings:

· Sell or rent your parent’s house.

· If it seems likely your parent will come home at some point and you don’t want to sell, look into securing a reverse mortgage or line of credit on her house.

· Liquidate antiques, jewelry, guns, cars, or collections.

· Sell rental property or land.

· Investigate in-home respite care (certain conditions apply).

· Determine if your parent is eligible for VA benefits

Portions of this article excerpted from When Your Aging Parent Needs Care: Practical Help for This Season of Life(Harvest House Publishers) by Candy Arrington and Kim Atchley. www.whenyouragingparentneedscare.com