For many adult children, watching their aging parents struggle with daily living in an unsafe home is a distressing reality. The situation becomes even more challenging when those parents adamantly refuse to leave despite clear evidence that their environment is no longer safe.
Consider the real case of an elderly couple, both in their late 80s. The father has already suffered a severe fall on the stairs resulting in a head injury, a broken hip, hospitalization and rehab. He now relies on a walker but still struggles with poor mobility. The mother, while not as severely impaired, is unsteady on her feet and depends on a cane. The home they have lived in for decades is filled with hazards, from the treacherous stairs inside and out, to a bathroom that poses a significant fall risk. Despite their adult children’s repeated pleas to move to a safer environment, such as an assisted living facility, they refuse.
The Emotional and Practical Challenges
This scenario is not uncommon. Many elderly parents cling to their independence and their long-time home, viewing any suggestion of moving as an attack on their autonomy. They associate their house with memories, comfort, and a sense of control over their lives. Even after suffering serious injuries, they may minimize the risks or believe that a simple adjustment—like a stair lift—will solve the problem. However, in cases where frailty and falls are frequent, no single home modification can ensure their safety.
Home Modifications May Not Be Enough
For example, a stair lift can help if the elders are safely able to get on and off it. Even with that, the rest of the house poses an ongoing danger with anyone unsteady on one’s feet. In the example here, the dad would have trouble getting himself and his walker onto a stair lift. The mom is easily confused and would likely forget how to hold onto her cane when using a stair lift.
For the adult children, this creates an ongoing dilemma. On one hand, they feel a profound responsibility to protect their parents from harm. On the other, they cannot legally force their parents to move unless they are deemed mentally incapacitated. As a result, they live with constant worry, fearing the next inevitable fall or medical emergency.
The Risks of Staying
The risks of remaining in an unsafe home are clear. According to the Center for Disease Control and Prevention, falls are one of the leading causes of injury and death in older adults, and a single bad fall can result in a rapid decline in health. A fractured hip, like the one suffered by the father in this case, often leads to a significant loss of mobility and independence. Studies show that more than half of elderly individuals who break a hip never regain their previous level of function.
Why Aging Parents Refuse to Move
There are several psychological and emotional reasons elderly parents resist moving:
- Fear of Change: Moving is overwhelming, especially when it means giving up the familiar surroundings of their longtime home. To an aging adult, the home where they’ve lived for years symbolizes security, even if this is not actually true.
- Loss of Independence: They may see assisted living as losing control over their lives.
- Denial: They may not recognize the extent of their physical decline or believe they can manage with minor adjustments.
- Financial Concerns: They may worry about the cost of assisted living or believe it’s not a necessary expense.
- Mistrust of Institutions: Some fear they will be neglected or mistreated in a facility “with all those old people”, despite many high-quality options available.
What Can Adult Children Do?
Adult children cannot force their parents to move until or unless they have control over both healthcare and financial decisions for their parents. Getting that control can be very difficult, as aging parents resist, sometimes with anger and aggressive responses. We see this occurring often at AgingParents.com where we advise families, including the children of the elders in this piece. The parents typically are made the legal appointees as successor trustees and on the Durable Power of Attorney (DPOA) for each other. No clear alternative exists in most legal documents when the frail or impaired aging parent refuses to resign and allow the competent adult child to take over, either financial decisions, healthcare decisions or both. Instead, two frail aging parents in failing health are supposed to continue to be legally in charge of one another.
Added Danger: Two Impaired Elders In Charge
This reciprocal appointment idea is deeply and traditionally embedded in estate planning documents lawyers create. It makes sense as long as the adults in the matter are both fine and capable of good decisions. When one or the other declines physically and mentally, the estate documents, including the trust and DPOA, cannot be changed unless an aging person resigns or is removed.
Then the real error in the estate planning comes to light. Most lawyers are not being creative nor flexible in drafting these documents. Most of the time, the documents say that no one can remove the elder from the position of authority for all decisions until they are declared incapacitated (also called “incompetent” by lawyers) by two medical doctors. That would be good if the stubborn elder were willing to see two doctors to have their capacity evaluated and tested. If they are too stubborn to consider moving to a safer environment, you can imagine their total refusal to be evaluated for their capacity by two doctors. This flaw in estate planning can lead to disastrous results. Even when the aging parent has appointed a capable adult child to succeed them in decision-making at the time they become incapacitated, the elder will not allow the appointee to take over anything. The elder won’t admit to being incapacitated.
As an observer of many of these dilemmas from a medical/legal perspective, I can only offer educational programs to the Bar and beg my lawyer colleagues to change the way they draft these trusts and other documents. Some readily agree and allow more flexibility for determining incapacity. They write into the trust that in the event of incapacity, a psychologist, or one treating physician, or a unanimous vote by all the beneficiaries of the trust can determine incapacity of the person in charge. Other creative methods also exist and are used in trusts by the smartest lawyers doing estate planning. That can literally save the life of a frail elder like the dad in this story.
Other Possibilities To Persuade Aging Parents:
Involve a Third Party – Sometimes, hearing concerns from a doctor, clergy person, geriatric care manager, or trusted family friend carries more weight than hearing it from their children.
Consider In-Home Care – If they refuse to move, hiring an in-home caregiver can provide some safety and assistance, though it may not eliminate all risks. This is an immediate expense. Not only is it a new responsibility for the adult children to keep the caregiver accountable, it may be difficult for the aging parent to accept that they need this help.
Monitor for Changes – If their condition worsens, revisit the conversation. A crisis, such as another fall, may change their perspective. If that happens, which is likely, seize the opportunity to persuade aging parents to resign from the trust or other documents at that time.
The Hard Reality
Despite their best efforts, adult children may ultimately have to accept that their parents have the right to make unsafe choices. This leaves adult children in the painful position of waiting for a new crisis before action can be taken.
The Takeaways
- When you, the adult child first notice new frailty and difficulty with an aging parent’s balance, initiate the conversation about how to remain safe. Do not wait until there is a fall and hospitalization. Perhaps repeated cautions, offered respectfully, emphasizing how it causes a worry burden on you can help.
- If your aging loved ones are just fine right now and competent for decisions of all kinds, ask to review their trust and DPOA with them. If they allow this, the documents can be modified to remove the unfortunate “two medical doctors” rule that can become so problematic as parents age and the risk of impairment increases. You may be able to get an opinion from a new estate planning attorney to amend the parents’ trust and change the DPOA to allow for the possible resistance of the aging parent.
- Don’t give up trying to persuade changes for safety. Starting with initiating home care may be a good beginning.
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