The decision to place an elderly parent into care in the face of their express wish to remain in their home is one of the most painful challenges of this life phase. The decision may seem simple when remaining at home will almost certainly result in significant injury and unnecessary suffering, yet this does not negate the distress of those making the judgment. This represents one of the last shifts of responsibility and authority in the parent-child relationship which begins with the infant fully dependent on their parent, ideally exercising their authority in a responsible and compassionate way. With time and growth, parent and child become more equal with little need or desire for one to exercise authority over the other but as the parent ages and becomes more vulnerable the child takes this role and begins to make decisions on behalf of their parent. While the decision for the parent to ‘leave home’ may not be the first big decision the responsible child has made, it can produce significant fear in the older person and guilt in the child. Both know this change may escalate symptoms of cognitive decline as the external markers on which they have come to rely are removed. The loss of community and social contact is also distressing and has been exacerbated by constraints imposed by COVID. A study by Derrer-Merk et al (2022) provided support for the COVID 19 ‘Social Connectivity Paradox: the need for social connectedness whilst maintaining social distance which challenged family equilibrium, wellbeing and quality of life in older people’.
The decision may also reveal and reinvigorate fractures which have been managed by physical distance between both parents and children and siblings. Where one child has taken the burden of responsibility for care, their siblings may either decide to take charge and disenfranchise or abnegate responsibility and then blame for choices made. The older person may also accuse their child of trying to ‘get rid of them’ or beg not to be relocated. Such fractures often reflect unresolved past relationship difficulties which return at this time.
Managing elderly relatives can be both rewarding and difficult. The most protective action is to address past hurts, misunderstandings, and grievances before a crisis arises, so all family members are fully aware and accepting of the proper authority they should exercise with support from those around them.
Elfriede Derrer-Merk, Scott Ferson, Adam Mannis, Richard Bentall and Kate M. Bennett: “Older people’s family relationships in disequilibrium during the COVID-19 pandemic. What really matters?” Ageing & Society (2022), 1–18