The good news, familiar by now, is that people are living longer. We also know the world’s population is aging. With the maturing of North America’s largest demographic group, the baby boomers (people born between 1946-1964), the U.S. and Canada anticipate nearly one-quarter of their citizens will be over 65 as early as 2031. For the adult children of aging parents, this statistic can seem daunting.
In Paola Scommegna’s February 2016 report, Today’s Research on Aging: Family Caregiving for the Population Reference Bureau, she summarizes current U.S. aging statistics, housing trends and their effect on family caregivers. “In the United States, the vast majority of care that allows older people to live in their own homes is provided by family members who do not receive pay for their services,” she writes.
In addition, as parents live longer, “with chronic disabling conditions, particularly dementia,” and government policies move to “deemphasize nursing home care” in support of community living, the pressure felt by the sandwich generation (those simultaneously caring for aging parents/parents-in-law and their own children) has never been greater. As a result, “meeting the care needs of older Americans will become more challenging for families,” Scommegna explains.
Although a growing number of options exist as living choices for aging parents, they can be divided into four very general categories:
- those who continue to live independently in their private residence (house, apartment, condominium);
- those who move in with one of their adult children;
- those who live in senior housing—also known as assisted living--where a variety of levels of service and assistance are offered;
- and those who are placed in long-term care facilities.
Scommegna notes that providing “uncompensated care for a spouse or parent living with physical limitations can be both rewarding and . . . harmful to the care provider’s well-being”. Nevertheless, the choice to move an aging parent into a long-term care facility is not an easy one.
Based on the Canadian Coalition for Seniors’ Mental Health (CCSMH) guide, Mental Health Issues in Long-Term Care Homes, when an older adult can no longer accomplish daily living “tasks like bathing, getting dressed, going to the bathroom, and eating. . . independently, this can lead to [the] decision.”
Understandably, the actual move into a long-term care facility and the ongoing experience there can take both a physical and mental toll on the elderly parent. Researchers are also starting to pay more attention to the effects of the relocation experience on the child/ren or spouse who had previously provided care.
The Family Caregiver Alliance’s 2016 publication, Depression and Caregiving, reports that although “many caregivers are finally able to catch up on much-needed rest, the loneliness, guilt, and monitoring the care a loved one receives in this new location can add new stress”. Furthermore, for some caregivers, the depression felt “at the time of placement” may persist long enough to require their own professional mental health assistance.
For the residents, thanks to increased respect for and recognition of mental illnesses and treatments, researchers are beginning to document the mental health challenges of elderly people before, during and after moving to senior care facilities.
CCSMH’s guide on mental health issues in care homes underlines the fact that mental illnesses do not go hand-in-hand with old age: "Many people think that mental health problems are just a normal consequence of aging. This simply isn’t true. They are usually signs that something is wrong that requires attention from a healthcare professional.”
Moreover, the guide sheds a positive light on the knowledge that mental health “. . . problems can be treated. . . Some problems associated with aging cannot be cured yet, but there is still a lot that can be done.”
A 2011 study by the University of Adelaide’s Joanna Briggs Institute in South Australia--The experiences of older adults from moving into residential long-term care—examined existing research into the effects of these care facilities from data collected as far back as 1945. The study found evidence of “a variety of negative consequences associated with relocation including depression, increased sense of loneliness and alienation, decrease in functional competence, cognitive decline, decline in general condition . . .”
On a positive note, however, Adelaide’s researchers reported that negative statistics were countered by evidence of good experiences in long-term facilities, including “. . . positive outcomes such as improved emotional well-being, enhanced environmental awareness, increased activity participation and greater social engagement”.
Education and professional development opportunities for professionals in the field of mental health are also on the rise, supporting the need to ensure the mental health of long-term care residents. The American Psychological Association, which sponsors continuing education for its psychologists, recently supported a course taught by William Matteson, Ph.D., called Aging, Mental Health and Long-term Care.
The mission of the course, Matteson wrote, is to recognize that “currently the quality and availability of mental health care [in long-term facilities] leave much to be desired”. In order to improve, Matteson puts the onus on the professionals: “. . . there must be a fundamental reworking of the delivery of services, and this includes the establishment of high-quality mental health care – delivered by you.”
In order to promote the mental health and overall well-being of seniors in care, CCSMH’s guide suggests staff of every long-term care facility participate in ongoing training to ensure residents receive personalized care; think of families as “partners in care”; focus on a resident’s strengths; and, inherent to mental health, staff must consider the physical, social and spiritual health of its seniors.
Canadian Coalition for Seniors’ Mental Health. (2009). Mental Health Issues in Long-Term Care Homes. http://ccsmh.ca/wp-content/uploads/2016/03/ccsmh_long_termBooklet.pdf
MacLeod, B., LCSW, Reviewer., (Retrieved November 29, 2017). Family Caregiver Alliance. Depression and Caregiving. https://www.caregiver.org/depression-and-caregiving
Matteson, W., Ph.D., (Retrieved November 29, 2017). ContinuingEdCourses.Net. http://www.continuingedcourses.net/active/courses/course071.php
Richards, S., (May 2011). The Joanna Briggs Institute, University of Adelaide. The experiences of older adults from moving into residential long term care. http://journals.lww.com/jbisrir/Fulltext/2011/09161/_The_experiences_of_older_adults_from_moving_into.20.aspx
Scommegna, P., (February 2016). Population Reference Bureau. Today’s Research on Aging: Family Caregiving. http://www.prb.org/Publications/Reports/2016/todays-research-aging-caregiving.aspx