Caregiving: Married Couples in AL & Their Adult Children

Marriage has many protective factors, including greater insurance against having to relocate to a long-term care (LTC) setting. However, some older married couples do move to assisted living (AL) when the health care needs of one or both partners outweigh their collective ability to meet those needs. While the number of couples in LTC settings is small, some scholars predict that there will be an increase in the number of couples moving to AL settings. Couples who transition to and reside in residential care settings together experience both an individual and shared understanding of the phenomenon. The experiences of adult children caring for a singular parent in a long-term care setting are well-documented. However, the caregiving experiences of adult children caring for both their parents in an AL setting have yet to be explored.

A researcher at the Gerontology Institute at Georgia State University recently published a study examining the parental caregiving support experiences of adult children caring for two parents in an AL context. Twenty married couples residing in AL settings and ten adult children (representing eight of the 20 married couples) participated in in-depth qualitative interviews about their experiences with the AL residential setting. Participating married couples ranged in age from 66 to 94 years old. The adult children ranged in age from 45 to 68 and included five daughters, four sons, and one daughter-in-law.

Results indicated that adult children experienced several challenges unique to finding LTC accommodations and caring for two parents. With regard to relocation, adult children had difficulty meeting the residential needs of both parents when their parents’ needs were sometimes quite different from one another. Couples’ collective needs were determined by those of the frailer parent. AL settings were not necessarily the first residential choice, but ultimately had to be chosen when one parent did not qualify for more independent living based on his or her health status. Space was an additional challenge as many adult children shared frustrations about their inability to find adequate space and suitable floor plans that would accommodate a couple’s needs. One concluding and notable finding was the concern some adult children had regarding the continuation of spousal caregiving in the context of the AL setting. For some, the choice to move their parents to an AL setting was to diminish or remove the caregiving burden for one of their parents because of the physical risks that were involved. However, many adult children found it difficult to convince a parent to relinquish their spousal caregiving role to the AL staff. These adult children had to resign themselves to accepting the risk, yet they continued to fear what might happen to one or both of their parents. An additional twist for many of these adult children was that they felt conflicted about intervening in spousal caregiving because they also recognized the emotional benefits that the caregiving role provided for their caregiving parent.

This research demonstrates the need to consider the unique needs and concerns of partnered residents of long-term care communities compared to those residents residing in LTC communities without partners. While environmental design is perhaps an obvious barrier for couples residing in LTC communities, there exists additional, unique concerns for couples and their families with regard to spousal caregiving. Potential interventions need not only consider the needs of the couple but also consider the concerns and influence of additional family members. As family structure continues to be more varied and nuanced a more comprehensive approach to including family members in resident care decisions must be considered.

Kemp, C. L. (2012). Married couples in assisted living: Adult children’s experiences providing support. Journal of Family Issues, 33, 639–661.