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Friday, December 19, 2014

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Moving to be close to family

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It seems to make sense: move your parents close to you so that they will get care when they need it.

The issue has come up for me with my patients and my own family. The potential impact of such a move isn’t always appreciated by those whose motives seem to make sense, “to be close should there be medical and support needs.” But, a move from a known neighbourhood and a social network can be traumatic and may leave the older person feeling isolated.

The idea that the family, “especially the grandchildren,” will be able to easily visit often may end with disappointment for the older person. Even when circumstances seem ideal because of the apparent devotion of grandchildren, what is often forgotten is they have busy lives and visiting a beloved grandparent may not always be a priority. For the older person, whose expectations might be of frequent visits and a close relationship, there is often a disappointment as they “wait” for the visits and opportunities for emotional intimacy.

I have witnessed situations in which parents are relocated to the same neighbourhood as the caring children, based on the assumption that they will be close to their children and the grandchildren. The trade-off may be that the neighbourhood does not have other attributes that make it a welcoming and attractive place to live. A move to the suburbs, for example, where the children live, may eliminate the opportunity to just “go downstairs” and be in a neighbourhood that has familiar types of restaurants and stores close by.

I recall one situation years ago when a daughter convinced her father, long a widower but managing in a smaller community in Ontario where for years he had a successful furniture business, to move to Toronto in order “to be close,” as she was worried about his functioning independently, even with some help that she had arranged for him. When I saw him in my office, he revealed to me how lonely and unhappy he had been since the move.

“I know my daughter loves me, and my grandchildren try to visit as often as they can and they are very sweet. Sometimes they take me out for dinner or for a coffee, and I get invited to their house for Friday night dinner and to all the simchahs, but most of the time I am alone. I tried joining a senior centre, but it really is not for me. I was never a joiner.

“At home, everyone I met knew me – many had bought furniture from me at some time in their lives, and I could almost always remember what they bought so there was always something to say. And all the store owners knew me – I didn’t go to the supermarket but to the local stores, even through the prices were a bit higher, because everyone knew me. Here I am a ‘nobody,’ just an old man who sometimes comes in with his daughter or a younger person who is likely a grandchild.”

So what’s the answer? Sometimes the motivation to have the parent move is valid, especially in the face of illness or severe cognitive decline. But everyone involved should avoid romanticizing the benefits of the move and realize that there may be lots of “alone” time for the older person, so efforts should go into exploring socialization options that might be acceptable and meaningful before the move actually takes place.

 

 Dr. Michael Gordon is medical program director of palliative care at Baycrest. His latest book is Late-Stage Dementia, Promoting Comfort, Compassion and Care. His previous book, Moments that Matter: Cases in Ethical Eldercare, follows his memoir, Brooklyn Beginnings: A Geriatrician’s Odyssey. All can be researched at his website: http://www.drmichaelgordon.com.

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