America’s population is graying, as they say. And the retirement home industry is booming as a result, expected to swell exponentially over the next several years. Meanwhile, nearly a fifth of Americans provide care for an adult, according to the AARP. And more than half of adults ages 50 to 80 provide care for someone 65 or older, according to the University of Michigan’s 2022 National Poll on Healthy Aging.
For many adult caregivers—especially working ones—something will eventually have to give. Psychologist Allison Applebaum, Ph.D., knows this all too well. The author of the forthcoming book Stand by Me, Applebaum cared for her aging father—legendary composer Stanley Applebaum, whose many memorable musical feats included arranging strings on the 1961 Ben E. King hit “Stand by Me.” She is also the director of the Caregivers Clinic at Memorial Sloan Kettering Cancer Center in New York City.
While the elder Applebaum expressed his desire to be cared for at home, it wasn’t always possible. He began experiencing signs of heart and kidney failure in his late eighties, and ping-ponged between hospitals and nursing homes for months. The first time the musical savant needed nursing home placement, the revelation blindsided his family.
“Balancing paid employment and caregiving was incredibly difficult,” Allison Applebaum says, adding that it was “the hardest thing I’ve done.” Caring for her father, who died in 2019, was “really a full-time job.”
She was far from alone in her plight. Some caregivers will inevitably need to place Mom or Dad in a home—and for those who do, the decision can be daunting.
A continuum of care
For those faced with such a choice, let’s start with the basics: What’s the difference between a retirement home and a nursing home?
If you’re not really sure, you’re not alone. That’s because such facilities exist along a continuum of care, says Nancy Swanger, founding director of the Granger Cobb Institute for Senior Living and associate professor at Washington State University in Pullman.
On one end are communities that are simply age restricted—perhaps for those 55 and older. Further along the spectrum is independent living, which provides additional services like landscaping, snow shoveling, and perhaps weekly housekeeping. Residents can cook on their own, but a certain number of meals may be provided. Group activities may—and ideally should—be offered at both.
Then there is assisted living, which offers help with activities of daily living, known in the industry as ADLs. Residents are still largely independent but receive the assistance they need, be it with dressing, toileting, or medication management.
More intensive is a nursing home with skilled care, which offers 24/7 medical support, in addition to the services mentioned above. Hospice care may be involved if a patient is dying—or memory care, if a patient has dementia.
Choosing a home for Mom or Dad can feel like a job in and of itself. Fortune spoke to experts in the eldercare economy, asking them what adult children should keep in mind when helping a parent choose where to spend their golden years. They offered the following guidelines.
The time to talk about this is now
Your parent’s wishes for long-term care should ideally be discussed when they’re of sound mind and in good health, Applebaum says. So, too, should finances, as much of the industry is considered private-pay.
Among items to consider: What resources do your parents have to pay for a retirement home? Will private insurance cover any portion of care? Do they have long-term-care insurance? Are they on Medicare and/or Medicaid, which may cover some care needs? (If they’re not on either but qualify, now is the time to start the application process, which can be complicated and lengthy, she says.)
And tough questions should be asked of yourself and other family members. Are you able and willing to pitch in to pay for care? Are they?
“Conversations like that need to happen early,” Applebaum says, or you could be blindsided, forced to make a rushed decision or a less-than-optimal choice. “Much of the distress I see in families is borne out of the fact that they didn’t have these conversations.”
Distance matters more than you think
Contrary to popular belief, caregiving responsibilities don’t end when Mom or Dad moves to a retirement home. The level of care a home provides—or says it provides—may be less than what your parent needs, Applebaum points out. You may find yourself wanting—and needing—to be around more than you anticipated.
For Jen Squilla, a vice president at Miami-based PR firm Max Borges Agency, it was the latter. When her mother-in-law ended up in senior care at Miami Jewish Health, Squilla was grateful it was a quick trip for family and friends, who would stop by frequently to “get ice cream together and sit under a banyan tree and enjoy some sun.”
She recommends ensuring the facility is one grandkids might enjoy visiting, if applicable, and checking on COVID-related visiting restrictions, if any.
Community is (almost) everything
That said, Swanger recommends adult children don’t automatically choose the closest home for mom or dad, assuming it will be the best. A location a bit farther away, while inconvenient to you, might be the best choice for your parent if it has a warm, welcoming atmosphere and activities that keep them engaged and enthused.
Earlier this year, U.S. Surgeon General Vivek Murthy issued an advisory on a national “epidemic of loneliness,” contending that the impact of isolation is “similar to that caused by smoking up to 15 cigarettes a day, and even greater than that associated with obesity and physical inactivity.”
“Especially during COVID, we learned that isolation is not healthy,” Granger says, citing stories of those in nursing homes whose lives were seemingly truncated by the isolation of pandemic lockdowns. “We’re social creatures, meant to be around other people. If you live there by yourself long enough and you don’t have regular contact with other people, you’re going to die sooner.”
Granger suggests looking for a home with a robust social package—one beyond bingo night and crafts. Thanks to the demands of Boomers, who enjoyed the social experience of college and might seek something similar during their retirement years, homes are broadening their perks, offering bistros and coffee shops, access to continuing education, and transportation to collegiate sporting events and performances.
“I would want them to have things to do that they like, to look forward to,” she says. “If it’s a little further out of the way for me, it’s just an inconvenience I need to suck up and bare.”
This may or may not be a forever home
Your parent’s needs may change over time, Swanger and Applebaum say. Both recommend choosing a community that offers many stops on the continuum of care, so your parent can avoid disorienting moves and keep that all-important community they’ve come to know and love.
It’s their decision, not yours
Homes these days increasingly feature nifty bells and whistles, Swanger says, from zippy Wi-Fi and the latest tech to fitness centers, music rooms, and tennis courts.
Neat stuff, right? You’d love it. But would they? Ultimately, the decision of where Mom or Dad ends up should center on their wants and needs as much as possible—not on your likes or convenience.
“It’s a balance between honoring a parent’s goal and what’s feasible,” Applebaum says.
How employers can help
Finding a home for Mom or Dad will likely entail multiple site visits and tours, meetings, and copious amounts of research—a heavy lift for anyone, no less those with full-time jobs. What can employers do to encourage and retain talented caregivers?
Terri Stewart—senior vice president and head of global healthcare, government, and public affairs at Maryland-based biopharmaceutical firm EMD Serono—says her company encourages a culture that embraces caregiving in the following ways:
Training managers to offer opportunities—like projects, travel, and promotions—to employees who are caregivers, instead of assuming they’re too busy.
Providing unconscious bias training to reinforce the notion that caregivers are whole people and capable workers.
Offering job-sharing, hybrid, remote, and part-time options to workers who need them.
Having company leaders share their caregiving journeys with employees.
“Challenging family situations should not prevent a talented person from joining our company or carrying out all of their professional activities,” she says. “If everybody is doing this—your managers are showing this, your leaders are talking about it—it removes that fear. It is all of us, at all levels.”
A version of this article appears in the December 2023/January 2024 issue of Fortune.
