When a Spouse Is the Caregiver: Is It Time to Consider Assisted Living?

The National Institute on Aging (NIA) notes that the person who takes on most of the everyday care is often a spouse. A husband or wife usually lives in the same house, is often older too, and may feel that asking for help means failing a promise. NIA also notes that a primary caregiver, especially a spouse, may be hesitant to ask for a break.

The care can creep up slowly. First it is driving and medicines, then help in the shower, then getting up at night. Because there is no single moment when it changes, many couples carry on long after the work has become too much for one person.

NIA says caregivers are less likely than others to get checkups and look after themselves, and as a result tend to have a higher risk of physical and mental health problems, sleep problems and chronic conditions such as high blood pressure. It lists these signs of caregiver stress:

• Feeling exhausted, overwhelmed or anxious.
• Becoming easily angered or impatient.
• Feeling lonely or cut off from others.
• Trouble sleeping, or not getting enough sleep.
• Feeling sad or hopeless, or losing interest in things you used to enjoy.
• Frequent headaches, pain or other physical problems.
• No time to exercise or prepare healthy food.
• Skipping showers or other personal care.
• Misusing alcohol or drugs, including prescription medicines.

Some situations put both people at risk. A caregiver who has to lift or catch a partner can be hurt. A caregiver who has not slept through the night in months is managing medicines and appointments while worn out. A spouse whose own health is failing may not be able to call for help if both are in trouble at once.

If any of this sounds familiar, two steps help. First, tell your own doctor that you are a caregiver: NIA says doctors can advise on your health and may know about support groups and respite in your area. Second, ask your spouse's doctor what level of care your spouse is likely to need, and whether that has changed. Our guide to caregiver burnout and respite options covers support in more detail.

NIA describes respite care as short-term relief for a primary caregiver, lasting from a few hours to several weeks. It can happen at home, at an adult day center or in a care facility. Family, friends or volunteers can sometimes provide it, and professional services charge by the hour or by the day or week.

California has a statewide network of Caregiver Resource Centers, described by the California Department of Aging. Each one offers caregivers, at low or no cost, information and referral, family consultation and care planning, short-term counseling, support groups, legal and financial consultation, and financial help with respite such as temporary in-home support, adult day care and short-term or weekend care.

A short stay in an assisted living community or board and care home gives the caregiving spouse a rest and lets the couple see what that kind of home is like. See respite care placement for how short stays work locally.

Often the spouse who needs care moves to a licensed home nearby and the other stays in the house. The couple still sees each other every day, but the heavy lifting, the night care and the medicine schedule pass to staff.

This arrangement raises money questions: two households on one set of savings and income. California's Medi-Cal program has spousal protections for some long-term care programs; read about them in Medi-Cal protections for a spouse at home and talk to an elder law attorney about your own case before deciding.

NIA says feelings of sadness, frustration and guilt are normal for caregivers, and notes that a primary caregiver may need extra support while adjusting to the other person's absence and to living alone at home. Family and friends can help by checking in on the spouse at home, not only the one who moved.

Some couples move together, even when only one needs much help. California's Health and Safety Code, section 1569.269, lists among a resident's rights in a residential care facility for the elderly the right to share a room with their spouse, domestic partner or another person of their choice, when both live in the same home and both agree. Whether a particular home has a room that suits two people is a separate question to ask each one.

California regulations require a home to appraise each prospective resident's needs before admission, so each spouse is assessed on their own, and homes set their own prices for couples. For room sharing, pricing and what happens when one partner's needs change, see assisted living for couples.

Hamssa Benrekia is a placement specialist in Torrance with a background in hospice, palliative care and home health. She helps couples and their families in the South Bay and Harbor area of Los Angeles County find licensed assisted living communities and board and care homes, whether one spouse is moving, both are, or you need a short stay first. To talk it through, contact Hamssa. More topics are in the California Assisted Living Placement Guide.