Stop 06 of 08
Should I move my mom closer to me or hire help? The questions that actually decide it
You have been asking "should I move my mom closer to me or hire help" for months, usually on the drive home from the airport. Every version ends the same way: one answer feels loving and the other feels like giving up. This page treats both as loving, because both are, and replaces the feeling with a worksheet.
The National Institute on Aging puts the decision in one sentence that is worth taping to the fridge: housing choices may depend on the person's health, ability to perform activities of daily living, financial resources, and personal preferences, and the NIA's advice is to talk about the pros and cons of each option before making a decision. Her preferences are on that list. So are yours, though the NIA does not say so, and this page will.
The worksheet: her side of the table
Answer these in her words, not yours. If you do not know an answer, that is the next phone call.
- Her friends. Name three people she sees every week who are not family. If you can name them, moving her means taking them away. If you cannot, the house may already be lonelier than you think, and moving may add people rather than subtract them.
- Her church, her club, her Tuesday. Whatever the fixed point of her week is. A parish of forty years does not transfer. A bridge group does not transfer. Write down what she would lose on a Sunday.
- Her doctors. How many, how long, and whether she trusts them. Twelve years with one physician is a relationship a move resets to zero. Whether she is safe to live alone at all is their question, not this page's.
- Her house. Not its value. Its stairs, its bathroom, its distance from a pharmacy, and whether it is the house you grew up in, which changes what "sell it" means to both of you.
- Her answer. Ask her plainly, once, when nothing has just gone wrong: "If you ever could not stay here, would you rather have help come to you, or come to me?" Then believe the answer, even if you do not like it.
The worksheet: your side of the table
These get skipped because they feel selfish. They are not. A plan that breaks you is not a plan.
- Your guest room. Is there one, is it on the ground floor, and can she reach a bathroom without a staircase. If the honest answer is "she would be in the basement," you are not moving her closer; you are moving her downstairs.
- Your marriage. Say the question out loud to your spouse before you say it to her. A yes, a reluctant yes or a no is data you need before the conversation with your mother, not after.
- Your kids, your job, your own body. The NIA is direct about what caregiving does to the caregiver: caregivers tend to have a higher risk of physical and mental health issues, sleep problems, chronic conditions such as high blood pressure, and even premature death, and are less likely than others to get preventive health services. Moving her into your house moves the job into your hallway. If you are also raising children, the sister desk Between Mom and Kids is written for the daughter whose guest room, calendar and marriage are all part of this decision, and it goes deeper on that half of the table than this page can.
- The monthly flight. If the thing that is unsustainable is the flight, say so. "Flying home every month is killing me" is a real reason, but it argues for help in her house as much as for a move. What it does not argue for is doing nothing.
How long does this last?
The question underneath the question is how long you are planning for. The Administration for Community Living says someone turning age 65 today has almost a 70% chance of needing some type of long-term care services and supports in their remaining years, that women need care longer, 3.7 years on average, than men at 2.2 years, and that 20 percent will need it for longer than five years. Those are averages about a population, not a prediction about your mother. But a plan for six months and a plan for four years are different plans, and the numbers say to build the second and be glad if you only need the first.
Who pays, either way
Whichever side of the table wins, the money question is the same and it has a public answer. Medicare does not pay for long-term care; you pay all costs for non-covered services, including most long-term care. The same Medicare page says that although you are not eligible for long-term care under Medicare, you may be eligible for it through Medicaid if you meet eligibility requirements in your state, or you can buy private long-term care insurance. In Missouri, Medicaid is called MO HealthNet, which the state says can help with benefits Medicare does not normally cover, like personal care services, and the state's health department describes its Home and Community-Based Services as programs that help older adults live in their homes or communities rather than moving to a nursing home. Help in her house, if she qualifies, may be partly public. Help in your house, in another state, is another state's rules. This site prints no prices for anything. Ask each program what it costs and what it covers.
If the answer is bring help to her
The objection you will hear first is "I do not want a stranger in my house." Family Caregiver Alliance has the best answer to it in print: it advises telling the person that you need help, and that accepting hired care is something they can do to help you, not a sign you are going to abandon them. That reframe works because it is true. A daughter 500 miles away who knows someone is in the house on Tuesday and Thursday mornings sleeps on Monday and Wednesday nights.
Missouri's health department sorts help at home into three types: home health, which is skilled and mostly Medicare; in-home care under Medicaid; and private duty or private pay, which covers aide personal care, respite and companion care, needs no physician order, and for which the state issues no license. The third kind is what a daughter can set up from another state with a phone call, and it is what the paid placement on this site sells. New Plan Care is an independently owned non-medical in-home care company in Chesterfield. The towns a far-away daughter actually asks about from that office are Ballwin, Chesterfield, Eureka, Glencoe, Grover, Pacific, Valley Park, and the rest of St. Louis. It is a client of OwnersFirm, which publishes this site, and it pays to be named here. If "help comes to her" is where the worksheet lands, Call (314) 405-0887 or read what it does. Ask what the hours cost on the call; this page will not invent a figure.
If the answer is move her closer
Then the NIA's long-distance page has your next task listed already: research long-term care options, such as an assisted living facility or nursing home, or, in your case, the ground-floor room and the doctors near you. The NIA's advice on timing is the part to take seriously: the best time to plan is before the older person needs extensive help, because planning gives you time to learn about services and lets her make important decisions while she is still able. A move decided in a hospital hallway is a move nobody chose. One decided at a kitchen table in October, with her church already told, is a move she agreed to.
And there is a third answer the worksheet allows, which is "not yet, and here is what would change my mind." Write that sentence down. It is the most honest plan there is.
What to do tonight
- Fill in her side of the table. Three friends, one Tuesday, her doctors, her house, her answer. Leave blanks where you do not know.
- Say the question out loud to your spouse. Write their answer down next to hers.
- Write the "not yet, and here is what would change my mind" sentence, even if you think you already know.
- Do not call her about it tonight. Pick a calm weekend. This is a kitchen-table decision, not a phone-call decision.
When to ask the care team or the doctor
One line on the worksheet is not yours to fill in: whether she can safely live alone at all, and for how long. That is partly the stairs and the stove, which you can see, and partly her health, memory and balance, which her physician has to weigh. Before any move, ask her doctor two things with her permission: what does her care need to look like in a year, and what would a move mean for the conditions they are treating. If there has been a diagnosis, ask what it means for driving, for cooking, for being alone overnight. Take the answers to the table. Do not let this page, or your guilt, answer them for you.