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Couples with Different Health Needs Can Now Live Together in Some Long-Term Care Facilities

New options include extra assistance and relieve well spouse of some caregiving duties


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Nitat Termmee / getty images

Margaret Gerlach spent her career as a nurse. So, she knew that people with cognitive or nervous system disorders decline more quickly when deprived of the companionship of loved ones.

That’s among the reasons why, when she and her husband, Harry, were considering moving into senior living, “we looked for places where we could live together. It never occurred to us not to.”

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Harry, who is 78, has Parkinson’s disease, which at one time might have invited scrutiny from senior living providers hesitant to let someone with a progressive nervous system disorder stay independently with his spouse.

More long-term care communities are making room for couples in situations like this who are intent on remaining together.

“You’re used to dealing with each other,” says Margaret, who is 74 and moved last year with her husband to The Landing, an assisted living community in Alexandria, Virginia, where he gets additional care every day in the apartment that they share.

A growing need

This kind of arrangement is in increasing demand among the growing number of couples entering retirement while one or the other faces long-term health issues — particularly dementia and Alzheimer’s disease, which affect 55 million people worldwide, with nearly 10 million new cases every year, according to the World Health Organization.

“A lot of couples historically would have had to live separately,” says Jonathan Garber, executive director at Watermark Retirement Communities, which runs The Landing and two other assisted living communities, in Rockville, Maryland, and Fairfax, Virginia.

These were designed to let couples with varying needs stay together in the same space, even in memory care, where there are apartments with two bedrooms and a shared common area and bathroom. Under most such models, the couples live in their own apartment and are visited by specialists and home health aides.

“The healthy spouse doesn’t have the burden of worrying about dressing, bathing, medication management. We take care of all that for them,” explains Garber. “They can make new friends, go out to dinner with other members, live a somewhat vibrant life and know their spouse with needs is being taken care of.”

Meanwhile, he notes, there are things the couple still can do together. “They’ll have meals together; they’ll watch TV together. So, they’re still able to enjoy life.”

This avoids the added trauma for someone already in decline of abruptly being separated from a partner.

“When a person moves, period, it’s a hard adjustment. If you move with your family member, it’s so much easier,” says Sheryl Zimmerman, co-director of the Program on Aging, Disability and Long-Term Care at the University of North Carolina at Chapel Hill School of Social Work.

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After all, says Mike McClernon, owner and advisor at Assisted Living Locators of Long Island in New York, “these are people who have spent 50 years or more together. They’ve been waking up together every day.”

On the downside, if a cognitive disorder causes the ill person to become disruptive, it can intrude on neighbors. And it can be draining for the spouse without impairment to watch a loved one slowly get worse, up close.

“It all depends on the character of the relationship, and if they really signed up for better or worse, the well spouse doesn’t resent it,” McClernon says.

Like the Gerlachs, Woody and Rita Franke “can’t imagine living separately,” says Woody, who is 80, as his wife was getting help from a home health aide in another room.

Rita, 79, has memory issues, and Woody needs dialysis three times a week. But after 59 years of marriage, he said, they’re grateful to remain together at The Providence, in Fairfax, Virginia, another Watermark community, to which they moved last year from Texas to be closer to their daughters.

spinner image Woody and Rita Franke
Woody and Rita Franke
Courtesy of Woody Franke

“There’s always a chance that she might have to go to memory care, but so far she hasn’t,” Woody says. And even if she does, it’s three floors below in the same building.

Some assisted living communities don’t let couples live together when one needs significant help with day-to-day activities. Most require residents with a dementia diagnosis to be transferred into memory care facilities, sometimes in separate buildings on a campus. Though they can visit, spouses typically are not allowed to move with them. “Going across the bridge,” residents of some of these places jokingly call it.

This is slowly beginning to change. Like Watermark, the 10 Highgate Senior Living communities in Arizona,California, Montana and Washington State let couples with different needs live together or close by, including in what it calls its “memory care neighborhoods.”

At others it remains uncommon. At Erickson Senior Living’s 21 properties in 11 states, for instance, spouses tend not to continue to live together after one requires higher-level nursing or memory care, a spokesman said.

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A ‘case-by-case’ basis

“A fair number of [providers] do offer this as an option,” says Dee Pekruhn, director of life plan communities services and policy at Leading Age, which represents nonprofit aging services organizations, though she says she based that only on informal discussions and anecdotal evidence and not a scientific survey. “The majority don’t market it as a sales or marketing component. It’s really more of a case-by-case kind of situation.”

McClernon says his clients are increasingly asking about this option, however. “I get this question on a regular basis,” he says. And more are succeeding in staying together in assisted living, even when one partner has an impairment.

That works best when health challenges are in their early stages. “We don’t want someone to move in and six months later have to change their life again,” McClernon says. “If people can live together for a while, with some help, they pass the first test.”

The second test, he says, is whether the well spouse is willing to provide at least some care. “If they are able and willing to do that, that’s another positive screen we take them through.”

The healthy partner also needs support — from family or friends, for instance — says Pekruhn, a former independent living administrator. “There are times that I have seen where it actually was better that the [ill] spouse moved to a different level of care where they could get the support they needed.”

There is also safety to consider, McClernon adds. Someone with dementia who tends to wander probably should be in a secure memory center — not with a partner. Mobility issues also play a part. “When it gets more serious, especially when physical problems start to manifest, it becomes very difficult to live together.”

Zimmerman envisions apartments in senior living communities being set up to simplify this, with wayfinding elements and short hallways that make everything easier to find.

If one spouse does eventually have to move, she says, another benefit of having stayed together “is that at least the person with memory issues has gotten familiar with the building.”

The important thing is that couples have a choice, says Vincent Mor, a professor of health services policy and practice at Brown University’s Center for Gerontology and Healthcare Research.

“If the well spouse is able to and wants to continue to take care of their loved one, that should be their decision,” Mor says. “These are fundamentally individual choices that people need to make.”

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