March 19, 2022

When A Spouse or Partner Needs a Different Level of Care

This is a common occurrence I hadn't thought much about: how do you handle living arrangements when one half of a couple needs a different level of care than the other person? If you are living at home but your spouse should be in an assisted living situation, what options do you have to remain a couple? If your partner resides in an assisted living apartment but you must be transferred to a nursing care facility, must you be separated?

Since we experience the effects of aging at different times and levels, it is quite likely one person will need professional care much sooner than their significant other. The first step is to gather information well before you think you may need to make important decisions. This allows for the couple to feel a bit more comfortable about what an establishment looks like, how spouse accommodations or visiting arrangements are made, and the overall quality of the facility.

Both people must come to accept that at some point they may not live together or as close as would be preferred. My Dad's assisted living facility did have apartments large enough for two, but that is not always the case. There are many that have only have single-occupant rooms.

Acknowledging that you may not be able to live in the same place as your partner is a tremendously emotional realization, but one that must be faced. If you require much more care than your partner, for example, he or she may be able to continue to live at home while you are somewhere else. I imagine that is one of the toughest decisions we may need to make, but safety must be foremost. 

Also, we can't forget that there are two people involved. One may be in a situation where mobility and health issues severely limit their ability to leave the apartment. If the other person is still healthy enough, the facility chosen should provide enough social activities, and transportation to shopping and medical appointments. Otherwise, the more active spouse will naturally feel some resentment in being shut off from the world. 

The financial pressure of any assisted living arrangement can put a strain on even the strongest investment foundation. Medicare provides no help for assisted living costs, which can average between $4,000-$7,000 a month. Normal health care for someone is provided under Medicare, such as a doctor visit or in-patient care at a hospital. But, living costs are not. This fact alone is one of the reasons so many of us want to age in place as long as possible. Even with in-home health care, the expenses aren't quite as daunting. 

If you are covered by Medicaid instead, there is a spousal protection regulation that can help the at-home spouse maintain financial resources greater than normally allowed. The specifics and restrictions are too much for this post but should be explored if this is your situation.

Two final thoughts I would like to add. For some, this post may be better suited to what your parents are facing. You may be young enough that the living arrangement decisions can wait a bit. But, mom and dad or your in-laws must be prepared and willing to make some hard choices. Here is a link to a solid overview of the issues that arise when your parent or relative lives by themselves: What to watch for when an elderly parent lives alone.

If you are single, the decision of when and where to live when your health requires it will be both easier and tougher. You don't have to take into consideration another person's needs, feelings, and health. But, neither do you have a partner to help you share the decision-making process.

Even so, researching your options, reviewing your desires, figuring out your finances, and visiting some facilities well before needed applies every bit as much as it does to your couple friends.

While not directly addressing this issue, here is a post from last year about being single and retired. If you missed it, give it a read: Retired and Alone.

I realize this is not a pleasant thing to think about, but, essential. Exploring your options before being forced to make a choice is critical. Discussing the options and possibilities of a life that looks very different than the one you are living now should not be swept under the rug. Time has a nasty habit of not waiting for you to be comfortable about the future. It does what it will do with distressing quickness.


  1. Hello Bob. I m a long time reader and first time commenter. First, I want to thank you for all your hard work on this wonderful blog. I enjoy it immensely. I am a 65 year old retired widow of 7 years and the subject of today's post really hit me hard. I am on a one woman campaign to get everyone I know to face reality and realize they need to make plans and arrangements before it's too late and someone else has to do it.

    My late husband was 12 years older than me and we have no children. He retired in 2006 and I still had many years to work. Long story short, he had some terrible health issues that he ignored and became extremely ill and dementia set in. I took care of him at home as long as possible (while working 12 hour days). We came to the point he could not drive, stay at home alone or function very well. In home help from Medicare was a joke - 30 minutes once a week! I HAD to find a solution because I couldn't quit my job and we couldn't afford assisted living for him. I did a LOT of research and finally decided the best option for our situation was a private group home. I would not recommend them in general, because most of them are not a place you would want to be or put your loved one. After a long search and much touring of homes, I found a very good one about a mile from our house. It was a private home, licensed to take in 6 residents at a time, run by two very caring sisters and some helpers. Even so, I had to stop by almost every day to check he was being properly cared for (he was) and that he had everything he needed. In addition to the $2,000 a month fee to keep him there, I had to provide all his medical equipment and products, all his medications and oxygen, TV for his room, etc., etc. I still had to get him to all of his doctor appointments and try and take him out once a week, while we still could. Living apart after 35 years was a struggle, but we made it work.

    I hope I'm not coming across as complaining. I just want people to understand that life changes on a dime and I was not prepared for any of this. Every day was a new challenge of some sort and yet I thank the Good Lord solutions were put in front of me and that I made it through the stress and heartache. I am now trying to decide what arrangements I want to make for myself when I can no longer live on my own. Thankfully, I have a couple of nieces and nephews I can count on to help me move when the time comes, but they have all moved to different states, so nobody is close if I need help in the near future.

    I apologize for the length of this comment, but you really struck a chord with me and I applaud you for addressing this subject! Pat in Nevada

    1. First of all, thank you for your regular readership. Leaving your comment is much appreciated. I am glad the subject resonated with you so strongly.

      Your story is exactly why I wrote this post. I doubt any of us are fully prepared when serious health issues create a series of difficult decisions, often made when we are most vulnerable. Making arrangements for a spouse, partner, or ourselves can be overwhelming.

      I am glad you mentioned group homes. At one point my wife was a lay minister, charged with visiting and watching out for an elderly member of our church. After several not-so-pleasant attempts to help him find suitable places to live that he could afford, she located a group home that seemed to be a good fit. The married couple that ran it were attentive and fully committed to the eight residents. He was happy and well cared for in the last two years of his life.

      In your situation, I certainly understand the challenges you will face, hopefully many years in the future. To think that about it now and prepare some options, plus find someone to protect your wishes is the course all of us should be taking.

  2. Another important topic, Bob. I watched my mom (in her late 80's) take care of her husband as his health problems and consequent visits to the ER and overnights in the hospital became more frequent. They really needed in home care daily, but it was really difficult to find during the worst of the pandemic. He passed away and she is just over one year out and finally starting to feel better - both emotionally and physically.

    Her husband was adamant that he didn't want to move across the street into the assisted living part of their CC development, and she was not interested in moving over there with him. So they struggled along at home. One week she needed a break, so we picked her up and had her visit here for a couple weeks leaving one of his daughters to do the caretaking. None of his kids realized what she was going through, because she's a retired nurse and will keep working until she drops (her upbringing and conditioning, I guess). When she returned, the daughter immediately said, "You can't do this anymore. I'm exhausted and I'm much younger than you." So they started working on finding him a spot, but there was massive paperwork to get him into the vets' facility he preferred and it just takes time. Covid made it all worse. Long story short, the only way they could talk him into any kind of facility (he was very ill, but sharp mentally) was to agree that he could return home as soon as he felt better. Needless to say, that didn't happen. He ended up in a nursing home for a couple weeks, and then moved to a hospice home where he died shortly thereafter.

    We all need to think through what we want to do if/when this situation presents itself. Caregiving is hard, hard work. My mother's doctor finally convinced her she couldn't keep it up by telling her she would end up in a nursing home with him if she didn't get help. She now lives in that same independent living unit, feels safe, and has a meal delivered daily, plus a regular cleaning service. But she will be 90 in a few weeks, and over time, she will need another plan, too. She has definite ideas on where she will and will not live, and I'm not looking forward to the discussion. Most people don't want to be in a facility, but in the end most can't do it alone and it's a BIG job for a loved one to take on.

    1. I am familiar with someone saying I want to die in my own home. That mindset is just not workable. The spouse or partner, or family, is put into an impossible position of ignoring that person's wishes or putting themselves through a horrendous amount of work and self-denial.

      Luckily, in the case I am thinking of the person (a man) finally agreed to move into a facility that would allow his wife to have some of her own needs tended to. But, it was a struggle.

      I have to thank my parents for their foresight in this regard. They moved from their own home into a three=level CCC several years before either showed any reason to do so. But, they had determined they would not put the burden of caregiving on family members.

      As things turned out, within three years my mom developed problems that demanded almost full time care before her death. Dad soldiered on in an assisted living apartment until he passed in 2015. Betty and I have every intention of following that example.

  3. Oh this puts fear in my heart, as I am alone, no children and friends are my age or older. I’ll live at home as long as I can, but then I need a plan. I think it’s despicable that our extremely wealthy country full of extremely wealthy people and large corporations that we won’t offer better healthcare and services that don’t put the elderly into bankruptcy. It’s all due to greed.
    I’m also a big proponent of "right to die" societies as I believe we should have that right and not should be my choice. So I’ll continue to look for a way out before I’m faced with that choice of leaving my home for good and negating my money going to charities that can do so much good for others.

    1. The "right to die" issue, or doctor-assisted suicide, is legal in some states already. Obviously, that is a real hot button issue for many, probably right up there with abortion. One concerns the end of a life, the other a beginning.

      While I understand the religious objections, if we are free to make up our minds about everything else in our lives, I tend to agree that freedom should extend to how we depart. Months or years of pain and financial ruin does nobody any good. It prolongs suffering for everyone involved and has death at the end anyway.

  4. My 92 year old father moved in with me so I could provide care for him. He had been living in an independent living facility and hated it. He was also starting to become a problem with the staff and other residents (he was a curmudgeon). I was able to take care of him for 2 years before his dementia and physical condition required more than I was able to provide. The constant vigilance and care was taking a big toll on me, to an extent that I would only realize later. After a bad fall it was clear that he had to be placed where he could me monitored more closely. I found a place not far from my home and he seemed to settle in. But then I discovered that my days of vigilance were not over. I had to constantly check to make sure that the staff was providing the care they had promised. It was highly variable, and after COVID hit, problematic. Every time I expressed a concern about his care, the fees we were paying increased. He had another unattended fall, I complained and shortly thereafter his monthly charge went from $7200 to $9150.
    About a month later, there was an outbreak of COVID. My father became infected and died at age 95 about a week later. It has been just over a year since his passing, two years since he lived with me and I still find myself waking with a start to even the slightest noise--still thinking he is with me.

    This experience has taught me several things: 1) Care givers need care. 2) Anyone in a facility lacking family or friends to advocate for them are at real risk, and 3) I will never enter such a facility and I will take whatever steps necessary to make sure that I don't.

    My heart goes out to all who find themselves in this situation.

    Rick in Oregon

    1. Your story is a powerful cautionary tale of what lies ahead. I am glad you raised the issue of continuing to check on the well being of someone even after being placed in a facility. And, the monthly price you quote is enough to scare all of us.

      We were lucky my parents were in a place provided first rate care at all levels. But, I know that is not always the case.

  5. Hi Bob! Such an important reminder to us all no matter what our age. Even though my husband and I are healthy and only mid-60s we are well aware that we have no children and that we need to talk about and make arrangements for when that time might come that we need such care. Not a pleasant topic for sure but so important to talk about our options. One good one that we are exploring is care in Mexico. Not only are the prices far more reasonable, but the caregivers there are often much more compassionate and dedicated because of their culture. Besides, the weather is often much nicer and you can be outside most of the year. Waiting until you are forced to make decisions like these are not good for anyone. Best to make plans in advance. ~Kathy

    1. I hadn't thought about taking care of these arrangements in another country. I know you and Thom have had good experiences with medical care in Mexico. That is an interesting option for people to explore.

      Thanks, Kathy.

  6. I live alone, as you know, in a house not well suited to aging in place. When we have talked about this, I admitted I have no real plans in place. I know I run a risk of having my choices made for me if I wait too long, but so far.... I am sure there will come a day when you can call me from your comfy retirement community and tell me you told me so!

    1. I hope not. You have family near you who would do everything for you, but you know my advice before I type it: don't force your kids and relatives to have to make the very hard choices that are coming.

      Assuming we make it up to see you this fall, we can have a heart-to-heart talk. We love you and want what is best for you and your loved ones.

      Besides, we would never say we told you so...just send good wishes your way.

    2. I know you would never really say it, but you might rightfully think it! Love y'all and hope to see you in the fall.

  7. One thing you didn't mention is that one partner will die before the other one and that is probably another article. My husband became seriously ill with heart failure and I took care of him along with his medical team . I still worked full time but took off as needed. he passed away last February. Luckily he was able to stay in our home until that dreadful day.

    1. Yes, that would be another post. If there is the forced separation that this post addresses, what is the next step after the death of one half of the couple? What are the living choices, what decisions have to be made, and how does one continue with a life that has been irrevocably changed but still holds potential for happiness?

      Thanks for sharing your story, Sherry, and giving me an idea for a follow-up.

    2. I already know for a fact my wife will significantly outlive me. What I don't know is if I will require extra care towards the end. Years ago, I had the opinion that my wife would outlive me. I did not know it for a fact, but I proceeded as if it were true. All of my financial decisions have been aimed at making sure she had more than ample assets to last the rest of her life, regardless of her physical/medical needs. We have also extensively discussed the need for her to never allow another partner to access her financial assets. At that age if anybody else enters the picture they better be financially self-sufficient. This may sound harsh but there is no way to replace lost assets at that stage of life. Lastly, I refuse to be one of those people that declines to the point of requiring my wife to do everything for me. I do have a plan for making sure that does not occur. A disabling stroke would be the only situation I cannot plan for. If that happens, I will fully accept being sent to a nursing home. Staying at home and coercing someone else to give up their quality of life to care for me is not my idea of an equitable situation.

    3. I agree completely, Fred. Getting your affairs (yours and your wife's) set up is one of the responsibilities of marriage.

      I especially want to emphasize your final sentence:"Staying at home and coercing someone else to give up their quality of life to care for me is not my idea of an equitable situation."

      Well said.