Planning for Long-Term Care: Filial Behavior and Relationship Quality of Adult Children with Independent Parents

Abstract

We investigated involvement of adult children in planning long-term care for still-healthy parents, within four decision making activities. Respondents' age, personal authority, and family stressors had positive effects on considering parents' future needs. Daughters engaged in considering care arrangements and discussing possibilities with parents somewhat more than sons did. Discussion was influenced negatively by family stressors and positively by personal authority. Preliminary planning and making final decisions occurred rarely. Results suggest that these four activities (considering, discussing, planning, deciding) are sequential steps. Recognizing sampling method and homogeneity limitations, implications for professionals concerned with longterm care are identified. Key Words: adult children, independent parents, long-term care decision making, relationship quality. Planning For Long-Term Care: Filial Behavior and Relationship Quality of Adult Children With Independent Parents* Mark C. Bromley** and Rosemary Blieszner Gerontological research has established the role of adult children in the provision of long-term care, instrumental support, and health-crisis decision making for their elderly parents (Brody, 1977; Shanas, 1979; York & Calsyn, 1977). Research on the role of adult children with their independent parents, however, has been overshadowed by the plethora of studies on care giving, caregiver burden, and care receiver autonomy or psychological well-being. We do know that independent older adults are influenced by their children in major health matters (Pratt, Jones, Shin, & Walker, 1989), desire emotional support and advice from their children (Blieszner & Mancini, 1987; Hamon & Blieszner, 1990), and state a preference for remaining in their own homes and receiving assistance from paid helpers or relatives should the need for help arise (McAuley & Blieszner, 1985). Many adult children ponder the question of what they should do for their parents if, and when, a parent becomes dependent and the question may be contemplated while the parent is still healthy and independent. Because behavior varies across individuals and families, there is no sure way to determine what adult children should do (Brody, 1985). Only a few researchers have investigated the long-term care decision making with adult children that precedes the onset of dependency needs in older parents. Lieberman (1978) found that adult children who were older, female, or Black were more likely to endorse confronting issues that acknowledge a parent's dependency needs. Also, those in working-class families are more likely than those in middle-class families to feel that discussing dependency issues is appropriate. Hansson, Nelson, Carver, NeeSmith, Dowling, Fletcher, and Suhr (1990) found that 85% of the adult children they surveyed had begun to think about issues and concerns related to long-term care of elderly parents. Such thinking was most often stimulated by health crises, an increased awareness of the risks of aging for the parent, and disruptions to the parent's status and relationship network. Some researchers have considered parent caring along a continuum of needs and responses. Hansson and associates (1990) found that adult children's consciousness about their parent's needs progressed in an orderly fashion over time from thinking about the need, to learning about aging issues, and then to monitoring the parents in specific areas of concern. Gonyea (1987) used a process approach to examine the decision making of caregivers when considering institutionalization of elderly family members. The process consisted of recognition of the institutionalization option, discussion of the option with other people, and implementation of the option through planning activities. These stages led to the actual outcome of the decision, the placement of the older adult in an institution. Gonyea (1987) found that the perceived affective relationship was most predictive of the caregiver considering institutionalization, whereas the level of personal care needed by the parent influenced caregivers to discuss and implement plans for placement. …