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What happens to elderly people when they can no longer look after themselves? Many go into residential care, but for others, it's time to move back in with their adult children. Here, Judith Healy and Stella Yarrow describe what this really means - for everyone involved

Moving in with their adult children is a real option for elderly people, but little is known about why they do it and whether the arrangement turns out well. When we explored the stories behind the statistics we found that the perceptions of parents sometimes differed markedly from that of children, and that community care policies often failed both.¬

Community care policies are based on the assumption of family care, yet fewer elderly people moved to live with family during the 1980s than moved into institutional care.­ But living with relatives remains a significant avenue for frail elderly people: one in ten octogenarian or older women in private households lives with a son or daughter. The trend away from this kind of arrangement, however, suggests that community care policies will have to try harder to make this a viable option.

The households in this study reflected the demographic pattern, since the typical elderly parent was a very old and frail widow, suffering from poor health and becoming increasingly confused, who had moved to live with a married daughter whose children were grown up. We carried out in-depth interviews in 24 households with adult children and - separately - with their elderly parents, most of whom had moved in with a daughter or son within the previous year. The move was often precipitated by illness and the family had little time to consider the decision.

In the interviews, both parents and children agreed that the parent 'couldn't stay on alone' even with more intensive community services. Parents and children had different views on sharing a household, but both felt that they had little choice in the initial decision.

'Going into a home' was virtually a taboo topic. 'I have my family, so there was no question of that,' was a typical response. Most elderly parents found the idea abhorrent, while sons and daughters also had a poor opinion of institutional care. Residential and nursing homes clearly should improve their standards in the eyes of these people, who need good quality supported accommodation options.

The daughters and sons had mixed feelings about a parent coming to live with them but felt a strong sense of duty, the fulfilment of which also gave them satisfaction. Most felt guilty about the idea of 'putting mum in a home', even when the parent needed full-time nursing care.

At the same time, though, the elderly people felt apologetic about moving into their child's household since they had generally vowed never to do so. But they had come to the point of being unable to carry on alone and felt that it was natural to turn to family, rather than to strangers. One mother said: 'When you have someone of your own who you know is looking after you, your mind is at rest, you don't have to worry. She is my baby daughter and she is very good to me.'

The parents we interviewed were either happy or had no complaints about the arrangement. But their families were more ambivalent, particularly since they did not know how long the parent might continue to live with them.

One group of interviewees found the arrangement manageable, although difficult, and expected to look after the elderly parent for 'the rest of her days'. Another group saw family care as a stage before institutional care. A third group believed that there would come a point, such as the parent developing incontinence or severe dementia, beyond which they could not continue, and some felt that they had reached this point already.

The elderly people stressed that they contributed money to the household budget and that they were 'paying their way', and had a little extra money to 'buy treats'. The social security money paid to the parent or to their carer helped these elderly people feel less anxious about 'being a burden'. Cash for care and community services gave elderly parents greater peace of mind, as well as helping family carers.

Family carers complained that there was too little information about goods and services, and that they had to be persistent to obtain it. Many felt apologetic about asking for help since they knew that social services funds were scarce and must go to those in most need. They were made to feel guilty, even though their labour saves the public purse a considerable amount of money.

One daughter said: 'At no stage have social services said: "Your mother needs this and we are going to provide it." It has been a case of discovering what might be available and then asking. I think I'm fairly clued up and fairly articulate. When I needed things, I found the right person to ask. But I am sure there are many people who don't.'

As the interviewees were recruited through health and welfare organisations, most households were getting assistance from social services but the amount of help varied and was seldom enough. Although critical about the inadequacy of community services, most people were grateful for the assistance that they did get and were appreciative of the staff who came into their homes.

When family carers were asked what would help most, regular and responsive respite care was a key request. Other requests ranged from a live-in temporary carer or day minding at home to day centre facilities.

The admission of elderly people to respite care could be distressing, however, and had to be carefully handled. 'I did have her in a respite place for a week,' one son said. 'When I went to collect her she was crying, she wouldn't let go of my hand. So I thought, never again. I'm never going to do that to you again.'

Half the women carers in this study had managed to reconcile paid work with family care because they worked part-time flexible hours, had understanding employers and supplemented public services with private help. Most wanted to keep their jobs, needed the money to meet the extra costs of care, and wanted a break from home. Others were worried about whether they could return to the workplace after a period of family care.

There was little evidence from this study that family carers had received a better deal under the new community care policies. Much remains to be achieved if family carers are to be supported rather than exploited, and the dignity of elderly people maintained.

¬ J Healy and S Yarrow, Family Matters: Parents Living with Adult Children in Old Age, The Policy Press, Community Care and the Joseph Rowntree Foundation, University of Bristol, 1997

­ E Grundy and K Glaser, 'Trends in, and transitions to, institutional residence among older people in England and Wales, 1971-91, in Journal of Epidemiology and Community Health Vol 1, pp 531-540, 1997

Judith Healy is programme director and Stella Yarrow is senior research fellow, both at the Policy Studies Institute

· To order Family Matters, published this week by Community Care, the Policy Press and the Joseph Rowntree Foundation, see advertisement on page 24.

What families need

· Information for elderly parents and their families about supported accommodation options before decisions are made.

· Information for elderly parents and their families about living in shared households.

· Accessible information about the benefits and services available for family care.

· A choice between good quality supported accommodation options.

· Family carers to be seen as service beneficiaries in their own right.

· Benefits and services that empower elderly people.

· An income that covers the cost of caring.

· 'Family friendly' workplace policies in order to reconcile jobs and care.

· A range of adequate and responsive services.

· A range of respite care choices.

· Housing designed or adapted for extended families.

· Affordable services.