It expands to a regular weekend visit, then mid-week trips to the doctor. Then you're making daily calls to be sure medications are being taken and your elder is able to answer the phone. You stop by every night on the way home.

They say everyone wants to stay at home. If we discount the woman who for twenty years has detested the retirement location her husband insisted on, or the couple who are bone tired of taking care of the empty four-bedroom house they raised their children in, this is the way most people feel.

But for most of us, even "successful" aging eventually brings with it some loss of flexibility, some aches and pains, perhaps vision and hearing changes. It gets harder to do what needs to be done to stay at home without help. If memory problems surface it's eventually downright dangerous to live alone at home. If one spouse needs a great deal of care, the other spouse can become exhausted and depressed, and often dies before the more "disabled" spouse.

So, eldercare at home requires a great deal of thought and preparation if it is to go well.

Staying at home can be the most expensive choice of all the residential alternatives available. In a group living situation (assisted living, personal care home, or nursing home) an aide will take care of several people. His or her salary is spread across all of them. At home, an aide or companion is giving undivided attention to just one or two people and there is no one with whom to share the cost. This kind of elder care can get expensive fairly quickly.

Once the amount of care needed at home expands to more than 5 or 6 hours a day, it begins to be less expensive financially to look for alternate living arrangements. Of course, this is "only money." There are a lot of other benefits to staying at home that have nothing to do with money. But if money is tight, it can make staying at home difficult if not impossible as time goes by.

The decision to stay at home should be a joint decision. Ideally both the caregivers and the care recipient will talk about what is and what isn't possible to do at home before urgent needs arise. Unfortunately, there isn't always the opportunity before an emergency crops up and decisions have to be made in a hurry. Whether you have the chance to talk it over ahead of time, or you're working against the clock, the "thinking & talking" points below should help to clarify whether staying at home is the best decision.

Many families say they are willing to do "whatever it takes" to keep an elder at home. Most often they make this decision while caregiving is not overwhelmingly difficult. But as time goes by and demands on their strength and time increase, they find themselves stretched to the breaking point - often before they see it coming. This is eldercare creep, and it's almost universal for those who are trying to take care of aging loved ones at home.

Few caregivers are in a position to leave jobs and families to take on complete responsibility for an elder's at-home care. Eventually almost everyone has to turn to some kind of outside help. If your elder is capable of understanding this, and is willing to accept that staying at home will eventually involve financial costs, then staying at home may be an excellent choice.

If your elder isn't willing to consider at some point having help from someone other than family, then remaining at home will probably be immensely difficult for the long term.

The following list gives you some important things to consider and talk over. Note that most of the items on this list suggest that the older person must not only have the funds, but must be willing to use them. He or she must also be willing to accept the help. This is often the big barrier that many older folks aren't willing to cross.

  I understand that if my needs increase I may some day have to pay for additional help to stay at home. I understand the approximate cost of this kind of help, I have the funds to pay for it, and I am willing to use my money for the help I will need to stay in my own home.

   I have a close neighborhood support system (other than a family member) who I can call on in an emergency. These people are at home during the day and are willing to help.

   My home is in good repair, and I have working smoke detectors. If not, I'm willing and able to get started on making it so, or I'll hire someone who can do the work.

   I am not confused. I would know what to do in an emergency. I would be physically able to do it. If not, I would be willing and able to pay the costs of having someone stay with me, and I would be willing to accept someone other than a family member.

   I have not fallen more than once in the past 3 months, and I was able to get up by myself if it happened. If I have fallen more frequently I understand that I probably need someone with me when I walk. This may not always be a family member, and I am willing to accept help from others.

   I can remember necessary daily activities such as taking my medications and bathing, or I am willing to accept assistance from someone who comes in regularly to help me if I cannot do these things.

   My bedroom and bathroom are on the ground floor.

   I would be able to get around indoors using a walker or a wheelchair, or I can afford the necessary renovations. There are no sunken rooms. Thresholds are not raised. Doors are wide enough to pass through.

   Indoor clutter is minimal, or I am willing to clear out/ rearrange my rooms.

   I have an alternate source for transportation if I should be unable to drive, and I am willing to use it.

   I can prepare nourishing meals and clean up afterward, or I am willing to accept (and pay for if necessary) help with my meals.

   I can do light housework and laundry, or I am willing to accept and pay for help if necessary.

   I have an extra bedroom where a companion or aide could spend the night.

If you and your elder have not both been able to honestly say "Yes" to most of these items, then staying at home for the duration will be extremely difficult, especially for the elected caregiver. An elder who is too "independent" to acknowledge that he or she may one day need help will probably refuse the help when it is really needed. This can put your care "creep" into caregiver overload and burnout, as well as create an unsafe living situation.

If your elder does not have the funds to pay for necessary renovations to his home or extended care through the day, this checklist will give you a better idea of when it will be a good idea to start seriously considering your alternatives.

Of course, if you're properly covering all your bases, you'll be looking seriously at all your alternatives as soon as you can, and before you make any decisions.

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