More Helpful Eldercare Information
• The ABCs of Aging: A Glossary of Eldercare Terms
• Eldercare Facilities: An Overview of the Options
Your widowed, lonely mother-in-law changes the subject every time you want to talk with her about your idea that she should move into a retirement community. She doesn’t want to talk about “it.”
Your 80-something mother and father are finding their health failing. You are sensitive to their need to remain in control. You know that they do not want to talk about “it.”
Your uncle’s memory has noticeably worsened during the past year, and your aunt is showing signs of frustration and exhaustion. You try to talk with her, but she doesn’t want to talk about “it.”
This “it” can be too frightening to contemplate, too overwhelming to consider, and certainly seems to be something that most people would just as soon avoid. Unfortunately, this “it” does not go away.
What is this “it”? “It” is the reality of aging. To a certain extent, each person can choose the “half-empty” or “half-full” approach to growing older and the accompanying changes that usually occur. “It” does not necessarily have to be all doom and gloom. “It” can be a time of great empowerment for those who look to all that they have experienced and how they can use their inner resources to tackle the challenges that lie ahead. For others, however, aging is tantamount to cumulative, unrelenting loss. “It” overcomes them.
Today, people are living longer than ever before. And with advanced age often comes the need for care. Meanwhile, the traditional caregivers, the middle-aged adults in the family – by today’s standards that means 40-, 50-, even 60-somethings (i.e., us!) – have demanding careers and busy lives of their own. As a result, many midlifers today are faced with balancing these things with not only active involvement in their grandchildren’s or adult children’s lives but also an increasing responsibility for the well-being of an elder loved one.
Nearly 80 percent of these “sandwiched” caregivers are women. And, on average, they can expect to spend 18 years of their lives helping an aging parent, often while caring for a younger family member, too. Adults age 85 and older are the fastest growing segment of our population, and 58 percent of the over-85 population is disabled in some way. This is a daunting challenge for today’s caregivers.
It’s Never Too Soon to Talk
Growing older does not automatically bring incapacity, but when it does, physical and cognitive changes can come on quite suddenly. Thus, it is critical to recognize that it is never too soon to talk with your elderly parents or relatives about the future. It is just another form of family planning.
Topics can include:
• the parent’s lifestyle interests
• concerns and directives for medical care
• financial-management issues
• long-term care insurance
• housing choices
• options for care.
Obviously, if your parent has been diagnosed with a debilitating illness, these talks are urgently needed. But, even if your parent is relatively healthy and independent, discussing his or her future is critical to maintaining the greatest chance of continued autonomy.
Talking while everyone is well has many benefits, including self-determination for the elder, clarification for the family, better decision-making than in a time of crisis, and overall peace of mind. Others can act with confidence when needs arise because the elder’s desires have been spelled out.
Nevertheless, starting these conversations isn’t always easy. Unresolved parent-child or sibling conflicts are just some of the “hot buttons” that may get pushed when the family attempts to talk. And the parent’s diminished position of power in the family can also be frightening for the elder and the adult children.
When discussing issues of health, competency, finances and living arrangements for the last years of a parent’s life, eldercare experts emphasize the importance of being sensitive to their feelings.
Instead of directly asking, “So, do you have long-term care insurance?” or “We’ve noticed you are having trouble taking care of yourself,” begin the discussion in the context of a relative or friend’s experience. For example, “This is what happened to Aunt Alice. We want to be better prepared.” Or put the discussion in the context of your own life, such as, “I’m starting to plan for the time when I might have trouble taking care of myself. This is where my documents are. I’ve signed a health-care proxy. Have you made any of these plans yourself?”
It helps if you “own” the problem. Avoid saying, “You know, Mom, since you had the stroke, you really can’t take care of yourself anymore; you need help.” Instead, try saying, “Since you had the stroke, I can’t sleep or concentrate at work. I’m so worried about you being on your own and being able to take care of things. Would you help me by coming to talk with someone who can help?” Most elders are not going to be resistant if it is expressed in the context of putting their adult children at ease.
Today, some companies offer long-term health insurance to their employees and family members, including parents. If this is your situation, you could say to your parent, “We have this available. Would you be interested?” and take the discussion from there.
In some cases, prior to the onset of any difficulties, the elder may want to engage in the “it” conversation to ensure that their wishes are understood and that their children will act accordingly when the time comes.
While many adult children don’t end up playing an active role in their elder relative’s planning process, eldercare experts point out the importance of knowing who to go to when the time comes – the attorney, the health-care surrogate, and so on. Listen to the responses you get, and let your parents know you care about them and want to be able to follow through with their wishes.
Above all, approach the subject with dignity. Social worker Rona Bartelstone, M.S.W., a nationally recognized leader in the geriatric care field, notes that “adult children often describe taking care of parents as being like taking care of another child. But while they may need care like a child, the elder never becomes a child again. That’s critical to remember.”
Increasingly, elders’ adult children are turning to professionals for assistance with their loved one’s care needs – especially if they don’t live near the elder or if family members disagree on his or her condition and needs.
“Professional help can be costly,” Bartelstone admits, “but mistakes can cost much more in financial and emotional ways.”
Professional eldercare consultants, or geriatric care managers, can help to facilitate discussion and decision-making among family members. They can help you assess your elder’s needs and sort out the “unknown possibilities” and the “what-ifs.”
An eldercare consultant’s first objective is to keep the choices in the hands of the older adult. Unfortunately, so many of us put off planning “it” because we avoid contemplating loss of health. We deny it could happen to us or our loved ones. Of course, once a health crisis occurs, the decisions are shifted to others – a spouse, offspring or other relatives – who must grapple with sudden responsibility while under the stress of a family crisis.
A professional with clinical expertise in facilitating family discussions and a knowledge of the myriad choices for elder living can guide your family through this unfamiliar territory, helping you discover options, define choices and make decisions.
Warning Signs: What to Watch For
How can you tell if Mom or Dad is “frailing,” especially from a distance?
“They may be offended by your asking penetrating questions,” says gerontologist and author Raymond T. Coward, Ph.D. “Or they may say they’re doing fine, because they can’t bring themselves to tell you they didn’t feel well enough to go grocery shopping, so they ate nothing but cereal for three days.
“You have to keep on top of it, and that means not just telephone calls but face-to-face visits,” Coward says. If it’s impossible to visit frequently, talk to your parent’s neighbors, friends and clergy to find out how he or she is really doing.
Here are some of the signs to watch out for.
• Any major behavioral or functional changes.
• An accumulation of diagnoses (more than two).
• Falls or repeated hospitalizations.
• Short-term memory problems.
• Periods of confusion or disorientation.
• Calls from your parent’s friends or neighbors expressing concern.
• More frequent requests for help or support.
• Weight loss over the past year.
If you live far from your parents, you may need to make frequent visits to assess their situation and reach out to their friends, neighbors and clergy for accurate information between your visits.
• A Place for Mom – This free eldercare referral service’s Web site has tips on what to look for when visiting facilities.
• Assisted Living Directory – An online directory to assisted living facilities Information and senior care.
• Eldercare Online– An Internet community for those providing eldercare.
• ElderIndustry.com– This Web companion to Joy Loverde’s book The Compete Eldercare Planner provides resources and information on eldercare issues.
• ElderLifePlanning.com – Offers support and resources for caregivers, including information about long-term care, home health care and insurance. The site also contains a discussion forum and a database of eldercare professionals.
• FamilyCareGiversOnline.com – Features a thorough section on home safety, including fall prevention.
• HomeInstead Senior Care – Offers a database of in-home care and assistance providers located throughout North America. Providers are bonded and insured, covered by workers’ compensation insurance and have passed a criminal background check.
• National Association of Geriatric Care Managers – The goal of this nonprofit professional association of practitioners is the advancement of dignified care for the elderly and their families.
• The Complete Eldercare Planner: Where to Start, Which Questions to Ask, and How to Find Help, by Joy Loverde, Times Books, 2000.
• The Fearless Caregiver: How to Get the Best Care for Your Loved One and Still Have a Life of Your Own, by Gary Barg, Capital Books Inc., 2001.
• How Did I Become My Parent’s Parent?, by Harriet Sarnoff Schiff, Penguin USA, 1997.
• You and Your Aging Parent: A Family Guide to Emotional, Physical and Financial Problems, by Barbara Silverstone and Helen Kandel Hyman, Pantheon Books, 1990.