Except for the years when my father was serving in World War II, my parents were inseparable during their 54-year marriage. Then, 14 years ago, Dad died at the age of 80 of a brain tumor.
My mother, who was just 73 at the time, was pretty much self-sufficient for about a decade after that. She still played tennis, drove her car, and got together with friends and neighbors, including fellow retirees from her years as a kindergarten teacher who met monthly for lunch. After a few years, Mom had a new romantic partner as well.
Then, about four years ago, my sister and I got the call. It was the call to which many baby boomers who have an aging parent can relate. Who makes the call can vary. It can come in many forms -- a phone call, a letter, an e-mail, or even someone making a comment. It is that defining moment, that wake up call if you will, the one where you can no longer deny that your parent needs help.
Whether the call is from a physician, a sibling, a spouse or romantic partner, a friend, a neighbor or, in some cases, from the police or even the fire department, it is that call that distinguishes the moment when you go from being an adult child to someone who will now have to be the parent to your parent.
Giving Up the Car
For many of us, the first big change in our parents independence occurs when it becomes prudent for him or her to stop driving. (See, Seniors in More Severe Auto Crashes Than Younger Drivers which reports on a study conducted at Kansas State that analyzed the driving patterns of those aged 65 and over.
Parents who live in an urban setting, where driving was rarely an issue, may find it has become more difficult for them to take public transportation because of diminished mobility or increased feelings of insecurity around strangers. It is often left to the Boomer to help his or her parents to get around. And thats just the beginning.
Seek Out Help
If you find yourself becoming your parents caregiver, it may be useful to invest some time and money in meeting with an eldercare or geriatric manager or counselor. They can guide your parent or you through the world of senior care that you and your parent or parents are now entering.
Linda A. Ziac, president of the Caregiver Resource Center, has been working in the eldercare field for 35 years. She emphasizes that no two situations are the same. Ziac gets calls from adult children who are trying to get things in place but their parent refuses to talk about it, as well as calls from seniors from 60 to 90 saying that they want to explore help for themselves.
You can find a local eldercare manager or counselor the same way you would find any trusted professional: ask friends, your own physician, or senior services in your own or your parents community for referrals. Then perform due diligence checking out their credentials, testimonials, or websites. Usually there is an initial consultation for a fee and if additional services are requested, you would negotiate with the eldercare specialist what assistance will be needed and what it will cost.
Becoming Your Parents Advocate
One of the best gifts you can give to your aging parent or parents is to become their advocate. This is especially important if a parent starts to have a diminished capacity and can no longer deal with such everyday activities as walking, feeding or dressing oneself, making phone calls, or cooking.
As eldercare counselor Ziac points out, there is a big difference between being your parents advocate and helping and taking over in a way that makes the parent feel worse. Ziac says, There has to be a conversation between the senior and the family to honor the wishes of the senior. They cant just come in and dictate what the right thing is to do.
Even if the final decision about what your parent wants to do is up to him or her, you can still help by doing some research. For example, if your parent has vision challenges such as macular degeneration, you can explore if there are free services for the visually impaired in your community. Volunteers may be available to read to your parent on a regular basis for one to two hours a week.
As long as your parent is still self-sufficient and able to get to the programs and participate in activities, or has a caregiver to help out as needed, you can explore senior centers in your parents community to see what she or he might want to participate in.
Getting a Geriatric Assessment
If you suspect that your parent has Alzheimers or another kind of dementia, you might want to get a detailed geriatric assessment through a hospital or a neurologist. This will give you a starting point of how your parent is currently functioning as well as suggestions about what medical or social services your parent would benefit from. One such program is run by the Center for Healthy Aging at Greenwich Hospital in Greenwich, Connecticut.
The assessment is conducted by the Geriatric Health Team which consists of a geriatrician, who is a physician, board certified in geriatric medicine, a geriatric nurse practitioner, a pharmacist, a gerontologist, and a social services liaison. (Your parent would first be seen and evaluated by an internist who would make the determination that your parent should be referred to a neurologist or geriatric assessment center.)
Housing and Caregiver Considerations
Author Mike Campbell has spent more than 18 years in the senior housing and care industry including visiting hundreds of nursing homes or assistant living residences on behalf of his former employers. He also comes to this topic from a personal perspective. Campbell and his siblings, all of whom live in Ohio, and his mother, who is 81 and living in Florida, are deciding where she should live since her second husband died. (Campbells father died suddenly at age 57 of a heart attack.)
In his book, When Mom and Dad Need Help, Campbell identifies nine basic housing options that seniors and their Boomer children need to consider:
(1) parents moving in and living with you;
(2) adult day services, a community-based option, with your parent still living in their same home;
(3) home care services, while still in the same home;
(4) moving to an independent community with supportive services;
(5) assisted living communities;
(6) stand-alone Alzheimers dementia communities;
(7) nursing care facilities;
(8) Continuing Care Retirement Communities (CCRCs)which offer all of these levels of care on one single campus; and
(9) hospice, the final option.
Campbell says there are pluses and minuses for each option. One concern is cost but another key factor is the staff. According to Campbell, You want to have adequate staff and adequate training.
In assisted living and nursing care residences, the recommended maximum staff to resident ratio varies depending upon the shift. For the morning (7 a.m. to 3 p.m.) shift, Campbell suggests that the maximum assisted living ratio should be 10 residents to one direct care staff. In a nursing home, Campbells maximum recommended ratio is 5 direct care staff to one resident.
In addition to finding out the staffing ratio, you and your parent will also want to tour any residences that your parent is considering. Here are some questions you want answered:
• What is the ambiance of the residence?
• Are activity rooms in use?
• What is the dining area like?
• Is the food up to the standards that you and your parent were expecting?
• What will this residential option cost?
• Are there any additional fees beyond the daily room rate and meal charges that you should know about such as charges for various types of assistance, from administering medications to escorting to meals or activities, as well as any one-time or recurring activity fees?
• How long is the lease and what, if anything is the obligation for payment of the monthly rent if there is an extended hospitalization or death that requires breaking the lease?
• How friendly are the staff and fellow residents?
• Is there an emergency system in place if your parent falls and cant get to the phone such as pull cords in the apartments that connect to the front desk or to 911?
Hopefully your parents will have already taken care of the major legal issues such as having an irrevocable or revocable trust, a will, a durable power of attorney, and a health care directive. (See A Legal Wake Up Call for Boomers for a discussion of these key legal concerns.) You should look at these legal and estate issues from your parents perspective. It may be helpful to consult with the family attorney or an elder care attorney on these matters.
As Carolyn L. Rosenblatt, who was a nurse for 10 years, a lawyer for 30 years, and who is now an elder care advisor and author of The Boomers Guide to Aging Parents, says, Everyone needs to have a durable power of attorney for finances and a health care directive for health.
Everyone Ages Differently, On Their Own Timetable
At the assisted living residence where Mom now lives, there is a petite healthy woman who is 103 years old. Everyone points to that woman as a role model of aging. On the one hand, it is very comforting to know that someone could be 103 and still be in excellent shape, walking on her own, and needing minimal assistance with everyday self-care.
But, on the other hand, it is a false standard by which all others are compared. For one thing I have learned most about aging is that there is a very wide disparity in how or when someone loses their mobility, develops dementia, suffers from chronic pain, arthritis, or contracts life threatening diseases like heart disease or cancer. Therefore, its important to keep the focus on the abilities and challenges of each senior rather than making him or her feel unfairly compared to someone else who seems to be faring much better even at a more advanced chronological age.
I have also learned that seniors deal with the changes they are going through in unique ways. Some become very angry and resentful, looking back at the way things were; others are accepting and positive. Excessive and ongoing depression and sadness in seniors, however, is not necessarily a normal part of aging; it is treatable. If your parent is showing signs of chronic depression, seek out a geriatric social worker or counselor, psychologist, or psychiatrist for help. (See Depression Not a Normal Part of Aging by Fred Cicetti).
Meeting Your Aging Parents New Relationships
As your parents life changes, they may also be forming new friendships or even romantic relationships, which may be an adjustment for you. For example, 49-year-old Brenda, whose mother died suddenly in 2008 after 51 years of marriage, said it was a challenge dealing with a new stepmother for her and her siblings.
It wasnt a few weeks before my father was looking for a new wife, said Brenda, and he was quite open about his desires, even before my mothers funeral. He did not want to be alone and he was going to make sure that was not the case for the rest of his life. Within five months, he was online dating, and he quickly found someone who looked exactly like my mother. It was comforting and disturbing all at the same time. Within 17 months, he was remarried. All has gone well with the marriage, however a couple of my siblings have had great difficulty with the transition to having a stepmother.
Health Care Issues
Coping with the myriad of healthcare issues is a large part of the aging process and can take a lot of time and attention. Although some parents will be fit and self-sufficient even into their 90s or beyond, others will have one or more health concerns that require your time.
With the advancement in medicine today, conditions that seemed a part of aging that just had to be endured are now treatable even if not curable. For example, there are medications that internists can prescribe for incontinence; urologists may even have additional treatment suggestions including surgical procedures, to minimize or eliminate this as a health care issue. Research advances in treating any number of age-related health care problems, such as macular degeneration, dementia, arthritis, depression, or hearing loss. You may also want to find local or even out-of-state experts who can help.
How Are They Going to Pay?
As elder care advisor and lawyer Rosenblatt points out, One of the biggest problems we have as Boomers is that many parents did not plan on living this long and have outlived their money. That leaves the question, how is your parent going to pay for their care?
You may want to hire an elder care attorney or specialist with whom you can have a family meeting to weigh the various options. If your parents got long term care insurance in their 50s or 60s, that is one possible option; if they are already in their 70s or 80s or older, it is probably too late to buy such insurance. Since your parents are over 65, they will have Medicare, but Medicare may not pick up all the healthcare expenses.
Your parent might want to look into the feasibility of buying gap insurance which covers some or all of the difference between what healthcare costs are reimbursed by Medicare and the actual costs. (Because of the recently-passed health care reform bill, you may want to check with an elder care expert about what is changing for senior healthcare.)
If your parent needs to go into a nursing home, or if you need a nurse to care for your parent in his or her home, you might want to find out if your parent is eligible for Medicaid to cover some or all of the costs. Since this is an extensive requirement and application process that varies from state to state, you might want to hire an elder care attorney to help your parent with this.
Acceptance and Perspective
Recently I asked my mother, who now needs continual care since she has mobility, vision, and memory issues, if her situation is hard on her. No, she answered, much to my surprise. Thats good to hear, I replied with relief. Then she continued, with absolute clarity and certainty, It makes me feel loved.
I learned so much in that exchange with my mother. I was looking at her situation as an outsider rather than as the one who has resigned herself to the walking and memory challenges that are part of my mothers new world. I also did not understand that she views her situation from a very different perspective than I do. I am a young 61-year-old. My mothers world is now mostly made up of other seniors with physical and mental challenges of their own who are in their 70s, 80s, 90s, and beyond.
Caring For Ourselves
We Boomers also have to remember that its okay to turn to other family members, romantic partners, friends, or even local support groups if we need help in our caregiver role. (See Managing the Stress: Tips for the Caregiver at the AARP website.
It Will Never Happen To Me!
I try hard to make time for Mom by visiting her regularly and calling often. I like to think that I wont be so dependent on my children when I am that age. Not me! I jokingly tell my sons, who are now ages 20 and 24, that when their father and I are in our late 80s, well be traveling around the world in a hot air balloon, joyfully independent and healthy.
However, deep down inside I can hear a little voice telling me that my mother and every other senior dealing with the tough physical and mental challenges of growing old probably had that same dream and hope when they were my age. It is a reminder to live our dreams as fully as possible while we still can because aging and all that entails is happening to all of us.
- AARP Membership association for anyone over 50 with articles and resources about caring for your aging parents including a related PBS video that can be played online.
- National Association of Professional Geriatric Care Managers Membership association for elder care managers.
- National Family Caregivers Association Educational and advocacy group that offers free membership to all family caregivers.
- National Academy of Elder Law Attorneys An association that represents attorneys with specialized training in elder law issues. Includes a searchable directory.
Books and Articles
- Hugh Delehanty and Elinor Ginzler, Caring For Your Parents: The Complete AARP Guide. New York: Sterling Publishing Company, Inc., 2006.
- Sheryl Garrett, editor. Caring for an Aging Parent. Chicago, IL: Dearborn Trade Publishing, 2005.
- Paul and Lori Hogan, Stages of Senior Care. New York: McGraw Hill, 2010.
- Jan Yager, Ph.D., Friendships: When to Hold em and When to Fold reprinted from Caring Today magazine