I recall an Erma Brombeck story years back when she recounted the day she and her aging mother became aware of the role change between them as child and caretaker parent. While Erma was driving with her mom next to her in the front seat something abruptly crossed in front of the car. Erma hit the brakes and then instinctively reached across to put her arm in front of her mom to protect her from lunging forward, as you would a child. The moment after the car stopped safely they both simply looked at each other and realized what had transpired. The need for the daughter to protect the mom had signaled a role reversal and what now lie in the future for both of them.
This role change is not something that comes easy for parent or child. The lifelong independence of your mom and dad does not go quietly into the night and providing for their needs without it having the appearance that they are no longer in complete control is an emotional tightrope for an adult child to walk. When that time does arrive, approaching it with a dialogue that respects their rights and shows your genuine concerns for them will make the rough ride go a lot easier. Here are six primary areas to focus on if you are faced with doing this yourself.
1. Establish residency – Where are they best suited to live? Can they continue at their own residence or do they need to move to a place where typical household chores are minimal or a nursing home where around the clock care is required? There are many private and federally funded senior housing quarters where yards are maintained and transportation services are available to get them to the super market or a doctor’s appointment. Their health may have deteriorated to the point where they need a care giver either to live with them or visit them frequently on a daily or bi-weekly basis. A quick search engine check under “elderly housing options” will provide resources that will help both parent and child make appropriate decisions.
2. Financial status – An aging parent and a child’s ability to assist with funds will determine where residency will wound up, among other considerations. They may have enough for rent/mortgage payments but what about costs for utilities, property taxes, insurance premiums, home care and maintenance expenses, food, transportation, phone/internet service and special medical needs not covered by their health care insurance? Aging parents whose only monetary resources are Social Security benefits will determine how much you should contribute IF your budget allows. For many families this creates a problem with resources stretched thin raising your own family. Sit down with Mom and Dad and work out a reasonable budget that works for both of you while allowing as much freedom for them as possible.
3. Medical Care – The single largest expense outside of any housing costs for an aging parent will be medical expenses, including their pharmaceutical needs. Because of age-related health issues, seniors 65 and older will spend nearly 4 times as much on medical expenses than healthier young adults. Unless your aging parent is amongst a small minority that has provided a comfortable financial asset in their senior years, Medicare and Medicaid will serve to cover a large portion of these needs for low and middle income people. Your aging parents may need assistance to apply for these benefits, if they haven’t already, to understand the specific rules for enrollment which may entail contingencies. Much of this can be accomplished on-line at the agency’s website – www.medicare-medicaid.com. Help schedule doctor’s appointments and make sure all of their health care professionals have your home and work numbers where you can be reached quickly. Be pro-active in tracking down the lowest possible costs for medications. AARP is one of the best resources for this need as it is with other consumer needs for the elderly.
4. Nutritional needs – Nutrition is important for aging parents who are prone to eat whatever is available and convenient. Some health care expenses can be minimized by eating healthy, balanced meals. As our parents age their ability to put such meals together are hindered by arthritic conditions and the ability to focus. Preparing daily meals in advance either at their home or the responsible child’s home is one way to ensure this is properly addressed. The Meals on Wheels programs is a great back up resource for active and transient children care-givers. It’s a volunteer program so if you use this vital resource in your community, be sure to contribute time or money to help sustain it.
5. Activities – Quality of life will obviously diminish as people age. The physical traits that once allowed them to hike mountain trails, ski, swim, hunt, run marathons, dance and other physically engaging activities become a thing of the past for the most part. There are many programs though that will address the limited physical capabilities of the elderly that still allow them to stay in the game. Staying active keeps vital hormones productive and sustain the immune systems that fight diseases. It important that Mom and Dad not succumb to sedentary lifestyles that can bring on debilitating illnesses. Local civic centers, churches and educational entities are great resources to help create and initiate an activity plan that will meet your parent’s specific needs and wishes.
6. Address end-of-life issues. There will come a point when the most difficult part of your job as a care provider for your parent must be confronted – addressing their final rites and end of life wishes. If you think this will be too difficult for you to deal with directly get another close family member to help you with it. Also, it may help to seek some spiritual guidance, if not for your parents then for yourself. Coming to grips with the end of life cycle is something we all avoid but when looked at from the healthy perspective that each generation plants a seed for the next, a continuation concept of this sort mollifies the pain we all experience when we lose someone close to us.
There are a host of actions that will have to be considered. End of life counseling should be scheduled between you and your parents (long before the parents’ mental faculties deteriorate), the family physician and a member of the clergy of the faith that they are associated with, if any. Check to see if your health insurance policy covers this; it may. What will take place if their physical health deteriorates beyond any quality of life measure or if they go into a coma and are medically deemed brain dead? When and what will necessitate a DNR (Do Not Resuscitate) order? Has a will been finalized? Will there be a traditional casket burial or will they opt for cremation? Has a grave site been located or some ideal landscape where they wish their ashes to be spread? For many religious people the thought of an afterlife is as wondrous as it is uncertain, no matter how much we prepare ourselves for it. For the non-religious there are still those conversations we can have with our parents to muse about the possibilities in order to take the edge off of death’s finality
In all things as you address your parents aging needs, do so with dignity and grace. The mind and body are always in conflict with one another. The aging signals the body sends to the mind are often ignored or misinterpreted by people who once lived vibrant, productive lives. Their willingness to allow you to help them as they age must be a mutual transition. If they know you are there waiting to pick up the slack when time takes its toll on them, their submission to your concerns for them will come more freely. Give them as much room as they feel they need and you feel comfortable they can handle.
Prior to her passing, Gilda Radner waxed philosophical asserting that “life is about not knowing, having to change, taking the moment and making the best of it, without knowing what is going to happen next.” Slow things down and try to be patient as those who once provided for you as you matured come to grips with the reality that that shoe is now on the other foot.
Agency for Healthcare Research and Quality
Meals On Wheels Program