Chapter 2 - Beginning to Look for
Answers & Adapting to New Roles
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You're now searching for information about your aging parents. As we mentioned in the last section, you may have simply begun to worry a bit more. You’ve been noticing things that concern you about mom or dad's physical changes, self-care or memory. These are perfectly normal issues; you have a right to be concerned, yet it's a concern that needs to be managed.
Parent-Child Interactions and "Ageism"
From the dawn of time, tension has been a part of the parent-child relationship. Most of us went through a teenage phase that frequently strained the relationship with our parents. Then, for decades you and your parents may have gotten along extremely well. Now, however, as you enter this new phase of your life and theirs, you are finding that tension has returned. Their behavior and/or demands on you have become problematic. You are noticing those little changes. Mom mentions the new medications she is taking. On a recent outing you notice that dad is having trouble keeping up with you. You have begun to worry about them. None of your friends have dealt with these issues so you are in unchartered waters. It is time to face the fact that your parents are getting older. This requires some planning and adjustments to your new roles.
One of the problems may be our own attitudes. We grew up with grandparents who either came to live with us or went to live in a nursing home. We inherited an “ageist” attitude. As much as we intellectually know that the world has changed, we are programmed to certain beliefs about aging.
We also don’t believe that we will ever get old. We work diligently to ward off anything that we perceive to be related to old age. Who is it, after all, who’s buying wrinkle cream and Viagra, and having cosmetic surgery? It's the Baby Boom generation, in blissful denial about the second half of our lives. How dare our parents remind us about what we have ahead of us!
Boomers as Controllers
Our generation also likes to be in control. Whenever we're asked to participate in an activity, some of us misinterpret the request as an invitation to take over. Put several siblings of this generation in a room and usually more than one wants to be in charge. We mention these facts because we want to offer a bit of advice. We have all heard the phrase “parenting the parent.” Please resist the temptation to do that. Instead, we suggest you partner with your parent. Jessica Tandy in the movie “Fried Green Tomatoes” becomes exasperated with one of her friends and says, “I’m old; I’m not a child.” You are all adults and ideally everyone realizes it. Try to find a balance between being protective and being in denial. Involve your parents in all decisions that affect them and try to respect their wishes whenever possible. Proceed cautiously.
Most aging parents resist giving up control to their adult children. After all, they have always been in charge and you will always be their child—and by definition, children never totally grow up. Giving up control equates to giving up freedom. None of us relishes that. Freedom simply slips away with the loss of mobility, decision-making, the checkbook and the car keys. I look back at the years before the death of my 92-year old grandmother and the most dramatic decline in her health began the day we sold her car and she watched it being driven away by the new owner.
Aging means change and you have come here for help. Let’s begin by talking about what you should start to monitor and what may trigger discussions about the need for increased care and supervision, and/or a change in housing.
Does your parent need help with housekeeping, yard work or laundry? Perhaps a recent injury or a decline in physical health has made these tasks too arduous. Bending and lifting can place too great a strain on the older person. Consider arranging for routine household maintenance to be done by others. It is relatively inexpensive to do so; most of it can be hired on a weekly or bi-monthly basis at a cost as low as minimum wage. Seek recommendations from neighbors, local senior groups, high school counselors, local churches or licensed in-home care providers.
Seniors may be reluctant to invite strangers into their homes. Do your best to find reliable, trustworthy individuals to perform these tasks if a family member is unavailable to do so. It is important that the work be done by someone with whom your parent(s) has a level of comfort.
If grocery or pharmacy shopping is a barrier to your parent’s independence, it's a problem easily solved. Many stores now offer delivery services. Orders can be called in or placed via the Internet for same-day or next-day delivery; charges for these services are usually minimal. Alternatively, whenever possible, schedule shopping trips to include your parent. This saves time and is an excellent chance to visit and assess how well they are doing.
Bathing and personal care become more difficult as we age. Our homes often cannot accommodate the frailty of aging. The 14-inch to 20-inch side of a bathtub/shower can pose an insurmountable barrier to someone who can no longer balance on one foot, let alone raise a leg more than a couple of inches from the ground. Wonderful bathroom retrofits are now available that provide a swinging door into the tub or remove the tub completely and replace it with a walk or roll-in shower. Of course, this can be costly. Again, in-home services can provide this kind of assistance on a one-time or regular basis, and the cost is still fairly modest.
Diet and nutrition often becomes a concern as we age. Seniors complain about how hard it is to “cook for one.” Or, you might hear, “I’m just not hungry.” True, our caloric requirements do lessen as we age, but the need for nutrients does not. There may also be diminishing senses of smell and taste that make eating less appealing. Make sure that your parent is eating at least one good meal each day. Perhaps they can share a meal with neighbors or friends on a regular basis, or dine with a local senior group or at a local community center. This will alleviate another common concern: diminished socialization. Fortunately, we are a society for which most group activities involve food. If you can find a seniors’ gathering, there is usually something to eat. Ask your parents to tell you what they typically eat. Ask if you can check their refrigerator and cupboards for stock and inventory the pace of consumption. If necessary, you might contract with Meals on Wheels or a similar company for a daily delivery service.
Health care and medications are inevitable concerns for adult children, fearing that parents will over- or under-medicate. There are simple devices that can serve as reminders. You might lay out the week's medication in pillbox compartments or small baggies that are clearly marked with day and time for administration. You can also purchase devices that can be programmed like an alarm clock to remind your parent to take their pills and notify you or others if the dose was not taken.
Mobility may be a concern, too, as getting around can become progressively difficult as we age. There are several available alternatives. Encourage daily walking if it is physically possible. An electric chair or scooter is a good alternative, with the cost often covered by Medicare. You might also investigate the availability of volunteer escort services, free or lower-priced taxis, shuttles or public transportation.
Socialization—activities and contact with friends—is important for your parents. Too often, seniors become prisoners in their own homes, but this is a problem that is easily resolved. Pay attention to whether your parents have stopped seeing friends or have gradually stopped engaging in activities they've previously enjoyed. The underlying cause may be a serious condition, such as depression, for which you will need professional medical advice. Or, the concern may be hearing or vision loss that can be addressed and improved. The problem may be boredom. Old friends may have died or moved away. Suggest a visit to the local senior center. Isolation is debilitating; it can dramatically accelerate the aging process. If you are unable to provide regular visits, make sure that you find someone to do so in your place. Check with the senior center or local service group for volunteers who can stop by the house and chat on a regular basis. Televisions and computer monitors may allow you and others to have a frequent video visit. A lack of social stimuli can be a major factor in seeking a lifestyle change for your aging parents.
Safety is another major concern of adult children. You may not realize how difficult the simplest of tasks can be for an aging parent. Such tasks as putting on a sock, opening a door or getting out of a chair can be daunting. When you visit your parents in their home, pay attention to what they seem to struggle with or avoid. There are readily-available lever door handles, sock assistants and hydraulic chairlifts, to name only a few of the many devices that help persons with physical limitations to live independently. You can find a list of more than 30,000 assistive technology devices on the Department of Education Website, www.abledata.com; they will answer your questions at 1-800-227-0216.
Resources are abundant, but you need to know where to look. Although the Federal government offers an enormous amount of information, you may find their websites difficult to navigate. We've discovered that the best resources are the Eldercare Locator (www.eldercarelinkdirectory.com) and the local Area Agency on Aging whose number can be found in your local directory. There is also the National Institute on Aging's Resource Directory for Older People (www.nia.nih.gov/HealthInformation); you can call them at 1-800-222-4225 with a specific question. Both Medicare www.medicare.gov (in the Home Health Compare section) and www.medlineplus.gov are good resources for home care needs. There is a relatively new specialist--the Geriatric Care Manager—known as GCM—who specializes in assisting older people and their families in determining long-term care arrangements. The GCM will work with you to prepare a health care plan and can assist with finding appropriate services. GCMs are particularly helpful when family members live far apart. They charge on an hourly basis for this help; unfortunately, it can be expensive and it is probably not covered by insurance. Choose carefully, because this is not a tightly regulated industry. You can find a list on www.caremanager.org or call Elder Care Locator at 1-800-677-1116 for resources in your state.
Finally, you will probably need information regarding costs and the availability of insurance coverage, as well as financial assistance. Knowing how you are going to pay for the medical equipment or services is an important part of your plan. Some devices may be covered by Medicare, private “Medigap” policies or other private health insurance, long-term health care insurance or Medicaid. As adult children purchase long-term health care policies for themselves, they are discovering these policies are also available to their aging parents. Some long-term health policies even offer coverage for Assisted Living expenses if services are provided as specified in the policy. Begin with a call to your insurance agent or for resources and information regarding this type of policy go to www.longtermcare.com. For more detailed information, read the Toolkit chapter entitled, "Insurance: Who Pays?"
Realistically, the preference for many aging individuals is to live in their homes as long as possible. It may also be the least expensive alternative, because paying for in-home services is usually less expensive than moving into an assisted living facility. Your parents want to stay home and in-home health care will allow them to do that. The range of in-home options is far more extensive than was available to previous generations. In-home health care is a rapidly growing industry. But when—and if—safety and/or health concerns make living at home infeasible, fortunately there are numerous housing possibilities that also were not available to previous generations.
Now that you have begun to do some research you may want to move on to the Toolkit chapter entitled “Careful Planning Is the Key.”