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Expect to Care for Your Parents? Plan Early
By Sarah Baldauf
October 23, 2007

When adult children are faced with a parent's sudden health crisis and must make decisions about ongoing care and living arrangements, the need to act quickly can take an emotional toll on the whole family. Alexis Abramson, author of [GOOGLE]The Caregiver's Survival Handbook: How to Care for Your Aging Parent Without Losing Yourself[/GOOGLE] and vice president of research at Retirement Living TV, talks with U.S. News about the importance of long-range planning, and of keeping your parents in the loop—and their wishes top-of-mind—as they become more dependent.

You warn adult children against sweeping in and taking over for their parents. What's the danger?

When you lose your independence and you begin to have to be dependent on someone else, the emotions about the losses involved become very strong. That's why so many mature adults become depressed and can become angry. We can avoid some of this by respecting how they feel and what they're thinking. Rather than just make decisions on behalf of our parents, we can help them make decisions.

You argue that the decision-making should begin long before anything actually starts to change. What's the advantage?

I cannot emphasize enough the importance of planning. Let's say Monday they're fine, and Tuesday they have a stroke, but you have no idea what their preferences would be—to bring in a home healthcare worker or to move them into an assisted living situation, for example. You need to know what their wishes are. It can be very expensive to have to solve a crisis, which often is what happens when a caregiver doesn't plan. If you want to decrease your financial investment in caregiving, increase the emotional comfort level between you and your parent, and allow your parent to age as gracefully as possible, start talking.

You've got to talk to your parents about finances. My grandfather died and he kept telling us over and over and over that he had a bank account in Switzerland but he never told us where it was. We've been looking for it for 20 years now! You need to talk about what their desires are in terms of long-term care—do they want to stay in their home as long as possible? Do they want you to be their full-time caregiver, or would that make them uncomfortable?

What sort of approach do you recommend to get the conversational ball rolling?

When the conversations start is individual, and it's really about the disease state that a parent is in. But I think when our healthy parents turn 65, say, when Medicare kicks in, it's probably a good time to start by making an overall assessment.

When the parent starts to need help, how should children proceed?

I am a believer that the expectation must be that everyone is involved. You need to talk to your family members about what kind of role they want to play. I think what we often do—especially as women—is take the martyr role and let other siblings off the hook.

You should treat caregiving like it's a business. There should be someone who's the CEO, who delegates responsibilities, but in a way that will motivate. For example, just because your brother's an accountant doesn't mean he wants to handle your parents' finances. Find out what he wants to do. Also, be creative; if your nephew can't find a job and needs to make some money, you pay him to take your mom to the doctor and sit with her. She doesn't ever have to know that.

My feeling is that getting someone in who knows what to look for and who is not emotionally involved—that's really a big part of this. A geriatric care manager is a trained outside observer who can come in and say, "Is your mom always this thin?" Sometimes the solution can be as easy as moving food a little bit lower in the cupboard so she can reach it and maybe eat more. They can also help get the right services in place, like home healthcare, or manage the situation locally if you live far from your parent. The National Association of Geriatric Care Managers is pretty fabulous for finding a local geriatric care manager.


Having a plan in place is important because when a crisis occurs there is often little time for planning.

IMO the most important preparation for anyone who is dealing with ageing parents or anyone whi is over 18 for that matter is to write a living will.

A living will is an official document that outlines one's wishes in the event of a medical crisis and when they are not able to express their wishes for care of termination of care.

Children of ageing parents should also have power of attorney for the parents' finances, so the rent or mortgage can be paid, along with any other ongoing maintenance costs.

If person who is ageing, and has assets they want to protect, and does not have children or any reliable person who can administer their affairs, arrangements can be made with financial institutions such as Trust Companies or Banks with personal banking facilities to take over the functions described above (for a fee)

The alternative can be a bureaucrat appointed by the state who would make decisions about one's helath care and financial affairs.

Additional information on Living Wills is available in this Psychlinks Posting
This is an anxious issue for me.

A while ago, I was listening to 2 co-workers sharing stories of when they for their mothers, both of whom had Alzheimers and died. They mentioned sisters but no brothers yet both women have brothers. Another woman at work spoke of caring for her ex-mother-in-law who was dying of cancer. She did so because she still had a very good relationship with her ex-MIL and had a good friendship with her. Her ex-husband, however, was very rarely on the scene and had to be told to help out.

Noticing the distinct lack of men in these cases and the fact that my brothers and I were brought up the old fashioned way where women were expected to do certain jobs while all men were expected to do nothing around the home, I felt fearful about having the role of caring for my parents thrust upon me.

What made me especially anxious about this was that I have a severely disabled child who will need care for the rest of his life. He's not terminally ill so he could easily outlive us.

So, I broached the subject with my mother, I said, "You and Dad need to consider your care options for when you're older as I won't be able to care for either or both of you as I've got a severely disabled child to care for."

My mother's first response was, "If Dad dies first, just leave me in the room with the pills." (Nice! Send me on a guilt trip!) Then later she began asking me to do things for her, things which she'd been doing for years and was perfectly capable of still doing (she was only 55 at that point) and I was alarmed at what she was asking me to do, i.e. writing out greeting cards for her. Considering her health was and still is fine, I suspected she was trying to 'rein me in' in order to keep me close so I'd be well and truly roped into caring for her and Dad in their old age. She'd say things like, "You're going to have to do that for me because I can't," or "I can't do that because I'm thick," (she isn't thick). I refused to write out the greeting cards for her and as for other jobs she asked me to do, I assessed them and if she was able to do them, I suggested she did, otherwise I would supervise her doing them, all the while encouraging her.

One day she told me about all these women who she knew of (but didn't know personally) who care for their mothers. I felt this was a negative comparison but didn't dare pull her up on it because I'm scared of upsetting my mother. I said, "Caring's a very hard job." "Oh no," she said, "They find it easy." Considering she didn't actually know these women, I very much doubt she will have known how these women truly found caring for their mothers. In addition, I'd bet they didn't have a severely disabled child to care for as well!

Soon after, she began telling me of how she and one of her sisters used to go to their parent's house to cook and clean for them as their health was failing.

I got the feeling with all these things she was saying: You have to look after me (and Dad). Look, I can't do these things and need you to do them for me. Look, all these women care for their mother's so you can look after me (and Dad) too and, Look, I cared for my parents so you can care for me (and Dad).

It's as if my disabled child was in her blind spot. She just didn't get the fact that I would already have my hands full. My son is getting bigger and heavier all the time. He's 13 and a young man. He's my height now (can only stand supported, he'd fall over otherwise) so he's going to be much taller than I am. We have to hoist him as he's too heavy to carry and he's still in nappies. None of this will change, except he'll get bigger. But she didn't 'get it'.

She clearly didn't understand what I'd said from my concise sentence and it took me writing a post on a messageboard we're both members of saying what I would do with a generous windfall of money (I'd either buy live-in help who would become my son's carers after we're either dead or in need of care ourselves) for it to finally dawn on her that my reluctance to care for her and Dad in their old age wasn't personal but situational. My post asked questions like, "When are we going to get our freedom as normal parents do in their forties when their children fly the nest and are off doing their own thing?" I explained that we're going to either have to get help in or continue to drive ourselves into the ground but it seemed very unlikely we'd have any freedom other parents experience.

In addition to this, my mother was telling me about one of her co-workers who has an overbearing mother. This mother would turn up at her daughter's house the minute she finished work and would not leave until the daughter and her husband were going to bed. They got no couple time and no time as a family with their children. The mother would book herself on the same holiday as the family without being asked and my own mother was shocked when she heard the disgusting way that this mother spoke to her daughter. Witnessing and hearing her co-worker getting stressed about her mother, made my mother take stock.

My mother has been absolutely amazing for this last year. She's not made any negative comparisons, not asked me to do jobs she's perfectly capable of doing herself, she's stopped moaning that she 'never' sees me and when we have seen each other our time together has been truly beautiful. She's not offered to look after my children so my husband and I can enjoy a night out and neither have we asked, mind you, but other than that, our whole relationship has improved, I feel, largely due to what my mother's co-worker went through.

Recently, I was able to speak with my mother again about the future and she got it. The discussion was very calm and sweet. It was all thanks to my cousin (of course she'll never know what she's done and hasn't actually 'done' anything). My mum was telling me how my cousin is so good to her parents, i.e. buying her Dad a car, paying for her parents to go on holiday etc. I would have taken that as a negative comparison but this time I asked, "So, if a child doesn't do those things for their parents, does that make them bad?" She changed the word 'good' to 'kind' and I asked the same question with the word 'kind'. My mother specified that my cousin was able to as she had the financial means and she didn't mean children who didn't do those things for their parents weren't bad or unkind etc. I knew what she really meant but it was reassuring to know that it wasn't a negative comparison. From there, I somehow broached the subject of my parents senescence and it was totally fine. It was actually one of the best conversations we've ever had. :inlove:
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