Throughout our lives we are usually identified by our roles as son, daughter, brother, sister or parent. As our parents age, however, roles often reverse or take on new meanings. Because today’s baby-boomers increasingly find themselves assuming the role of “caregiver,” they begin to feel the necessity to become proactive in the care of one or both parents. Issues surface that have remained buried. Parents often find themselves battling their adult children for authority in decision-making.

Open communication with elderly parents is an optimum condition but one that is not an option in many families. Short of this, adults with elderly parents need to realize that they will always be the “child” in the eyes of their parents. Baby boomers not only respect authority but are much more health-conscious than those over 65 who feel surprise at their still-existence on earth.

Adults with elderly parents need to educate themselves, not only with written information but with personal knowledge of their parents’ habits and problems. Timing is everything, and that old adage certainly applies to assisting a parent in making their transition from independent to needy or problematic.

Elderly parents may never openly admit a problem or ask for help, but the educated, alert offspring can easily pick up subtle clues.

Visiting your parents presents an opportunity to notice changes in habits. Slowness in dressing, eating and walking are obvious changes. A prolonged delay in opening mail or driving a familiar route should be considered a cry for help. A brief review of the medicine cabinet can also provide offspring with important medical knowledge as to what medicine is being prescribed — not necessarily taken — by their elder. This is by far one of the most common problems adults face when dealing with parents who are just beginning to fail.

While a parent may give up the fight in going to a physician, and while the same parent may follow through in getting a prescription filled, it is quite common for the untouched bottle to remain in a medicine cabinet or
nightstand drawer. Breaking down and taking the medicine would be admitting to themselves that a problem exists, and this is simply not an option to many elders. Therefore, adults should be keenly aware of the types of medicines prescribed and familiarize themselves with the medical problems to which the medicines are correlated.

Rather than involve the court system or attorneys as elders begin to fail, adults need to reach out to siblings, relatives, church friends and volunteer services.

Many siblings today live hundreds of miles apart, and in many cases also live far distances from their parents. Family members – ALL of them — need to become proactive in the management of their parents’ healthcare. The familiarization with prescribed medicine is the first important step, and if the elder refuses to discuss their medical problems, offspring should establish a relationship with their parents’ physician. The medical community often welcomes this show of caring; however, others dissuade the intrusion. Family members should never withdraw when the first door slams in their face, but should persist until finding a method to establish some sort of common ground with their parents’ healthcare provider.

The alert, knowledgeable offspring will also be more prepared to deal with deeper issues as the patient’s condition worsens. Nursing homes and home healthcare, in combination with finances can become a full time concern. Parents are often reluctant to discuss both their medical condition or financial situation with adult children, but when health deteriorates to the degree that outside help is necessary it is vital for the primary caregiver to be aware of both.

Most importantly, children should be aware of their parents’ insurance and exactly what it covers. Financial awareness is crucial here, for few elders are totally covered by any insurance plan. When nursing homes appear to be the only alternative to independent living, children often begin to question the feasibility of having a parent move in with them.

Ironically, government aide is available to eldercare housing facilities but not to adults who caregive to parents within their homes. The financial burden on the children is often the deciding factor in the decision made regarding the elder’s future home. Again, the more knowledgeable the offspring is regarding insurance and costs of facilities (including transportation, medicine and meals) vs. cost of moving a parent into the child’s home, the easier a reasonable decision can be made.

On a personal note, my mother passed away in April 1999 after a year long illness. Before she lost the capacity to communicate, she struggled to clarify all legal matters to me, her only child. Specifications regarding stocks, bonds and back accounts were utmost on her mind. This one act on her part enabled me to be proactive not just in her medical needs but her overall financial needs as well.

Every family is different, as are the needs for every caregiver. However, money seems to be one of the more basic concerns for all parties involved. Regardless of whether a parent is to be placed in a Nursing Home or
move in with offspring hundreds of miles away, money often becomes the deciding factor upon which life-altering decisions are made. Insurance companies need to be contacted to find out what opportunities policies provide. Financial information is crucial in assisting adult offspring in making decisions regarding their parent’s healthcare.

A second controversial issue between elders and their offspring is independence, or the lack thereof. Your parent has driven to the grocery, drug store and all points in between all of her adult life, only to be told now that they no longer possesses the ability or good judgment to drive. In the best of circumstances this is stressful, but to those whose parents have truly lost the ability to make wise decisions behind the wheel of a car, it can be devastating. Now the subject of transportation becomes a major issue. Who is to take off work to transport Mom (or Dad) to the doctor? Chances are, Mom or Dad will disagree with their limitations, thus setting the stage for further confrontations. Battles never “solve” confrontations — they merely deepen the resentment already felt among all parties involved.

The loss of driving ability, the relocation of a parent and the need for questions involving financial matters all are underlying causes of the biggest fear an elder has — that of losing independence. Although offspring
caregivers must deal with numerous situations as they arise, they elder fears losing their “rights” more than the sum of all the other parts. There’s a juggling of guilt vs. need for the elder — a battle that is never quite won.

We as caregivers need to be fully aware of that battle raging inside the elder while we cope with the daily tasks of caregiving. Any adult child with the potential of caregiving should — above all — watch for signs in aging family members for the onset of illness or failure. Awareness can provide a caregiver with the advantage he/she needs to plan, take necessary steps, consult with health care professionals and be prepared for what may lie ahead. Refusing to face the inevitable cripples the caregiver, and ultimately the elder, as the caregiver has chosen to remain ignorant of choices that can and should be made.

Thousands of articles, hundreds of books and numerous movies have been based on the subject of caring for the elderly. What has not been emphasized to the full extent is the subject of what the elder experiences as his/her world collapses, their health deteriorates and independence disappears.

Those of us who are adult children and are or have cared for an elder have no doubt witnessed first hand the effects that the loss of independence have had on our loved ones. We take for granted so many of life’s “little
things.” Last minute additions for dinner only require a short drive to the corner market. The batteries for the TV’s remote control have gone out and we have to manually get up to change channels. The phone rings and you remember the cordless phone is still on the charger instead of perched by your easy chair, which makes you have to disengage yourself from the cushions if you want to talk to the caller. These examples are common in our daily lives and are easily rectified, although most of us would classify them as impositions.

Now realize what an elder who is barely mobile or perhaps already bedridden would go through in similar circumstances. In the first place, they wouldn’t be fixing dinner and would only hope that a loved one would be preparing it for them. To them, that would be the imposition — having to cause further work for someone they loved. Secondly, if their remote’s batteries ran out, chances are they would have to wait until a loved one remedied the problem or merely shut the television off. There again, to the elder the imposition would be in having to rely on their caregiver for help instead of being able to handle it themselves. And the phone ringing? Elders who are farther in their journey down the final path of life rarely want to talk on a phone, much less struggle to reach for it or find it amid their sheets or blankets.

We all want to believe our parents will live forever. We often don’t see them as men or women — but as Mom and Dad. When we are faced with role reversals and find ourselves making the decisions and often saying “no” to the people who always made the rules for us, it effects all of us in different ways. There are no rules for this game, and no “rights” or “wrongs.” There are merely guidelines from which we can take advice from
those who have dealt with these issues before us and hope we do all within our power to make our elder’s last years/months/days on earth peaceful, comfortable and loving. We must go with our inner feelings much of the time as to what would be right or wrong for our loved one, and as our elder sees how difficult the attempts are on our part, he or she often is willing to compromise on situations that could have caused major rifts within the family.

The issues with which we must deal are numerous and diversified, but the more open those involved can be with each other and the better communication they can achieve, the more successful they will be in working
toward the end in harmony, peace and love.

Copyrighted by Patti St. Clair 10/31/1999