Looking After Your Aging Parents
– By Suzanne Soto-Davies
What do you do when your mom and dad need help? How do you break through the financial communication barrier? To what extent are children responsible for their parents? How to we help our parents be where they want to be?
Researchers say we have a 90 percent chance of someday caring for aging parents. The realization is that our parents' care is usually precipitated by a traumatic event or "wake-up call" that leaves us little time to make important decisions. Children are left to make these gut-wrenching, life-changing choices without much information available to them.
In the July/August issue of Silver and Gold, we introduced a discussion on Looking After Your Aging Parents, written by Ruth-Lynn Hamilton, a retired nurse who lovingly depicted her personal experience through looking after her mother. Ruth-Lynn wrote about her mother's failing health and stubbornness to accept help, and the article planted seeds which introduced tips and thoughts to consider when getting involved in elder care.
Through this article, we offer some further ideas on where to start looking after your aging parents:
Opening the lines of communication
The first step is to begin discussions with your parents about how they see their future lives unfolding. Opening the lines of communication early, and taking into consideration how they see their lives from different angles, including: financial, physical, emotional, social, familial, and working through how they'd like to live should they no longer be able to drive, cook, afford their home, visit as often, etc.
The nursing industry has determined three separate categories for elder care, based not on their age but on their personal physical and mental abilities:
- Active Seniors
- Supportive Seniors - individuals who live at home but require some form of outside support, such as occasional meal delivery, driving assistance, garden care or bathing assistance.
- Supported Seniors - individuals who are living in a nursing home or receive full-time care.
5 Frequent Mistakes made by those with Aging Parents
Theanna Zika, owner of 'Heavenly Helpers' in St. Louis, says the five most frequent mistakes made by those with aging parents are:
1) Avoiding the discussion of alternative living arrangements for aging parents: Whether they want to stay and home or not, it is important to be proactive about beginning discussions about options and choices. "If you wait and start talking about it after your Dad has fallen and broken his hip, there is no time to be low-key – you are now "under the gun" to find answers quickly!". At this point sometimes the options of "how they'd like to live their lives" are limited.
2) Not having a clear picture of your parents' financial situation.
Do they have a long term care policy? What other financial resources are available to them? Discussing personal finances is a touchy subject, but although your parents may have already arranged their finances and care through the assistance of a lawyer, it's important to consider touching on the subject with them and being clear on who this person is, how to reach them and what their wishes are. (More on this topic below).
3) When your parents' health starts to fail, thinking that a nursing home is the only option.
Theanna says it's important to understand there are plenty of options around, and if your parents are adamant about remaining in their own home, chances are good that you can arrange for quality care there for them, regardless of how long they live. You can also get a bit creative about combining several types of care – whether Dad goes to an adult day care facility three times a week, other days he may have a caregiver assist temporarily or even stay overnight. Then you or other family members can fill in the rest of the time. Bottom line is, don't jump into the nursing home option without exploring other alternatives first.
4) Not getting help until the last minute.
Nothing is more stressful than trying to formulate a plan of care knowing your Mom is coming home tomorrow from the hospital. There is no way to make good, rational decisions that quickly and under that much duress. "Start early doing your homework," explains Theanna, "begin to form a relationship with a couple of agencies or facilities you feel comfortable with. When and if an emergency strikes, you will be calling up on people who know you and who are familiar with your loved one's situation."
5) Looking at cost alone when deciding on care.
This can go either way. Very expensive nursing home facilities may not have very good track records when it comes to caring for their residents. Don't just look at pretty websites, videos, fancy tours or brochures. It's important to talk to as many residents and their loved ones as possible, to get a true sense of the care the facility provides. And when it comes to in-home care, the lowest hourly rate may not be your best option.
What if parents don't want to talk?
Marilyn Ellis, an Author, Speaker, Professional Organizer and Senior Move Manager in the San Francisco area has helped many families understand and cope with the delicate process of seniors' life change. She has learned that there are two sides to every story…
"Dynamics in families are often, or not always, complicated." Marilyn explains. "Sometimes seniors are in denial that they need help or have some dementia. Sometimes, it is because there are unresolved hurts and resentments that suddenly surface in this new crisis."
Marilyn says we need to begin by understanding our parents' point of view. This "role-reversal" where the child becomes the parent, and the parent is the 'helpless child' is not easy on them. She suggests asking them what a solution would look like, rather than telling them what you think they should do, which she says often changes the dialog to positive and puts the responsibility back on them.
Marilyn also suggests not letting one stubborn parent refuse help to the detriment of the other parent. "Appeal to the stubborn person's 'love of their partner'. If that doesn't work, feel confident that safety comes first and do what you have to do despite their objections. You may have to ignore the rants of one parent to protect the other. Be prepared to be strong in this regard."
You may not feel comfortable in your new reversed role as a parent to your parent, but you also cannot take the risk of their health care being taken over by those less-concerned, or less-familiar with their situation.
Leony deGraaf, Financial Advisor and owner of deGraaf Financial Strategies in Burlington, has seen this unfortunate situation occur first hand:
"A client of mine in her 80's, was thinking of selling her home to move into a retirement residence, but got cold feet at the last minute. A few weeks later her in-home assistance reported my client's failure to take medication, and in turn she was held at a local hospital's Acute Psychiatry Ward for 7 weeks, and deemed incompetent to make further decisions about her health or her property."
Leony further adds the importance of advising aging parents of the importance of updating their Power of Attorney documentation for property AND for personal care, with their wishes clearly stated, otherwise the Office of the Public Guardian & Trustee can take over and make the decisions for them.
What we need to do, when and why
Bart Mindszenthy, co-author of the Canadian bestseller "Parenting Your Parents: Supporting Strategies for Managing the Challenges of Aging in the Family", has been through the chain of personal experiences many Boomer children go through every day with regards to their aging parents.
"My experiences with eldercare so far aren't that different from what many boomers have experienced, or surely will," says Bart. "From the thousands with whom I've shared experiences in town hall meetings, church basements, synagogues, and on radio talk shows, I've heard a relentlessly consistent dual message: I didn't deal with things soon enough, and I'm having a hard time doing the right things."
For Bart, advanced eldercare should be all about 'Quality of life, not quantity of life', and his personal journey through the care of both his mother and father led him to be an elder care advocate, and being the host of the Canadian community for family caregivers at mycarejourney.com.
Bart shares the three key things Boomers with aging parents really should think about and do:
1) Collect information now. When your parents are well, is the time to gather a host of information. Now is the time to break down that totally silly self-imposed barrier virtually all families create: the barrier of talking about the inevitable. Now is the time to ask for the information that'll be needed sometime in the future – information about insurance, financials, health; about what key professionals are advising them; wills and executors; about powers of attorney for general and health; and yes, even about sibling responsibilities and roles, end of life wishes, funeral arrangements, and disbursements of mementoes and heirlooms. Having all that information will be critical at some point in the future; not having it could mean the difference between getting it right and getting some things terribly wrong.
2) Be an active healthcare advocate. Start taking an active role in your parents' state of physical, emotional and cognitive wellbeing. The health care system is fragile, older patients often don't get the kind of time and attention they need. Add the fact that often our aging parents start having several health conditions requiring different medical specialists and other health care professionals. The chances of miscues, miscommunications and mistakes mushroom. That's why we need to go to medical appointments whenever possible, sometimes despite the objections of proud parents.
3) Dump the guilt. It's important to understand guild in eldercare comes in two distinct modes: the first is inflicted upon us by our parents. It's when we call and they say: "Well it's about time, we could've been dead by now!" It's when they complain we aren't being thoughtful or helpful enough. This is their way of reaching out to us; of trying to get more of our attention. Actually, it's what we did to them when we were children, remember?
The second is self-imposed by us. It's us trying to second-guess what to do, what not to do, what we should've done or not. We all do it, it's human nature. Knowing in your head and heart that you're doing the best you can is what counts the most.
Bart goes on to explain, "If you can manage these following three elements of planning, support, and self-awareness, you'll be a much happier Boomer in every way. I learned to manage these the hard way, and I know it cost me mentally and emotionally. I also know, from hearing from so many of my fellow eldercare givers, that these elements are high on their list of worries too."
Home is where the heart is
In order to take an active role in the health and wellbeing of your aging parents you must consider not just what's best for them, but most importantly, what their wishes are. Families of seniors have to be willing to look deeper into the lives that their parents are living, and ask, "Are my parents safe, happy and engaged in their current living situation?"
Taking into consideration their lifestyle, and the three health and care categories mentioned above (active, supported, and supportive living), there are again another three main options to consider in terms of Housing for the aging parent. All three options should be discussed as early on as possible in order to consider parents' wishes and before you have to make the decision for them.
1) Aging in Place: This is a senior care industry term for helping elderly remain in their home rather than living with family or going into an assisted living residence such as a retirement community or nursing home.
This is not just about whether they can still cook for themselves, shovel snow or garden, dust the top shelves or keep a clean refrigerator. Aging in place should also be inclusive of social participation, communication with others and mental motivation; access to immediate support by neighbours or nearby family members; ease of accessibility in, around, and out of the home; feasibility and access to transportation should they no longer be able to drive; and of course, safety = From the outside in, and the inside out - do they live in an Age-Friendly neighbourhood? Is their home safe from others entering? Is it safe from themselves? Lighting, rugs, stairs, shelving, structure, etc.). Is it adaptable to accommodate their aging needs?
Take Bart's advice and become an eldercare advocate: Sweep through their home as a structure, and as a shell to support their lifestyle and promote their safety and wellbeing.
Whichever holes you see missing (not just literally-speaking), work diligently WITH THEM to resolve them, or at least to begin talking with them about the possibility of bringing outside help to manage in the future.
2) Moving in with family
In the September/October issue, the Lou Volk & Alison Walsh Re/Max Real Estate team provided a great editorial piece on "having your parents move in". This powerful piece depicted a growing trend on how this lifestyle change can benefit both children, their parents, and even grandchildren, in more ways than just financial. With the right home layout and perhaps minor modifications, this option can be very suitable for looking after your aging parents. (Email us for a copy of this article info@sngpublishing.com)
3) Moving elsewhere
Although your parents may "have had it" with gardening, driveway accessibility or leaky roofs, they may not say anything to you unless you are the one bringing up the conversation about exploring options. Whether it's their attachment to the home, or the consideration that the children would be the ones attached to it, it's a conversation that must be had!
Consider their lifestyle and wishes, and have an open discussion about moving elsewhere – up north, out of town, down south, downsizing, into a supportive retirement community, and even into the possibility of a nursing home in the future. Test the waters and see what they've thought about already. Explore questions they have and assist them with finding out information about what they do not know about.
The money issue
After her father passed away at the age of 94, Minda Cutcher was going through her father's records and discovered he had lost out on the opportunity to take advantage of thousands of dollars in benefits and reimbursements because he didn't know they were available, didn't know how to claim them, wasn't able to fill out the paperwork or do the internet research. Perhaps Minda's father was just too proud to ask for help.
After 30 years in the private sector, Minda started her own company concentrating on helping other seniors organize and manage their finances and care. (mindacutcher.com) As she explains, "Having a discussion with your parents about their finances is always tough. For us, it may bring back memories of those uncomfortable teenage sit-downs with mom and dad. For them, it can bring up a range of emotions:
- Suspicion: "Why are you asking?"
- Anger: "It's none of your business!"
- Fear: "What if my kids realize I'm not in control as I pretend to be?"
- Relief: "It's becoming more of a burden, but I've been too afraid to ask for help."
Engaging your parents in a dialog about their finances helps ensure that they can be independent and helps you keep informed of their situation, so they can lead the life they want and you can have peace of mind. You may find the parent not open, comfortable or willing to discuss more in-depth financial information. They are entitled to their privacy and don't have to disclose all their finances with their children, however it's important for you to be aware that 'someone is', and to know 'who they are' (whether a lawyer, accountant or financial adviser). A simple, comforting question asking your parent to make you aware of this information, will ease everyone's mind and safeguard any future concern.