June 29, 2011

Showing Love: How Do I Help My Aging Parents?

Originally posted last September, I thought this upcoming holiday weekend was a good time to think about family and loved ones by re-running this. I've left the article unchanged even though there is a significant difference since it was first published: My Mom died in December so now I am focused on caring for my Dad..

If you didn't read this the first time, I hope you find it helpful and meaningful. Caring for our parents is a difficult task, but one that demonstrates our love. If you do remember it, I promise a fresh post on Friday just in time for the long 4th of July weekend.

One of the toughest things many of us face is dealing with our parents as they age. Watching someone you love decline is not pleasant. My mom and dad are struggling so I am learning as I go. Since they live in town that makes my wife and me the primary caregivers, though my brothers do what they can by long distance.

Almost 4 years ago, my parents had the foresight to move into a retirement community. It offers independent and assisted living options as well as a nursing care center. They wanted to avoid the situation where one or both became unable to care for themselves or too sick to be accepted into such a facility. We had discussed other options: caring for them in their own home for as long as possible, or even moving in with us. But, in the end mom and dad insisted that the benefit of the three level system was best. As it turned out their timing was excellent. Within 18 months my mom’s health began to take a dramatic turn for the worse. Dad is a trouper but his failing memory and hearing loss often leaves him somewhat befuddled.

Anyone with aging parents knows about all the daily decisions that I faced .Can anything be done to make their home safer to help prevent falls, burns, or other accidents? Do the bathrooms have grip bars? Are the throw rugs slippery? What in-home services does the facility offer? Asking these questions directly to my parents usually didn’t generate helpful responses. For quite awhile their contention was that they could handle everything even when that was not so. Finally, I had to just go ahead and take the necessary steps.

Older folks often suffer from poor nutrition. Meals are skipped or poorly planned. If the person’s eyesight is failing or gone, even the heating of meals becomes a big challenge. Luckily, the facility where my folks live has a few dining options so two of the three daily meals are taken care of. Breakfast at home or a light lunch doesn’t create an insurmountable obstacle, at least for now.

Next on my list were financial issues. Again, some foresight proved very helpful. Various health and legal directives were up to date. What about paying bills and taking care of taxes?  I assume that this can be an area of conflict, particularly if the relationship between parent and grown child isn’t the best. The fear of being taken advantage of is very real for seniors. Careful explanations of the consequences of missing credit card payments, utility bills, or tax problems are required. My dad was more than willing to turn almost all of that over to me.  I now can interact directly with their investment counselor and make decisions. After being added to the checking account I can pay bills. My dad still wants to receive copies of the  bills and statements so going paperless hasn’t happened yet.

One the biggies I have yet to deal with is the taking away of the car keys. From discussions with friends and what I read in various blogs, I know this will not be fun. My mom has been unable to drive for a few years due to increasing loss of vision. So dad is the one who takes her (and himself) to all the doctor’s appointments, food shopping, and all the errands of daily living. I check his car every time I visit for new dents or scratches. So far so good. When he begins to forget enough to become a danger, or has an accident, I will have to step in. Their community has constant shuttle and on-property transportation but it will be a major withdrawal of independence when the car keys disappear. Click here for an excellent article on how to accomplish this with the least grief for all.

Each parent takes multiple pills every day, so the management of that can’t be left to chance. I have met with their family doctor and I do have the legal authority to intercede if needed. But, there is no one to guarantee that the right pills are taken, at the right time, and in the correct dosage. I am watching for signs of trouble and will have to find a solution when that step becomes crucial.

Memory loss comes with age. Already I sometimes have those frustrating “senior moments.” Both parents were having issues in this area that are becoming worse. In my mom’s case, she broke her leg and ankle about 17 months ago. That put her in a hospital for almost two weeks and then into the nursing center. She doesn’t remember breaking her leg. I assume some of that is the brain blocking out bad experiences. But, it is still amazing to me that whole episode is not real to her at all. Dad has almost no short-term memory either. Luckily, he is a list-maker. His daily to-do list is written down in great detail in a notebook he carries with him always. Within the last year I have taught him how to feel comfortable with using a cell phone. If he gets lost, or has an auto breakdown, I’m hopeful he will call me for help.

The broken leg really accelerated mom’s decline. She is confined to the health center, except for regular trips to the hospital for other issues. While she is allowed to “visit” their apartment, she will not be allowed to return there to live. That awareness, along with her almost total blindness  have left her with little to fill her day and mind, so the slippage continues. Dad spends most of each day sitting in her room, reading the paper, or discussing doctor appointments, but that is causing his world to close in too.

I’m afraid this is not a post that will end of a burst of optimism. Dealing with aging parents is mostly about facing reality. On several levels my folks are blessed. They have the financial resources to be in the facility they are. They have family in town who visits at least once a week, sometimes more. After 63 years of marriage they remain deeply in love and committed to being there through good and bad. Mom and dad were there for me. It is my time to be there for them.

 If you haven’t faced this issue yet, you probably will. If you have been through this, then you have experiences I ask you to share with all of us. There are all sorts of questions, problems, and possible solutions I have skimmed over or missed completely. I would very much appreciate your feedback and comments on this subject. It may not be pleasant, but it is real.

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  1. My Dad died at the age of 81, but his decline started well before that. During his lifetime, he often went through lengthy bouts of depression, and in his later years, the depression mingled with confusion, memory loss, irritability, and no doubt endless boredom, making his last years a nightmare, not only for him, but for those of us who tried our level best to be patient and understanding. He took boatloads of pills, and I often wonder how much the medication contributed to his moodiness and overall state of mind.

    My Mom had no life at all during those years, such was her sense of commitment to taking care of him. In his final years, he could never be left on his own for fear of falling or getting into some other sort of predicament. With his confusion, he would often mistake her for someone else, and sometimes he would even convince himself that there were 2 versions of her, one good and one evil. He would often hallucinate and sometimes vehemently accuse her of cheating on him, even though she tended to him on an almost 24/7 basis and had no time to take care of herself, let alone find a boyfriend.

    In later years Mom did all the driving. This tiny woman would load a man who could hardly walk under his own steam into her car and trot him around to his doctors’ appointments. I have no idea how she managed this without help.

    If Mom was to have any time to herself in those years, it would require that I be available to “babysit” Dad while she went out. I hated every minute of it. I loved my Dad, but we seldom saw eye to eye on anything (I suppose the way many fathers and sons do). Conversation was difficult for any number of reasons, not the least of which was because he was so confused about what was going on around him, sometimes repeatedly asking me if I was going to take him home soon, when he was sitting in his favourite chair in the only home he’d known for 40 years. How can a man look out his front window at the same neighbour’s house that he’s seen every morning for 40 years and want to know if we’re going home soon?

    My Dad would fall constantly. Even with his walker, I would have to walk slightly behind him with my hand gripping his belt to try and steady him so he wouldn’t hit the deck. You haven’t lived until you’ve had to wipe your father’s blood off of the kitchen wall because he split his head open on a corner after taking a spill. Or how about putting his head through the side of the bedroom dresser after falling backwards? And try lifting an elderly man off the floor by yourself when he’s too feeble to help in the process. I use to grab a blanket and wrap it around behind him to try and get some leverage to pull him back up on his feet, but sometimes I just had to wait it out until someone else came along to grab one arm. There is so little dignity in old age that I often wonder why we all seem to want to live forever.

    I don’t judge my Dad based on those years. At his best, he was a decent, hardworking man, always willing to help a neighbour or drive the local kids to hockey practice when other fathers were nowhere in sight. It’s an unfortunate fact of life that the most recent memory we’re likely to be left with of an aging parent is usually a snapshot of them when they’re at their fragile worst, both physically and mentally, and possibly a glimpse into our own future.

    How's that for upbeat?

  2. I deeply appreciate your sharing this experience. Your statement, "I don't judge my Dad based on those years" is extremely important. A life is the sum of many events, not just the ending which we may have little control over.

    Thank you for your story. I have learned more about what to expect just by reading it.

  3. My father declined quickly around 80. We found a great care center in Phoenix. Between that and the public transportation- he got around pretty well and mom followed in the car. You are right- taking keys away was the worst. Fortunately, Dad had a fender bender with a women with children in the car. I convinced him that if he had killed a child in that car he would never have been able to live with himself. It was a sad day for both of us.
    In his final days he called me Mommie. His own mother passed when he was 18 months old. He couldn't eat those days- I knew his body was shutting down. He had to have all of our permission to pass on.

    Mom is considering moving into the same complex. I don't see her doing it anytime soon because she continues to be social and get around. Still the dings and dents in her car indicate it might not be too much longer.

  4. I am not looking forward to the car key issue. I'm glad I ran across the excellent article about this problem and was able to add a link to my post. Even so, having all the knowledge and being sure you are doing what must be done doesn't make it any easier. I guess it often takes some sort of accident like your dad's to resolve the issue.

    Thanks, Janette, for adding your comments to this important discussion. I sincerely wish for you strength as you deal with your mom's situation in the future.

  5. Looks like I lead a similar life. My MIL lived with us for 10 months. She came to live with us because she was lonely. She was a joy to have around as I was going thru empty nest syndrome(last child graduated from college and on his own). She became a wanderer and suffered from dementia. She is now living in a wonderful memory care unit.They know how to keep the mind stimulated. I too believe I may be looking at my future and its hard to watch. She has been there 2 months and believes she has been there for years. I just pray her money lasts since the future will only be a nursing home.

    My husband will be retiring in Dec after a long career in retail(with very long hours). He will look for a partime since his pension is small.I will continue to work 30 hour with full benefits.
    I am a little nervous but feel we are moving in a good direction.

    I enjoy reading your blog.


  6. Sue, thanks for sharing the story about your mother-in-law. It is hard for any of us to contemplate what the future may hold for us and loved ones.

    My wife's biggest fear is her losing her memory and not knowing me or the kids and our life together. She knows it is actually harder on those who do remember and have to accept what is happening.

    I wish you and your husband the best of luck in the new phase of your lives that begins in December. Life isn't very exciting without occasional change, and this will be a big one!

    Thanks for your kind words and keep on reading. I can always write more !

  7. We also are going through some of this with my husband's parents. Fortunately (or perhaps not so fortuantely) their minds are fairly good but my father in law is so weak that he cannot transfer himself anywhere without help. My mother-in-law can see and hear little. For us some of the most difficult aspects have been respecting their autonomy while encouraging or cajoling them to assisted living and now nursing care - and knowing that they are bored and frustrated by their situation. Often there are no right choices, only the best we can do. Take care.

  8. Hey Chris,

    I copied your comment from here and left a response on the post that went up October 10th...A Real Life Love Story. Your observations were on the mark and I wanted visitors who came for the most recent post to have a chance to read what you wrote.

    I also hope to direct a little traffic to your excellent blog.

  9. Has it been less than a year since I wrote that comment?
    My mom is in full decline- and a move to the retirement center may be too late. I plan on being in Phoenix for at least a month in the fall. I've been there once a month since this decline started.
    I agree with Chris- frustration seems to be the worst part of the situation since my mother has all of her wits (and more) and just cannot understand why her body is being so bad!

  10. Hi JBO,

    I was hoping someone who had left a comment almost 10 months ago would update their situation...thank you for being that person.

    In the situation of an aging and declining parent 9-10 months is long enough to see a dramatic change, like in your mom's case. Most retirement communities do have strict rules about the health, both mental and physical, of incoming residents. If you wait too long, a nursing home is the only alternative.

    The frustration my mom felt toward the end is exactly what you and Chris refer to. Her body completely betrayed her while her mind was still functioning well. It is sad and heartbreaking to watch.

    I hope when you are in Phoenix this fall we can meet up for a cup of coffee and a personal conversation. I miss your blog and appreciate you being a regular visitor here. Drop me an email when you know your planned dates and maybe we can get together and share stories about our parents.

  11. Bob,
    You struck a nerve! I missed most of the real issues about my parents aging due to distance- both physical and psychological. I coped by serious denial but left my parents to manage. They moved into one of those three level places but when they needed assisted living, for some reason they weren't approved to move. The biggest problem was financial. My father did not relinquish control and made some bad decisions. I stupidly thought that my mother could refuse to go along. They didn't run out of money and they chose how they wanted to live and what kind of relationship they wanted with me and my family. I could have done better by them Looking at myself now I think about what my kids will face when it's my turn.

  12. Hi Ralph,

    My wife and I have had that "talk" recently several times between ourselves . We are not even remotely ready to move to a 3-level facility. But, we are committed to not leaving our kids with the mess caused if we wait too long.

    When to go? That is the $64 question.

  13. I am grateful that my inlaws have made some wise choices and now reside in an appropriate seniors' community. I can see us doing the same thing when we hit our late 70s. Also, I recently purchased long term insurance. We are blessed that they made the hard choices and have spared us from needing to do so. I am determined to do the same for my own kids.
    Of course, the emotional issues are not diminished.


  14. Good afternoon Dr. Keith,

    Late 70's is about our timetable,too, so we have a good 16-17 years before that time.

    For now my wife and I have decided to pass on long term health insurance. We know that is a calculated risk, but the premiums and exclusions make it prohibitive.

  15. Both my parents have died, so these are not issues I'm facing now, but I'm commenting anyway to say that having lived through my parents' last years, I recognize much wisdom in this post. (No surprise--there is always much wisdom in your posts!) It is a challenging stage for our parents and for us. And it informs the decisions we make, looking ahead for our children. Thank you.

  16. Galen,

    Thank you for the kind words. This is is tough period most of us must pass through at one point or another.

    I visit my Dad once a week, but know his time is coming sooner rather than later. I am so glad he is still in my life.

  17. My parents, who lived in an adjoining state, had their full continuum of care retirement community picked out and were in process of selling their own when my mother was diagnosed with Stage IV of a cancer that killed her within a month...so fast, they never even figured out the primary type of cancer.

    After her funeral, as my father began to work on her estate, it became clear that he was suffering from vascular dementia. And, shortly thereafter, his bladder cancer, heart arrhythmia and kidney failure were diagnosed. I believe we'd have lost him quickly, too, if we hadn't acted quickly.

    He was admitted to an assisted living unit of the same sort of retirement community here that he'd sought back home. I was able to work with a team of doctors and his facility staff to get bladder surgery and chemo, a pacemaker, and to make the medication and dietary changes for his kidneys. He had four more very pleasant years, especially after meeting a lady, a fellow resident, who'd grown up near his childhood home...so there was even a little romance involved.

    Next week, I have an appointment with an insurance agent. Time to get that CLTC insurance policy, myself. I'll have to do without a lot of the small perks that make retirement more pleasant in order to pay for the premiums, but I can't imagine the alternative.

  18. Good morning, Nance,

    Thank you for sharing your story. That much heartbreak to handle in such a short amount of time must have been a real test for you. Thankfully, your dad was able to beat the odds for "four more very pleasant years."

    I keep going back and forth on the LTC insurance. But, maybe it is something my wife and I should revisit.

  19. Sending them into a decent and peaceful retirement community is the sweetest thing you could offer to them.

  20. Hi RC,

    They made the decision and we will be forever grateful.

  21. Thanks so much for your site. I recently attended a session on caring for your elderly parents. The first theme was, we are fortunate to have the opportunity to usher our parents at their lives end to meet their Maker.

    Another theme was, we have to remember all the good they showed us while we were helpless and learning to walk and grow up through the hassle of teen years and translate this into a joy to return the favor as they literally become the child again that we once were. We have the opportunity to show kindness to them for all they did for us.

    Seems in our busy world, focused on ourselves so much, we can lose sight of the importance of caring for those around us. Caring for our parents is an honor, though it may not seem like it during the mundane and sometimes downright gross moments. We have to keep an overall perspective that drives us through these times. I'm sure it wasn't all peachy when they wiped our butts either :)

    Anyway, these are some things I took away from the class (with my own additions). It truly is a matter of the heart. I have only begun these things as mine are still alert and functioning so I am doing a lot of prep work. Thanks again for taking the time.

  22. i have my parente alive my Mom is 80 years old she just have hipa repalcemnte , my Dad is 83 years old not doing well with everything is going on with my my Moms`s health
    i work i`m 58 years old and i am the support of them they leave on my country Nicaragua, they asked for me to go and take care them i will just have my retirement.how can i do it. ? what i need to apply fo it.

    1. I'm afraid i can't answer your specific questions about what you will need to take care of your parents. But, you are certainly showing the love our parents deserve from us. After all, think of all the sacrifices they made for us while we are dependent on them.

      A hip replacement is a big deal. Your mom will need lots of daily care and support. Your dad needs reassurance that he is helping and is an important part of her care. Over time, he should be able to adjust to her condition and become more able to handle her care.

  23. TheCaregiverSpace.org is a free social network that allows caregivers to share their experiences, find critical resources, cope with stress and effectively combat the isolation and exhaustion of providing care for someone they love.

    1. I just look at look at this site. It does look like it could be an excellent resource for caregivers. Thanks for the updated information.

  24. Thank you for sharing those trying times with us. Sometimes, it's just hard to think that the ones you looked up to as role models have become too weak to even take care of themselves. It's a rough reality check, but it's one we have to accept. The amount of time and effort you put into taking care of them is astounding, and you really serve as an example for others.

    Theodore Wong @ Live-Incomfort.co.uk