December 2, 2009
When Parents Age

Helen Anna Davey, born October 30, 1922, mother of five children, including my twin sister and me she had at age 41, has always been a strong, vibrant woman. Even after my father passed away in 1976, she remained strong and took good care of her family. As time has passed, she has aged before our eyes, and our mother has transformed into a weak, helpless, person, who can no longer take care of herself. My mother is a breast cancer survivor, but is not the cancer that has left her in this weak, broken, condition. She had polio as a child. Because of the treatment, (body cast, brace, and later surgically shortening muscles), her right leg and foot were shorter, and as a result, she limped. She had a hip replacement years ago, but now the damage is beyond repair. She also had some muscle damage in her arms, which is greatly limiting her arm movements now. Although her body is failing, her mind and spirit are still very strong. So, as my elderly mother’s health is deteriorating, and she can no longer care for herself, my siblings and I face a great challenge as we take on the tremendous responsibility of managing the financial, legal, medical, and final arrangements for her, while we try to navigate through a difficult minefield of emotions. Parenting your parent can be a very awkward, difficult, and at times, frustrating task. Both you and your parent can feel many emotions ranging from gratefulness, to anger, to guilt. For example, I feel completely at ease taking care of my daughter, but taking care of an adult, specifically the one that fed, clothed, and bathed me as a child; it does not feel natural at all. As a parent, I have learned patience parenting my own child; strangely, I find it more difficult to be patient with my mother. Maybe because I am accustomed to her being able to take care of herself, I do not know. Naturally, feelings of guilt and depression follow. While we deal with these difficult emotions, it is also important to remember that your parent rides this emotional rollercoaster with you. My mother is living in constant pain, frustrated by weakness and her immobility, worried that she is a burden, and fearful because she is losing control of her life. When I asked my mother Helen, to describe some of her feelings she said, “It is so frustrating, not being able to do even the simplest of things.”, and remarked, “I feel guilty sometimes because my children have to do so much for me”. She went on to say that, she was very grateful to have all five of us around her (Helen Davey). Now having five brothers and sisters can be a blessing and a curse. On one hand, you have more than enough people to help with everything, but at the same time, getting all five of us to agree on anything is a miracle. While we all want the best for our mom, usually, we all have a different idea of what the best is. With so many varying opinions, conflict between siblings is inevitable. To help circumvent these conflicts between family members, one person should become kind of the head of the family. This helps keep everyone centered. If your parent is coherent, they should decide (Loverde 27). My mother made the choice for herself, and my oldest sister Kathy has taken the lead role in our family. Because working together requires a lot of cooperation and coordination, it is crucial to keep everyone informed. There are doctors’ appointments, shopping, baths, meals, medications, and many other things to manage, while we balance work and family in our own lives. Mr. Robert Torres suggests in “The Caregiver’s Handbook”, that families should have regular family meetings to help keep all this running smoothly. My family has found this to be a very helpful tool. As we embark upon our new responsibility as caregiver, we first want to make sure our parents are getting the best medical care. Becoming informed is the best way to accomplish this. Families should get to know their parent’s doctor and find out which hospital he or she works with. In an emergency, you will know who to call and where to go (Torres-Standovik Pt. 6). In addition, families should establish a line of communication with their parent’s doctor. Good communication with the doctor helps to educate you about your parent’s conditions, thus, making you better prepared to care for them. This can be done by note, phone, or by simply going to the doctor visits with your parent. Because of Privacy laws, communication with the doctor can be a problem. To avoid this, your parent can simply notify the doctor that they can speak to you (Torres-Standovik Pt. 6). Familiarizing yourself with their medical conditions is essential. Everyone involved with caring for your parent needs to have a complete list of medical conditions, allergies, dietary restrictions, prescription medications, and a dosage schedule (Torres-Standovik Pt. 6). We each have a copy of this because this information is not just vital in an emergency, but it is necessary for my mother’s daily care. As our parents age, their medical needs become greater. Therefore, it is important to make sure your parent has enough medical insurance. The government provides Medicare to senior citizens at age 65, but you really need to do your homework because Medicare is very complex. Original Medicare, which covers many basic health care services, may not be enough. When their medical needs are greater, Medicare Health Plans, like HMOs, PPOs, and Medigap Insurance can be a better choice. Run by private companies and approved by Medicare, these plans generally offer extra benefits and in most cases keep costs lower, [ (www.medicare.gov) ]. In “The Complete Eldercare Planner”, by Joy Loverde, we are reminded that just as we look for symptoms to determine our parent’s health, there are also symptoms that tell you they are having other difficulties. Sometimes it can be something subtle or it can be extremely obvious, but the time will come when you see that your mom or dad is having trouble doing things at home. Dishes stacked up in the sink, bills piling up on the table, or their hygiene is just not as good as it once was, can all be signs that they need help, or can no longer live alone or unassisted. Evaluating the situation, if not handled carefully and objectively, can cause a tremendous amount of anxiety and stress for your parent. Certainly, they are feeling frustrated, embarrassed, and frightened because they are losing control. For that reason, it is important to approach the issue without being judgmental or angry. Therefore, while you observe the condition of the house and your parent, you should also consider your parents’ feelings (Loverde 22). While trying to decide what your parent needs are, it is easy to forget that they are an adult, not a child. As such, they must not only be included in any decision making, but should be in control of the decisions as well. Remember, one of their fears is that they are losing control of their lives. My family made this mistake. In the end, the five of us bickering about what would be best for our mom; we only scared and hurt my mother. “You are all making plans and talking about me like I’m not even here”. “Will you be planning to lock me up in a nursing home next?” my mother said. First, you should evaluate what your parent’s needs are. Financially, life can be difficult for most aging Americans. The Administration on Aging states that one of the first services an elderly person may look for is help with meals. Aside from being proud, my mother is no different. After initially refusing to take a “hand out”, my mom tried Meals on Wheels. Most of the volunteers are elderly themselves and she enjoyed the casual chitchat when the deliveries came. In addition to nutritional assistance, state and federal benefits are available to help with prescription drugs, utilities, healthcare, housing, and legal assistance, for those who are eligible [ (Administration on Aging) ]. Not being able to keep the house clean is another issue our elderly parents face. As we age, physical tasks like pushing a vacuum, doing laundry, or cutting the grass become more difficult for us. If you have five children, this is not a problem at all; however, there is help for those who do not have the support of a big family. For housework, shopping, and even baths, you can employ someone to come in once or twice a week, according to their needs. While the internet can assist you with finding a reputable caregiver service, you still should always get references for their employees. However, when you are looking for a caring, trustworthy caregiver, to come into your mother’s home, a personal reference is priceless. If living alone is not an option anymore, Assisted Living facilities can be a good choice. For those who cannot manage daily activities alone, but are not completely helpless, Assisted Living can offer a feeling of independence and a sense of security. Many have activities, dining room options, family gathering rooms, transportation for shopping, hair salons, and the amount it costs to live there reflects this. However, there is no medical assistance offered. Assisted Living is more like an apartment in a senior community with a few extras. Finally, if your parent needs constant medical attention and their needs become greater than what your family can provide in the home, ultimately, the choice must be a nursing home. Because of my mother’s physical limitations, we knew we had to do something. However, because of her determination (stubbornness), we continued to let her live alone in her trailer. To concede, she let us take over housework, shopping, driving her places, helping with meals, and baths. As my mother became weaker, even with five of us caring for her, it was clear that we could no longer provide her with the care she needed. One evening, my mom was so weak that she could not get out of her chair. Since her phone was across the room; she sat there all night and half of the next day, waiting until someone arrived. Life alert, the pager worn around the neck, in case of emergency, would have been useful in this situation. After this incident, we decided a nursing home would be better able to provide her with the fulltime care she needs. Unfortunately, this is where we are at with my mother. A bleeding ulcer had contributed to my mother’s weakened state. In addition, the pneumonia that followed, kept her in the hospital for a while. We used this time to explore and investigate nursing homes. The internet was extremely helpful, providing tools that compare and grade each institution. Again, personal references are priceless here too. When investigating a nursing home, you should make a checklist of questions to ask. Basic things to look for in a nursing home are; see if the facility is Medicare and Medicaid certified, if the facility has the level of care needed (skilled, custodial), if they have beds available, and see if its close enough for friends and family to visit. Next, you will want to observe the residents living there. See if the residents are clean, well groomed, and appropriately dressed. You should look at the living spaces to see if they are clean, well kept, and free of overwhelming odors. In addition, you will want to inquire about if belongings or furniture can be brought in, get a list of policies i.e.; visiting hours, activities, baths, meals, medication, private phones, TV, and anything else you can think of [ (www.aarp.org) ]. Of course, when you are checking out a facility, you must look closely at the staff too. Ask if they have a doctor on staff, if the nursing staff is licensed, and if there is a Registered Nurse present, [ (www.aarp.org) ]. Now once you have found a great place for your parent to live, you need to work out the financing. Medicare will pay for a participant's stay in a nursing home, but only for a limited time. If even after being discharged from a hospital, if your parent continues to need skilled nursing care, Medicare will pay for the first 20 days stay in a Medicare approved nursing home. In addition, Medicare will pay a portion of the cost, for up to 80 more days. After that, neither Medicare nor a Medigap policy will pay for any services. Medicaid is a program for low-income elderly people who have few assets. To qualify for Medicaid, you must meet an income and asset test. [ (Administration on Aging) ] Considering we sold my mom’s car a long time ago; her trailer, transferred into my sister’s name and sold, any money she had in the bank is just about gone; her social security is all that she receives each month. As a result, the home she is in is affordable, with the help from the state. As always, when she needs other things like; clothes, haircuts, or any of the basic necessities, we all pitch in. Usually, handling a parent’s finances only comes up because they become suddenly ill. Janet Morris, an Elder Care attorney, recommends that families deal with this issue before a crisis happens. Having legal documents in place, is the best way to ensure that the bills will be paid, and your parent is able to choose the decision maker themselves. Since the legal Power of Attorney will take over the finances for your parent, your parent must choose a trustworthy, responsible person to handle the task. A Living Trust is another option for financial planning. A Living Trust is a legal document that holds property including real estate and bank accounts. If the trustee (your parent), becomes incapacitated, the trust names the person that your parent choose to handle their assets. It dictates in the trust exactly how the person should use the assets in the trust to care for the parent. Both of these documents should be drawn up by an Elder Care attorney (Morris). Just as your parent should be in control of their financial decisions, end of life choices are just as important for them to make. Having Power of Attorney for health care will insure your parent’s wishes will be carried out. Just like Financial Power of Attorney, when your parent becomes incapacitated, it will give instructions for medical care and name the person charged with carrying those wishes out. In the end, this will prevent family members from struggling with each other about those sometimes, tough medical decisions. Your parent may also consider a DNR (Michigan’s Do-Not-Resuscitate Order) or POLST (Physician’s Order for Life-Sustaining Treatment); this gives them the ability to declare they do not wish to be resuscitated in the event their heartbeat or breathing stops. The state of Michigan requires that a physician sign a DNR form and that a POLST form be signed by a physician or nurse practitioner (Hospice of Northwest Michigan). Of course, if your parent has an estate, or even personal property, it is important to make sure there is a will. This will enable your parent to decide what they want to pass on to each family member, and even pets in some cases. As most of my mother’s assets have been dissolved, she has only a few personal belongings and memories to share. What has not already found its way to its intended recipients, will, when the time comes. Obviously, making the critical decisions can be very difficult. However, making the critical decisions during a crisis can be even harder. This is why planning ahead is so vital. Planning in advance allows your parent to maintain control of the decisions. Aside from this, advanced planning can also keep family members from struggling over the medical, financial, and personal issues. Deciding between burial and cremation is one of those personal issues. There may be religious beliefs, financial concerns, or just plain old fear that can drive this decision. Because he had a fear of being buried alive, my father wanted to be cremated. My mother, on the other hand, she wants to be buried right next to him in Glenwood Cemetery (she was, and still is a very stubborn Irish Catholic woman). This is a good example of why to have all your last wishes in legal form. Even the funeral can be pre-planned. By pre-planning a funeral, your parent can make his or her own choices. Robert Gilbert, a funeral director at UHT Funeral Home offers a checklist for families interested in pre-planning. Prayers, hymns, eulogy, the coffin, cemetery plot, open or closed casket, the number of days for viewing, a memorial service at church, or a service at the funeral home, there are many choices to make when you are planning a funeral. Pre-planning the funeral does not require any money. However, you can pre pay for the funeral. The average adult funeral costs approximately $7,000.00, not including the marker or a burial plot. By pre paying, you can pay at today’s costs, avoiding inflation [ (Gilbert) ]. Although my mother has a burial plot next to my father at Glenwood Cemetery, there is still an additional cost to make the hole and for what they call a vault. A vault is made of cement and it is what the coffin is placed in before it goes in the ground. This will add approximately $ 900.00 to the tally. Some families have a luncheon following the service. This is certainly an additional cost to consider. My family has discussed this already. Fortunately, my sister Mary has the room at her home. Therefore, my family will be cooking and gathering at her home. Once the planning is complete, and the all the decisions are made, it is time to plan the financing. Overall, we have estimated the cost will be between $8,000.00 and 9,000.00. While exploring payment options, you should look at bank accounts, CDs, life insurance, and any pension income. With no life insurance policy, the money from the sale of my mom’s trailer and car is all we have. Some of this money was put into a CD for future use. So the funds will be available when they are needed, my sister Kathy has access to the account. Although this is a good portion of what we have estimated we will need, we are all aware and preparing for the possibility that we could still fall short. Preparing for the end reminds us that saying goodbye to a loved one is never an easy thing to do, even if it is expected. It helps to focus on the good memories you have of that person. Although, there are many grief support groups available, sometimes it can be better to speak with a friend, someone in your family or your family’s priest or pastor. The important thing is to talk about it. Holding things in can cause unnecessary stress, and you will usually find that sharing it with another person can shine a different light on things. Caring for your aging parent is a serious, fulltime commitment. Although my role in my mother’s care is not a significant one, I take it and my responsibilities very seriously.
Through my research, I have discovered many things to help aid my family in our mission. ~ Plan early. Don’t wait until a crisis comes up. Talk to your parent about their issues, doctors, plans, and their wishes. ~ Keep them involved in with the decision making. This can also help ease their fears. ~ Research everything. Ask a lot of questions and gather as much information as you can. The internet can help a lot here. ~ Patience, understanding and faith, will carry you far. ~ Lastly, get as much help as you can. Since there are so many things going on at once, any extra help is a godsend. So enlist your siblings, the grandchildren, and friends to help. From dealing with doctors, to just simply dropping by for visits, there is a role for everyone. With my father passing away so early in our lives, my mother has always remained strong. She has kept our family centered. She has been our rock through many difficult times over the years. Therefore, I feel it is not only my responsibility, but it is my honor to care for my mother. As my siblings and I embark on this difficult journey, we are learning that although we do not always agree on everything, we all agree that our mom’s care and happiness is our priority.

Works Cited

Administration on Aging. 2009. 23 September 2009 <http://www.aoa.gov/AoARoot/index.aspx>.

Children of Aging Parents. 2007. 13 September 2009 <http://www.caps4caregivers.org/>.

Davey, Helen. Interview. John Davey. September 2009.

Elder Care Online. 1997-2009. 13 September 2009 <http://www.ec-online.net/>.

Gilbert, Robert. Funeral Director John Davey. 29 October 2009.

Hospice of Northwest Michigan. www.hospicenwm.org. 2009. 28 October 2009 <http://www.hospicenwm.org/mcp.html>.

Loverde, Joy. The Complete Eldercare Planner, Second Edition. Three Rivers Press, Crown Publishing Group, 2009.

Morris, Janet. "Smart Now." 2008. SmartNow.com. 28 October 2009 <http://www.smartnow.com/page/4909>.

Torres-Standovik, Robert, LCSW. "The Caregiver’s Handbook." January 1990. www.ipl.org. 25 September 2009 <http://www.acsu.buffalo.edu/~drstall/hndbk0.html>.

www.aarp.org. 1995-2009. 24 September 2009 <http://aarp.org/>.

www.medicare.gov. 2009. 24 September 2009 <http://www.medicare.gov/default.asp>.