Before I wrapped up this series, I wanted to share some odds and ends thoughts about helping parents as they age. This list would probably vary from person to person because parents age differently: we know a man well into his 80s who stills travels internationally and just got remarried a couple of years ago, but both of my parents had serious health issues in their 60s and died before they turned 70. Some parents are pretty self-sufficient as a rule whereas others need a little more help. Some want help, some don’t. These suggestions arose primarily from our own experience of seeing my mother-in-law through the last dozen years or so of living alone, then not being able to live alone, then going from assisted living to a nursing home to home with us. Some arose from friends’ experiences. By all means tailor any of this to fit your situation. I’d welcome any suggestions or experiences you’d like to share in the comments.
1. Have “the talk” – about finances. It’s hard to say when this should be done, but it should be well before finances become an issue and before any kind of dementia has set it. I’ve heard of some with dementia who thought their kids were “after their money” when they tried to work out power of attorney and such when the parent could no longer handle their own affairs. Some parents will be on top of things and will initiate the conversation with you (which is preferable). One suggestion would be to ask your parents as they get close to retirement how they’re set for the coming years and what their preferences would be if anything should happen to make them unable to take care of things.
In our case, my mother-in-law was the one who handled the finances in her marriage, and after her husband died she was happy to give her oldest son power of attorney. When she moved here, power of attorney was given to Jim since he would be the one actually handling her finances, paying for assisted living, supplies, etc. He got a joint bank account with her name and his on it so either of them could write checks. For years she wrote checks for church and for Christmas presents, but he wrote checks for bills. She would sometimes ask about how things stood but seemed content with how things were being handled.
2. Have the other talk – about end of life issues. This can be a difficult or awkward situation, and some parents will not want to discuss it at all. If something should happen and your parents have not made any living will or advanced directives, all you can do is try to make the best decisions you can. I’d advise you to do some research before having to make a decision in a crisis. For instance, we thought feeding tubes should always be offered if needed, but then discovered there are situations where it would cause more problems than it solved. When my dad needed a ventilator, one sister-in-law was adamantly against them because she had seen people who were for all practical purposes gone, but were kept alive on a ventilator; however, my father only needed one for about ten days. I once felt that CPR should always be performed, but on an elderly person, chest compressions can break bones. If you can gather information beforehand, you’ll be better prepared to make these decisions in a crisis.
3. Sibling involvement. It helps if everyone can be involved in the discussions and decisions that have to be made. Some of these, particularly end-of-life issues, can be especially delicate and emotional. If all the siblings are nearby, it’s best if they can all be involved in a parent’s care, but realistically it does not always work out that way. If the lion’s share of care falls to one sibling (often due to distance), continue to stay involved, show interest, ask how things are going, etc. Abide by their decisions unless there is neglect or abuse. If there is an elderly family member with no children, others need to step in. We knew of a situation where an older lady in our church lived with a daughter who had some kind of mental issues, was a hoarder, had stuff stacked all over the house with only a narrow pathway for the older lady to get around in her walker, had something like 16 cats, some of whom she kept tied on strings in one room, which smelled horrible. When we knew of all this, we tried to help, but found out that unless there was active abuse, there was not much we could do as “outsiders.” Someone called animal control. and they came and took a few of the cats, but that is all. Another lady tried to help the older lady find a different place to live, but ultimately she did not want to leave her daughter. At her funeral when I saw rows and rows of her relatives, all I could think was, “Where have you people been the last several years?”
4. Help where needed, but unobtrusively. Long before parents get to a place where they can’t live alone any more, they might need help here and there with a variety of issues. They begin to lose steam or get to the place where they can’t see well and may not even know of some problems.
We lived 2,000 miles away from my husband’s parents, but the last several times we visited, my husband would seek for something to be done around the house (like rebuilding the roof on the carport, etc.) and suggest doing it while we were there. It gave him and his dad some time to do something together, helped with something that really needed to be done, and kept his dad from climbing a ladder to do it himself. 🙂
We noticed the last several years that my mother-in-law was in her own home that things like dishes weren’t being done as well, not because she was letting them go, but because her eyesight and sense of touch was getting to the place that she didn’t realize she wasn’t doing as good of a job. I’m a bit germophobic, so when I’d drink a glass of ice water with “floaties” in it, I’d get pretty grossed out. This was before the days of readily available bottled water. She didn’t have a dishwasher, didn’t have room for one, and would not have wanted one anyway. We started getting paper plates and plastic cups when we visited, to “make things easier on her” – -which was technically true. There were always piles of dishes after every meal, and sometimes she accepted help, but more often than not she liked to do them – it was her “thinking time.” Having some disposable products did help lighten that load, but it also helped us be assured that we were eating and drinking off clean utensils.
I mentioned earlier that sometimes household help can be hired, especially if the family doesn’t live nearby.
You may need to transfer things like Thanksgiving and Christmas to your house rather than the parents’ home, or at least spend time helping them get ready for it. You have to tread carefully with long-standing traditions like this: some might feel relieved not to have the pressure and work, but some might get their feelings hurt.
I mentioned helping unobtrusively: you don’t want to barge in and take over, or make them feel inadequate. Try to offer whatever help you think might be needed in a way that encourages them rather than demeans them.
And sometimes you just have to accept that things like the housekeeping might be at a lower standard than it once was. The last few years my mother-in-law lived alone, she pretty much let her dog have the run of the place, and every surface was covered with dog hair. It was a nuisance, but it wasn’t a safety or health issue, and his companionship meant a lot to her.
Sometimes helping means insisting on something they may not like. My mother-in-law was very much a status quo person who didn’t like to make any changes. Even when her hearing aid was not doing any good, she insisted it was fine, and we had to gently insist on going to the audiologist to be evaluated for a new one.
Sometimes helping may mean running interference. My mother-in-law had trouble with one physical therapist at the assisted living place (he had a Croatian accent and she couldn’t hear him well, couldn’t understand what he wanted her to do or why). He thought she was just being uncooperative. My husband had to take time to be with them for their first few sessions to help them interpret each other, but after they they got along great.
5. Help them to be as independent as possible as long as possible. At home or even in the lower-ranged assisted living care, there might be tools you can gets or little things you can do to help them be involved in their own care as long as possible: the seven-day pill holders to help keep their medications straight and help them remember what to take when; “reachers” to help them with hard-to-reach items (I use one of these myself!), an device to help open jars (I use one of those, too), etc. My husband tied bits of rope between his mother’s dresser drawer handles to make it easier for her to open them when she began to have trouble with them. He also put easier-to-read labels on the TV remote for the most-used buttons.
There will come a time when they will likely need help with just about everything, but for as long as possible let them do what they can do. We had elderly neighbors once, two sisters, who cut their own grass well into their 70s. One of them even painted her back steps at that age. My first impulse was, “Oh, we should go over and help them with that!” But one of them in particular liked being able to take care of herself. I just watched a Waltons episode when the grandmother came home after having a stroke, and every time she tried to do something, someone jumped up to do it and told her to relax. They meant well, but they made her feel helpless and useless. Even as their abilities diminish, let them do what they can safely do.
6. Don’t squelch talking about the past. As this post points out, they don’t have that much future left, and it may not look all that bright and cheery. This is a great time to ask them about their growing-up years – and a good time to write some of these things down for posterity. One of the things I regret with my mother-in-law is that I didn’t ask her more about these things and didn’t write down what she did say.
7. Help them find usefulness and purpose. This overlaps a bit with the above two points, but an older person can get pretty discouraged when they lose some of their abilities and even lose their home. Once when we had my mother-in-law here for dinner, a funny story from her past came up that we all enjoyed and laughed over: she did as well. Then she said, “Well, at least I’m good for a laugh.” It didn’t hit me until then that she might not have felt she was “good for” much of anything else. You can encourage a parent that as long as God has them alive, He has a purpose for them. Psalm 92:14 says, “They shall still bring forth fruit in old age; they shall be fat and flourishing.” Perhaps you can help them organize their photos into albums (something else I wish I had done) and hear the stories behind them. Remind them often that you’re glad they are here.
8. Always honor and respect them as your parents. I cringe a little at the phrase “parenting your parents” or the idea of “switching roles” with them. In one assisted living place, when we came to pick up Jim’s mom for something, one of the aides said, “It’s almost like you’re the parent now, isn’t it?” and then turned to his mom and said, “Your daddy is here.” Umm…no. Even as she has lost more of her abilities and we’ve taken on more of her care, we don’t think of her like that. As she has experienced a bit of dementia, Jim has had to remind her about some things from time to time (like using her fork rather than her fingers at meals or insisting her hands be washed), and sometimes that might have involved a sharper tone if she persists, but we don’t treat her as a child. I know family dynamics can be tricky and some parents can get more child-like, but as much as possible we still need to show them honor and respect.
9. Forgetfulness and dementia. My mother-in-law does not have Alzheimer’s, so I can’t really speak to that (and again, I’d welcome any perspectives you’d like to share in the comments). She has had a degree of dementia. It’s usually worse when under stress or when anything different is happening, and it has increased over the years.
As a general rule it doesn’t help to say, “Don’t you remember?” (Lisa suggests here to give them the answers rather than questioning them). Sometimes it does help to gently remind them of things: for instance, when Jim brought his mother here from ID, the folks at her church had all given her cards and told her good-bye, and all her kids and several grandkids had come to a combination 80th birthday/farewell party. Yet on the plane, she told Jim, “I think I’ll just stay for a few days and then head back home.” He wisely didn’t try to “set her straight” then and there, but later on he said, “Remember when all the folks at church gave you cards? Do you remember what those were for?” At some point she said, “Oh, that’s right. I’m moving to South Carolina.”
A nurse in the nursing home once told a member of a group from our church who were visiting that it is best not to alter their reality. Sometimes when they get “stuck” on something, distraction is the best tool. When Jim traveled with her, she’d say things like “I sure hope you know where we’re going” and get a little rattled by it all. Even though he is a seasoned traveler, instead of just telling her, “Don’t worry about it, I’ve got it covered,” he told her what gate he was looking for at the airport and asked her to help him look for it. That gave her something to occupy her thoughts. Recently she was “stuck” on needing to go to her daughter’s house. Jim wasn’t home when this started, and at first I tried to remind her that she lived in TN now and that her daughter was back in ID. But that wasn’t sinking in. It was one of our worst weather days this winter, and when Jim got home, he told her, “It’s snowing out now and the roads are icy, so we’re just going to stay here for the night.” He had to go over that a few more times, but after a while her thoughts turned a different direction.
Even in visiting in the “memory care” unit of assisted living, residents would stop us and ask us if we could help them get somewhere. At some level they knew they weren’t home, and some of them were constantly trying to figure out ways to get there. One lady stopped Jim once to say that something was wrong with her car and she needed to get to it. It was close to dinner time, and he said, “I tell you what, why don’t you stay and eat dinner, and we’ll see about your car later.” She felt so honored to be asked. 🙂 (On a side note, when visiting a nursing home or a memory care or Alzheimer’s unit in an assisted living facility, sometimes it is best to avoid engaging the residents in much conversation. When we visited my m-i-l in regular assisted living, we talked with the other residents quite frequently. But we quickly found that in the “memory care” unit, they often wanted you to help them with something, and when you couldn’t, they would get agitated, sometimes angry, and even start yelling and cussing, which not only disturbed themselves and others but made it hard on the aides to get everyone settled back down. We learned to just cheerfully say hello in passing without stopping to talk, and if we did get stopped and asked for something, we’d point out one of the aides and say, “Maybe she can help you.” )
10. Helping them deal with government agencies. Even if you have power of attorney, there are many situations where an agency will want your parent there. Once when my husband was trying to deal with one particular issue (I forget what it was), the man he was talking to wanted to talk to my mother-in-law on the phone. My husband tried to tell him she was very hard of hearing and especially had trouble hearing on the phone, but the man insisted. So my husband went to her room at the assisted living facility, called the man, put the phone on speaker, and they tried to have a conversation. When she couldn’t hear and Jim was trying to convey to her what the man had said, the man shouted, “Don’t you dare tell her what to say!” Understand that they are trying to protect the elderly from being taken advantage of by unscrupulous relatives (unfortunately that does happen), but sometimes they do make it unnecessarily hard on those of us who are trying to help get necessary things done.
11. Smooth awkward moments. You don’t need to call attention to every mistake or fumble: if they’re aware of it, they probably feed bad enough already. Just help take care of spills or messes or whatever without making an issue of it. When they start needing help with personal issues, just handle it as matter-of-factly as possible – I took that cue from when I’ve had surgeries and illnesses and needed help with things I’d much rather have done on my own. Usually the nurses just came in and we got it done, and some of them were even cheerful about it. When my mother-in-law started needing help going to the bathroom, she’d say apologetically, “I bet you never thought when you got married that one day you’d have to help your mother-in-law go to the bathroom.” Well, no, I hadn’t. 🙂 And helping someone that way or changing dirty Depends later on is not really anyone’s favorite thing to do, but it helps to just look at it as meeting her needs and to handle it with as much grace as possible. My husband is great at easing awkward issues with humor.
12. Don’t neglect spiritual needs. Linda had a great post on this. When they can’t read the Bible for themselves any more, take time to read it to them. Some can handle CDs to hear the Bible read. Jim’s mom liked to attend church Sunday mornings until perhaps the last year or so when she just got too feeble and had little energy. When she was in the nursing home, a group from a church we were familiar with had a church service there Sunday afternoons, and Jim went over and accompanied her to it.
13. Have patience. There can be a multitude of frustrations as a parent gets older, even when we understand that they can’t help what they are doing and saying. This is probably the area that I most often prayed for while my mother-in-law was in assisted living, and often while driving there I often prayed and quoted to myself Colossians 1:11: “Strengthened with all might, according to his glorious power, unto all patience and longsuffering with joyfulness.”
The ultimate principle is to “do unto others as you would have them do unto you” (Luke 6:31). Put yourself in their place and treat them with as much love and grace as you would want others to show to you in the same situation.
Grandmother’s Beatitudes
Blessed are those who understand
My faltering step and palsied hand.
Blessed are those who know that my ears today
Must strain to catch the things they say.
Blessed are those who seem to know
That my eyes are dim and my wits are slow.
Blessed are those who looked away
When coffee spilled at table today.
Blessed are those with a cheery smile
Who stop to chat for a little while.
Blessed are those who never say,
“You’ve told that story twice today.”
Blessed are those who know the ways
To bring back memories of yesterdays.
Blessed are those who make it known
That I’m loved, respected, and not alone.
Blessed are those who know I’m at a loss
To find the strength to carry the Cross.
Blessed are those who ease the days
On my journey Home in loving ways.
– Esther Mary Walker
Related reading here at Stray Thoughts:
With All Our Feebleness.
Despise Not Thy Mother When She Is Old.
Caring For a Parent at Home.
Assisted Living and Nursing Homes.
Decisions for a Parent’s Care.
How Older Women Can Serve.
A Public Service Announcement Concerning Walkers.
Senior Version of “Jesus Loves Me”
Am I Doing Any Good?
The Winter of Life.
Related reading on the Web:
Insignificant Is Beautiful.
Maintaining Sanity During Dementia’s Cognitive Decline.
8 Things Not to Say to Your Aging Parents.
Elders Who Abuse Relatives Taking Care of Them.
Adapting Your Home For An Older Parent.
10 Ways Caring For Parents Is Different Than Caring For Children.
You Are My Sunshine.
Alzheimer’s…My Reflections.
I’m Still Here.
A Psalm For Old Age.
Stray Thoughts 