Children must respect aging parents while making tough choices

January 30, 2005

Bob Wachowicz didn’t realize his 88-year-old mother-in-law needed help until last spring.

"She’d been living alone in Nebraska for the last 16 years, " the Scottsdale resident said. "On the phone, she’d put up a good front. We hadn’t known she’d deteriorated until she met us for our daughter’s wedding."

When she exhibited signs of mild dementia, "we couldn’t send her back to live alone, off a gravel road, seven miles outside of a little Nebraska town in that weather." They found themselves torn between a mother’s wishes and her needs for late-life care.

Four years ago, James Bourassa hiked the Grand Canyon with his father-in-law. "He’s 93 now, and started to show his age more and more," Bourassa said. "We kind of talked him into coming down here. He was pretty accepting."

Last October, his father-inlaw moved into their Scottsdale house. Bourassa had refitted it with grab bars and guide rails, but he voiced a concern now common among baby boomers. "As his health deteriorates, what avenues should we be looking at?" he said then. "I was at a loss."

THE CHILD/CAREGIVER

Situations like these are waking a generation of adult children to the late-life needs of their elders. "Until something happens, you don’t think about it," said Virginia Morris, author of "How to Care for Aging Parents" (Workman Publishing, $18.95). "Then suddenly, you’re a caregiver, managing from one crisis to the next."

Child/caregivers face the challenge of respecting their parents while taking the lead in many aspects of their life. They must honor a parent’s wishes while making hard, practical decisions on nursing homes, long-term care and power of attorney. They must brave sibling disputes and cross age-old boundaries to discover what their parent can capably do, what funds and resources are available to cover the rest, and how to make the two ends meet. Now in its second edition, "How to Care for Aging Parents" provides a comprehensive guide on the logistical, financial and emotional angles of this life transition.

"Ideally, a parent’s care begins before problems arise," Morris said. But those facing hard decisions right now can take comfort: There are more options than you think.

"I updated the book (from 1996) because a number of things have changed," Morris said. "Assisted living facilities have popped up everywhere." These programs offer a range of incremental choices. "If your parents need just a little help, what about having a young person who needs room and board come live with them?" she asked. "Or finding a senior center, where they can get meals? Group homes get a few friends together and one health aide goes between them, doing laundry or whatever needs to be done."

Solutions vary with each parent’s needs (see sidebar), but access to the alternatives is readily available. "You don’t have to call 14 different places to track them down anymore. You can look up your area agency for aging online," she said. (The Arizona Department of Economic Security Web site — www.de.state.az.us — has several pull-down links related to aging and the elderly.)

Research can mean the difference between being overwhelmed and coming to the rescue. Assuming your parents are covered is a way to get blindsided or go broke.

"People don’t realize how much long-term care costs," Morris said. "They think Medicare or insurance covers everything. But the average base cost of a nursing home, for instance, is $60,000 to $70,000 a year. You can easily go through a big savings account very fast. There are programs: Medicaid, insurance policies, things you can do. But you can’t just go on assuming ‘They’ll be fine.’ "

THE TWILIGHT PHASE

Initially, Wachowicz’s mother-in-law just wanted to go home. "She doesn’t understand she’s not totally capable," he said in November. "She’s trying not to adapt to life out here."

Living together proved difficult, and Wachowicz and his wife sought counseling to manage the strain while they considered late-life options. "I know someone who put her mother in a home much too soon," he said. "You have a major apprehension about doing the right thing."

Control can be a thorny issue; parents and children must understand limits. "Caregivers need to take care of themselves," Morris said. "You set parameters. ‘I can visit you twice a week, help you with finances, but I need time for my own life.’ You’re no good to a parent if you’re exhausted and feeling guilty all the time."

And the parent who refuses to accept help, or even admit a problem? "That’s the hard one," she said. "You can push and prod. But if they’re competent and aren’t burning the house down, they have a right to take those risks."

In the flurry of change, the need for quality of life cannot be overlooked.

"The worst thing possible is thinking, ‘She’s old, she can’t do anything anymore,’ " Morris said. "Exercise, at any age, makes a big difference. Making sure their diet is OK, that they’re getting fresh air." Even those with dementia must feel included: "Keep them in the family loop. Include them in all the stupid updates. The spiritual activities. People can live with any kind of disability as long as they feel their life has purpose."

Two months later, Wachowicz’s mother is still adjusting. "She’s better, less negative," he said. "She talks on the cell (phone) to friends in Nebraska. They tell her, ‘You’re lucky you’re there.’ "

At the same time, Bourassa’s father struggles with the advanced stages of cancer. "He’s in his last days, so it’s hard," Bourassa said. But he credits Morris’ book for help, even through this final phase. "You have to deal with these things," Bourassa said. "The living will, the power of attorney. Get it done beforehand. So, when the moment comes, you can be there for your family."

MORE ONLINE

While bringing up end-of-life care can be difficult, it allows parents to declare their wishes instead of forcing their kids, years later, to argue over "what they would have wanted." Find out the best ways to start the discussion at www.eastvalleytribune.com.