-Kay Paggi, LPC, NCGC, CMC

“My mother doesn’t even like me, she never has.”

This statement is not uncommon at a support group for the adult children of elderly. It seems out of place, coming from someone who cares enough about the parent to be attending a caregiver group. Yet it is repeated, over and over again, at different meetings and in many different ways.

“My father moved to another city after my parents divorced. I did not see him from the time I was nine until he got off the airplane to come live with me.”

“My mother was sightseeing in Europe when I graduated from high school; she didn’t care enough about me to even attend my graduation ceremony.”

Why are these people spending their precious time and resources caring for their aging parents when they were not nurtured by these parents?

Partly it has to do with hope. People universally seek parental approval and acceptance. A hallmark of entry into adulthood is the parent’s recognition of their child as an adult and acceptance of the child as a peer. Children who have not had parental approval often will continue to seek it, even after they have children themselves. The sad reality is that, if the parent has not loved and approved this adult child during the past years, he or she is unlikely to have a change of heart now, no matter how much caregiving is provided.

Partly it has to do with love. Just because the parent was indifferent to the child does not mean that the child does not love the parent. Most children do love their parents, even when that love is not returned or demonstrated. When the parents age and become frail, the unloved child often shows his love by providing assistance for the parent, because the child loves the parent.

Partly it has to do with self-respect. Most people believe they have the responsibility to provide care for their parents as they age. If they fail to fulfill this, they lose respect for themselves.

Responsibility

Where does this belief, that adult children have the responsibility to provide assistance for frail parents, come from?

Some find it mandated in the Bible, as one of the Ten Commandments. “Honor your father and your mother, that your days may be prolonged in the land which the Lord your God gives you.”  ‘Honor’ is defined as ‘to treat with respect’. Besides being the foundation for Jewish law, these commandments provide excellent common sense guidelines for living a satisfying life. The commandments were given at a time when people continued working until they died. Retirement was unknown. When the father of the family grew too frail to work, he still retained ownership and control of the family wealth and property until his death, including the right to cede it to whomever he pleased. It absolutely makes sense to treat the person who controls your future with respect!

There is no mention made of any responsibility to provide support or financial assistance for frail adults who have ended their working lives. Such a concept was unthinkable.

In 1900 the average lifespan was 49 years in America. In Biblical times, it was much shorter. Certainly there were those individuals who lived to a very advanced age but they were the exceptions, not the average. During most of the history of the world, death has not been associated with age. Childbirth, famine, disease, and war caused death. Most people were not fortunate enough to survive to become old enough to die of old age.

In more recent times, people who had the misfortune to live long enough to be unable to work went to the poor house if their children were unable to provide food and shelter for them. Conditions in these establishments were so deplorable that families made as many sacrifices as necessary to keep their parents from the necessity of going to one. There is an excellent discussion of the history of long term care in America at http://www.elderweb.com/history by Karen Brown. There was no law requiring adult children to provide care for their frail parents.

There is no such law today. Parents are required by law to provide for their offspring. Children are not required to provide care for their parents. No one will take adults who refuse to support their parents to court.

The decision to provide care for frail parents is a choice; care for offspring is not.

The Power of Choice

There have been several studies done on improving the quality of life in long term care facilities. Once such study gave residents on the first floor eggs, pancakes bacon and fruit for breakfast every morning. They had movies every Tuesday and Thursday. During the study the residents on the second floor could choose whether to have eggs or pancakes, and they could choose whether to go to the movies on either Tuesday or Thursday. At the end of the study it was found that the residents on the second floor had less depressed mood and were generally in better health than the participants on the first floor. Why? The second floor residents exercised the power of choice; the residents on the first floor had no choice.

If adult children believe that they must provide care for their parents or else, the care they provide is far more likely to be perfunctory than if they make a conscious choice to provide care. Gifts that are freely given are more generous than mandatory ones. Angry, exhausted caregivers often say that, given a choice, they would never see their mother again. Yet, when asked to visit only when they want to visit and not at any other time, these same caregivers actually visited more often than previously.

Given a choice, most parents would rather have a cheerful adult child drop by for an unexpected visit than a scheduled visit from a harried adult child. Coerced caregiving is impossible to hide. Even dementia patients can be aware of the impatience of their children, or their reluctance to visit.

Choice impacts the quality of care. Adults who choose to visit a frail parent instead of attending their child’s school function will be much less resentful than those caregivers that believe they must visit. These caregivers feel forced by their aging parent to miss their child’s school function; they are angry and the quality of the care they provide suffers.

Authority

Parenting children is an awesome responsibility. Requirements for not only food and shelter, but also medical care, religious training, and education begin at birth. Parents of teenagers are increasingly held accountable for the behavior of their offspring.  Parents are responsible for providing an ethical foundation, culturally appropriate behaviors, manners, and driver training. It is considered an act of responsible parenting to take away driving privileges or the keys to a car as consequences for reckless driving.

That same action is illegal if the keys taken belong to frail parents. According to the law of the land, even if a minor child pays for their own car and owns it outright, their parent has the right to suspend access to it. To take the keys to a car owned by a parent is considered an act of theft, punishable by law. To take the car or hide the car is illegal; to damage the car so that it cannot be driven is illegal, if it is legally owned by another adult, even if that adult is driving recklessly.

The difference is authority. You have not only the responsibility to parent children but also the legal authority to do so. No one has the legal authority to set limits on the behavior of parents, except the state. If an adult has been tried and found incompetent to limit his or her own behaviors, then the state is empowered to name a guardian for that person. The guardian is then responsible for limiting their ward’s actions, and has the legal authority.

This is very different from a Power of Attorney (POA). A POA names an agent to perform certain tasks. These tasks can still be done by the granting party, and the grantor retains the right to remove the POA at any time. A POA does not grant authority to manage money, allow medical care, or limit behavior unless it is specifically mentioned in the document.

A POA for grounding misbehaving teenagers is not necessary, nor is it necessary to have a POA for medical care to take children to physicians or authorize medical treatments.

There is a world of difference between assuming responsibility for care and having the authority to provide care.

As long as an aging, frail adult has not been found incompetent to manage their own affairs by a court, they retain the authority to make their own decisions about whether or not they will drive, how they will spend their money, and what medical treatments they will receive.

This is the appropriate place for recalling the Commandment: treat your parents with respect. To respect means to honor the wishes. There are times when as a concerned and living caregiver, it is necessary to honor your parent’s decisions, even when they seem to you to be wrong.

Limits of Responsibility

So, does this mean that at some point in life, an older adult gets carte blanche? Can an older person demand and expect to receive any attention or financial support from an adult child? Or are there limits?

At some point in life, children become adults. The authority for providing support, money, and guidance passes from the parents to the child, as well as the responsibility. The new adult becomes responsible for acting like an adult and gains the right to be treated as an adult and a contributing member of society.

When parents make a decision that is unwise or even harmful, the respect owed by the children does not require them to support it. Loving adult children can respectfully decline by stating their continuing love and respect for the parent while refusing to assist with implementing an unwise decision. A guideline is to treat parents in the same manner that good friends are treated.

For example, a good friend decides to quit working and move to a commune. You, as his friend, may advise him on the inadvisability of this decision. If he persists, then the bonds of friendship do not require you to assist him in making the move. You can remain his friend but still refuse to help him do something that, in your opinion, is harmful. This leaves the door open. Later, when your friend decides that the decision to quit work and move was a poor one, you are still his friend. He will remember that you supported him but not the decision, and will know that you are available for help with implementing a better choice.

A common problem that parents and their adult children experience is the difficulty remembering that the children have changed from dependent children into independent adults. This transition affects the nature of the parent-child relationship. Adult children who are having difficulty with their aging parents often find that they are relating to their parents in the same ways they did when they were children, and then they wonder why they feel resentful. It is the young adults’ job to remind the parents that they are now dealing with a peer. They must remind themselves that it is permissible to say “no” to mama, and to set limits on parental demands. It can be difficult to act like an adult around parents. It is very difficult to make your own independent decisions when you are still need parental approval.

This dilemma causes much grief for adult caregivers because they cannot have it both ways. Honoring parents is an adult to adult process. Adult to child (of whatever age) puts the balance out of kilter.

Summary

You cannot parent your parents. Caregiving adult children cannot take the keys  when their frail parents do not drive responsibly. Caregivers must use tact, diplomacy, deception, peer pressure and other tactics to achieve their goals. At the same time, they must treat their parents with the respect due them, even when their behavior is childish or unreasonable.

Treat aging and frail parents with respect. Is it respectful to help frail elders move into a new house that they cannot possibly manage the upkeep on? Is it respectful to drive them on numerous errands during work hours, or it is more respectful to ask that they use the van available at their facility? Is it respectful to do for them what they are capable of doing for themselves?  Do you honor your mother when you allow her to refuse care from anyone by you? Is your mother honored when you are too tired from caregiving to nourish your own children?

Long lives bring bonus time. They also bring new questions and the need for new moral and ethical guidelines. That’s your job. Your parents’ generation is the first in history to live into late life. Your generation is the first generation to provide care for parents, on average the same number of years that you provide care for your children: 18 years. The precedence you set now, as you provide care for your parents, will establish the guidelines for future generations. Be careful what you establish.

Kay Paggi is a Licensed Professional Counselor in TX who specializes in aging and caregiving. She is a National Certified Gerontological Counselor, and a Care Manager, Certified. She works as a professional geriatric care manager.

Two days later I wrote, “This is horrible. B really wants to leave Lourdes’s house and go home, and I have no business taking her. How am I going to get through this? I can see how hard it is for Lourdes to care for her, and she’s only into her third week. It’s been six years for me. I have to rise above these thoughts. Otherwise, I will either be dead or take on the traits of the disease. Neither is acceptable.”

My emotions were all over the place.  My mother had just been diagnosed with Alzheimer’s, and I was still reeling from the shock and the clarity that diagnosis brought. I loved my mother and I wanted to help her.

My journal was a lifesaver before and after the diagnosis. It let me vent, analyze, and find hope. It never argued or interrupted. It listened unconditionally, which gave me the space to process events and my reactions to them.

Why should caregivers journal? Writing gives perspective and restores sanity. Writing is a lifeline as well as a record. Writing saves lives. Do not underestimate its power.

What do you do if you have nothing to say?

Look around the room for an image or a sensory detail—the way the sun makes a path on the carpet, the way steam rises off a cup of coffee, carrying the aroma of morning with it. Listen to the high pitched whirring of an omnipresent machine, the tick of the kitchen’s black-and-white, kitty-cat clock—any image at all.

What do you do if you can’t get started? Sentence starts like those listed here can help.

Today I feel…

No one knows I worry about…

I don’t like to brag but…

I lust after…

Next time…

What if…

Pick a sentence start and finish it. Write another sentence. Voila! You are journaling.

Where can you find sentence starts?

There are over 200 in You Want Me to Do What? Journaling for Caregivers. I wrote the book once I realized how lucky I was to have a journal that helped me process my “stuff.”

You might be thinking that only writers can journal. Wrong! A writer is someone who writes. That can be you.

After she got her copy, Joanne Padley, writer and staff member at the State University of NY at Buffalo said, “What a good idea the book is.  I’m sure it will help me sort things out as well as serving as a good reference book and one day, a good remembrance.”

She’s right. According to Marilyn, who wrote in one of my workshops, “Writing from the heart seems to be all that is needed.”

Want to start right now? Finish the sentence, “Today I feel…” and keep going. Go wherever the writing takes you. Get your story, your nuances, your frustrations, your hopes, and your love on the page. Your story is buried treasure.

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B. Lynn Goodwin is the owner of Writer Advice, www.writeradvice.com and the author of You Want Me to Do What? Journaling for Caregivers. Order it from Amazon or at http://www.writeradvice.com/ywmtdw.html. You’ll also find more information about journaling, workshops, and the author there.

Families Urged to Keep Alert for Signs Seniors Need Help

Watching your once active parents or other relative decline into someone who needs constant care is heartbreaking and overwhelming. But with 36 million seniors living in the U.S. and the elderly population projected to double, caring for a senior loved one is a reality most people will face.  That’s why Senior Helpers, a leading provider of in home senior care, advises family members to learn the signs your senior relative needs assistance.

It’s much better to arrange for help for an elderly family member while they can still be part of the process rather than during a crisis because it gives everyone time to make thoughtful decisions,” says Peter Ross, CEO and founder of Senior Helpers.  “Seniors often believe getting help means being moved out of their house and that’s where the resistance to any kind of help comes in.  But many times in home care is a better option.”

Senior Helpers’ elderly care experts remind people to respect a senior family member’s pride and dignity when discussing the need for assistance.  Approach the topic with respect and understanding and express concern for the family member’s safety.  The warning signs could be an indication of many issues so if there is a concern it is important to contact a doctor.

10 Warning Signs a Senior Relative Need Assistance

• The house is cold, the telephone is cut off.
• Losing track in a conversation, forgetting the names of children, grandchildren, the day of the week, etc.
• The death of a spouse.
• The refrigerator and cupboards are half empty even though you know the relative can still get out.
• Personal hygiene is poor.
• Constantly making excuses when asked to go somewhere or do something, or wanting to be alone.
• Sudden weight loss.
• Never cleaning or delaying home repairs.
• Failure to take prescribed medications.
• Behavior changes.

“The best way to keep track of a senior family members situation is to keep in touch with them and this is one time where being nosy is justified,” says Ross. “Visit or call often and use one of the warning signs as a way to approach the topic if needed.”

“You can take away the car keys, disable a car or have police confiscate a person’s driver’s license but that can create hard feelings,” says Peter Ross, founder and CEO of Senior Helpers, the fastest growing provider of in-home care for seniors. “We encourage families to hire a caregiver to drive their loved ones around and help with daily tasks. The caregiver is not only the driver but can be an extra set of eyes and ears at doctors’ appointments or grocery shopping. Plus, caregivers are great companions and often turn into good friends so the senior doesn’t feel lonely and can still stay active and social.”

Consider the problem with the recent wave of car crashes in the past few months involving elderly drivers:

• Plymouth, MA. (June) A 73-year-old woman faces criminal charges after ramming her minivan into a crowd. She was involved in three previous accidents since turning 70.
• Danvers, MA. (June) A 93-year-old man accidentally hit the gas instead of the brake and drove his car into a Wal-Mart, injuring a woman and her 1 year old daughter.
• Winter Park, FL. (May) A 78-year-old man is accused of leaving the scene after hitting and killing a pedestrian.
• Tierra Santa, CA. (April) An 86-year-old woman drives through the front glass window of an office and hits a man who later dies.

“Our reflexes naturally slow with age, and it’s difficult to measure how slow is too slow when driving,” adds Ross. “Some states are considering requiring driving tests for seniors, but driving tests can miss the onset of diseases like Alzheimer’s  that affect judgment, understanding and memory which cause many of the accidents. So often the family has to recognize it’s time to stop the senior from driving.”

WARNING SIGNS AN OLDER PERSON’S DRIVING ABILITY MAY BE IMPAIRED

• Drives too fast or too slow, brakes often or abruptly changes speed.
• Has trouble reading signs, pavement markings, or seeing after dark.
• Misjudges distances, frequently gets lost or misses turns.
• Has difficulty operating vehicle controls or confuses gas and brake pedals.
• Has difficulty making quick moves, is easily startled or fails to notice other vehicles.
• Acts agitated, confused, lethargic or anxious
• Struggles with left turns

So what is the solution? Hire a caregiver who can be a driver and companion. It worked for Anne Worster of Denver, Colorado who hired a caregiver to drive her 96-year-old mom to doctors’ appointments because it was difficult to leave work. “It was great because the caregiver took notes and called me right after the appointment,” says Anna. “I got a full report and it made me feel at ease that I wasn’t sending mom in there alone. Plus, it’s so nice to trust someone to drive mom so I don’t worry about her safety or the safety of anyone else.”

“Children must reassure their elderly parents they can still see friends and be involved in activities even if they can’t drive,” says Ross. “Hiring a caregiver who can be a driver eases some of the conflict in the decision to take away the keys because it preserves the senior’s independence and provides a companion at the same time.”

If we still keep our elders at home, they are happier, and often healthier, but more at risk psychologically, socially, physically and emotionally.

Often, Caregivers are unaware that they indeed are Caregivers. “Oh, I just help my mom eat.” Or, “I help bathe and dress my father.” While we do help those we love with activities of daily living (i.e. bathing, dressing, and feeding), it is important to be aware that we become Caregivers for seniors when doing these activities on a daily basis. Once we do this, we can then work towards receiving help.
Caregivers are spouses, children, parents, workers, volunteers, grandparents, and anyone who helps another person is a caregiver. These tasks can be quite time consuming.
Caregivers themselves run the risk of burnout as well. Some profit and non-profit agencies provide respite or day away programs for senior care. This alleviates the burden or providing the quality of care that our seniors deserve.

Family Caregiving Roles

• Bathe their loved ones
• Wash, dry, and brush their loved one’s hair
• Brush teeth; clean dentrues
• Shave loved ones legs, underarms, and/or face
• Do laundry
• Shop for groceries and then cook/prepare meals
• Run errands
• Drive loved ones to appointments
• Administer medications; give shots
• Make sure loved one is safe
• Provide emotional support

The family caregiving role can be quite time consuming, not allowing Caregivers to take notice of how they are feeling. In order to be effective Caregivers, it is important for us to recognize the signs of stress. Then, we are able to relieve some of this stress and perhaps stop stress before it creeps up on us.

Signs of Family Caregiver Stress

Withdrawal
Caregivers may withdrawal from family and/or friends. They may also stop doing activities that were once enjoyed, such as knitting, reading, or walking.
TIP: Look to family and friends for support. Sometimes we just need to vent our feelings about the current situation. Even if you don’t feel like going out with family/friends, try to force yourself to get out of the house. You deserve a break!

Sleeping Difficulties
Caregivers may have a hard time falling asleep and/or staying asleep.
TIP: If possible, take short naps throughout the day. If your loved one lives with you and has a nap, lie down as well. Try not to think of all the things you have not done. Those things can wait. Your health is more important than running to the store for some milk.

Exhaustion
Caregivers for seniors may be overly tired from all the caregiving for seniors tasks, such as running errands, cooking, and cleaning. They may feel that there is not enough time in a day to do everything they need to do.
TIP: Try not to overload yourself each day. Make a list and stick to it. Prioritize your list with the tasks that are most important. You know your limit the best, so if you find yourself getting tired, stop and relax.

Lack of Concentration

Caregivers have so much on their mind that I call it “brain overload.” The mind may be wandering, thinking about what else has to be done.
TIP: Take things one day at a time. Again, make a list and check tasks off as soon as they are complete. Hang a calendar on the wall, so you can see what appointments you may have and also to prevent you from making more appointments on that day.

Weight Loss/Gain
Family caregivers may find that they are gaining weight due to emotional overeating. Or, Caregivers for seniors may not eat due to not enough time or no appetite.
TIP: Being healthy is very important. It will give you more energy during the day. If weight gain is a problem, consult your physician.