Coping with an Aging Parent

The following two articles are reprinted with permission from the Growing Older column of The Seattle Times.

How and When to Intervene with An Aging Parent:
Last week, I responded to a letter that disagreed with my advice to a reader who was struggling to protect her 96-year-old father by moving him from his home of 56 years first to a mobile-home park, then to a retirement community — all, it appeared, against his wishes.

Although the reader meant well, I said she needed to involve her dad in the decision-making. He had the right to say no, as do we all, even if it put him in danger. The woman who wrote in response has parents in their 90s who live far away. She implored me to change my advice and give adult children the right to assert better control over their stubborn, aging parents when they resist.

"Parents who need care and refuse it aren't just cute, independent and feisty (as far too many will tell you)," she wrote. "They are in some sort of very bad psychological space of unhealthy denial. These parents come across as no longer caring a smidgen for their children, especially when they themselves are getting older and are exhausted from trying — and feel guilty for not understanding."

If anything captures the angst and anger of adult children going up against the brick wall of a parent's obstinate resistance to change, it's this single paragraph. I've long been amazed at the adult children who pay no attention to their parents, despite obvious impairments — and have none of these worries. For the many others who do, however, some older parents react with a swift kick to the shins.

"Leave me alone," they demand. "I'm fine!" Often, they're not — sometimes they're in horrible shape, and it's obvious to everyone but themselves.

So what to do?

The first rule: Don't allow harm to others. If your parents' behavior puts others at risk — driving being the most obvious example — adult children (and neighbors, friends and doctors) must step in by contacting the authorities.

Otherwise, says Virginia Morris, author of the eldercare classic, "How to Care For Aging Parents," if your parent has a mentally competent spouse, it's largely the spouses' job to decide when and how to intervene. You can offer information, advice, and resources, but the spouse is in charge.

If you have a lone parent or two disabled parents who appear to be mentally incapacitated, have them evaluated for depression or dementia (both causes of poor judgment). If a physician determines your mom has a dementing illness, you — or the person named in her durable power of attorney for health and finances — can begin making decisions about her life.

But when the parent's daily existence begins to crumble and he's still lucid, the situation gets markedly more difficult. "Your duty to protect your parent is superseded by his right to make his own decisions," writes Morris.

You can step in to make sure he's paying his bills, turning off the stove or taking his pills if he'll let you, but there are limits to what you can do to force the changes you believe are necessary. A competent parent has the right to say no, no matter how crazy it makes his kids.

The primary tool, as inadequate as it sounds, is communication. Talk about these issues early, while your parents are healthy. If you didn't when you should have, start now: slowly, gently, carefully, calmly. Tell your mom that the changes you think she needs are in her best interest, and that's your goal. Don't issue orders and "shoulds," but rather, "Have you thought about this?"

Raise issues by discussing someone else — what happened to a neighbor who had a stroke and her kids didn't know what to do. Clip something out of the newspaper or a magazine and show it to your mom; tell her you'd like to talk about it. By taking the focus off your parent, she may learn from what others have done.

Hold a family conference, inviting all critical people (including siblings you don't like). Invite your parent to attend (if she's not demented) to voice her opinions and preferences, as well as to hear the concerns of others. Sometimes she'll be shocked by what they say, but when she hears it from several people at once, it's more likely to register.

Then listen. You may discover your mom has different priorities than you do. Living independently may be more important to her than being safe. Or her idea of a retirement community may stem from long-ago visits to her grandmother in a horrible nursing home. Or she may not want a certain surgery, being more interested in living fully than in living longer.

"Understanding her point of view will help you let go of futile battles," writes Morris. It might also spark some efforts at compromise.

Sometimes the best influence is going through someone else — an in-law; a sibling; a trusted neighbor; or someone in authority, such as the parent's physician, pastor or lawyer.

All of this takes time; it rarely happens overnight, which is why you have to start this conversation early, before a crisis — and why it's extra difficult if your parents live far away.

Next week: What happens if nothing you do works?

Coping with Aging Parents' Decisions--Even When They Seem Wrong:
Watching an older parent disintegrate — living in unsafe conditions, giving money away, becoming isolated and depressed — is among the most difficult stresses experienced by adult children today.

We could tell our kids what to do when they were young, but our parents are a whole different kettle of fish. They don't have to mind us or even listen. As long as they're mentally sound, the law protects their right to do what they want, including living dangerously.

What prompted this discussion was my response to a stressed reader several weeks ago whose 96-year-old father refused to be happy about the major changes she'd made in his life to make him safe. Although her intentions were good, I said, her dad had the right to do what he wanted, including saying no. This elicited e-mail from another daughter (and many others) at her wits' end dealing long-distance with very stubborn 90-year-old parents. They refuse to make any changes, she wrote.

"We have failed and are left with anguish and the realization that there's no solution at all." She implored me to change my advice.

I wish I could. I might have been able to prevent my parents' own crisis a decade ago had I been able to make them do what I wanted. But I couldn't. As long as my dad was competent mentally, he had the final say over himself and my mom, who had Alzheimer's.

Personality drives much of what happens in eldercare. Some parents plan years ahead for the changes they'll need because that's who they are. Others require a gentle nudge from family and friends, perhaps their physician. Still others respond to stronger measures, such as:

• Guilt: Tell your mom how your worry about her has hurt your marriage, for example, and how you need her help to restore it by knowing she's safe.
• Tough love: Refuse to be at your dad's beck and call every day when you have a job and he can hire in-home help (even if he doesn't want to).
• Negotiation: Convince your mom to move to an assisted-living facility for six months, and promise she can return home if she doesn't like it.

There are many ways to peel this carrot, so be creative.

I believe it's honorable and right for adult children to convince their parents to try options that will make their lives safer, healthier and more pleasant. Nonetheless, no one can force parents to do anything against their will as long as they're mentally competent.

So what do you do if you have a parent like this? Two simple words: Let go.

In eldercare, there's only one person you can count on or control: you. Once you've done as much as you can to help, you have to stop; there may be some things you can't change.

As one reader put it, "I just got a call from my very frail, 90-plus-year-old father, saying he and my mom have decided to remain in their home — this from a person totally dependent on his 90-year-old wife and sole caretaker, in the middle of nowhere, thousands of miles from my brother and me.

"No one said that growing old and watching your parents grow even older would be easy! I realize how little training we have for this role, especially when it's not one we're asked to play but feel we must. Given my parents' state of mind, which is quite lucid, I bow to their wishes and have come to terms with the idea that 'their decisions are their own.' "

A geriatric-care manager or therapist might be able to help adult children come to terms with their parents' choices. Some counties have programs that can provide this counseling free, especially if dementia is involved. Adult Protective Services (APS) protects people 60 and older from harm (by others or themselves) and may help in extreme cases.

For both resources, contact the Eldercare Locator office at 800-677-1116 or go online to www.eldercare.gov.

There's also a different angle to consider. Today's oldest generation — now in their 80s and 90s — survived the Great Depression and World War II, creating one of the most stubborn, frugal and independent generations in American history. When they were growing up, people didn't live routinely into their eighth or ninth decades as they do today. They had no role models to prepare them.

What does this say about us when we're in their shoes?

As the reader whose angst started this conversation wrote: I hope my generation will build a body of knowledge and experience "that will enable us to recognize the symptoms in ourselves in future years and not go down this path of denial." Amen.

- Reprinted with permission f rom Growing Older, The Seattle Times, March 12 and 19, 2007. Liz Taylor, a specialist in aging and long-term care, counsels individuals and teaches workshops on how to plan for one's aging — and aging parents. You can e-mail her with questions at growingolder@seattletimes.com or write to Liz Taylor, The Seattle Times, P.O. Box 70, Seattle, WA 98111. Retrieved from: http://old.seattletimes.com/html/growingolder/2003611034_liztaylor12.html and http://www.seattletimes.com/seattle-news/health/coping-with-aging-parents-decisions-8212-even-when-they-seem-wrong/ cited in ElderLawAnswers, ElderLaw News e-mail, April 02, 2007

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