The Care of Aging Parents: Making the Last Laps Rich (Part II)

In Part I on this topic, I centered the post around the idea of setting an intention of what we want in the healing and transformation of the relationship with one's aging loved one.  Opening to the feeling aspect of what it is we want prepares the ground for the details, and helps sees us through the challenges of what is put into play—what, hopefully, we and our parents want.  In this Part II, I will deal more with the nuts-and-bolts of how to provide the sustenance that makes these last laps rich and meaningful for you and them.

Once the intention is set, it is good to determine how you and your elder are going to work together.  Are they handing everything over to you, abdicating all control?  Or do they want to be co-determiners as long as possible?  How will this work, how is it imagined?  Part of the healing in the relationship is the sublime relating we do with them, and they with us.  The confronting the hard things in a soft way, the 'yes' and the 'no's. The disagreements, fears, the sensitivity to the taking control and having little say.  It's this territory that is fertile, if not a challenge to navigate.  This is where we attempt to optimize our Listening,  our Attending-to/Attention, our Observing.  This is where breath and a nuanced appreciation for what Is can transform the difficult transitions.

You see your elder aging, having a more difficult time doing basic things, like laundry, cooking and cleaning.  You might even notice a hygiene deficit or important memory lapses (not taking medications in a timely manner, forgetting to pay bills, etc.)  By this time, it's late in the game.  It's late in the game, because of Denial.  Denial on everyone's part.  Experiencing or noticing a decline in a loved one or self is not easily accepted and often minimized.  We want the old homeostasis, even though change is well underway.  We think it's ok for them to be left alone for a few hours, or even though their balance is somewhat shaky, it's ok as long as their cane is nearby.  This lack of acknowledgement of a decline is denial and it is dangerous.  The primary concern we should have is safety.  Are they safe 100% of the day?  They aren't if they're forgetting medications, leaving the kettle on when on the stove or not being hygienic.  Always best to err on safety's side.  Have more coverage, not less.

Decline comes in all gradations;  gradual to quick.  It's important that once it is underway, there are watchful others around regularly to gage needed interventions.  It might start with grocery runs, housekeeping every other week, or help with a weekly shower.  A decline in social engagement outside the home is a subtle marker as well.  This often happens when an elder realizes they are losing memory (uncomfortable conversing with people who know them but whom they don't remember knowing) or have lost a physical fitness that makes it uncomfortable to be more active.  Losing memory can be very subtle and effectively hidden  by vague responses.  Dementia is masked by depression and sometimes vice versa.  He/she that has created an intention to be the 'observer' engaged with the elder becomes responsible for this watching and deciding/co-deciding with the elder when intervention is required.

Every situation is so different. There are myriad ways people can creatively care for loved ones, and also myriad situations in which the caring transpires.  It may be a collective of family members, or a trusted caretaker or group of them who reports to an adult child who is far away.  Determining the elder's wishes (early on, if possible) is helpful in determining what can be set up (home care, elder care in a senior community, etc).  And of course what is physically and financially possible for the adult child.

Early on, it is vital to consider obtaining power of attorney and/or a medical healthcare proxy for your parent.  It is easier for you to manage your parent's finances this way, and there isn't any holdup when it comes to healthcare decisions.  Outside sources that may be of help are your elder's doctor's office (might have referrals to home care agencies, social workers, etc), and local community senior centers which have programs during the day. Also seek information about alternative resources to support your loved one's needs, be they day/night companions, meals on wheels, rides to doctor appointments, groceries, etc.  If your elder is coming from a hospital situation, case managers and hospital social workers are knowledgeable goldmines regarding external resources and medicare/medicaid insurance payment of needed medical supplies; mine them fully.  Visiting Nurse organizations will do a full home assessment to determine level of care required and make suggestions.  Often, Medicare/Medicaid and private insurances pay most of this service.

When deciding on an elder institution (if that is an option you are considering), ask a lot of questions, field them not only to the 'home', but other professionals.  Hospital nurses that deal with the geriatric population often have an interesting perspective.  They see people come in from different places in different conditions, they hear and are aware of the best and worst places.  From institutions, ask for family references.  What are the activities (i.e.,  are residents ever taken off campus?), is there music, art, plant, pet therapies? What is the ratio of care, caregiver to resident?  Is there a "care for the caretaker" program helping with staff burnout? You should be able to get a rating on the establishment from the better business bureau, possibly AARP, etc.  Once an institution is decided upon, it behooves you to form congenial, informed relationships with the staff; they see you frequently, they know your expectations, they are aware of your strong advocacy for your parent.  When things go awry, a steady, calm, rational response is much more powerful than a reaction.   The former elicits respect from staff.  The latter elicits defensiveness and does not bode well for the care of your parent.  This being said, uncharacteristic strong reactions infrequently provided (and merited), are a heads up, pull-up-your-socks reminder to caretakers, which can go a long way to improving care.

For all caretakers, at any level of care, at any point in time, it should be assumed burn-out, compassion fatigue, will develop.  It is a huge undertaking having the welfare of another in your hands.  Being connected to one's breath, finding nourishing quiet moments for oneself helps to soften the hardness, opens one to another type of rest and rejuvenation.  Take care of yourself; make sure those caring for your loved one are also taking care of themselves.  It is through this regular practice where the quandaries, obstacles and difficulties are often relinquished.  Less tension in your body and in your life allow for another understanding, a possible spark of creative genius in solving a problem, an attraction to the thing or person that is needed in a moment.  This is the miracle of this process.  The process of healing a relationship, transforming a life in the middle and at the end.  This is what makes the last laps so rich, even while it is so hard.