Having a parent or two when one retires can certainly be a blessing. However, all emotions on this subject, both positive and negative, might have a direct connection to one’s “happy home” in childhood, and the quality of those relationships at the time. I have recently concluded a journey, metaphorically, with both of my parents, who passed on at the ages of 94 and 96, respectively. There are many important lessons to be learned from this role as “geriatric supervisor” for which I never consciously volunteered.
Surprisingly, my father was an executive in a national nursing home chain. One would have thought that he would have made all the plans, in advance, as needed. My first major blunder was to rely on that theory. By way of illustration, because of ongoing and predictable declining health, my mother was taken suddenly from their condo by ambulance to the hospital, and both parents had to move into a continuing care facility quickly without any prior planning. They lived in an independent living apartment for a brief time, but then eventually both became next door neighbors in the medical facility until their deaths.
My unexpected responsibilities included two major and two minor moves of all household possessions, a minimum of a dozen trips to the ER, taking over responsibility for finances and medical care, the creation of new wills, the hiring of an Eldercare attorney, application for Medicaid, and final disbursement of inheritances to grandchildren.
Elder Care in other Countries
There is some truth to the cultural lore, that children in Asian countries take in
their elderly parents, unlike us selfish Americans. Unfortunately, recent data is changing concerning those long-standing practices. Currently, only 40% of children in China have aging family members living in their households. India has a law, The Indian Maintenance and Welfare of Parents and Senior Citizens Act, for which noncompliance fines are imposed. Still, home-based eldercare is still not as widespread as it used to be. Part of the difficulty in the United States is that we have a jury-rigged system of isolated caregivers with limited resources.
The Emotional Burden of Caregiving in the US
The most obvious fallout from our American “non-system,” is the huge emotional burden for caregivers. These feelings are intense and complex. They involve unresolved issues from childhood and adolescence, as well as the competing twin feelings of desire for closeness and inevitable conflict. There is a constant tug of war between caregiving and self-preservation, which generates fear and guilt. Most of all, there is an unexpected and time-consuming role reversal for which we are not prepared.
The Roots of Complex Emotions
To understand the complex feelings of adult children, we need to go back to our
own origins, and to the scientific theories of Imprinting and Attachment Theory. If your Psychology 1 memory serves you, you will somehow associate the concept of imprinting with ducks. Ducklings are experts at following their elders and imitating their behaviors. This “filial imprinting” has a chemical component, which is needed for survival in the wild. Human infants also replicate this type of behavior with their caretakers, and this strong identification develops the concept of trust. It also sets up a number of behavioral and language traits related to survival and bonding. Now you know why you have a strong need to take care of your aging parents and not leave them on an ice flow.
Understanding imprinting is only the beginning of the process of unpacking your strong feelings. John Bowlby and Mary Ainsworth have a lot to say on this matter in their lifelong work on Attachment Theory. In a nutshell, the way parents respond to their human offspring has a huge effect on later behavior, and consequently on how adult children will feel about the caretaking role of their aging parents.
If everything goes well, the parents notice their young children’s needs in the world and respond promptly to them. If this happens, and it does for 55% of us, a child will grow up to have a strong sense of self and be responsive to others. This is called "secure attachment." But there is another 45% of us who were not so lucky. Those folks might have had parents who were anxious and preoccupied, dismissive, fearful and/or avoidant of their responsibilities. If you were in that second group, elder caretaking will be especially challenging.
Elderly Parents do not get a Free Pass
Judith Warren from Texas A&M University has pulled together a brilliant treatise
on this subject in the Texas Agriculture Extension Series entitled Building Positive Relationships: Adult Children and Aging Parents Series (2016). Surprisingly, she actually includes responsibilities for aging parents. Nowhere have I seen this perspective addressed. My own parents felt no need to look further down the road than to the next week’s grocery shopping. My mother refused all assistive devices and any plans to leave her condo under any circumstances. She was not bothered by middle of the night calls to my husband and I when she fell out of bed, or when the EMS needed to respond if we weren’t available. My dad felt no need to protect any of his assets from exorbitant and long-lasting nursing home bills.
Happily, Ms. Warren includes these parental responsibilities: understanding the stage of life of the adult children; cooperating when help is needed; making it easy for adult children to help, accepting help graciously, communicating, and sharing what it is like to age. Of course, it is necessary to have these conversations before the inevitable crises are in progress. Imagine how outcomes would be different if aging parents subscribed to such civilized ideas.
This publication does, however, lay out the culprits of old age which can make us more compassionate towards our parents who might not be behaving up to
code. Our parents are experiencing ongoing losses in the areas of health, financial security, friends, spouses and societal roles. This is not a happy time. The intersection of our hardwiring from childhood with these burdens promote the inevitable conflicts, as do different values, poor communication, and a lack of sensitivity on either side.
What can be Done to Facilitate Caretaking
Ms. Warren offers some excellent suggestions for the delicate balance that is
needed for long term caretaking. Caretakers need to assess what degree of closeness they can have with a parent – what amount of time and energy is tolerable. Can old hurts be reconciled or left behind? Can the parent be recognized as an individual with personal needs, goals and imperfections? Can the relationship be more reciprocal, with the aging parent doing some amount of work in trying to understand the adult child and her needs? Can the common traps of trying to control too much and looking for love in the wrong place be overcome? The basic ideas are to recognize rights and responsibilities of both parent and adult child, and to enlist help from healthcare providers, social workers, and community agencies to spread out the responsibility. An unexpected reward of such an approach might be a better acceptance and understanding of one’s own mortality.
An excellent partner in this process would be an Eldercare attorney. There is a huge learning curve, and we only visit this stage in life once. My personal attorney helped my mother get on Medicaid, while preserving some assets for inheritance. The Power of Attorney documents for both parents were used so many times in hospitals, banks, and other institutions, they became dog-eared. My attorney was well known in my parents’ continuing care facility, and helped me negotiate many uncomfortable situations. Your mantra should be “get others to help.” This is not a solitary job. If our country does not provide the“village,” you will need to create one yourself from your local experts.
How will it feel when your parent’s life is over? You will be proud of how you helped. If you want to have something left of yourself for the future, do take this wise counsel.