Adventures in Elder Care: Decisions

Eldercare

A few years ago I happened upon a couple of blogs dealing with being a caregiver for elderly parents, and they were a help to me even before we got to that point. Those blogs are no longer active, and for some time now I have been thinking of writing some of the experiences and things we learned along the way with my mother-in-law in the hopes that they may be a help to someone else.  I had hoped to contain everything I wanted to say in one post, but it got to be way too long even before I finished, so I thought I’d better divide it up into sections.

Scripturally and morally we’re obligated to care for our parents when they can no longer care for themselves. In Matthew 15:3-6, Jesus says to the Pharisees, “Why do you yourselves transgress the commandment of God for the sake of your tradition?  For God said, ‘Honor your father and mother,’ and, ‘He who speaks evil of father or mother is to be put to death.’ But you say, ‘Whoever says to his father or mother, ‘Whatever I have that would help you has been given to God,’ he is not to honor his father or his mother.’ And by this you invalidated the word of God for the sake of your tradition.” (This is from the NASB, which I think gives the clearest meaning to this passage.) God did not honor their gifts supposedly to Him at the expense of neglect of their parents. In instructing the church concerning the care of elderly widows, Paul writes in I Timothy 5:4: “But if any widow has children or grandchildren, they must first learn to practice piety in regard to their own family and to make some return to their parents; for this is acceptable in the sight of God,” again from the NASB. Both it and the ESV say “children or grandchildren”; the KJV says “children or nephews.” But the idea is that our first responsibility and ministry is to our family. The “sandwich generation” is not a new phenomenon: people have always needed to care for their parents and grandparents in some way. Besides the “obligation” of such care, we should be glad to “return the favor” of caring for those who cared for us for so many years.

Most people really don’t think seriously about what to do with a parent who can no longer live alone until they get to that place. Admittedly you can’t really make a decision until the time comes, because it will depend on the family’s life circumstances and just what condition your loved one is in. But it is good to do some research and have some discussions before you have to make a decision in a crisis.

I would say to anyone nearing retirement age that, as much as we don’t want to think about losing our independence, we have to face the fact that that day will come to all of us. It’s good to look ahead, prepare advance directives, talk to your children about your wishes and financial state, etc. We could even start reducing the amount of “stuff” we have squirreled away in attics or sheds before we get to the place where we don’t have the energy to deal with it so our kids won’t be faced with that chore.

It often seems as if other people see that an older person is having trouble living alone before that person realizes it, but I would make every provision for them to remain in their own home as long as possible. Most people wouldn’t relish the change from private home to a dorm or hospital type setting where anyone can come into your room at any time unless they are extremely gregarious, and many would feel burdensome moving in with their adult children. Some folks I’ve known have hired some household help to come in a couple of times a week; I’ve known some who rented out a room to a college student whose responsibilities around the house offset their rent (some degree of housecleaning, taking care of the lawn, perhaps some cooking, etc.)

The main reason for moving a parent out of their own home would be safety issues: the danger of falling, of forgetting to take medicine or taking too much because they’ve forgotten they already took it, etc. Even still, necessary changes need to be discussed and urged upon the parent without running roughshod over their wishes and feelings. It’s usually better to plant the seed that we need to start thinking about the future long before the need actually arises.

In my mother-in-law’s case, she wasn’t taking any medicine that we needed to be concerned about. We were all concerned about her living alone after her husband passed away. She lived 2,000 miles away from us but had a daughter and grandkids nearby. When my husband visited a couple of times, he noticed the housekeeping was declining and the dog had the run of the place (probably for companionship. They’d always had dogs, but they had never been allowed on furniture or to have free reign in the house, but now every piece of furniture was covered in thick dog hair.) He flew up to ID to accompany her to our home in SC and back for a visit to our house since we didn’t think she could travel alone, and while there he took her on a tour of an assisted living facility “just to see what it’s like.” She said it was nice, but she wasn’t ready for anything like that yet. Just about the time we felt like we needed to gently insist that she needed to consider moving, her daughter became available to move in with her. That gave everyone a reprieve from having to make any changes for a time. I don’t believe her daughter was ready, mentally and emotionally, for her to move to a facility yet, either. They did well together for a time, but then my mother-in-law began having some falls, and one time could not get herself up until her daughter got home from work. Additionally, her daughter began having some back trouble and could no longer help her with things like getting out of the bathtub. They both finally came to the conclusion that the time had come for a major change.

The next step, of course, is trying to figure out what that change should be. My husband and I discussed the possibilities many times as did my husband and his oldest brother long before this day actually arrived.

There are several things to consider when deciding whether to move a parent into your home or an assisted living facility:

1. Housing situation. Not everyone has the space to include a new adult addition, or the house might not be conducive to someone with physical problems.

2. Availability of other family members. It’s easier to bring a parent into your home if you have some kind of support system than it is to do so alone.

3. Finances.

4. Mental ability. If the elderly parent has Alzheimer’s or mental confusion, someone would need to stay with them all the time, and even a family with a stay-at-home member might not be able to manage that between errands, school obligations if there are school-aged children in the house, etc. I know some handle this by hiring someone to stay with the elderly parent a certain amount of time each week.

5. Level of care needed. There might be some situations in which the older person needs physical or medical care that can’t be given at home.

6. Relationships. Some older people will always see their adult child as a child, and won’t follow instructions about medical care (e.g., medicines), food, etc., but they would take such instruction from medical personnel in an assisted living situation.

7. Personalities. We might be loathe to admit this and we might think that every family relationship should amicable, but in real life that is just not the case. Some relationships prosper with a little bit of space for each party.

8. Safety. Particularly Alzheimer’s or some forms of dementia in advanced stages may cause some patients to physically strike their caregivers when frustrated or angry even if the patient would never have done that in earlier years.

9. Socialization. Assisted living could provide the mental stimulation of interacting with others and participating in the activities there, and it might encourage folks to know there are others who are going through the same things she is.

10. Independence. If a person is not capable of being alone, mentally or physically, for short periods of time, it would be hard to bring them into the family home unless someone else in the family can be home all the time, or the elderly person is able physically to go with the family to their activities. It might seem odd to list this as a factor when a person going into assisted living seems to be giving up their independence. But in such a facility they actually do get to make some of their own decisions and schedules to a degree and have their own living space. Some would feel that if they lived with their children they would be an imposition (even if the family is glad to have them), and they are more comfortable being on their own as much as they can be.

In our case, the biggest factor was that our home was not conducive to my mother-in-law’s needs. We had a split level at the time, and she could not handle the stairs safely. The other major factor was that we still had kids at home, one of whom was not driving yet, so our lifestyle involved a lot of taking kids to school, practice, and activities as well as errand-running where we couldn’t leave Mom at home alone. A friend who takes care of her mother-in-law with Alzheimer’s takes her with along with her to her granddaughter’s outings and school activities, etc, and she does fine, but my husband’s mother wasn’t physically capable of that and probably would not have been interested in that, either. She was very much a homebody, and even when her own kids were home, she didn’t go to many of their activities. Socialization was a smaller factor: I almost hate to even use that word because I know it is leveled as an unfair charge against home-schoolers has been a lack of socialization, and most of them get plenty of social interaction and don’t really need to be put into a classroom of people the same age to get it. But we  knew if my mother-in-law lived with us, we would be her whole world — she wouldn’t feel the need to or have the desire to interact with others besides surface greetings at church. Too, some of my own physical issues made me unsure I could help with hers: in fact, when she visited, I inadvertently hurt her shoulder trying to help her out of the tub.

My husband had been researching the nearby assisted living facilities and found one with more of a homey rather than an institutional feel just a few minutes away from us. In the next post in this series (probably next week) I’ll discuss some of our experiences with assisted living and nursing homes.

Disclaimer: This series is not meant as professional or medical advice. It is merely based on personal experiences and offered as information and encouragement. 

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12 thoughts on “Adventures in Elder Care: Decisions

  1. I’m so glad you are sharing about your experience and so many of the issues to be considered. I haven’t had this conversation with my parents though they are each so different, it will be interesting to see how it goes. I can see how having siblings to help bear the burden can ease the transition.

    I had a friend whose parents were both diagnosed with Alzheimer’s within months of each other. Her father’s condition worsened much quicker and he had to be in a care facility. She took her mother to live with her family but the strain on everyone (particularly her teenaged children) was a heavy burden. I think it lasted three years before her mother had to be in nursing care facility. This was a hard decision to balance between honoring her mother and doing what was needed for everyone involved.

  2. We know we’ll probably have to deal with this at some point and so I pay attention to these posts which you write up and I’m glad you take the time to spell these things out.

    When Jonathan’s mother died 7 years ago, we had to start cleaning out the house and WHAT a BIG chore that was! I vowed at that time not to make it so hard on my kids and when we’re done with items I’m trying to remove them from the household now (within moderation on the offchance that someone else we know could use said items soon or that we might need them again ourselves). But I think it is ever so helpful to keep a neat and organized house for a multitude of other reasons as well. But this being a factor which I consider now having had to go through a garage and attic that hadn’t been sorted or cleaned out in 25 years.

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