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Aging is a stage of development for both an aging parent and for their adult child. Even when the parent is relatively healthy, both must negotiate this new phase. For example, when adult children help their arthritic parents put on shoes and socks …   and when those parents have to ask for help … it’s a moment that causes each of them to take notice. 

Like other stages of development such as adolescence and adulthood, aging has challenges as well as opportunities for growth and deepening relationships. But sometimes, the aging process leads to unexpected and unwanted life changes.

Most parents never want to become a burden on their children, yet unexpected illness or infirmity may make it impossible for them to continue to care for themselves.

The need to provide care-giving to parents is increasing. With the aging of the Baby Boomers—10,000 turn 65 every day—this trend is certain to continue and escalate. Tens of millions of adult children will one day join the millions of today’s caregivers—who are usually women. 

Sometimes, caregivers find themselves in the difficult position of being stuck in the middle, needing to balance the needs of two families—their parents in addition to their children and spouse. This stresses their emotional, psychological, physical, and spiritual health, as well as their finances and interpersonal relationships.  Sometimes, Baby Boomers who themselves are beginning to cope with age-related health issues, are confronted with the care-taking needs of their elderly parents, adding to the existing challenges to their own health and well-being.
 
How are we to prepare for this eventuality that will necessitate parents and children finding themselves in a different relationship than each had ever imagined? What do we need to know in advance? How can we start the conversation? What if we don’t have a good relationship with our parents? How can we take care of ourselves while taking care of our parents? 

Diana Y. Paul, Ph.D. and Virginia A. Simpson, Ph.D., FT have faced these issues both in their professional and personal lives. They have written about common as well as complicated problems, as well as the possibility of interpersonal healing, in their books, Things Unsaid: A Novel and The Space Between: A Memoir of Mother-Daughter Love at the End of Life. Here, they share some of their recommendations:

Begin the conversation regarding end-of-life wishes while everyone is healthy.

Discussing death is difficult for most people, but if you wait until someone is ill, fear may cloud every decision. The following are guides for discussion and then to keep as needed documentation of end-of-life wishes: Advance Health Care Directive, Five Wishes (legal in 37 states), and Go Wish Cards. Five Wishes (living will) is legal in 37 states, and is the first living will to talk about personal, emotional and spiritual needs as well as medical wishes. Go Wish cards may be used as a game to help facilitate the conversation. (Other helpful resources and books are listed at the end of this article.)
 
Make sure your siblings are part of the conversations.
 
Find out what are they willing and not willing to do. Consider drafting and signing a formal agreement so that no one can later come back and insist they never agreed to do something that now needs to be done.
 
Research your local assisted living facilities and hospices.

See if there is an Office on Aging or professional Gerontologists who can help guide you through the necessary preparations you will need to make.
 
Cope with conflicted relationships.

Family dynamics from youth carry over and influence caretaking. Unresolved conflicts make caring for parents more difficult because of resentment at having to care for a parent who was critical or less than loving. This is exacerbated by the natural inclination of parents to have some resentment that their children are trying to parent them, such as insistence they take their medication, not drive a car, move from their current home into an assisted care facility or into the adult child’s home. When the family dynamics are problematic, it can be helpful to seek assistance from a professional counselor before making changes in the parent’s situation. During counseling sessions, the focus will be on the history of the parent/child relationship as well as the current relationship, and how to best work together to achieve the best decisions in the here-and-now.

Move a parent from their home into yours.
 
This is a difficult situation for parent and child alike. Paying attention to the possible isolation that may result is important. If the two live relatively nearby, there is less of a dramatic change and the maintenance of longstanding social ties can be facilitated. If not, look for social groups for elders in the new neighborhood and make contacts with them prior to the move.
 
Talk to doctor(s) to learn what their philosophy is about end-of-life care
 
You need to know whether or not their beliefs are aligned with your wishes. For example, some doctors will try to keep someone alive no matter how much suffering is involved. Do you or your parents want that or would they prefer to have care stopped when there is no reasonable hope for any qualitative life recovery?
 
Give your parent and yourself a gift.

Finally, Drs. Paul and Simpson recommend thinking about discussions with an aging parent about death as a gift. Talking about death is an opportunity to heal relationships and become closer. When we know our deepest wishes and fears have been heard and will be honored, we can come to the realization that we have done the right thing for ourselves and loved ones. When we know our deepest wishes and fears have been heard and will be honored, we can relax knowing we are loved and will never be abandoned.
 
Resources

  • Aging With Dignity (www.agingwithdignity.org)—inspired by the life and work of Mother Teresa of Calcutta, their mission is “to affirm and safeguard the human dignity of individuals as they age and to promote better care for those near the end of life. You can purchase Five Wishes either through their website or by calling 1-888-594-7437.
  • Association for Death Education and Counseling® ((www.adec.org)—an international, professional organization “dedicated to promoting excellence and recognizing diversity in death education, care of the dying, grief counseling and research in thanatology.
  • The Conversation Project (www.theconversationproject.org)—“Dedicated to helping people talk about their wishes for end of life care”
  • Go Wish Cards (www.gowish.org).
  • Hospice Foundation of America (www.hospicefoundation.org)—educates the public and health care professionals about death, dying, and grief.

References

Gawande, Atul, Being Mortal. New York, NY: Henry Holt, 2014

Paul, Diana Y. Things Unsaid: A Novel.  Berkeley, CA: She Writes Press, 2015

Simpson Virginia A. The Space Between:  A Memoir of Mother-Daughter Love at the End of Life. Berkeley, CA: She Writes Press, 2016 

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