How to Care for an Aging Parent


How can you repay someone who did so much for you?
How can you repay someone who did so much for you?
© iStockphoto.com/digitalskillet

Receiving bills is an unfortunate side effect of having a mailing address. Each month, we all receive some variety of financial statements reminding us to pay up for the services we received. Water, cable and credit card bills we expect, but what if you went to your mailbox one day to find a statement from your parents, a completely itemized account of your childhood expenses on legal stationery? That's what happened to writer Bernard Cooper, who titled his 2006 memoir "The Bill From My Father" in reference to the $2 million his dad claimed he was due.

While many of us may hear joking horror stories about the hours spent in labor or more serious tales of parental dreams deferred so that we could go to our first-choice college, few of us are ever asked for financial remittance for the time and effort that went into raising us as children. However, as people live longer, more and more children, now grown, are finding that there does come a time when they pay their parents back.

As parents age, roles become reversed as their adult children become the caregivers. Sometimes, it's just providing a quick ride to the store, the way your mother might have driven you before you had your license. Other times, you may find yourself changing the diapers of the person who once changed yours. Gone is the hope and joy that comes from changing a baby's diapers, though; for grown children, it's immensely difficult to see a parent's independence and dignity stripped away.

­But even as a caregiver's heart breaks in that instance, at the very same moment the caregiver may be resentful that he or she has less time to spend with his or her own family or on the job. The caregiver may be engaged in a delicate dance with other members of the family concerned about the aging parent, as well as negotiating the new parental relationship. Caring for an aging parent can truly be a roller coaster of emotions that requires one's very best sense of humor, communication and organization skills, and patience.

­It may be heartening to learn, though, that in a national survey of caregivers, more than 80 percent said they found caregiving rewarding. That doesn't mean it's not difficult, particularly when you're thrust into the role due to a crisis like a stroke or a fall in the home. In this article, we'll give you some of the tips you'll need to move past the chaos to find the reward.

Living with Aging Parents: You're Under My Roof Now, Dad

Living in the same house gives grandchildren and grandparents a chance to get to know each other.
Living in the same house gives grandchildren and grandparents a chance to get to know each other.
© iStockphoto.com/AndreasREH

One of the most monumental decisions to be made about aging parents is where they will live. Each option has pros and cons. For example, your parents may naturally want to stay in the home they live in, because they're familiar and comfortable with it. Their friends, albeit also aging, are nearby, so they have means to socialize. However, their house doesn't accommodate the problems they have getting around, nor is it nearby to any grown children who might be able to help out.

Generally, the dwelling decision will probably boil down to how much supervision and nursing care your aging parents need. Their home may be adequate if they make some modifications like adding grab bars in the shower and cabinets that are easy to open with arthritic hands. A home care aide could visit a few times a week to help out. If they need a little more supervision, options include assisted living or a group home. The nursing home is an option for someone who needs more intensive medical care, while a continuing care retirement community provides all levels of care, from assisted living to nursing, depending on when the resident requires them.

­All of these options, however, can be expensive, and often, grown children will bring their parents under their own roofs. To some, this may be a cost-cutting measure, while others couldn't bear the guilt of putting their parents away in some institution. Bringing a parent home is not even a question to consider in some cultures; it's just what's done.

Just because it seems like the affordable, gracious thing to do for your parents doesn't mean that being one big happy family again will be easy. Caregivers may find themselves stuck in the middle between aging parents who'd rather be in their own home and their own children who may not want to share a bedroom just so grandpa can have one, too. After living apart, it may be hard for parents and their grown children to cohabitate again, particularly if space is limited and if the relationship was already strained to begin with.

One way to ensure success in the endeavor of living with an aging parent is to sit down and identify rules and responsibilities. For example, if the caregiver disciplines his or her children by denying them dessert only to find out that grandma gave them a scoop on the sly, there are bound to be conflicts. Communication is key, though that's easier said than done, particularly if the aging parents suffer from a malady such as hearing loss or memory problems.

We touched on costs a bit in this section, but we'll explore the topic more in-depth on the next page.

Caregiving Money Matters

Who pays for this?
Who pays for this?
© iStockphoto.com/jgroup

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There are no two ways about it -- getting old is expensive. Just how expensive, of course, will depend on factors such as disease and mobility. For caregivers, figuring out what Medicare, Medicaid and insurance benefits their aging parents are eligible for is akin to being stuck in a never-ending maze with signs printed in different languages. It can be frustrating for aging adults to see that a life of hard work isn't enough to pay for a nursing home. Some aging adults elect to use up their savings so that they are eligible for Medicaid, while others may pinch pennies and go without in order to be able to leave their children something in their wills.

­Caregivers often have to assume the financial responsibilities for their parents; the first step of this process involves a fact-finding mission. Caregivers should create a list of income sources, assets, debts and liabilities -- the whole shebang. Coupled with insurance policies and Medicare/Medicaid information, a financial picture should start to emerge, which will provide the caregiver some direction on money matters. Caregivers may also need to research financial assistance their aging parents may be eligible for, either from the government or community groups. For example, aging adults may be eligible for utility company discounts or could attend senior center-sponsored health fairs to get free screenings.

Unfortunately, caregivers are usually trying to make heads or tails of their parents' financial situation while taking a hit on their own money matters. Some caregivers have to cut back on work hours or even quit their job in order to care for an aging parent, and when you consider the loss of employee-sponsored health insurance or a 401(k) match, it's estimated that caregivers lose out on more than $600,000 over the course of their lifetimes [source: Fetterman]. Though many companies offer parental benefits such as maternity leave, few extend elder-care benefits.

While caregivers lose out on income and benefits, they're simultaneously losing money out of their own pocket. If a parent and caregiver live under the same roof, there's the costs of additional food, minor modifications to the home or the price of gas to travel to and from doctor's appointments. It's impossible to add up all the costs of having a parent live with you, but the AARP estimates that caregivers who put in more than 40 hours a week of care spend an average of $3,888 of their own money each year on their parents, while those who provide a lesser amount of care pay out $2,400 a year [source: Fetterman]. And time is money: The AARP also estimates that the economic impact of all that "free" care provided by children was worth $350 billion in 2006 [source: Fetterman].

We'll have to add to that cost of aging when we consider legal issues on the next page.

Legal Considerations for Long-term Care

Advance medical directives ensure your end-of-life wishes are carried out.
Advance medical directives ensure your end-of-life wishes are carried out.
© iStockphoto.com/ebstock

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An essential part of long-term health care planning involves a trip to an attorney's office. Advance medical directives are legal documents that let your loved ones know what to do should a medical emergency arise. A living will spells out what degree of life-sustaining measures or life support you want. It can be uncomfortable to think about whether you want a feeding tube in your last days, but facts like these must be considered. A health care proxy designates a person to make medical decisions for you, should you be unable to make them yourself.

­For non-health-related matters, aging parents might want to consider a power of attorney, which appoints someone to perform tasks such as writing checks or paying bills should you be unable to do so. And if you have very specific ideas about who should get your money and possessions, then you'll want to get a will or discuss the idea of setting up a trust. Caregivers should know the location of all these documents; after all, if the living will is stuck in a safe-deposit box that no one can access, then no one can guarantee that the aging person will receive the care he or she desires.

So far, we're assuming that the aging parents can be a part of these legal conversations, but should they decline before talks about a living will or power of attorney can take place, then a caregiver might have to consider going to court to obtain a guardianship. When a caregiver holds guardianship over a parent, he or she has the legal authority to make decisions on everything from financial matters to life-sustaining treatments (a conservatorship, by comparison, only provides authority over the finances). As you might imagine, guardianships can spark bitter arguments among siblings, particularly if one feels that the other is after Mom's money. If conflicts arise, you might need to seek out a mediator.

If you're a caregiver assisting a parent through this process, use this time to get your own legal documents. Likely, caregiving will give you many ideas of how you yourself want to be treated in your old age, and providing these documents to your own family will save you time and worry later.

A Day in the Life of a Caregiver

Many aspects of caregiving, such as legal matters or housing, involve a cut-and-dried checklist. The daily life of a caregiver, though it requires supreme organization, has no such checklist. Caregivers must constantly adapt to their aging parent's needs while coping with the unexpected turns their own lives take. The numerous tasks of caregiving add up to a full-time job, on top of a career and regular family commitments.

Caregivers may be called upon to tackle diverse tasks, including:

  • Preparing meals and feeding them to the aging adult
  • Providing transportation to medical appointments, picking up prescriptions and administering medications
  • Bathing and dressing the aging parent
  • Assisting the aging person with getting on and off the toilet or changing diapers
  • Managing finances and paying bills

These tasks are complicated by the many medical conditions that can befall the elderly, including adult-onset diabetes, arthritis, heart disease, Parkinson's disease, glaucoma, cancer, depression, Alzheimer's disease and dementia, to name but a few. It will become increasingly difficult to care for a person who can't communicate his or her needs if they have impaired speech or hearing or memory loss, and watchful supervision will become even more critical in the case of impaired sight.

If you're feeling completely at a loss for how to complete some of these tasks, consider caregiver training provided by the Red Cross or another community group. In these classes, you'll learn specific skills for attending to the elderly, including how to transfer a frail adult from a bed to a wheelchair, how to bathe someone who can't get out of bed and how to help someone who's fallen.

Caregiver training also offers a way for people to make contact with other people in their situation. Having a support group can make all the difference in not losing your mind and your life to caregiving. Find out more about getting help on the next page.

S.O.S.: Getting Help with Your Aging Parents

A home care aide can relieve some of the caregiver's burden.
A home care aide can relieve some of the caregiver's burden.
© iStockphoto.com/deanm1974

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In January 2007, the Archive of Internal Medicine published a survey of caregivers that revealed that fewer than 5 percent of caregivers use any sort of support group or respite care opportunity [source: Brody]. Respite care refers to services offered by adult day care centers or senior centers, which care for aging adults during the day, as well as more long-term options provided by some nursing homes. These nursing homes will care for short-term residents for a few days so that the caregiver can take a break.

­Unfortunately, many caregivers don't seem to register "taking a break" as part of their vocabulary. Taking a break will only hasten guilt, which caregivers already have in spades. They may feel they don't give their aging parent or even their own children and spouse enough attention, and so they compel themselves to run on all cylinders 24 hours a day. However, it's extremely important for caregivers to take time for themselves and recharge. A run-down, resentful caregiver is no caregiver at all. Without taking brief breaks, caregivers put themselves at risk for mental problems such as depression and anxiety disorders, as well as a whole host of physical ailments that can attack an overstressed person.

In an ideal world, a caregiver has siblings that are willing to pitch in to help their aging parent, but if that's not an option, look for community resources. The Area Agency on Aging can put you in touch with senior centers that would cater to the aging parent, and many religious congregations may have outreach programs that would provide the elderly person someone to talk to for a few hours. These groups might also know of support groups for caregivers; these groups can help caregivers deal with the whirlwind of emotions they may deal with daily, including stress, anger, guilt, loneliness and isolation.

It may seem that we haven't painted a very rosy picture of caring for an aging parent, and there really is no way to disguise that it's extremely hard work. However, that survey of caregivers mentioned at the beginning of the page? That same survey found that more than two-thirds of caregivers found their role rewarding despite all the emotional, physical and financial stress [source: Brody]. At the end of the day, that time spent caring for your parent may prove to be some of your most precious and memorable time together, and all those difficult times at the end of life may only strengthen your bond.

For more on aging and caregiving, please see the links on the next page.

Related HowStuffWorks Articles

Sources

  • "Aging Parents and Common Sense." AXA Equitable. 2006. (March 16, 2009)http://www.caregiving.org/pubs/brochures/agingparents.pdf
  • Brody, Jane E. "When Families Take Care of Their Own." New York Times. Nov. 11, 2008. (March 16, 2009)http://www.nytimes.com/2008/11/11/health/11brod.html?scp=33&sq=aging%20parents,%20care&st=cse
  • "Care for the Family Caregiver: A Place to Start." Prepared by Health Plan of New York and National Alliance of Caregiving for the White House Conference on Aging. December 2005. (March 16, 2009)http://www.caregiving.org/pubs/brochures/CFC.pdf
  • Deutsch, Claudia H. "Help for Aging Parents, and for Yourself." New York Times. Sept. 18, 2005. (March 16, 2009)http://www.nytimes.com/2005/09/18/business/yourmoney/18lunch.html?scp=2&sq=aging%20parents&st=cse
  • Dunne, Jemima, ed. "Caregiver's Handbook." Visiting Nurse Associations of America. DK Publishing, Inc. 1998.
  • Fetterman, Mindy. "Becoming 'Parent of Your Parent' an Emotionally Wrenching Process." USA Today. June 24, 2007.
  • Groskop, Viv. "Hope this finds you as it left me." The Observer. Feb. 25, 2007. (March 16, 2009)http://www.guardian.co.uk/books/2007/feb/25/biography.features1
  • Gross, Jane. "As Parents Age, Baby Boomers and Business Struggle to Cope." New York Times. March 25, 2006. (March 9, 2009)http://www.nytimes.com/2006/03/25/national/25care.html?#39;As%20Parents%20Age,%20Baby%20Boomers%20and%20Business%20Struggle%20to%20Cope='%20=&sq=&st=cse'=&scp=1&pagewanted=print
  • Gross, Jane. "Elder-Care Costs Deplete Savings of a Generation." New York Times. Dec. 30, 2006. (March 9, 2009)http://www.nytimes.com/2006/12/30/us/30support.html?_r=1
  • Hays, Constance L. "Beyond Denial: An 'Eldercare' Primer." New York Times. Feb. 27, 1994. (March 16, 2009)http://query.nytimes.com/gst/fullpage.html?res=9D01E0DA163AF934A15751C0A962958260&fta=y&scp=36&sq=aging%20parents,%20care&st=cse
  • Leland, John. "For Families of the Ailing, a Brief Chance to Relax." New York Times. August 19, 2008. (March 9, 2009)http://www.nytimes.com/2008/08/19/health/19aging.html
  • Matthews, Joseph L. "Choose the Right Long-Term Care." Nolo. July 2002.
  • Morris, Virginia. "How to Care for Aging Parents." Workman Publishing. 2004.
  • Nedd, Harold T. "Fighting Over the Care of Aging Parents." USA Today. July 30, 1998.