WHEN WILL IT ALL BEGIN?

Aging does not automatically herald dependency. If your parents are forward-thinkers, they will have planned ahead to preserve their independence as they age. In such a case, your parents may ask for your opinion or help from time to time but they may never need you to take over management of their lives. Caring for your parents may be as simple as keeping in touch and minding your own business.

The other extreme, caring for one or both parents may require years of round-the-clock care and emotional support. You may also have to co-ordinate those who provide services—from grocery shopping and medical treatment to feeding and personal hygiene—or take on some of the tasks yourself. One parent may need little of your time while the other consumes your life. Minimal support might be needed initially, but you may eventually have a parent move in with you (or you with them) so that you can administer 24-hour care.

Right now, you have your life and your parents have theirs. Why might you suddenly or gradually become involved in looking after one or both of your parents? The shift may be triggered by a medical crisis, such as a heart attack or stroke, or by a diagnosis of cancer or Alzheimer′s, or it might be precipitated by an accident such as a sports injury, car crash or a fall. Your parents may both appear to be healthy, active individuals until the sudden death of one reveals that one parent has been lovingly covering up the cognitive or physical problems plaguing their partner. Once the stronger parent dies, there is no one to compensate for the other parent′s decline. Grief may aggravate the condition. You may suddenly find yourself with a very dependent individual to care for.

Fortunately, aging is not a disease that automatically incapacitates everyone. In some cases, physical or mental decline may be gradual. It may not be obvious if you see your parents on a daily or regular basis. If you or your siblings live more than a few hours travel time from your parents, a change in one or both of them may be more obvious during occasional visits. Problems may be apparent only when you, and your brothers or sisters, compare your parents activities and interests on an annual or seasonal basis. Being observant is essential to successful caregiving and advanced planning.

Keep Your Eyes Open
It's often a good idea to compare notes about your parents with brothers, sisters and other relatives on a regular basis. Here are some advance warning signs of possible problems ahead:

• difficulty with daily tasks: cooking, dressing, bathing
  
• decline in personal hygiene: infrequent dental care, hair unkempt, stained clothing, uncharacteristic sloppiness
  
• personality alterations: evidence of bouts of depression (complaints, listlessness, boredom), disorientation, verbal abuse, uncalled for anger, unusual frustration, mood shifts
  
• diminished wellbeing: significant gain or loss of weight, hearing loss, vision problems, eating difficulties (particularly swallowing), bed-wetting or other signs of incontinence
  
• neglect of responsibilities: bills unpaid, unread newspapers piling up, home maintenance routines forgotten, not returning phone calls or emails
  
• sporting activity changes: an end to golf, bowling, tennis, bicycling or other favourite activities
  
• decline in social activities and interests: hobbies abandoned, traveling stops, volunteer activities ended, pet causes ignored, growing disinterest in previously-enjoyed group involvement such as a bridge club, circle of friends, religious community
  
• increase in abusive tendencies: greater use of drugs, alcohol or stimulants, misuse of medication
  
• memory or cognitive changes: reasoning irregularities, recall problems for names, words or familiar objects, repeating stories or complaints, excessive memory loss

FROM YOUR PERSPECTIVE

Your attitude plays a significant role in detecting decline in a parent. If you fear death—yours and theirs—you may want to deny that anything could change in your relationship with your parents. You may deliberately or unconsciously overlook signs of change. By ignoring shifts in ability, you may not champion the cures, treatments or small adaptations that could preserve your parents′ personal independence. If nothing is done, the situation may worsen for your parent until something drastic happens or practical solutions disrupt their lives.

Do your parents confide their most intimate fears to you because they know you will respect their ideas, even those that differ from your own? Do they believe that you will listen to their concerns and help them solve the problems that trouble them, whether you think these issues are significant or not? If you answer no to both these questions, your attitude may be blocking communication with your parents. If you cannot open your mind to their way of thinking, you will continually do what you think is best for them without finding out what they really want. This approach may cause conflict and ill-will. Your parents may choose to keep problems from you since they anticipate a controlling or negative reaction. The information presented in this guide may help you see things through your parents′ eyes and encourage you to resist the urge to try and control their lives.

Once you take on a caregiver role, you may have to do things you had not counted on, such as dealing with incontinence or maintaining late-night vigils. Although later chapters will explain how to anticipate these problems, the fact still remains that caring for your parents is not about you, even though self-preservation is vital to successful caregiving. One main goal in caring for your parents should be preserving their dignity and independence. Your opinion may take a back seat to how your parents react to change and how they feel about their lives.

As a bonus for respecting your parents′ desires and situation, you may find visualizing your own future less intimidating and more rewarding. Your parents will be a living example of what you want and don′t want in your own life. The awareness you gain by helping your parents deal with aging issues may also make you more receptive to measures that can keep you healthy and active and increase your financial security in the years to come.

THE SANDWICH FACTOR

Juggling two or three generations of family responsibilities has always been a challenge. If you have children and parents—your′s and your spouse′s—you may find yourself in the middle of many lives while still trying to squeeze out time for yourself. To ensure you do not take on more than you can comfortably handle, consider these suggestions for avoiding the sandwich squeeze:

• Do not let guilt drive you to do more than you can manage, physically, emotionally or financially. Few parents want to see their children or grandchildren harmed by efforts to help them.
  
• Do not take control of your parents′ lives if all they need is help finding ways to do things for themselves. Be an enabler and a facilitator, not their new boss.
  
• Do not let other family members dodge their share of the work load, financial responsibility and time commitment. No matter how distant or how busy, your spouse, children and siblings are, everyone should share caregiving responsibilities.
  
• Do not put your life on hold and become isolated by caregiving. Community agencies, nonprofit associations and the Internet have a wealth of support, respite care and information to offer you and your parents at little or no cost. Find the information and support you need to head off depression and burnout or you will eventually be of little help to anyone, including yourself.

HANDLING SENSITIVE CONVERSATIONS

At any age, sex and money are two of the hardest things to talk to your mother and father about. In broaching the subject of how well prepared your parents are for the future, you may be tackling both these subjects and more. Don't be surprised if you have trouble finding the right moment and the right approach to such conversations. Here are a few tips for getting started.

• Now is the right time.
  Waiting for the ideal time to talk to your parents may mean you act when it is too late. Try approaching each parent separately and casually at first. Share a relevant newspaper, magazine or online article with them. Use this book or its worksheets. Relate a real life story concerning a friend who put off speaking until a crisis arose. You might invite your parents to a seminar or give them a book that deals with retirement and estate planning issues. Keep your initial inquiry brief and establish that your interest lies in preserving their lifestyle and independence, not interfering in their lives.
  
  
• The offer may be enough.
  Your parent or parents have a lifetime of experience to call on and may not need your help, financial or otherwise. However, they will probably appreciate the offer and your ongoing interest. Once the lines of communication are open, you will find it easier to keep up to date with any changes that occur.
  
  
• Respect their right to live at as they wish.
  Your desire to avoid worry does not override the right of adults to live as they choose, even if that entails some risk. Adopt proactive rather than patronizing approaches. For example, instead of pushing parents to move before they are ready, encourage wellness, regular exercise, independence-enabling home renovations or the creation of a private suite for live-in help.
  
  
• Set a good example
  Explore existing and emerging retirement housing and lifestyle choices so that you can help your parents make informed decisions when they′re ready. Ask their opinion or explore changing options together—online and through seniors′ organizations.
  
  
• Listen respectfully
  When you ask your mother or father a question, give your full attention to the response. If an answer seems impractical, resist the urge to criticize. Instead, ask more questions to clarify their intentions.

FAMILY DYNAMICS

Your personal feelings towards your mother and father cannot be ignored. A healthy relationship with two-way communication is crucial to ensuring any caregiving you take on does not cause unnecessary stress for you and your family. If you have always had close, loving relationships with your mother and father, those relationships will probably guide you in the future. If you relate well to one parent and not to the other, now may be the time to let go of the past. Enlist the aid of the other parent to heal old wounds and be patient. Try to forge a relationship based on who you are now and what interests you share.

If you have unresolved conflicts, deep-seated resentments or an overwhelming indifference towards your parents, caring for them as they age may not be something you wish to undertake. If you grew up in a dysfunctional family, you may have little or no contact with your parents or find that seeing them inevitably ends in argument. However, dealing with past resentments now may benefit you and your children in the long run. For example, if your family has a history of alcohol or drug abuse, contact the local Alcoholics Anonymous chapter or other organizations that deal with resolving abuse-related issues within dysfunctional families.

If you abhor the idea of personally caring for your parents, don′t do it. However, even though you may not want to physically look after them, you may be legally responsible for contributing to their financial wellbeing. While many parents are reluctant to ask for "charity" from family members, elderly parents have successfully sued their adult children for financial support. If your parents lack the income and savings to adequately house and care for themselves but you and your siblings live comfortably, your parents or their legally-appointed representative might decide to sue to raise their standards of living in retirement to an acceptable minimum level. It may be wise to talk to your lawyer about offering direct or indirect financial support to your parents instead of facing possible legal action later.

In the past, caregiving fell to daughters and wives while other family members made superficial contributions. If you are the only daughter, resist the temptation to let others intimidate you into the caregiver role. Other family members do not have the right to make assumptions about what you should or shouldn′t contribute. If you typically make commitments out of guilt, not genuine intention, you should be wary of taking on caregiver responsibilities without carefully assessing the practicality of the decision.

If you have siblings, get them involved with the caregiving. Arrange face-to-face or conference-call meetings with your siblings long before your parents need help. Openly discuss views on aging, fears for your parents and possible contributions to their continued independence. If you can, start your own email discussion group, especially if distance is a factor. Begin sharing ideas and concerns now while your parents are able to participate in discussions and benefit from useful suggestions.


Get your brothers and sisters on board. Don't take on the whole burden of parental care yourself. This book should help open discussion with your parents and siblings.

• Call a family meeting to discuss care issues.
  
• Don′t volunteer. Silence works wonders to make others do their part.
  
• Divide the duties. If there are three of you, each should do a third.
  
• From each according to his or her ability… If your brother has lots of time, then parental visits might be his contribution. If your sister makes a lot of money, then money could be her issue.
  
• Bury your animosities. Sibling rivalry goes back to infancy… but it′s time to get over it. Your parents deserve more than your bickering.
  
• Hire a facilitator or mediator if you cannot talk to each other without fighting.
  

More may not be merrier If you share your life with a partner—wife, husband or other—there may be even more parents (and even other aging relatives) to consider. What would your partner′s parents expect of you if one or both of them needed support? What provisions have your in-laws made to preserve their own independence? Are there additional siblings and relatives to help out if the in-laws need temporary or permanent care? Do you ask questions before the need arises so that you are not hit with unpleasant surprises? Do you talk to your partner about possible strategies should both sets of parents need support at the same time?

LONG-DISTANCE CARING

Caring for your parents can be more challenging when you live in a different city, province or country than your parents do.

After retirement, some people sell the family home and change their lifestyle. They may travel the highways of North America in a recreational vehicle or settle in a retirement community. Your parents may summer at the cottage, winter in Florida and live in another province or country in between. Here are a few tips for staying in touch in spite of distance:

• Buy computers and get connected
  Computers are increasingly recognized as an important retirement purchase (for those who do not already have one) and a valuable caregiving tool. According to computer experts at the Massachusetts Institute of Technology, a significant proportion of the rapid growth of the Internet at the turn of this century was fuelled by those that we refer to as "retired". Your parents may already be among those contributing their lifetime of knowledge to the Internet. With the Internet and email, distance need not be a barrier to relationships. Email offers an easy, almost instantaneous, inexpensive way to communicate and can include photographs. Researching services and products in a community hundreds of kilometres away is fairly easy on the Internet. Online caregiver chat groups and networks, especially those dealing with caring for people with specific conditions, may be helpful to you and your parents.
  
  Retirement online
          Many elderly people fear ending up alone and lonely. Members of Winnipeg′s Creative Retirement Computer Club feel the Internet can be a powerful antidote to isolation and loneliness.
          "I got into computers when I lost my wife and needed something to do," said one of the +90-year-old members, who initially used his computer to write letters. Later he wrote his autobiography.
          "As I have travelled extensively through Europe and Mexico—I occasionally go there on the Internet to see what′s happening," he explained. "I have quite a few relatives around and I keep in touch with them. I am able to get out and get around but it could happen that, when I get old, I may not be able to. Then the computer will help. You never have to be lonely if you have a computer."
  
  
  
• Build a contact network in your parents′ neighbourhood.
  If you can′t visit to make face-to-face connections, use the telephone or the Internet to find likely community-based agencies, seniors groups, non-profit organizations, professionals and resource contacts. Keep in touch by email. Tell your parents about the connections you have made and encourage them to check out these contacts. Working together, you can build a network to support your parents and your efforts on their behalf.
  
  
  
• Get the local news.
  Subscribe to local papers and seniors′ publications relevant to your parents′ community. If you are up-to-date on issues and emerging services, this will help you react should a crisis arise or an opportunity appears.
  
  
  
• Encourage your parents to stay connected to their community.
  Isolation undermines independence. They need a network of friends and contacts to help them through bad days and to celebrate their good days.