When adult children are faced with a parent's sudden health crisis and must make decisions about ongoing care and living arrangements, the need to act quickly can take an emotional toll on the whole family. Alexis Abramson, author of The Caregiver's Survival Handbook: How to Care for Your Aging Parent Without Losing Yourself and vice president of research at Retirement Living TV, talks with U.S. News about the importance of long-range planning, and of keeping your parents in the loop—and their wishes top-of-mind—as they become more dependent.
You warn adult children against sweeping in and taking over for their parents. What's the danger?
When you lose your independence and you begin to have to be dependent on someone else, the emotions about the losses involved become very strong. That's why so many mature adults become depressed and can become angry. We can avoid some of this by respecting how they feel and what they're thinking. Rather than just make decisions on behalf of our parents, we can help them make decisions.
You argue that the decision-making should begin long before anything actually starts to change. What's the advantage?
I cannot emphasize enough the importance of planning. Let's say Monday they're fine, and Tuesday they have a stroke, but you have no idea what their preferences would be—to bring in a home healthcare worker or to move them into an assisted living situation, for example. You need to know what their wishes are. It can be very expensive to have to solve a crisis, which often is what happens when a caregiver doesn't plan. If you want to decrease your financial investment in caregiving, increase the emotional comfort level between you and your parent, and allow your parent to age as gracefully as possible, start talking.
You've got to talk to your parents about finances. My grandfather died and he kept telling us over and over and over that he had a bank account in Switzerland but he never told us where it was. We've been looking for it for 20 years now! You need to talk about what their desires are in terms of long-term care—do they want to stay in their home as long as possible? Do they want you to be their full-time caregiver, or would that make them uncomfortable?
What sort of approach do you recommend to get the conversational ball rolling?
When the conversations start is individual, and it's really about the disease state that a parent is in. But I think when our healthy parents turn 65, say, when Medicare kicks in, it's probably a good time to start by making an overall assessment.
When the parent starts to need help, how should children proceed?
I am a believer that the expectation must be that everyone is involved. You need to talk to your family members about what kind of role they want to play. I think what we often do—especially as women—is take the martyr role and let other siblings off the hook.
You should treat caregiving like it's a business. There should be someone who's the CEO, who delegates responsibilities, but in a way that will motivate. For example, just because your brother's an accountant doesn't mean he wants to handle your parents' finances. Find out what he wants to do. Also, be creative; if your nephew can't find a job and needs to make some money, you pay him to take your mom to the doctor and sit with her. She doesn't ever have to know that.
My feeling is that getting someone in who knows what to look for and who is not emotionally involved—that's really a big part of this. A geriatric care manager is a trained outside observer who can come in and say, "Is your mom always this thin?" Sometimes the solution can be as easy as moving food a little bit lower in the cupboard so she can reach it and maybe eat more. They can also help get the right services in place, like home healthcare, or manage the situation locally if you live far from your parent. The National Association of Geriatric Care Managers is pretty fabulous for finding a local geriatric care manager.