The New Nation - Internet Edition

Rumana Rashid

I have a friend whose mother lives out of Dhaka. Her father recently died. My friend has a child and a husband who works full time. Her older sister lives closer to her mother but has been reluctant to help. It has caused many arguments and put a real strain on their relationship. Does this sound familiar? I was recently at a gathering of seven friends and virtually every one of them had a similar story to tell about a parent who needed help and the lack of support and communication among their siblings.

You have just returned home from dropping off your 16 year-old daughter at his college dorm to begin his new life on campus. Wait! What is that thundering silence you hear as you walk in your front doorway? Could it be 'peace and quiet'?

Sure, you are part of the sandwich generation - raising children to be responsible adults while helping care for aging parents. But, your situation is pure. Your 65-year old mother lives independently in her own home. She cooks, go out with relatives, and even shop for her. To you, 'empty nester' has a nice ring to it.

And then the phone rings. A professional sounding voice at the end of the phone line tells you, "I'm Sitara Afroz from the City Hospital emergency room. Your mother is here because she fell at home and broke her hip. She's going in for surgery. After that she will go through recovery, rehab, and possible relocation. It doesn't look like she'll be able to return to her two-story house.

"The nurse on the phone continues, "Your mother is very upset. Can you come right away?" She adds, "Your mother hasn't seen her Medicare card in months. She thinks you have it. Can you bring it with you?"

In one phone call, your peaceful world has been turned upside down. You are forced to spring into action, as well as begin the process of long term care planning. The emotional baggage that comes with the family care giving job includes resistance to role reversal, stress, denial and resentment.

With some proactive planning, and clear, open communication with family members, a difficult 'train wreck' caregiving situation can be turned into a joy ride! We found the following strategies to be most helpful:

* Involve the elderly family member in every decision. Nobody likes to be left out of the plans.

* Ask for help. You are not alone. One in four households is providing care for an elderly family member. Your neighbor may have a good suggestion on a task you are trying to accomplish, because your neighbor's mother had a similar care concern. Men are the least likely individuals to ask for help, even though 44 percent of caregivers in the United States are male. Men tend to isolate themselves and believe that their situations are unique. Just like men don't ask for directions, they rarely ask for help in caregiving.

* Accept and enlist help from everybody. Get grandchildren involved. Make it one of the tasks for getting an allowance to call grandma every Thursday at 4:00pm. Or, have a grandchild visit his grandparent once a week to help open and sort the mail.

* Keep the holiday cheer momentum going. During these winter months the days are shorter, it gets dark earlier, and those holiday letters and cards have almost stopped altogether. Start the process again.

* Give your parent a job. Just because they can't get out due to their ailments or bad weather, doesn't mean that they can't have a sense of purpose. Bring them birthday cards to fill out and send.

* Take care of yourself, first. The instructions on an airplane tell you to put on your own oxygen mask first, before helping an elderly person or infant. This is a critical time for you to nurture your mind, body and soul with exercise, meditation and renewal. On this caregiving journey, think about the precious cargo that is in your charge. Know that you are doing your best. Your family knows it, too.

Ready or Not

"I'm not ready." If you are an adult child with aging parents who need to make a lifestyle change because of declining health, maybe you've already heard those four little protest words "But, I'm not ready" followed by… "for that kind of lifestyle." Or, "But, I'm not ready - I don't like change. I don't want to make a move, or alter anything that I am doing!"

Helping our parents make choices about where they want to live out the last chapters of their lives doesn't have to be a tug of war. After all, freedom of choice is the granddaddy of all freedoms - followed closely by, freedom to live where we want to live; freedom of speech; and freedom to live our lives unconditionally with those we love.

The freedom to move, or to stay put in our own homes becomes compromised for any of us when our own health and physical capabilities decline with age. There are 22.4 million Americans receiving some form of assisted care in their homes. Today's elderly face tough choices as the home where they have lived for 60 years becomes unmanageable with maintenance issues, or if the physical layout with stairs and multi-level living areas present safety issues and challenges to mobility.

"I've moved on the old home. This move made my kids 'worry-free'. I know I'm not a burden to them, and they know that the simple things, like shopping and maintenance are taken care of," said one resident of an old home about her decision to move with her husband.

Socialization, security and safety are added benefits of old home living. Sabbir Mostofa lives at Sweden and his elderly parent moved into an old home more than two years ago gained her own sense of relief about her parents' future.

"As their health became more of an issue, this move made so much sense. Now that my mother is gone, I don't worry about my dad keeping active or going to social activities, especially in the winter.

There is so much for him to do right there, and so many friends."

There are very few old homes in our country. With life care communities, residents will be cared for at every stage of their lives. One 62 year-old woman who had just moved into a old home saw this transition as one of her best decision about her future. "I don't want to have to move later on when my health declines."

Whenever possible, involve your elderly relative in the decision to move or stay. If the venue is unsafe, you have to take action immediately. Start the conversation, and then do the homework.

Old home allows them to do just that, livet not constantly work at keeping up their house or staying isolated. It allows them to do things they might not have a chance to do if they stayed at home, such as making new friends or participating in a new activity. It helps they feel more active, more involved in the community, more in control of their life, with the peace of mind that care is there if needed.

Both the parent and their adult children to step up and take action. "Who wants to sit at home alone wondering what is going to happen if they fall? Sometimes you have to bring out the "what-ifs" to help them see the whole picture.

Your current relationship with your parents was greatly influenced by the parenting messages they gave you when you were growing up. If you grew up in an abusive home, you will likely feel less inclined to help your parents in later life than someone who grew up in a loving home with parents modeling the importance of familial relationships.

When your parents become older, take notes if possible for future reference. Familiarize yourself with your parent's financial and insurance resources so if the time comes when additional help is needed. You will understand what is support is available to you and where the gaps might be. Identify some mutually agreed upon warning signs that your

parents may need help. For example, memory loss, worsening balance or mobility, reduced appetite, inability to pay bills or maintain a household.

The information you obtain from the above questions will help lay some groundwork for you if the time comes when you need to use it. Try to include all siblings either in person or by phone. The next step involves you and your siblings getting together and discussing some important issues:

* Make a list of the specific kind of help that is needed.

* Examine all of the available sibling skills when defining caretaker roles. For example who lives close, who has more financial resources, who understands insurance or health issues, who has more free time, who can offer physical or driving assistance, etc.

* Determine frequency of needed tasks. For example daily bathing vs. weekly groceries.

* Determine who is available to help with what tasks. If there is an area that is not covered, consider using outside help. Perhaps a friend, neighbor, or paid professional.

This role reversal where we take care of our parents can be emotionally difficult and stressful for all concerned. It can test everyone's patience and commitment. Tensions often arise when a sibling feels they are doing more than their share or when parents or siblings do not do what they said they would. When people lose their independence they can become angry or frustrated and take it out on those trying to help. It can also be an important opportunity for you to mend old misunderstandings. You can communicate in new and meaningful ways and strengthen family bonds when most needed.

Here are some final thoughts that will help you throughout this caretaking process:

* Be fair and flexible when dividing caretaking responsibilities. You may need to make job adjustments as conditions change.

* Be respectful of each other and maintain your parents dignity as much as possible.

* Plan a follow up session in an agreed upon time frame and include all involved to check and make sure how things are going.

* Those that are not physically close may help with insurance or phone calls or other tasks. You may plan periodic visits to relieve the others.

* Those that cannot physically help may be able offer financial support.

* If more help is needed, perhaps spouses, other relatives, or friends/neighbors can be recruited to help.

* All caretakers need a break at some point. Allow yourself this time. It will re-energize you and help all involved.