Cartoons: Roz Chast
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Facing What's Ahead
By Karen Houppert
You can help your parents plan for the tough times to come.
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Several years ago, Patricia Houppert, a 60-year-old elementary school teacher (and my mother), got a shock. While visiting my grandmother, Hazel Brys, in Florida, she answered the phone. "This is Dr. Kevorkian," said the man on the line; he was returning my grandmother's call.
Stunned, my mother walked into the bedroom where my grandmother was napping. With tears in her eyes, Mom handed over the phone. "Even though I knew my mother's feelings about death and the right to die, I couldn't believe she'd gone this far," she says.
For years, my grandmother had suffered from circulation problems in her legs. After multiple surgeries, doctors warned her that a return of poor circulation might mean she'd have to have her foot—or even her leg—amputated. Now one foot was ice-cold.
My mother was able to solve my grandmother's problem with the aid of a vascular surgeon and antidepressants. (And Kevorkian, who'd requested and reviewed her medical records, declined her as a "client.") Today, she is alive, independent and intact. But for Mom it was a wake-up call.
For baby boomers, two delicate and troubling conversations loom on the horizon. The first conversation is about moving parents out of the family home, a transition that seems to signify—for the aging parent and adult child alike—the beginning of the end. The second is asking parents how they want to die.
Though tackling these subjects may seem unthinkable, experts agree that they are best broached sooner than later. Take them on when they're still hypothetical, and you'll have bought the peace that comes with detachment. Wait until a crisis hits, and tension and terror set in.
Maureen Booth, a health-care researcher in Bowdoinham, Maine, learned this firsthand. When her 83-year-old mother (who has since passed away) broke her hip, Booth discovered that her mom had given plenty of thought to dying; eight years earlier, she had carefully drawn up her advance directives (the documents that give precise instructions about a person's wishes if she should become incapacitated; see Keeping Them Healthy)—but she hadn't really considered what old age was going to be like. The accident left her "totally blindsided."
Because of her mother's independent nature, Booth and her siblings—three sisters and a brother scattered along the Eastern seaboard—were reluctant to bring up the subject of assisted living, even when it became obvious that their mother's short-term memory was going—along with her mobility—and that remaining alone in her two-story home was not an option. The siblings debated the issue and fretted as they watched their mother grow more and more depressed in the rehab facility where she was recovering from surgery.
"Then one day, out of the blue, she said to my sister, 'What if I can't handle the house anymore?'" Booth recalls. The sister laid out some assisted-living options. The conversation cleared the air and made further discussion possible.
Studies have shown that adult children profess to be perfectly comfortable discussing assisted living with their parents, but in reality they hate to broach the topic. Is there an easy way in? "You might say, 'I heard Aunt Mary's in a nursing home. What would you want?'" says Virginia Morris, author of How to Care for Aging Parents, who warns that parents may initially refuse to talk. "But they will think about it and, in the long run, will warm up to the conversation if you stay with it."
What happens if you just can't bring yourself to mention it, or complex family dynamics make it too risky to discuss? You could ask a neutral third party to initiate a dialogue—for example, your parent's doctor. Dr. Paul Woolley, medical director of a Pennsylvania geriatric facility and a family practitioner for 20 years, has taken to initiating discussions of assisted living when older patients come in for annual physicals.
"I ask, 'How long did your parents live? When you get old and infirm, what do you want for yourself?'" says Woolley. "I've found that if you have this conversation in a context where the person's still healthy, sometimes you can move them along a bit in their thinking, get them to muse over and maybe act on this."
You should also visit assisted-living homes, learn what's available and what's affordable, and, if possible, get your parents to come along too. Then you're prepared if a crisis occurs. "My mother went through the dark night of the soul two years ago, crying and wailing and calling to God to help her all night long," says 60-year-old Laura Bader, who was in Ohio staying with her mother as she recovered from a bout with pneumonia, severe anxiety and a broken elbow. In the morning, Bader took the plunge. "I really think you should go into assisted living and get some help," she said. Exhausted, her mother agreed.
Fortunately, Bader had toured an assisted-living facility with her mom on a previous visit. Seeing what an assisted-living arrangement actually looked like diffused the stress and helped her mom to visualize her new life. Bader got on the phone, found out there was a room available and took it. She had her mom packed and relocated within two weeks.
One of the most important benefits of advance planning is that it helps preserve your existing relationship and makes it possible for your parents to feel that the move, when it happens, is their "choice" rather than your "demand." Booth and her siblings realized this, and that's why they did not push their mother to move out of the family home: "Our goal was to support Mom, so she owned this decision, so she wouldn't look back and say, 'A couple of years ago my kids took the keys to my house and made me go away.'"
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