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Securing the future for you and your loved ones

Planning ahead is the greatest act of caring

It was the call she hoped would never come. Her mother's voice, panic-stricken, incoherent, woke Karen from a sound sleep. She tried to calm her mother and reassured her that she'd be there in a few hours. When Karen reached her mother's home in Indiana, she found her lying on her bed in a state of physical and emotional crisis. “She had hardly eaten in days and was dehydrated and frightened. Her usually well-kept house was a disaster,” recalls Karen. She brought her mother home with her to Milwaukee, where she was immediately hospitalized. 

“We were fortunate to have access to a hospital with a comprehensive geriatrics program,” says Karen. “They stabilized Mom and did a complete physical and psychiatric evaluation.” An only child with a demanding job, Karen spent the next three weeks researching care options, organizing her mother's affairs, assessing her finances, and drawing up a power of attorney to make decisions on her mother's behalf.

“I had seen warning signs that Mom was deteriorating, but I explained them away. By the time these critical decisions had to be made, my mother was not in a condition to make them for herself. I had to make them for her under a lot of pressure, without the time or knowledge I needed to be sure I was doing the best thing,” says Karen.

Similar scenarios will be played out for millions of adult children and their parents in the coming years, as the aging population balloons to record numbers. According to recent studies, one out of four adults is involved in caregiving for older family members; three out of four caregivers are women. Unlike past generations, women today are more likely to be working outside the home and to have had children later in life. These trends all converge to create the “sandwich generation” phenomenon—millions of mid-life baby boomers squeezed between caring for parents and raising children still at home. Because 64 percent of caregivers are employed, and two-thirds report conflicts between work and caregiving, businesses are paying increasing attention to the impact of caregiving on the workplace.

Recent surveys of caregivers by the U.S. Administration on Aging concludes, “The common thread is a pressing need for information—information to provide reassurance that long-term care needs of elders will be met, and information that will permit seniors, baby boomers and caregivers of all ages to engage in rational planning and informed decision-making.” This is the goal of Aging Parents, a seminar recently launched by Aurora Health Care's Geriatric Services and available to EAP companies. According to Gina Graham, Aurora's director of Community Senior Services, “Education is absolutely essential in helping caregivers meet the needs of their loved ones and maintain their own physical and emotional health. Knowing what to expect, managing stress, and sharing with other people in the same situation can be tremendously helpful. Interestingly enough, many of our seminar participants are also using the opportunity to begin planning for their own future.”

The seminar also educates participants about the vast array of resources available in the community and how to choose the ones to best meet their needs. Aviva Zweben, specialist with the EAP's ElderCare Resource and Referral, says that planning ahead is key. “Learning about long-term care options, exploring the pros and cons of various alternatives before a crisis occurs, helps people feel more in control of their own futures and confident that they can make informed decisions when the time comes.”

Start talking

A recent AARP survey revealed that more than two-thirds of middle-aged adults had not talked with their parents about their plans for living independently in later life. This isn't surprising, according to Marilyn Lange, director of Village Adult Services, an adult day care provider. “We don't want to think about our parents getting old and dying, or our own aging and loss of independence. The role reversal—caring for the person who cared for you— is uncomfortable for most people.

And it often brings up old conflicts or unresolved issues we may still have with our parents.”

Lange suggests looking for the right opportunity to discuss the topic, and if your parent or loved one doesn't feel like discussing it, try again at another time. Plan with, not for, them. “It's extremely important to respect the older person's opinions and wishes about decisions affecting them, even if you disagree. The goal is to maintain their independence as much as possible and allow them as much control over their lives as is safe and feasible.”

“My Mom agrees we need to talk. Now what?”

Here's a checklist of issues to cover in planning ahead for your loved one's needs—or your own.

• What are your parents' housing options and preferences? 
• Do you know your parents' medical history and any medications they are taking?
• Make a list of names and numbers of friends, neighbors and other emergency contacts—apartment manager, doctor, pharmacy.
• Find out about your parents' finances. This is a sensitive area for most families, but critical to decision-making. Financial discussions may be easier if framed in the context of making sure your parents' wishes and goals are respected. Include income sources, monthly expenses, bank accounts and investments, property and net worth statements.
• Assess legal needs. What legal documents do your parents have or want to have (wills, trusts, powers of attorney)? Where are they kept? Drawing up an advance directive—which includes living wills and durable powers of attorney—will ensure that decisions are made consistent with your loved ones' wishes.
• Make a list of important account numbers in case of emergency (social security, bank accounts, credit cards, health and life insurance, driver's license).
• Gather information about helping resources you may need. Your county Department on Aging is a good centralized resource for information and referral on older adult services. If you'd rather hire an expert to do the “legwork” for you, a geriatric care manager can provide a comprehensive assessment of your loved one's needs and recommend a plan that is appropriate and affordable.
• If your loved one has multiple chronic conditions or is taking a number of medications, a specialized geriatrics evaluation program can provide valuable assistance. The Geriatrics Institute at Aurora Sinai Medical Center in Milwaukee is one such program, but similar resources are increasingly available throughout the country.
• Respect your parents' autonomy and ability to choose for themselves. Outline available options, offer suggestions, but let the decision be their own.

Continuum of care

There is a wide range of care options that enable people to continue living independently in their own homes, whether they require occasional support services from a family member or a homemaker, or more intensive in-home services such as personal care, nursing visits, physical therapy, or home-delivered meals. When living in one's own home is no longer safe, affordable or desirable, there are public or private housing units designed for seniors that offer services such as cleaning, meals and transportation. Moving in with an adult child or other family member is an option that works well for many families, but it is important to give careful consideration to the consequences. The loss of privacy, strain on personal relationships and demands on other family members may make this arrangement stressful for all concerned, and adult children should not feel guilty if they decide this is not the right choice for them.

Assisted living is one of the fastest-growing residential alternatives, where older people can live independently in a home-like atmosphere, yet have access to needed services as their situation requires, including health care, medication management and meals. A “skilled nursing facility” or nursing home offers the highest level of medical care available, including 24-hour nursing coverage. Frequent visits will allow you to monitor the care and attention that your loved one is receiving and advocate on their behalf when necessary.

While watching one's parent or other loved one grow old is never easy, it can also be extremely rewarding, giving families the opportunity to heal old wounds, grow closer, and express their love in a way that might have eluded them earlier. Karen, whose mother has now settled into an assisted living facility, says they are closer than ever before. “My mother and I had a very strained, difficult relationship for the past several years. The hours I spend with her each week have given us both a chance to let go of the past and value the time we have left together.”

Call your EAP at (414) 257-2124 or 1-800-236-3231.