FOF Roberta Satow is a psychotherapist and sociology professor at Brooklyn College. Her book, Doing the Right Thing: Taking Care of Your Elderly Parents Even if The Didn’t Take Care of You, chronicles her experience caring for her own mother, as well as the experiences of 50 other family caretakers across the country.
Posted on January 19, 2011
Roberta believes that the period of transitioning your parents from independence to dependence can be an incredible time of healing, growth and bonding--if you know how to handle it. Here, she talks about choosing the best living arrangement for your parents, without making them--or you--crazy.
When you start to notice your parents having difficulty taking care of themselves, what’s the first thing you should do?
In the beginning, minor changes may be enough. For example, your father may have difficulty shoveling the snow. Then you can suggest he hire someone to shovel the snow and he might be quite receptive. The problem arises when your father doesn’t want to hire someone, and insists on doing it himself.
How do you approach that stubbornness?
The question is, how intrusive do you get, and where do you set the limits? Ask yourself, is this issue dangerous? If your parent is becoming an unsafe driver, for example, you have to intervene, otherwise you’re taking your parent’s life and other peoples’ lives into your hands.
Sure--and that’s pretty clear. But what about the shoveling, where you know your elderly father has a heart condition, and it could be a medical risk, but he’s risking his own life, not someone else’s.
When you’re trying to get an elderly person to do something for his or her own good, you have to remember that they have a tremendous investment in being alright. There’s a huge loss if you confront them head-on with “You can’t do this.” The likelihood of a positive resolution is greatly enhanced if you can somehow distract from the bigger issue of physical decline. For example, give your father a snow blower for Christmas. Or arrange with a neighbor to offer to shovel the walk. Try to do it in a way that involves the lease loss of self-esteem
What if your parent is belligerent and angry no matter how delicate you try to be?
There may be someone better suited to have the conversation with him or her. Perhaps your dad has a friend, priest, minister or rabbi who he trusts. There may be another sibling who’s just better at dealing with dad than you are. If you’ve tried everything humanly possible, then it may be a cognitive problem that he or she is having. In that case, take you parent to a geriatric specialist, because there are drugs like Aricept and antidepressants which can really help.
Okay, so once you’re at the point where you know it’s not safe for your parent to live alone, what do you do?
There are three main options: hire full-time help to live with your parent, move your parent into your home, or put your parent in an institution. Obviously, financial concerns weigh into that, but my expertise is more psychological.
How realistic is it to have your parent move in with you?
Some people just know right away that there’s no way they could possibly have their parents live with them without their marriage falling apart or something equally stressful. Those people have to accept that it’s not an option and figure out what they need to make sure their elderly parent gets what he or she needs, but not under their roof. There are other people who want to have their elderly parents live in their home, but find that they can’t set boundaries and it ends up having a negative effect that they didn’t expect.
When is it successful?
I’ve found it has a lot to do with your cultural background. African American families are more likely to keep their elderly parents at home--even if they have dementia--often because that parent was integral in raising their own children. Hispanic people have similar attitudes. I went to a talk by a Puerto Rican geriatric doctor and when he and his wife got married, the first thing they did was get a house with two separate apartments because from the beginning they accepted that their parents were going to come live with them at some point.
So how do you know if you’re a good candidate to do this--apart for your ethnic background?
First of all, you have to have space--enough room in your home that you can have some privacy and your parent can have some privacy. Putting grandma in the room with her granddaughter is not a good idea. Second, your family needs to sit down and talk about this decision and have reasonable expectations. For example, it’s usually the woman who ends up becoming the caretaker, even if it’s her husband’s parent. So talk to you husband about what responsibilities each of you will take on.
Can you expect everyone to shoulder part of the responsibility?
Yes, as long as everyone is comfortable setting boundaries. It’s okay to expect your son to drive grandma to the mall on Sundays, but you don’t want to teach him to be a masochist. If the mall interferes with something he loves--like a regular baseball game--that might not be okay for him. Here’s a case that worked: A woman in my book had a two-family house and her widowed father lived downstairs. In the beginning, he made the family pasta fagiolo and was home when the kids returned from school. As he got less and less capable, they would bring in some outside help for him, but by that point he was such a part of their family that his care had been integrated into family life. The kids made him breakfast on the weekends, mom took him for walks, etc.
So if you’re not a good candidate for that, or if, perhaps, your parent has just become too much to handle in a home environment, then what?
Start researching what kinds of institutions there are in your area that might be possibilities. I personally like Continuum of Care facilities, where you have an apartment and you can cook for yourself or you can go down to the dining hall. As you start needing more help, they can provide more help. When you get to the point where you can’t live alone, there’s a nursing home. It’s all in the same area, so the people that you know from the beginning can come visit you, and there’s a sense of community--we’re all in this together. Also, make sure the place is close enough that visiting isn’t a hassle.
How do you introduce the idea of a “home” if you know your parent is resistant?
With my own mother, we asked her if she’d like to go to lunch with us at one of the places. We fully expected her to throw a fit, but when she got there, she had a very different reaction. She felt like the place was a hotel, and she was thrilled at the idea that someone was going to cook for her and take care of her. She’d also been fairly isolated, so she liked the feeling of people around her. In some cases, your parent will have an idea of these places that doesn’t fit with reality, and they end up being pleasantly surprised.
But what if it doesn’t work out that way, any your parent refuses?
At some point you might have to have a serious discussion and say, ‘this is untenable, we can’t do this anymore.’ They may have to do something that they don’t like, and it’s very unpleasant. But you have to have confidence that this is what your parent needs, and you have to bite the bullet. If you’re controlled solely by what the elderly person wants, you may be putting everyones' physical and mental health in jeopardy.
Finally, what if you’re questioning your own decision? What if you’re not confident that you’re making the right decisions?
When you start taking care of your parents, you can really regress psychologically. Issues crop up that have been dormant for years--anger, resentment, etc. Accept that you will feel ambivalent about a lot of these decisions. This is a great time to consider outside help. There are geriatric social workers who can help you find solutions and talk through whatever issues you may be having. You also may want to start seeing a therapist or counselor on your own. It’s a fertile time if you want to work out these old issues that have been left unresolved.