I’m going to place here at the beginning of the article some qualifiers, disclaimers, and caveats. The subject of this article is not going to be something abstract and arcane such as the Pitcairn Island economy in the 17th century. Rather, it’s about the real-life, practical things we may encounter and have to work through as our parents grow older and become less independent. Much of what follows comes from things I’ve done and experienced with my parents. I’m going to try to make this article frank, open, human, practical, and, hopefully, helpful. If something I’ve written seems over the top or outrageous, please ask me to clarify what I wrote before becoming upset. I probably was less than clear. If your parents are exceptions to some of the generalizations made herein, don’t try to apply ideas to them that don’t pertain to them or their situation. Unless you are an only child or your siblings live very far away, try to make caring for your parents a cooperative task with others in your family. You should also try to make a special effort to include your children (in ways appropriate for their ages) in caring for your parents. This will be important to their relationship with their grandparents, and will prepare them for when they may be faced with similar situations. Whether you are alone or are acting in cooperation with siblings, however, do not neglect your spouse and children. If this article seems excessively sad or discouraging, I wasn’t trying to cause readers to be fearful concerning this stage of our parents’ lives. At least some sadness is inherent in the aging process, as well as some joys. On a personal level, limitations from my upbringing, some aspects of my personality, and my family situation have me doubting, sometimes, both whether I have done well by my parents and whether, realistically, I could have done any better than I have done. Those doubts have certainly colored what I have written.

First, let me describe how we are situated at the time of this writing (February, 2004, updated September, 2004), I am an only child. When I chose the area in which I live, Silicon Valley, it seemed, then, to combine career opportunity (electronics) with being close to my parents. They lived "only" two hours’ drive away. My Dad cared for my Mom through her recovery from and life after two major strokes (over some 5 or 7 years), but finally had to move her to a nearby skilled nursing facility in late 1996. He had chosen it years beforehand. Around the same time, she was diagnosed with colon cancer, deemed inoperable due to her poor general health. She died about 10 months later, at age 82. I had been visiting her and my Dad every 2-4 weeks, but, when her final crisis came, there were only some 20 minutes between the first phone call from the skilled nursing facility concerning her critical state and the call telling me that she had died. The two hours’ drive I had thought to be fairly close wasn’t close enough for me to be able to be with her as she died, though my Dad was by her side. Within a month of when he moved my Mom to the skilled nursing facility, my Dad suffered a stroke, and soon had to move into an assisted living seniors’ complex adjacent to (and part of) the skilled nursing facility in which my Mom was living. After that (March, 1997), my wife and I took over his finances, my Mom died, he remarried and was widowed again, he became confined to a wheelchair, his need for insulin injections moved him into the skilled nursing facility in which my Mom had lived, and he recently died at age 90. When I moved to Silicon Valley in 1978, I was single. By the time my parents’ health began to decline, I had married, and my wife and I had 3 children (homeschooled from the start) who were in or approaching their teen years. Thus, the time of my parents’ increasing dependence coincided with our children’s junior high and high school years and their entrance into adulthood. In the past 2 or 3 years, my wife’s Mom also started to become less independent (my wife’s Dad died of cancer in the 1960s), and she recently moved in with us.

The "inspiration" for this article was the two recent cases of elderly drivers who lost control of their automobiles and ploughed into crowds of people. Sadly, as people become older, they may also become less aware of and react less quickly and aptly to things happening around them. Such awareness and proper reaction is critical to safe driving. This being the case, we need periodically to accompany our parents when they drive to the store, to church, or around their neighborhood. You can make it part of a normal outing without making much fuss about it or even letting them know you are observing their driving. Why make them nervous? Observe how they drive, how well they are aware of and react to their surroundings. Ask yourself, "Would I want my family driving on the same road or walking about their neighborhood when they are driving?" If the safety of their driving seems at all uncertain or maybe worse, arrange to have possible medical issues checked: vision; hearing; heart. New glasses may be all they need to drive safely. My Dad stopped driving because of a heart condition - atrial fibrillation - that caused occasional partial black-outs. My Mother-in-law stopped driving due to cataracts in both eyes, and problems with her awareness and reflexes. If there is no treatable medical cause and their driving seems or is unsafe, try to persuade them voluntarily to stop driving. Be sure you offer to help them find alternatives, including sometimes being their chauffeur. If their driving truly is unsafe and they are unwilling to give up driving, you need to look into the laws of their state regarding getting their licenses restricted or revoked. If you have to go to this extreme, it may strain or even break your relationship with your parents, but as recent events have shown, the possible consequences of not doing this could be much more terrible than a strained relationship or a bent fender on their car. Your being observant and acting on what you see may save lives - your parents, your family, people in your parents’ community.

While I’m writing about safety, you also need to be observant of your parents’ day to day life. Are they able to move about their house adequately? Do they need a cane or walker? Do they need handrails in their bathroom or next to their front door or garage door steps? Are their choices of foods appropriate (i.e. reasonably balanced in nutrition and correct for their medical conditions, if any) and stored safely? When they prepare food, do they handle and cook it safely? Do they forget they are cooking something on the stove or in the oven, thereby ruining metal cook ware, shattering glass bake ware, or causing fire hazards? Do they clean dishes, glasses, and cooking utensils properly (i.e. not a health hazard)? Are they keeping their home clean (as clean as has been their norm, or at least safe, with no food left lying around that could attract pests)? Does it appear that their clothing, towels, and bedding are being laundered with proper method and regularity? Are their lights, faucets, toilets, drains, and appliances all functioning properly and safely (you may need to arrange for repairs)? I realize that it will feel nosey to be watching all these things, but problems in any of these areas could jeopardize your parents’ health and safety, and could be signs that they require more frequent and immediate (or even professional) attention and care.

Requiring extra care need not force them to move into a nursing home immediately. Moving from their home - a familiar place with years or decades of memories - will be a very big, maybe even traumatic, step for our parents. It should be only be done when it is really necessary or they really want to do it. My Mother-in-Law recently reached the point where limitations in her ability to move about, balance, and ability to care for herself have made it unsafe for her to live alone in her home. On the other hand, life in a nursing home would be too limiting for her. I’m blessed to be able to say that our older daughter (age 21), with help from her brother and sister, moved in with her Grandma to be her companion and to help her with meals, housekeeping, shopping, and some personal care. My Mother-in-law has since moved in with us, living for eight months in our living room. We have since added an apartment for her onto our house. We have learned a couple of things about walkers. Some "normal" doorways are too narrow for a walker. My mother-in-law had to turn her walker sideways to enter our hall bathroom. Her new apartment has wide doorways to accomodate her walker or a wheelchair. We have also learned that she isn't too aware of where her walker is as she walks. Consequently, she frequently banged into into walls and door jambs (the paint had to be touched up a lot), and sometimes got stuck when trying to walk by furniture or things on the floor. Minimizing such obstructions is important. Some friends of ours have also had a complete "apartment" built in their house for their parent. In many communities there are individual nurses and nursing services companies that can either provide daily visitation or have nurses live in with the seniors. Such services are not free, of course.

Even when the time comes when our parent(s) can no longer live safely and healthily in their own or a family member’s home, there are differing levels of care available to them. The facility where my Dad lived (which has been somewhat of a pioneer in care for seniors) for some 7 years offers 3 levels of care, which are matched to residents’ needs and capabilities (and some state or federal regulations). "Assisted Living" is the least intensive. The residents have their own apartments, some of which include kitchens. The facility provides meals for residents who desire them (in a dining hall), assistance with medications, and nurses or aides look in on residents a couple of times a day. In the next more intensive level of care, "Personal Care", the apartments have a main room and a bathroom, and are all in one building (which makes getting around easier for the seniors), surrounding the dining hall. In addition to the care mentioned above, "Personal Care" includes increased supervision and assistance with daily personal care (e.g. dressing, showers, incontinence). The highest level of care is "Skilled Nursing". This is for patients who don’t require hospitalization, but need regular care from nurses, assistants, and/or therapists. The rooms are similar to, though a bit larger than, a two-bed hospital room. Meals are served in a dining hall or at the patients’ beds, as needed. The facility also organizes, for residents in all levels of care, activities, entertainment, and chapel services (there is a chapel on site). It needs to be kept in mind that, as the level of care increases, the patient’s degree of privacy and freedom decreases. Some of this comes with the kinds of care being provided; some decreases of privacy or freedom are necessary for the efficiency of the care providers. This loss of privacy and freedom may be frustrating to the patient experiencing the loss. One thing that does increase with the level of care is cost. Unless your parents are independently wealthy, this factor will have to be part of care-giving decisions. Other factors include the kinds of care needed and being able to keep your family involved in their lives.

You also need to become more aware of your parents’ finances, and possibly become involved. I realize this can get weird if there are tensions among you and your siblings, but doing so may end up saving your parents, your siblings, and yourself much difficulty and grief. Pay attention to whether your parents pay their bills correctly and regularly. Late notices or old unpaid bills can be clues indicating a possible problem. Yes, you’ll have to do some more snooping. If you find that there really is a problem (more than just a rare memory lapse), you or a sibling should graciously offer to take over handling their bills, either to write the checks for them to sign (and mail), or to handle their bills entirely Including getting signature authority on their checking account so you can write and sign checks to pay their bills). You - and more to the point, your parents - do not want your parents’ power or phone being shut off, a foreclosure on their mortgage, or an eviction due to your parents becoming forgetful. Also, watch their mail and checking account for clues that your parents have gotten involved in or been victimized by some kind of fraud. Be on the lookout for get-rich-quick schemes, unauthorized bank withdrawals or credit card charges by a third party, and pay-to-play sweepstakes contests (which may be set up to be technically legal, but are still a rip-off). My Dad got caught up, for a time, in pay-to-play sweepstakes contests. He frequently thought that manipulatively worded mailers were informing him that he had won some prize (he even thought this was the case with contests he hadn’t heard of before). He also thought that the increasing volume of sweepstakes solicitations he was receiving meant that "word had gotten out" that he was about to win something big. In reality, it just meant that the sweepstakes companies sold each other their mailing lists (I could tell this was the case from peculiarities in how mailers were addressed to my Dad). In other words, his response to one sweepstake contest brought him solicitations from dozens more. Before I saw to it that all the bank checks he had "disappeared", he had spent hundreds of dollars in $5, $10, $12, and $20 "processing fees". Real sweepstakes (e.g. Reader’s Digest or Publisher’s Clearing House) require no fees. Needless to say, he never won a dime, though it was a shadow over most of the last 4 or 5 years of his life and over my relationship with him. The sweepstakes companies play on several feelings and characteristics that are common among seniors: fears about having enough money; their enjoyment of receiving mail; their excitement at the possibility of winning a large amount of money; their credulousness of cleverly worded mailers that seem to promise much, but mean almost nothing; their difficulty in noticing that the requests for "processing fees" come every 2 or 4 weeks and that the $5, $10, etc., "fees" quickly add up to $100-$200 a month. Tell your parents never to give out their Social Security numbers, bank account numbers, or credit card numbers except to valid, reputable businesses with a valid need for that information.

Losing some of the independence and control over their lives can be a very frustrating experience for older people, our parents included. Issues or desires may arise that might seem trivial to us but which become magnified in their minds into enormous symbols that to them mean that they still retain some degree of personal control and independence. Finding ways to avoid such issues or wants growing into areas of conflict is desirable. Find ways, when possible, to satisfy or work around the want. For much of his last year, my Dad engaged in a "beer battle". He frequently experienced very uncomfortable heartburn. He was convinced that the only thing that brought him relief was to have a can or bottle of beer. That may or may not have been the case, but there were two problems with this. First, my Dad was a diabetic, and the extra carbohydrates affected his blood sugar. Second, he had resisted a reasonable limit, imposed by his doctor, of only one can or bottle of beer a day. Some days he demanded a beer two or more times, and became very unpleasant when he was refused. Once, when I thoughtlessly left a six-pack in his room (expecting the staff to take charge of it), he drank more than 3 cans in some 16 hours. After several weeks of conflict, at the request of the skilled nursing facility staff, his doctor rescinded his permission for the beer. I’m not sure what outcome was hoped for, but my Dad just became angry - at his doctor and at the skilled nursing facility’s head nurse. Finally, after several months’ standoff, the skilled nursing facility administrator, the doctor, and my Dad agreed again to a one-a-day schedule. Unknown to my Dad (I think), what he was receiving was an alcohol-free beer. As a whole, that schedule worked (my Dad did not want to lose "his beer" again), and my Dad thought he got his way. He forgot often enough to ask for the beer that I think it was at least partly a control symbol.

It is very common, as people get older, for memories of recent events, awareness of time and place, and the ability to keep things in perspective to become uncertain or be lost at times. Older people often live in their immediate "now". They may lose track of time and date (even flipping night and day, despite clues such as daylight or the lack thereof), may skip doses of or even double-dose their medications. Sometimes, when I would come into my Dad’s room in the early afternoon, he would ask me what I was doing there so early in the morning (i.e. he thought that 1:30 PM on his clock was 1:30 AM). Or he would talk about going to the dining hall for breakfast when it was 4:30 PM. Sometimes he talked of farm work he did "last year" when he hadn’t done any farming for about 10 years. You will sometimes have to (when you’re with them) remind your parents of appointments, meal times, and what day of the week it is. They may forget what they did a day or two previous (be sure to prepare your children for this). Seemingly small events (pleasant or unpleasant) may become disproportionately important to your parents. They may respond very strongly to minor slights - real or imagined - or annoyances. You will also find that simple pleasures and small kindnesses will mean a great deal to them (e.g., my Dad loved it when we took a 30 or 40 minute "walk" outside of the skilled nursing facility building). One curious quirk your parents may experience is that things vividly dreamed or imagined may become "memories", i.e. as "real" to them as the memory of a real thing or event. My Dad (who was a farmer) used to "remember" having stored some grain for future sale in a certain barn. I several times drove him to that barn to show him that it was empty (on occasions when he had asked me to make arrangements to sell the grain). My Dad also "remembered" having stayed a couple of days in a "new wing" of a local hospital, built, he thought, in the house in which he grew up. The hospital stay was real, but not at the one he thought he was in, nor had his childhood home been converted to a medical facility. I drove him several times to his childhood home so he could see it was unchanged, but both "memories" continued to persist. Usually I tried to avoid discussing such unreal topics, obviously not always with success.

The manager of a skilled nursing facility once informed me that after a certain point in elderly folks’ lives and health, they tend to stair-step from one crisis-and-plateau to another, generally downward (in health and ability to function), until death. She didn’t intend to depress me or mean it at all unkindly, but I thought at the time that she was telling me that my Dad would immediately start going downhill, swiftly and inexorably and die soon. This wasn’t her intent or meaning, and that was in 1997, some 7 years before my Dad did die. Indeed, there were some sad times - seeing a once strong, smart, independent man, my Dad, becoming weaker, increasingly unsure of himself, and more and more dependent on others. And "thanks" to sin rendering our bodies mortal, that process was steadily downward. But we also shared many joys, including, after my Mom died, a two year marriage to a woman who was in a "plateau" of her own during the time they met, got to know each other, married, and began life together. Sadly, her last "crisis" began about a year after their honeymoon. My Dad, in the 7 years after he had to move into the seniors’ community, shared the joys of seeing two of his grandchildren graduating from high school, his grandson becoming an Eagle Scout, and two of his grandchildren going on short-term mission trips to Mexico, Fiji, and China. My wife and I tried as much as possible to give him the joy of our love, expressed in taking care of his affairs and making sure he was part of our lives (despite living some 120 miles away).

Your parents’ declining years will have their share of trials, joys, and sadness. The trials and sadness come with their stage of life, but you can help create, accentuate, and cherish the times of joy. We need to try to prepare for the time when we transition to becoming loving "parents" to our aging parents.

In Memoriam: Walter Henry Storz met Jesus, Whom he had loved all his life, face to face on February 26, 2004

Updated: 5/6/05