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Conversations With Carol #3
Maintaining Elder Independence
By Carol Abaya, M.A.

One of the biggest challenges of being a sandwich generationer is helping aging parents remain independent and retain their own emotional self esteem.

This is Carol Abaya.    Today we will talk about role reversal,  what it means to our aging parents,  and what it means to us.

Regardless of how one looks at aging, everyone needs to accept the fact that relationship dynamics will forever be drastically changed.

An integral part of these changes is how we generally view our parents.  A geriatric social worker once put it this way to me.   "We have traditionally idolized parents.  They are here forever as magical, mystical protectors.  Now the parent can’t be there for us.  We have lost our protector.  We need to be there for them.  We have become the protector."

When you think about life’s roles and the role we play when we are a parent to a young child,  key words that comes to mind are  to protect   and, just as important, to  empower.   We do whatever we can to empower our children --  to help them develop  as good and independent human beings.

The word empower is also widely used in business.  There it means we help bring out the best in that other person.  In fact, the word has been developed  only in  the past decade  or so as a business management concept .

So in role reversal;   when we become a parent to our parent,    the word empower is very important.  Whether we are marginally involved in their daily life  or are responsible for their total well being,    we need to think  a lot about the meaning of this word.

Our objective,  as it was with our children,  and as it is in the work place, is to empower our parents.   To help them remain strong and independent, and for them to have an increased lifespan.

Needless to say, all advice given is easy to give when parents are healthy.    

But what happens when they become frailer or ill?

A geriatric care manager said,  "The idea of role reversal is very sensitive, both for the sandwich generationer and the older parent.  Having a parent step down from a position of authority or idolism is not easy to accept."

Sometimes the decline in health and physical capabilities is gradual,  and adult children  really don’t see the changes -- especially if they see their parents often. 

When you live far away, and see them infrequently, all of a sudden it may hit you that your parent is getting "old"   -- or ‘aged.’

I think it was at my eldest niece’s graduation from nursing school that I came to this realization about my father.  As he slowly and carefully made his way into the auditorium,  the thought flicked through my brain    "He really is getting frail."

Of course, he was 86 at the time, still driving, and working every day.   But the frailness was becoming more apparent.  I kept a closer eye on him after that.

What happens when your parents  are very independent people who don’t want anyone else -- much less a child -- to intervene in their lives?

Sometimes as adult children we have to make tough decisions.     And sometimes we become ‘involved’  when our parents really don’t know we’re keeping tabs on their welfare.

My parents lived together, 55 miles from me.  Until my mother became very ill and was hospitalized in January 1991,    my mother ran the house as well as a real estate business.   I became "involved" in their daily lives    only once before -- and then only    because it involved their safety.

My mother had fallen down the cellar stairs, and laid there for about 45 minutes.  She couldn’t get up herself.    My father was hard of hearing,   so he didn’t hear her calls.  She finally was able to get up herself.  Fortunately, she did not break anything, but was badly bruised..     However,   she did not tell us  about this incident until 3 months later.   About the same time, I watched how my father (then in his late 80s) went up the steps to the back door -- he used his hands on the steps to leverage himself as there was no railing.

So I had to make a hard decision.    Should I let them carry on as they had for more than 50 years -- or do I step in to ensure their safety?     Well, the safety factor won over.

I had my handyman put in rubber treads on the stairs to the basement, and  add a handrail on the stairs from the middle to the top, where there was none.    I also ordered a custom made  railing for the back outside steps and had it installed.  And I paid for this.

My parents protested.  They were upset with me for interfering.   But I didn’t want to be faced with an accident that could really hurt either one of them.

Did you know, for example, that more older people fall and seriously injure themselves in their own home than are killed in automobile accidents and plane crashes combined?

So fall prevention should top the list of how we can help protect our loved ones.

Then there was an on-going battle with my mother about replacing the carpeting in the house, which was  quite worn.   The "battle" went on for several years.  I retreated, because after all, it was their house.   But then in the last year,  I noticed 2 things.   That she was shuffling her feet along the ground as she walked -- as opposed to picking them up.    And the carpeting had become so stretched out that there were ripples in it -- over which she could easily trip.   Again a hard decision.

Do I let things ride -- or do I take action?    Again, because of the safety factor, I acted.

I told my mother that the carpeting had to go.  Needless to say, she didn’t like this.

But we all should have choices in life.   So,  I gave her choices --   as to what  could be done  after the carpeting was removed.   I told her she could leave the wood floors, which were in good condition,      or she could pick out new carpeting to her taste or I would pick out new carpeting.  I told her it was her choice.

After giving me a dirty look and objecting some more,  she did go with me to several carpet stores and selected what she wanted.   And she alone supervised the installation.

In the last few weeks of her life,  when congestive heart failure was taking a big toll,  she again  fought hard to maintain control of her life.  She  said she wanted to fire the housekeeper and live alone.   At that stage, it would not have been safe or advisable.    So, again, I had to make a hard decision.   I had to tell her that she could fire the housekeeper and hire someone else.    Or she could come live with me -- or go to Florida and live with my sister.     I told her that there was no way she would live alone.   My mother did not like my answer  -- and complained bitterly about it to whomever would listen.

But her safety, her health and her independent lifestyle were at stake.  I had to take the leadership role.  Was it comfortable to have to do this??   No.   But I felt there was no other choice that would enable her-- to empower her --  to remain in her own home, with her controlling her lifestyle and environment.

In our previous discussion about the parental role, we noted that children, especially teenagers, are struggling to become more independent and gain control of their lives.  Older people are struggling to remain independent and retain control of their lives.

So decisions, as much as possible, should be made with -- and not for -- parents.  In my own examples, because of the safety factors,  I felt I had to go against my own rule of thumb.

But when parents are so independent and stubborn, sometimes the sandwich generationer has to be the bad guy.

Generally, I’d say you need to identify things in the home that are safety related and need fixing or changing.  Then sit down and discuss what should be done -- and what could happen if changes aren’t made.

Helping an aging parent cope with life’s changes and communicating with them  is a different ball game  from the one we face when we are a parent to a young child,  when we are the ‘boss.’

Parents are mentally developed, mature, independence human beings,  who have controlled self and lifestyle for many years.

Now they are losing the ability to do for self -- and they don’t like this.

They resent the losses they’ve had to face in recent years.   They are angry with themselves and the bad rap they’re getting.      And they are scared stiff of the future.

Also, this eldest generation,   who grew up during World War 1 and the Great Depression,  are fiercely independent.    They are not very good at accepting help or advice,  from others  --  especially from their children.

This makes it  more difficult for sandwich generationers to ‘empower’ their parents.

A reader called me a couple of years ago.  She was extremely frustrated that her mother would not listen to her,  and insisted on going out during bad winter weather.  Her mother,  at 90,  was still driving.  She said that whatever she said, her mother disagreed with.   If she said day;  her mother would say night.  As my own mother had a strong personality, I understood her problem.  I suggested she literally "bite her tongue."  I suggested she step back and try to project what her mother would do when she gave advice.

The next week, the reader called me back.  "I took your advice,"  she said.  "The weather forecasts indicated there was going to be an ice storm.  On Sunday my mother likes to go to church.  I was tempted to warn her that she should stay home.  But then I figured  if I said anything  that it would make her more determined to go to church.  So I did not say anything, and my mother stayed home"

Another reader called,   and said she was frantic because her father insisted on making his own breakfast and lunch.  She was afraid he would cut himself with a knife, burn the food or burn the house down.  Any time,  she offered to help him,  he yelled at her and told her to get the hell out of the kitchen.   She said she felt guilty that she wasn’t doing everything for her father,  and wanted to know how to get him to let her make the meals.

My advice was to let him continue making his own meals.  I suggested she observe from a distance  how he managed to do everything   and to make sure he was able to really handle things safely.  If he could really do everything,  let him.

In this example,  the daughter felt guilty that she was not taking "proper"  -- whatever that is -- care of her father.

But think about the father’s feelings as the daughter wanted to take away something else from him  and for him to lose control over taking whatever it is he wanted, when he was hungry..

People need to feel useful.  And if getting his own lunch  made him feel good, this should be encouraged  rather than discouraged.

It goes without saying we could spend hours just talking about the philosophical implications of role reversal.  And we’ll go  into more facets of this another day.

But today, our objective has to be to  empower our parents -- like we did previously with our children -- to help them retain their independence as long as possible.   The worst thing sandwich generationers can do is to move into a parent’s life   like a bull in a china shop  and take over everything.    The less you do for a parent,  depending on true physical and mental abilities,  the better it is for everyone.

There are a number of things that can be done as a person ages to help maintain independence.  This   goes for yourself as you move into your 50s and 60s,  as well  as for your parents.  Remember the saying  "an ounce of prevention..."    very applicable in your role reversal situation,  as you have to take the leadership in the relationship.

Safety  is critical.     If the safety factor is implemented,  you will empower your parents to live in their own home longer.  As a concerned adult child or caregiver,  you will also reduce the number of chores you have to do,  and the time you have  to be involved in their daily care.   Everyone’s stress levels will be lower,  and your parent’s quality of life will be higher.

Safety proof the house or apartment.

Remember when we had young children or now when grandchildren come to visit?  What did we do?  We walked around looking for things that the kids could break.  Or trip over.  And we took action to prevent accidents.

This has to be your objective now -- to prevent accidents, which ultimately reduce independence.

Falls are one of the top three reasons seniors end up in hospital emergency rooms.

There are a number of simple things that should be done to prevent falls:

There are two other key reasons seniors end up in hospital emergency rooms.  They are malnutrition and dehydration;   and misuse of or negative interaction of medicine -- both prescription and over the counter.  In areas with a high number of seniors,  hospitals report that as many  as 70% of seniors are treated for one of these three reasons.

It’s often not fun to live alone, to have to cook only for yourself,  to take medicine on time when you’re not feeling well in the first place.

Let’s  take a look at how a senior can be sure of eating better. 

Malnutrition and dehydration -- not having enough liquids in your body -- need to be addressed.

Make it easier for your mother  or father   to cook for herself -- safely and healthy. Package foods in single serving sizes and freeze -- either fresh or pre-cooked.  Then your parent can take out enough for one meal.  If it is pre-cooked, then it can easily be put in the microwave.

I do this for myself.  I hate cooking.  So when chickens, for example, are on sale, I’ll buy several.  After cooking them, I’ll cut them up, and put them into baggies in one serving sizes.  You can do the same with chicken breasts.  And  you can package   fresh fish or  meat into one serving sizes.

Packaging food in single servings also prevent leftovers from building up in the refrigerator.  This eliminates the problem of spoilage which can result in food poisoning.   Food poisoning is another item high on the "bad" list for older people.

In most areas, there is a Meals on ‘Wheels program.  Your parent can be assured of getting at least one hot, nutritionally balanced meal a day.

Also, a marvelous "gift"  is to have a favorite restaurant deliver a   favorite food meal on a regular basis.  In some areas, there are delivery services that handle that service for a number of different restaurants   for a minimal fee.

Misuse of medicine is another  top reason seniors end up in the hospital. Medicine needs to be taken properly, if it is to be effective.   However, many people, as they go through their daily chores or work,  don’t keep looking at the clock and forget the time.   Or they may not remember what time to take the pills -- or if they’ve taken them.

When people become forgetful there are various containers and gadgets which can help ensure that medicine is taken properly -- even if you are not there every day.   A medical supply company can help you identify the best, given your parent’s alertness level.  There are even some with timers,  which give off beeping sounds at the time you have to take medicine

It is important that both your parents and yourself establish and maintain an on-going dialogue with your parents primary care physician as well as specialists.  I felt fortunate that my parents doctors always talked to us.  There was one time after my father, at 93, had hip replacement surgery, that the surgeon and I spent 45 minutes on the phone -- beginning at 10:30 at night.  Their doctors always answered our questions, patiently.

Long Distance Alert System

Your parents may live miles and miles away.   You don’t see them everyday -- or maybe not even every week.  How can you ensure you know what is happening?

As soon as we moved to where I am still living, more than 25 years ago,  I set up a neighborhood alert system.  I gave the next door neighbor my telephone number, and had theirs.  Every time the ambulance came to my parents house -- and it was at least once a year -- I received a call.  My father periodically had strokes.  But my mother wouldn’t call me -- she didn’t want to bother me.   One time, when the neighbor called me at 5 a.m., I called the hospital an hour later and spoke with my mother.

Why didn’t you call me, I asked?    "Well, I was going to."    " When?"  I asked. 

"Well, later......"

My mother was asserting her independence -- and as with her generation, was reluctant to ‘bother’ me.

Besides getting a neighbor’s telephone number,  have a list of numbers that include their family doctor, accountant,  the electric  and telephone companies, the mortgage company , and the local tax assessor.    If your parents are elderly -- as opposed to just being seniors who are still mentally alert -- you should also establish a dialogue with these companies  to make sure bills are paid on time.  If they’re not, ask the company to alert you.

We’ve talked a lot today about protection and empowering our parents as they age, and taking steps to increase lifespan.  Safety proof the house to prevent tragic accidents..  Address nutrition and medicine issues -- and take appropriate action.

Don’t be afraid   to  have your parents protest and don’t be afraid to go against their wishes -- especially when safety or health is the issue.

And remember, these TIPS are just as important for you,   as your age creeps up.  Get someone else to change those ceiling light bulbs.

Our visit today is over.  I look forward to tomorrow’s visit when  we’ll talk about TIPS and learning from others.  There’s no one right way to take care of others.  There’s no one right way to live one’s life.  But certainly, we can all learn from people before us, who have thought about life and uttered words of wisdom.  So, tomorrow I’ll share with you many words of wisdom found in a little tiny brown book that my mother passed on to me.  I know you will find them both profound and insightful as we move into the millennium.