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When The Time Comes

Caregivers-in-Waiting: Boomers Struggle to Map Out Plans for Aging Parents - Interview with Paula Span, author of When the Time Comes

Five families helped Paula Span illuminate the modern struggles of caring for aging parents in her new book."

Q. What about a shared household situation, where a parent is brought to live with a child?

A. Having a parent who is dependent and in your home is one of the more stressful ways to be a caregiver, and it’s important to know that going in. You might need help with this emotionally. Finding a therapist for you or your parent can be a lifesaver. In another story, Ilze Earner was taking care of her mother at her home as well as working as a professor with one child at home and one in college. She wasn’t sleeping well, was completely stressed out and needed a geriatric care manager. This person helped with assessment and also did counseling with Ilze and her mother.

Q. What do you think about boomers being told they’re selfish if they don’t take their elderly parent into their home?

A. I become angry. In a study by the University of Michigan, the researchers set out to look at the shift from elderly parents living with children to living independently. They found the rate was steady until after the 1940 census, when the number of elderly living with their children dropped like a ski slope. What happened? Did children stop loving their parents? No, the first Social Security checks got mailed, and as soon as the elderly could live independently, they did. So we can let ourselves off the hook, because they don’t want to be living with us, either.

Q. How is assisted living different?

A. It’s great to have this in-between option that’s always been around on a small scale. It really took off in the 1990s with Marriott and other large companies getting involved. A million people are living in assisted living situations. It’s not good at supplying health care, but it’s good at giving privacy and some degree of individual help. As a result, people tend not to stay for more than an average of 27 months. This arrangement is more likely to be a way station. You should also clarify the discharge criteria. At what point is your parent going to be too much for them and have to move? They may deal with mild dementia, but not aggressive behavior that may accompany it.

Q. Are nursing homes a difficult choice?

A. Children feel like they have failed if they take a parent to a nursing home, because no one wants to go there. This is true even though studies show that adult children stay very involved by visiting, bringing food, even doing laundry. Children should understand that there are times when nursing homes are the only appropriate place, unless you have tons of money for a day and nighttime aide—or if you have so little money that you qualify for Medicaid and your state allows those dollars to be used for home-based care. So the job is to find the best nursing home.

This is not a rational system. In fact, it hardly deserves to be called a system. It’s a patchwork of services. It’s always changing in terms of availability of services, providers of services and what they offer, costs—and if you say this is crazy, you’re right. Why do so much of Medicaid’s billions go to keeping people in nursing homes where they don’t want to be, as opposed to keeping them in their own home where they do want to be? It’s illogical and wasteful.

Q. Is hospice any better?

A. I’m a big advocate for hospice, which is not a place but a service. My mother was a hospice patient. Hospice makes it possible for very sick, elderly people to be with aides they trust. There’s not a better way to die, except for dropping dead, which rarely happens. Death from strokes and heart attacks are way down.

Q. Isn’t it hard to know when to call hospice?

A. Call them when you get a diagnosis. There’s no obligation, and Medicare pays for it. At least have a discussion. There’s a huge benefit to calling hospice early and not waiting until your parent is at death’s door. Hospice can’t do their job in four days or a week and a half. We take our parents to all kinds of specialists, and hospice is the specialist in end-of-life situations. People don’t have to die alone or in pain.

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