It's often the little things that can make a person's blood boil.
Case in point: Ann Allnutt gave her 85-year-old mother a basket for her mail. Read your mail, she said, and when you're done, put it in the basket where I can easily check it.
"I find everything in that basket but the mail," Allnutt, 68, says. "So, because of that, we missed paying insurance premiums, or we missed something that we need to take care of. I have changed the addresses on bank statements and she'll call and change them back."
Then there are the doctors' appointments her mother reschedules without telling her. Allnutt knows the dementia is likely to blame, but there's a part of her that thinks there might be more to it — that her mother is being difficult in order to hold on to her independence.
And then there's her father, 90, a survivor of two strokes, who says he doesn't need anyone to help him, yet in fact needs everything done for him. Both refuse to hire a home health aide, and both insist on staying in their own home.
"Up to a point, they think they can still do for themselves, and then they expect me to come in and pick up the pieces when things don't go well," says Allnutt, who moved back to Archdale, N.C., 13 years ago to help care for her parents.
How does this make Allnutt feel? Stressed, frustrated, miserable and lonely, she says. The situation has left her feeling unappreciated by both of her parents and has strained her relationship with her mother in particular.
Disharmony with Mom and Dad
All of these emotions, combined with the conflict and arguments, lead to a relationship that University of Southern California professor Merril Silverstein would describe as "disharmonious." The situation is not at all uncommon, at least in the United States. The relationship between adult children and aging parents is much more likely to be disharmonious here than in Europe or Israel, according to a 2010 study Silverstein authored in the Journal of Marriage and Family.
Silverstein compared data from a U.S. longitudinal study of generations with a similar European one that included responses from caregivers in England, Germany, Israel, Norway and Spain. Each country's study assessed responses from an average of 450 caregivers.
In Silverstein's study, 20 percent of Americans rated their parental relationships as disharmonious — more than twice the rate found in England, Germany, Norway, Spain and Israel.
"There seems to be more conflict, and less closeness, when [adult children] were caregiving or when the parent was frail," says Silverstein. For instance, the study compared older people's ability to climb stairs with the quality of the parent-child relationship. Parents who had problems with mobility — a measure of frailty — were more likely to report a disharmonious relationship with their adult children.
Why? Sociologists such as Silverstein believe differences in how cultures handle caregiving issues directly impact relationships at home.
The ease or burden of caregiving
In the study, the most amicable relationships were seen in Norway and England — countries with strong social programs that ease the financial burden of caregiving. In-home help is heavily subsidized there, as are assisted living and nursing home care. But cultural factors also come into play, says Svein Olav Daatland, senior researcher with NOVA, the Norwegian social research institute, whose data were used in Silverstein's study. Simply put, older parents in Norway don't want their children to do the laborious, and sometimes humbling, hands-on work of caregiving.
"This is hardly because they are not family-oriented," says Daatland, a gerontology expert. "Rather, they say, 'I don't want to be a burden on the family.' The response often is, 'When I no longer can manage myself, I need to have professional services brought in. Then I can be together with my family without obliging them to do any hands-on care.' "
In other words, families want to be able to get together for Sunday dinner and enjoy each other's company — not talk about who will help Mother to get out of bed in the morning, or who will be there in the evening to lay out the pills for the next day. Allnutt understands this all too well. When asked what would improve her relationship with her parents, her response is a simple one:
"It seems that the only time we share together are times when I'm doing things for them," Allnutt says. "We never really get time to have a one-on-one parent-child visit. If we could just go out and have a meal. Just the other day I took Mother shopping. She just wasn't physically able to stay away too long, but that was a good time."
Additionally in Norway, the stigma of "putting Mom in a home" isn't as strong as it is in the United States, Daatland says. In fact, the practice is relatively common: About 70 percent of the country's elder care resources go toward nursing home care. And assistance is affordable. Those who can stay in their home pay 2 percent of the cost of home health care. The rest is covered by the government. Once a person needs a nursing home, his or her cost for the care is capped at 75 percent of their basic pension, plus 85 percent of any additional pension or other income, regardless of how much money or assets they have.
Because care is affordable, families are not fighting over who will pay for services or worried that Mom and Dad will run out of money. Each generation in Norway retains its autonomy; the younger relatives don't feel as strongly about a sense of "duty" to their parents as families do in Spain, another country profiled in the study.
In Spain, adult children and aging parents were more likely to live together, because of cultural norms but also because the country lacks strong social programs to help older people. In Norway, however, independence is valued, and while parents often support their adult children financially, it rarely works the other way around, Daatland says.
In America, the desire for independence crashes into the realities of the demands of caregiving. Add to that an immigrant heritage that values providing direct care to aging parents, the rise of two-income families where women work and are strained by caregiving responsibilities, and the financial burden of the cost of in-home and long-term care — and you have a recipe for disharmony.
When Linda Higueras was growing up, her grandmother lived with her family until she died. "My parents were born in Latin America, and you don't put your old people in homes," she says. So when her parents' health declined — her father, 88, has dementia, and her mother, 84, was no longer able to care for him by herself — she moved her parents into her Sonoma, Calif., home. Culturally, it was the right thing to do. But emotionally, it was difficult.
"Things became so combative at my house with my parents living with me," Higueras, 55, says. "My mother and I were in opposition about what had to be done, and my father was just getting worse."
And then Higueras woke one night to a thud. Her father had fallen; there was blood all over the carpet. After the emergency room visit came a stint in a long-term care facility for people with dementia. But Higueras and her mother felt he wasn't getting enough supervision there, so they struck a compromise: Her parents would move back into their own home, but they had to agree to some paid help. Now Higueras and her brother pay for about 20 hours of assistance a week, and Higueras does most of the rest of the caregiving.
"One night I was changing my father's diaper and he said to me, 'I hate this. I hate this so much,' " Higueras says. " 'This is not the life I expected. And this is not the life I want for you either.' "
Higueras can't argue with that statement. She misses her old life, and that adds to the tension. She used to run marathons but hasn't been on a run, a hike or to a single Pilates class in months. "I think like most adult children we all have our separate lives, but now my life is intertwined with them," she says. "I can't take vacations. I have to be conscientious about trying to be over there as often as I can."
Loss of identity
It's that struggle to retain our individual identities that adds to the strain on the relationship, says psychiatrist Scott Haltzman, M.D., author of The Secrets of Happy Families: Eight Keys to Building a Lifetime of Connection and Contentment. This is a quintessential American trait that defines the boomer generation: those who are now doing the caregiving and are becoming the ones that have to accept being cared for.
"It was a little less than 50 years ago that Jack Kennedy said, 'Ask not what your country can do for you,' " Haltzman says. "People pay lip service to that now. It's really not an issue of what you can do for others, it's what can others do for me, it's about what will make me happiest."
Haltzman also says adult children often feel as if they're being robbed of their golden years. Their children might have finally left the nest, and parents who dreamed of being done with racing from soccer games to piano lessons now find themselves driving to doctor visits and pharmacies.
"I don't believe any generation has focused so much on the minute-to-minute care of children as our culture," Haltzman says. "It may very well be that young adults are exhausted by the time their kid leaves the home. They can't envision putting any more energy into caring for somebody — meaning their parents."
Not so golden years
Instead of living their dream retirement, adult children find themselves responsible for another generation. Resentment over this can put a strain on the relationship — even if adult children never voice those frustrations to their parents. And unlike raising a child, caregiving may offer few rewards. Jacqueline Marcell's father turned downright nasty as he aged, and in his final years he pummeled her with blistering criticism and verbal abuse.
"You're furious that you're being put through this," says Marcell, author of Elder Rage. "You have this roller coaster of emotions. I loved my father, I hated him, I wanted him to live, I wanted him to die, I wanted to kill him, I wanted to save him. And then you have the guilt for thinking, 'Why can't he just have a heart attack and leave?' And then you go, 'Oh my God, how could I think that?' "
These are all normal emotions, Marcell says, and they can't help but seep over into the relationship. And if anyone is going to be able to sense your underlying emotions, it's a parent.
But conflict isn't always bad, Silverstein says. In fact, it can bring people together. While in the study Americans were much more likely to report disharmonious relationships between generations, more than half of the participants reported their relationships as "amicable," meaning they were close, got along and communicated well.
"There could be a use for conflict and human emotions to solve problems," Silverstein says. "Conflict is a way to express different opinions, bring arguments to the fore and possibly allow them to be solved."
When Shari Bruce, 49, of Bethel Park, Pa., asked her mother to move in with her and her family, the tension strained relations throughout the house: between Bruce and her mother, Bruce and her husband, and her husband and her mother.
Bruce's mother, then 83, with dementia, chafed at her loss of independence and couldn't feel comfortable living in a home that wasn't her own. Bruce would hear her mother up at 2 a.m. in the kitchen and lie awake wondering, "Should I go down there? Does she need help? Will she get angry with me if I go?" The stress and exhaustion wore on her. Tensions hit a boiling point nearly a year ago, when her mother broke her hip.
"She said, 'I can't do this anymore. You have to look for somewhere else for me to live. This isn't working,' " says Bruce. While it was hard to let go of her mother's daily care, the decision to move her to a nursing home was for the best.
"Now that all of that is behind us and I know that she's very well taken care of," says Bruce, "we get along so much better now."
What do I do?
To get through these trying times without sacrificing the relationship, Marcell recommends that caregivers forgive themselves for the emotions they are feeling because they are completely normal. Accept the fact that you can't do it all, and get help. Adult day care can be a sanity-saver, she says, for both generations.
"Respite allows you to recharge again," says Marcell. "You've got to have time for yourself."
Cynthia Ramnarace writes about health and families. She lives in Rockaway Beach, N.Y.
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