Caring for Aging Parents
It is well known that one mother can take care of 10 children, but 10 children cannot take care of one mother. - Ancient proverb
Diana is ninety-three. She lives alone in the home in which she and her husband raised two children. When Diana was in her mid-fifties, her husband had a debilitating stroke that left him bed-ridden. Diana decided to care for him at home. Her children were in college at the time. No one expected she would be in the role of twenty-four hour caregiver for over ten years. Diana performed her task with grace. Almost forty years later, she recalls the relief offered to her by her church, by her community, and most of all, by God.
That experience shaped the second half of Diana’s life. After her husband died, she became a volunteer six days a week. She spent three days each week at the county hospital and three days driving for Meals on Wheels. The rest of her time was spent with hospice patients. Diana began to rent a room to graduate students for safety and companionship. She became active in several church committees and became the director for the college-age Sunday school department. She visits her family in distant states every year. At ninety years of age, she visited Africa. That was the same year she decided to quit driving. Friends of all ages were ready to help with transportation.
While there are more and more people living into their nineties, Diana is the exception. Not every senior adult can meet his or her own needs. Diana’s children care for her appropriately, from a distance, and do not interfere as long as she is capable of caring for herself.
How to care for aging parents is a real struggle for adult children. Many aging parents also find the transition of caregiving difficult. They have been our caregivers. Even if they have come to view us as adults, we are still their children. As their children, we also have some feelings and ideas that shape our interactions with them at this crucial stage of their lives.
Common Feelings of the Adult-Child Caregiver
Anxiety is rooted in our fear of the unknown and our inability to control the future. If we could, we would write a future for our elderly parent much like Diana’s. But, in fact, we cannot exercise this control. (Read Matt. 6:33-34 and Phil. 4:6.)
Fear is associated with the plight of the elderly. Often it requires adjusting to one loss after another. The elderly may suffer physical, social and financial losses. And finally, there is the loss of life itself. We fear this for our parents, and in experiencing it with them, we cannot avoid facing the same fears for ourselves. We, too, are mortal. (Read Ps. 23 and Rev. 1:17-18.)
Grief is the natural result of any loss. We are losing the people upon whom we have always depended. While our culture provides support for families who have experienced a death, it often ignores the kinds of losses caregivers experience daily. (Read Isa. 53:3-4.)
Anger is a normal part of the grief process. It can be experienced as frustration, irritation, annoyance, resentment or other variations. Sometimes anger results in blaming, and it usually will not go away by ignoring or suppressing it. (Read Eph. 4:25-26.)
Guilt is the most common and prominent emotion of caregivers. If an elderly parent has been “dumped,” the guilt may be legitimate and entail forgiveness. For most caregivers of aging parents, however, the guilt is related to unrealistic expectations of ourselves and myths of which we may not even be aware. (Read 1 John. 1:9.)
Myths about Aging and Caregiving
Myth One — Caring for an aging parent is new to us
In reality, we have been caring about these same people (who have always been aging), ever since we were old enough to care about anything. The difficulty comes when, as adults, we begin to feel the weight of shifting responsibility for their welfare. The caring is not new; the responsibility is new.
Myth Two — At some (unidentified) age, parents can no longer care for or make decisions for themselves
In fact, very few people become totally incompetent at these tasks. We use a lot of energy worrying about things that never happen. When we do find ourselves as primary caregivers for our elderly parents, we must avoid doing so with pre-determined ideas about our parents’ competence.
Myth Three — Caring for the elderly is like caring for an infant
There are tremendous psychological differences. An infant represents new life, full of potential. Normally, infants will grow and become independent. With an elderly parent, the expectation is quite different, making the caregiving itself more complicated.
Myth Four — We are obligated to be the personal caregiver for elderly parents, since they cared for us as infants
Many adult children strive to “repay” this debt, taking on an impossible task. Parents of infants and young children are said to “know what is best” for them. This is not so simple for senior adults.
Myth Five — Children today do not care for their parents the way they did "in the good old days."
The growing number of people in nursing homes is used to support this claim. In reality, the elderly are living much longer today because of medical advances. These latter years of life, however, are often accompanied by circumstances that make caring for them much more complicated. In “the good old days,” most of the seniors would have died much sooner.
As you and your parent are making decisions (together, whenever possible) for his/her care, there are several ethical concerns to keep in mind. Often decision-making focuses on issues of medical care. You may feel differently about medical treatment than your parent. As long as your aging parent is not suffering a loss of mental capacity, it is unjust for children and/or doctors to coerce treatment on them. The patient’s evaluation of the “benefit versus the burden” of treatment should be respected. In so doing, we value the autonomy of the competent patient and his/her understanding of what quality of life means.
Helping senior adults maintain their sense of dignity becomes one of the most important roles of a caregiver. Discussing advance directives with an aging parent can be very helpful. These are documents which state what kind of medical treatment the patient would not want, should they become unable to communicate their wishes. Advance directives address “life-sustaining” procedures (such as ventilators), and it is a good idea for adults of any age to have them.
Living arrangements for the elderly parent also raise some ethical concerns related to autonomy. We must respect their need for privacy, and at the same time, not allow them to become isolated. When aging parents want to remain in their own homes, there are a number of agencies and individuals who can assist, in addition to family. (See AARP Resource Kit.) When they cannot or do not want to live independently, parents are sometimes brought into the home of the adult child. This can be done quite successfully, but it should not be done without considering the toll it may take on other persons in the household. A good decision for an elderly parent can be devastating for the adult child’s spouse or children. The best option for an elderly parent must include consideration of the common good of the family.
Placing a parent in institutional care is usually the most difficult decision, which must be made. Often caregivers believe that placement represents their own failure. If the aging parent cannot live alone, even with assistance, and if caring for the parent in the adult child’s home is not medically advisable or is too costly to other family members, placing a parent in a nursing home does not constitute a failure to care. Placing a parent in a carefully selected nursing home, and caring for their emotional needs for family interaction can be one very good option.
Whatever living arrangements are made for an aging parent, adult children will want to know that their basic needs for appropriate medical attention, nutrition, exercise and stimulation are met. While it is necessary for senior adults to feel cared for, it is equally important for them to feel useful. Like Diana, senior adults are the backbone of the volunteer work force. Those who are unable to volunteer in a formal capacity will still need to engage in meaningful activity whenever possible.
The issue of autonomy runs throughout many decisions for aging parents and their children. The questions of if and when to quit driving and/or keeping one’s own financial matters in order can become a struggle. The decision to stop driving often increases the likelihood of further isolating the aging parent. The decision to turn over financial matters can be problematic for siblings and as unpleasant for the person designated to do this task as it is for the parent. All of these steps represent losses to an elderly parent and should only be taken when not doing so threatens the safety of the senior adult and/or others.
Practical Advice for Adult Children as Caregivers
Recognize and deal with your feelings. Finding a support group (formal or informal) is critical. Analyze your feelings of guilt. Distinguish between what you have control over, what only others have control over and what no one has control over. Act on what you control, and then let go of destructive thoughts and feelings about what you cannot control.
Recognize the myths for what they are. Your thinking and your behavior do not have to be controlled by myths. If you can gain some true empathy for your aging parent in his/her condition, you can probably trust your decisions. If you have regrets over the outcome of a decision, remind yourself that you made the best decision you could with the information you had at that time. Regrets often arise from information gathered after the fact.
Communicate with all family members, especially the elderly parent. It is usually easier for everyone if aging parents talk about what they are experiencing and what they want (e.g., outcomes of treatments, funeral arrangements). What often occurs is a conspiracy of silence among families facing a health crisis, with each generation trying to protect the others from unpleasant thoughts or information. If you, your parent and your siblings can talk openly and reach agreements, things are likely to feel more secure for everyone. Remember that you cannot control your siblings any more than you can control the aging of your parent.
Don’t try to go it alone. There are community resources, federal and state resources, family resources and church resources you may have not yet tapped. They can provide food, cleaning, nursing, transportation and other necessities. Remember that there are always options, and the best option does not require you to sacrifice your life to care for your parent. If you are the primary caregiver and your needs are not adequately met, you cannot adequately meet the needs of your aging parent. What our parents need most from us is our emotional support. Only we can grant that support, but we will have nothing to give if we do not also care for our own needs.
Geographical distance does not prevent you from helping your aging parent. Frequent phone calls can keep you in touch with your parents’ needs and can give them the support they need from you. AARP has many excellent publications about caring for elderly parents. One of them is a guide for long-distance caregivers. It includes a checklist of concerns, a list of services, which might be used to meet those needs, and additional reading suggestions and resources. Try to be patient and to keep a sense of humor. Practicing these virtues can be very challenging, especially if your parent has some form of mental impairment. Even without such disorders, senior adults frequently review their lives in conversation many times. Repetitive remembrances can become trying for the caregiver, but listening is important. Gently refocusing on the future can be helpful also.
Depend on God. Caring for an aging parent raises spiritual issues. You will be reminded of your own and your parent’s mortality. You may become intimately acquainted with suffering. You may struggle with what seems to be the injustice of the situation. Spiritual depth and growth is crucial in the journey of caregiving.
Hopefully, you can view this period as a pilgrimage for you and your aging parent. Some people seem to be natural caregivers. Others are not. If you are feeling stuck in this role (as if you must sacrifice your life to care for your parent), then consider other options available to you. In God’s eyes, your life is as valuable as your parent’s. You can care responsibly for your parent in a variety of ways.
Guidance, insight and assurance can be found in regular prayer and contemplation, time spent focused on scripture and fellowship with other believers who can support you.
Elaine M. Brody, “Parent Care as a Normative Family Stress,” Gerontologist, 25 (February, 1985), P26.
“Caring for an Aging Parent” is one of fourteen articles in the Getting Well: Christian Perspectives on Health, Sickness, And Ministry series. Getting Well deals with major health and biomedical issues.
The Christian Life Commission