In her late eighties, my mother begins to lose her grip. Checks bounce. Bills are misplaced and go unpaid. Bottles of Grey Goose vodka appear more frequently in her recycling bin. Afraid for her safety, friends begin putting her in a cab after they finish playing bridge. Soon she is dropped from the group. Jackie is at the beginning of both vascular dementia and alcohol dementia. In the late spring of 2017, my siblings and I decide to move her against her will into Tuscan Gardens residential care facility in Venice, Florida. It’s a clever, stealthy, risky scheme. To our great surprise, it works.
Caring for my mother is like having another job. As her Power of Attorney when she became demented, I had to make decisions that I thought were in her best interests even as she fought me every step of the way. I don’t recommend applying for it, but if you are an aging child of an aged parent, the job will likely seek you out. The job posting might look like this:
The successful candidate will:
- Serve as Durable Power of Attorney
- Be of sound mind and body and reasonably competent in the midst of unreasonable circumstances
- Decide when and how much to intervene as your mother becomes compromised.
- Work with physicians and caregivers to devise safe and respectful systems of care.
- Combine respect and firmness
- Become aware that you will revert to painful patterns of emotion from your childhood.
- Manage the fear and anxiety and the resentment provoked by your mother’s rage, denial, confusion and fluctuating competency.
- Confront her when checks start to bounce, bills get misplaced, and she spends hundreds of dollars monthly on payment to nonprofit solicitations.
- Learn to make decisions about finances, driving, household maintenance and repairs, competence, home health care, residential care, long term care, etc.
- Work with your siblings to create—when possible—consensus about major decisions.
- Remember that your mother’s well-being is primary and that the way you and your siblings care for her is the model your children will have when it becomes their turn to care for you.
The above job description contains many of the core issues and challenges that sneak up and surprise aging children of old parents. We never imagine that so much of our own aging will be devoted to caring for our frail or demented or dying parents. Even though there is increasing public awareness of the aging of the aging population and its health problems, there is no training for this job, whose burden generally falls most heavily on women and especially women in families with limited financial resources.
Why so many memoirs written about caring for elderly parents? Each experience is new, filled with unique intergenerational challenges, exhausting, and confusing. When siblings are involved, there is often conflict that brings out the worst in them–unresolved fear, competition, resentment toward mother and toward each other. Some of our best writers, as well as ordinary people, find the need to write about this experience. Writing is a way of making sense of things that cannot be predicted or controlled, e.g. forms of dementia with its uncertain and relentless progression; or decisions about care of the dying for which people are not prepared and haven’t thought about in advance. Among the most memorable works I have read on this topic are: Philip Roth’s Patrimony, Roz Chast’s Why Can’t We Talk about Something More Pleasant?; and Eleanor Fuchs’, Making an Exit: A Mother-Daughter Drama with Alzheimer’s, Machine Tools, and Laughter. These vivid and powerful works take us through humor and beauty as well as the heartbreak and shame. They can help us begin to understand and prepare for these challenges on our own lives.
For readers looking into these issues, I suggest Louise Aronson’s magisterial Elderhood, the richest and most comprehensive source for understanding heathcare for, as well as broad social and historical aspects of, aging and old age. As geriatrician she shares harrowing case studies of elderly people who have been misdiagnosed or mistreated by medical professionals. She also examines the ways an ageist modern society and the medical community and its depersonalized treatment protocols continue to fail elderly patients. Along the way, Aronson also shares her own struggle to care for her aging father, who throughout his mid-seventies to his mid-eighties suffered from a heart attack, a knee replacement, cardiac bypass surgery, pneumonia, an allergic reaction, a bladder infection, orthopedic surgery, and other ailments.
My mother’s dementia has progressed to the point where she needs more help. We have moved “memory care” unit at her facility. Our family is privileged to have long-term care insurance and other resources to ensure that she will be well cared for. Things now are stable, even as my siblings and I anticipate the next stage of her decline. We have set up guidelines and directives to care for her if we are unable to there with her as she dies. Even though I think I am doing a “good job” in caring for my mother, none of it eliminates the confusion, the ongoing sadness and grief that infuses my experience of caring for her, which is far from over.
Feature image by Dominik Lange via Unsplash