CHAPTER 1
CHANGING ROLES
Honor your father and your mother, so that you may live long in the land the Lord your God is giving you. — Exodus 20:12
On one of my visits to Tennessee from Colorado to visit my mother at her assisted living community the two of us started down the hall toward the dining room for dinner. Holding on to the railing that ran along one side of the wall with her right hand, my little five-foot mom reached her left hand out to grab hold of mine. "Somehow I always feel better when you're here to hold my hand," she said, as down the hall we went.
I knew that feeling well. When I was a little girl and Mom took me downtown to shop for a new Easter dress or back-to-school shoes, I felt better when she held my hand as we crossed the busy street. Going up those big, tall steps into the school where I would start kindergarten, I couldn't have made it without her hand to steady me. All my life I'd found security in reaching out for her and knowing she was there for me. Now she was saying, "Take my hand again," only it was my mom needing the reassurance, and I was the one being asked to find the courage and strength to provide it.
It's not like she was alone during the months between my visits. My two sisters were local and visited her frequently, and she was surrounded by other caregivers and friends in her assisted living community. But Mom liked knowing all three of her "chicks" were home to roost, and so holding my hand gave her a special sense of security.
To say I was pleased to take her hand is an understatement. But most of us, if we are honest with ourselves, are reluctant to accept the role transition such a simple gesture represents. We see signs of aging in our parents that startle or alarm us, but we dismiss them as momentary lapses or anomalies. After all, if we accept that we now must be the one to make the decisions and carry the load, then we are relinquishing the security we've always found in relying on our parents to do that.
Furthermore, how do we honor our fathers and mothers in this season of their lives? Do we support their wishes and desire for independence, or do we express our heartfelt concerns and insist on changes to protect their welfare? If we choose the latter, how strange that the role of caregiver and protector now becomes ours to play.
In her book Caring for Yourself While Caring for Your Aging Parents, Claire Berman writes about an encounter she had with a young man, an international lawyer, at a dinner party. It clearly illustrates how difficult and confusing such a change in roles can be. "The change in my mother has been very much on my mind of late," the young man said, "because the situation at my firm is no longer as stable as I'd like it to be, and I've been wondering whether to make a move. Many's the time I find myself instinctively reaching for the phone, wanting to talk to my mother about this, but then I stop myself because I realize that Mother's no longer able to support me in this way. I have found myself of late feeling a mixture of love and irritation toward my mother. She's eighty-four now, losing her grip on reality, and I have to be there for her instead of the other way around. The fact is, I want the mother I always had."
This loss of the parent we always had is a long process of grief and acceptance. Where's the mom with the insightful relationship advice? Who's going to fix the leak under the sink when Dad can't? We all tend to long for the parent we are already losing, and our reluctance to accept the role transition has nothing to do with our chronological age. Some of my friends lost their mothers at a young age and were involved in their care when they were only in their twenties or thirties. A special friend of my mom's was in his eighties when his mother passed away in a nursing home, but I don't think he found it any easier to say good-bye when the time came. None of them took the caregiving role lightly nor assumed it without some denial.
Regardless of how old we are when the roles change, we just wish things could stay the way they were a bit longer. We're scared. Our aging parent is scared. We don't know if we are up to the challenge. But we're sure of one thing: in the midst of so much uncertainty, holding hands is a good idea.
Generations Together
Not so long ago in America, and in some rural areas yet today, the question of who would care for Grandma or Grandpa as they aged was predetermined. The generations shared one home, and so naturally the elder person would age in place with a loving family to care for him or her.
Until she passed away when I was sixteen, my Granny Parker lived with us. Actually, my mother and father moved into her big farmhouse in Tennessee to help her take care of the place after my grandfather passed away at a young age, so it's more accurate to say we lived with her.
I don't think my parents intended to stay for long, but they did, and as our family began to grow, we gradually took over more and more of the house. It was Granny's choice to turn most of the house over to us, but she still lived with us. Of course, the benefit of this arrangement for my sisters and me was that she was always present in our lives.
My sisters and I were never uncomfortable in the company of older people because we lived with Granny. We never had a babysitter. If my parents went out, we just stayed home with Granny. On one of those evenings, Granny played the piano and coached me through the singing of two hymns so I could try out for the school chorus. Then she made me promise not to tell anyone she could still play the piano, because she didn't want to be drafted to play for church or family events! I'm in my midsixties now, and I still think of her whenever I sing "Fairest Lord Jesus" or "This Is My Father's World."
I learned a lot about aging just hanging out with Granny playing games, reading stories, or even plucking the hair that grew out of her chin for her. Daily I observed the way my mom stepped in to drive Granny to see her friends or to the doctor. I never knew that taking care of her mother-in-law was such a sacrifice on my mom's part — because she never made it seem like one. It was simply her role to fulfill.
My times alone with Granny were intimate and authentic, and many are forever etched in my memory. A special one comes to mind as if it were yesterday. My grandmother is sitting on our screened-in back porch with a big silver bowl in her lap and a big brown bag of what we call "string beans" in Tennessee on the picnic table beside her. As I watch her snap, snap, snap, I'm lulled by the rhythm of her pace and mesmerized by the sight of her gnarled old fingers as she works.
The method Granny used was second nature to her and is now second nature to me. She snapped off each end of the bean, peeled down the string, and then gave the bean two more quick snaps in rapid succession. Snap ... snap, zip ... snap, snap. That's the string bean symphony.
I wondered if the bowl fit perfectly in her lap because it was made to do so, or if her lap had just molded to the shape of the bowl over the years. Always the same bowl. Always the same kind of beans.
It was on these hot summer afternoons, helping Granny snap, that I had my best talks with her. I would occasionally ask a question, knowing it could be quite a few more snaps before I got an answer. The questions were both trivial and monumental, but the answers always seemed profound.
My grandmother died two days after suffering a stroke on her ninetieth birthday. Through the years, each time I sit down with a bag of beans to snap, I feel tremendously comforted and reassured. Snapping beans gives me a feeling of connectedness that transcends time and location. My grandmother snapped beans. My mother snapped beans and threw just enough pork salt into the water when she cooked them to give them a wonderful flavor. I snap beans, too, and try to add enough spice to add the flavor without the fat — an impossible goal.
Years ago when my then two-year-old granddaughter was visiting, I encouraged her to snap string beans with me. After snapping off each end, I handed the bean to her and asked her to break it into little pieces, never dreaming she'd be able to do so without help. Her chubby little hands tightened down on the bean and she twisted it until it snapped. "Ouch!" she said, as if the snapping noise indicated the bean had been hurt. I handed her another bean. "Ouch ... ouch!" she exclaimed as she gave it two perfect snaps.
The tears in my eyes as I watched her caught me by surprise. Now a new generation was snapping beans. Ninety-year-old, gnarled fingers ... two-year-old pink, chubby ones ... everything was connected. The strings that hold us together can be as simple and strong and purposeful as those on the beans. With a lot of "ouch" when they break.
The connections in family circles can still be this strong, but living together certainly makes the bonding occur more naturally. What happened to this comfortable blend of generations? When did it become the norm for grandparents to live alone or in a care center, often miles and miles away from their closest relatives? A look back may help us understand.
Looking Back
Although we tend to think that individuals are able to live longer now than ever before, that's not necessarily true. The average lifespan was indeed much shorter hundreds of years ago, but that is because many diseases back then had no immunizations or cures. Those in the eighteenth and nineteenth centuries who managed to avoid disease were as likely to live to a ripe old age as someone alive today. Now, however, so many more people are surviving that the cultural impacts are huge as we determine how to care for a much larger aging population.
The statistics are daunting. There are approximately 79 million Baby Boomers (born between 1946 and 1964) in the United States, if you include legal immigrants. The first of the boomers turned sixty-five in 2011. By 2030 there will be about 72.1 million persons age sixty-five and older in the United States, more than twice the number in 2000. This means that for the first time in history, seniors will outnumber children and youth.
Obviously, these statistics and others are sounding an alarm to all the providers and caregivers whom seniors will look to for help to live out their days in relatively good health and comfort. They also forewarn how our elderly parents, and we, may live out the last years of life. Many in the field say we are far from ready to meet the needs of the approaching "senior tsunami." In Colorado Springs, a nonprofit collaborative titled Innovations in Aging is working to address what are seen as key factors in getting ready for the aging wave: public transportation, isolation, health care, and low-income housing.
"We believe that creating neighborhood-based resources called iHubs (intergenerational hubs) to localize information and services to support seniors in their community will reduce transportation barriers and will increase health and safety for residents," said Beth Roalstad, executive director. Beth believes that communities "stepping up" are going to be crucial in the years to come — especially to fill in the gap for elders without family caregivers. Unfortunately, most communities have yet to address this growing need.
Historically, populations have approached aging with a combination of preparation and denial, much as we do today. During the Puritan era, roughly 1620–1700, there seemed to be a reverence for the elder saints of the church. Because only 2 percent of the Puritan society lived to the age of seventy, those who did were thought of as God's special people.
Throughout the early history of our country, the primary care for aging citizens remained with the family. Although we have many more institutions to assist us in this generation, those of you reading this book would no doubt agree that the primary responsibility still resides with the family, even if that looks different than it did years ago.
The first institutional homes for older people followed our nation's wars and were primarily established to care for veterans. After the Revolutionary War, Dr. Benjamin Rush, a personal friend of John and Abigail Adams, took up the cause. He also was the first to identify the onslaught of dementia in older adults.
After the Civil War, the industrial era in the United States developed so quickly that older people began to be left behind. Job seekers moved to industrial centers in hordes, and by 1920, more people lived in the city than in the country. In the 1920s and 1930s, social activism for the aging began in force, especially since older citizens suffered most from the Great Depression. It was into this social milieu that Frances Perkins, the first woman to be appointed to the US cabinet and serve as secretary of labor under Franklin D. Roosevelt, introduced the legislation that became the Social Security Act of 1935. A portion of that legislation was Old-Age, Survivors, and Disability Insurance. At the time of the act's adoption, the average life expectancy for men in the United States was fifty-eight to sixty years, and for women, sixty-two to sixty-four years. Benefits began at age sixty-five.
The ramifications of Social Security and the benefits established over the years since its inception are subjects for other discussions. Suffice it to say that you will learn more than you ever wanted to know about this program as you care for your aging family members. In addition, you will by necessity become educated about Medicare, created under Title XVIII of the Social Security Act and signed into law in 1965 by President Lyndon B. Johnson. Medicare was created to provide health insurance to people age sixty-five and older, regardless of income or medical history. Medicaid, added the same year under Title XIX of the Social Security Act, is the program that provides health insurance for individuals and families with low income and insufficient resources, including the elderly
All these programs deserve further study, and if you are in the midst of sorting out options and benefits for your aging parent, it's best to locate a professional to help you with the ins and outs. (See the recommended resources at the end of this book.) During the years my husband and I cared for my mom and his, I frequently thought of the elderly woman who I was sure existed in this country — the one without younger family members to make the phone calls, fill out the required forms, and navigate the choices these well-intentioned government programs provide. Such tasks can be beyond overwhelming for the average adult. They are nearly impossible for anyone with any level of dementia or confusion.
We've come a long way in terms of what we provide for our aging citizens in this country, and yet so much remains unchanged. The very old still need help getting to the bathroom. They still need help dressing for the day, and many need protection from a tendency to wander away unsupervised. Most need help making sound financial decisions or even balancing a checkbook. As much as some things change, so much doesn't. How we respond is the question. And the answers can vary from person to person, family to family. The answers you are looking for are the ones you hope and pray will be the right answers for your loved one, but it's so hard to be sure.
Moving Forward
While it's good to have the historical perspective, you are more concerned with how to get through this week without making the wrong decisions or frustrating the elderly person you love. Hopefully it's comforting to remember you aren't the first adult child to experience the angst that the change in roles creates. Regardless of how independently you have chosen to operate in your life and career till now, this is the time for collaboration, support, and the sharing of experiences and wisdom.
