but if it is, his or her wishes should be accommodated. Studies show that people fare better when they are in a familiar environment.
If staying home is not possible due to safety or other practical considerations, what type of living arrangement would be preferred (e.g., moving in with you, assisted living, skilled nursing facilities)? (See chapter 4 for living options.) Never assume that someone would be more comfortable sharing a residence with you than considering other arrangements—always ask.
With what does the care recipient need help? And, whom would he or she prefer do those tasks?
Assessing the Level of Care
That last question can be tricky. If someone is recovering from a surgery or health event, such as a stroke, the level of care required is usually obvious. But sometimes the signs are more subtle. As mentioned, most people don’t realize how much care they actually need or are unwilling to admit how much help they require. It may stem from a fear of losing one’s independence, not wanting to impose on loved ones and “be a bother,” or simply finding it difficult to ask for help. It’s best to start with the straightforward approach and ask what he or she needs help with, but don’t rely on that answer alone. Far too often, we don’t realize how much assistance a person needs until there is an accident or health crisis. Don’t wait for your loved one to ask for help! If you suspect someone needs more assistance than he or she is indicating, you can look for some telltale signs and use them to broach the subject of more care.
Remember, the person who tries to hide an unsteady gait and refuses to use a cane or walker when needed is much more likely to fall and break a hip. By the same token, the person who is starting to forget things is a prime candidate for leaving a pan on the stove or becoming dangerously disoriented while out walking or driving. Being observant and stepping in can often prevent serious problems down the road.
Signs to Watch For
Is It Really Role Reversal?
When an adult child begins to care for their aging parent, it’s often referred to as “role reversal,” but that’s not accurate. While it’s true that you begin doing things for your parents that they once did for you as a child, the dynamics are much different. I used to jest that it was much easier caring for my 8-year-old than my 80-year-old, because my son would listen to me (well, most of the time), while my mom rarely did. I may have joked about it, but there was really nothing funny about the situation. In fact, it could be exasperating! As a parent, you have authority over your children; you can tell them what to do and have the expectation of them following your directions or be punished. That is not how it works with your aging parents! Let’s face it, your parents will always be your parents and you will always be their child, which means there is a certain amount of respect and deference that comes with these roles. In simple terms, it makes it difficult to tell them what to do. You can strongly suggest, for instance, that your mother or father use a walker to avoid an accident, but you cannot force them to do so. You can reinforce the importance of following doctor’s orders or taking medications as prescribed, and even assist with the administration, but again, you cannot order them to comply. This makes caregiving especially frustrating, because you have all of the responsibility for someone’s well-being, but none of the authority.
Similarly, many spouses caring for a husband or wife find themselves in a precarious position. Adults are not children, and even when they are unable to care for themselves, they do not want to be treated as such (would you?). Trying to force someone to do something against their will, even if your intentions are noble, will create nothing but resentment and hard feelings. Unless someone is suffering from diminished mental capacity or declared mentally incompetent, a caregiver can only do so much.
After my mom’s second hip fracture, the social worker at the hospital told me in no uncertain terms that she should not be living alone. Her tone was accusatory—in her mind, I was obviously neglecting my mom. What the social worker did not know was that I had been trying to get my mom to move in with us or consider an assisted living facility for years. In fact, I had begged, pleaded, used guilt, and in my less proud moments, resorted to threats—all to no avail. She adamantly refused to give up her independence, even after several accidents and surgeries. Was I happy about her decision? No. Was I constantly worried about her safety? Yes. Was her stubbornness slowly driving me crazy? Absolutely! But, what could I do? So, I looked that social worker in her eyes and said “I agree completely; she should not be living alone. You try telling her that!”
The social worker spent over an hour talking to my mom about why she should change her living arrangements, and when she finally left, she looked like she wanted to tear her hair out. (Welcome to my world, I thought.)
