Your mom drove you to the doctor and dentist for appointments. Your dad made sure you got your homework done. Your parents made you eat your vegetables. That was their “job.” Now, the world is upside down and it is the other way around. Now, you are the chauffeur for shopping and doctor’s appointment and more, you have to make sure dad does his homework – paying the bills and doing the tax return, and it’s payback time and you make your parents eat their vegetables. Being the responsible child for aging parents can only be called a “role reversal,” and it is a rough roller coaster ride of emotions.
Even worse, you may even have gained the enormous responsibility of serving as a healthcare surrogate, maybe even moving one or both aging parents into your home, to assisted living or a skilled nursing facility. This time of life is when you may have to make some of the hardest decisions of your life – allowing or withholding medical care. It truly is a role reversal in every sense of the phrase. Even worse, as time passes and age takes its toll, your role grows and grows – and becomes harder and harder.
This new role is hard, emotionally and spiritually. The Biblical mandate is to honor your mother and father, Exodus 20:12, and that becomes an increasing difficult responsibility as your parents become less capable. To make matters worse, sometimes they become less responsible as well, making your “job” harder still. The goal? Stay positive and you will reap the blessing of obedience and you may have a chance to help your aging parents receive the best care in the best circumstances possible.
Exodus 20:12
12 “Honor your father and your mother, so that you may live long in the land the Lord your God is giving you.
(NIV)
The Idlewild Foundation has the following recommendations which may help you recognize what is happening and allow you to help effectively.
1. Prepare
If your role is to become the parent for your aging parents, you can’t just assume that role silently. There are two areas of preparation. First, you have to convince your parents to allow you to assume that role. That will take time, frequent conversations and will require a display of your reliability in meeting the diverse and difficult roles of transporter, appointment scheduler, financial manager, adviser, counselor, and personal assistant. Second, you have to have the required legal paperwork to allow the doctors and providers to communicate with you. There are four main types of papers you need to have. They are a Living Will, a healthcare surrogate designation, a durable Power of Attorney and a HIPAA Release. They relate to each other but they play separate roles. All help you care better for your aging parents.
Living Will
A living will is a written statement setting out a person’s desires regarding their medical treatment in circumstances in which they are no longer able to express informed consent. A living will is an advance directive, an expression of your wishes for yourself for end-of-life care. It is a very technical legal document and can best be done with the assistance of a capable attorney. Florida law has technical requirements so online forms cannot be used without careful scrutiny.
A Health Care Surrogate Designation
Periods of mental incapacity are not always limited to end-of-life times. Any competent adult may designate authority to a health care surrogate to make all health care decisions during any period of incapacity. During the person’s incapacity, the health care surrogate has the duty as the circumstances require to meet and consult with appropriate health care providers.
A Durable Power of Attorney
A power of attorney is a legal document that gives someone you choose the power to act in your place. In the event you should become mentally incapacitated, you will need what are known as a “durable” power of attorney for medical care and finances. Florida law was substantially modified effective October 1, 2011. If you have given a Power of Attorney that was drafted before that date, you may wish to consider have it updated.
HIPAA Release
HIPAA is a federal law that was designed in part to protect patient privacy. At times it does that job too well and blocks even family members from communicating effectively with doctors and hospitals. Most facilities and physicians will allow full communication with a Health Care Surrogate Designation or one or more of the other documents, but in an abundance of caution, many attorneys will recommend that you also have a HIPAA Release.
For more details, see our article Documents (and Protections) Everyone At Every Age Should Have under Resources for You/Legal Documents. In our Blog we have run and are running a series of articles on Estate Planning, running from February 26, 2019 through September 2020.
2. Be Alert
Most changes as aging occurs will be gradual. Know that sudden changes in behavior typically arise from sudden problems requiring immediate attention. Confusion on Monday that wasn’t there last week might be normal, but it could also be a sign of a medical condition or event such as a mini-stroke. If your mother starts walking unsteadily and falls or becomes weak, she may have an infection (urinary tract infections are common among elderly women), medication side effect, or perhaps even a minor heart attack or stroke.
Pay careful attention to your aging parents’ abilities. Do not trust your recollection because slow changes may not be noticeable. Instead, write down or record in some fashion your parents’ capabilities and track the changes over time. This will help you identify even subtle, gradual changes. It may feel like you are keeping a diary against your parents but this is actually quite similar to their marks on a door frame showing how tall you were on certain dates or at certain ages as you were growing up – it is just in reverse.
Know what is normal for your aging parents at a particular age. Your knowledge and awareness is essential for your role as the responsible new “parent.” By informing the primary care physician thoroughly of changes, you improve the chances of an accurate diagnosis and prompt treatment.
Know the medications each aging parent takes, keep a chart and medication schedule and, if possible, you will want to keep a copy of the pill bottle labels. That way you can know how often each is to be taken. Know what the medications are for. Track the taking of medications as well since medication management becomes more and more difficult as aging occurs and memory becomes less certain. This may require you to count the pills and count back to the date the prescription was filled. There are pills boxes with up to four compartments per day but after a time, even those become difficult for the elderly to manage. There are electronic pill boxes available online that have audible and visible alarms when medications are to be taken. But they require accurate filling of the compartments on a weekly basis.
Keep a medicine chart so that each doctor knows all medicines being prescribed by all doctors. Keep track of alcohol use, caffeinated drinks, and anything that might interact or affect medicines being taken. Many things can affect the effectiveness and even safety of some medications. Does this sound like a lot? It is – and to a degree it requires that you learn a great deal about the aging process. This knowledge may help you as you age.
It is not enough to just be alert. When you see something, take the next step.
3. Investigate
Mom forgot you were coming over even though you told her yesterday? Dad forget to go to that appointment you scheduled for him? Before jumping to the conclusion, as many people do, that Alzheimer’s disease or dementia is the culprit, your parent may be experiencing a condition far more curable and far less serious: a vitamin B-12 deficiency, hypothyroidism, early stage Parkinson’s disease or even depression.
When discussing an aging parent’s decline with a physician(s), make sure you consider all the possibilities. To prepare for the appointment, make notes detailing how any decline has manifested itself; loss of appetite, failing short-term memory and so forth and how long you’ve noticed these changes. Now you can use the information that you have been keeping in that diary.
4. Be Realistic But Also Encouraging
Growing old is almost inevitable. Behaving old is not. Even worse than being old is treating others as if they are old and incapable. Instead, maintain a positive attitude. Your attitude needs to be one of encouragement, blended with tenderness and compassion.
Philippians 2:1-4
1 Therefore if you have any encouragement from being united with Christ, if any comfort from his love, if any common sharing in the Spirit, if any tenderness and compassion,
2. then make my joy complete by being like-minded, having the same love, being one in spirit and of one mind.
3. Do nothing out of selfish ambition or vain conceit.Rather, in humility value others above yourselves,
4. not looking to your own interests but each of you to the interests of the others.
And always remember, you are following in the footsteps of your parents and your children are watching how you care for them. The best life lesson is often watching a life well lived.
Take the case of an aging parent who is incontinent, a very common development. This is humiliating to someone who has raised little children and lived a life of strength and independence. As a result, your parent cuts himself or herself off from friends and maybe even withdraws from you. Depression among elderly people, especially those who have lost a spouse or have declining abilities, is all-too-common and is often not noticed or treated. Here is where you, as the compassionate encourager, become a lifesaver to a parent drowning in what feels like an ocean of neglect and decline.
5. Quality of Life Counts
Focus on what your parent or parents enjoy the most and want to do and keep doing. If it is traveling, you may have to become a traveling companion. If it is reading, a bit of training to use a Nook or Kindle or other electronic reader may make the task of locating good reading materials easier. If it is a sport or game, guess what? It may be time for you to assume that parental role of learning that new game and learning how to lose skillfully!
Never believe that old saying that “you can’t teach an old dog new tricks.” Even if you believe it, never say it or apply it to your parents. Try new activities, take them to new places, and encourage them to learn new skills. Explore the changing interests and needs of your parents in order to help them make the transition of seasons less stressful and far more pleasurable. New activities are mentally stimulating, often involve healthy physical activity and can open new interests and enjoyment of life. You may fail more often than you succeed with these efforts, but so what? Your new favorite phrase may become “You can do it!”
As abilities decline, your presence alone may become the most important part of a day or week. And the visiting grand kids become a blessing, even if they are exhausting. Be conscious of something that is true for all relationships; often it is the little things that count the most. A surprise visit, an unexpected call or card, flowers on a special day or just for no reason at all other than you love them, can make all the difference.
Preserving the dignity and expanding the world of our parents as they age is perhaps the most important thing we can offer our parents. We learned from them, and now we are giving back to them. They have earned it. Let me add that you should never forget that there is a lot of wisdom still in that elderly parent. Talk with your parents of their past, their lives and their walk with God. Do it while you still can.
Psalm 71:18
18 Even when I am old and gray,
do not forsake me, my God,
till I declare your power to the next generation,
your mighty acts to all who are to come.
Asking them about their lives, and then just listen. That will likely mean more than almost anything else you can do. It does become more about the quality of life than the quantity. Help make those last years the best years!
Psalm 92:14
14 They will still bear fruit in old age,
they will stay fresh and green, …
About the Author
John Campbell has retired from a 40 year legal practice as a trial attorney in Tampa. He has served in multiple volunteer roles at Idlewild Baptist Church in Lutz, Florida where he met Jesus. He began serving as the Executive Director of the Idlewild Foundation in 2016. He has been married to the love of his life, Mona Puckett Campbell, since 1972.