Thinking about taking in an aging parent into your home ?

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The occupational therapist, Nira Rittenberg of the Baycrest Health Sciences Centre, recently wrote a Toronto Star article about considerations to be made before taking in an aging parent into one’s home.

Nira’s article disturbs me on many levels

Our society is becoming more and more self-centered, self-driven and self-motivated as typified even by this professional caregiver. The title of the article implies that rejection of taking an aging parent into one’s home is the foremost option in making that decision. This may be true, should such a consideration be the first initiative. Should the first initiative give thought about the aging parent; to give consideration as to how it can be done. Thinking in this manner results in the family having a positive goal in view and it is working toward a positive goal. The considerations which Nira suggests the family do, need to be done but her pragmatic and practical conisderations are cold, objective and seemingly without care. Her article leads one along a course of practical planning, analysis, and examination, with the inevitable conclusion for the famly being that live-in care is not a viable option. Prepare for that decision and accept. 

My difficulty with Nira’s article is one with which I am struggling with more and more: does our society today seem to jump on the self-serving bandwagon first and foremost before giving any give consideration to responsibility, integrity, ethical principles, obligations and even love.

I write from personal experience, some of it tainted with feelings of guilt and some with gratitude that family bonds, family responsibility, and family love still exist. As an only child, in the prime of my professional career when my mother needed home care, I was unable to undertake that role. Distance, time, job obligations and non-existence of work flexibility options impacted on my decision to move my mom to a home. We were blessed in that we found and were accepted into Providence Villa, an absolutely amazing retirement home. The care my mother received could be surpassed only by that given by the angels in paradise. This could be another story. But caring for my mom home was not a viable option.

On the other hand, I have a 93-year-old mother-in-law, 80% blind, nearly totally deaf, physically unable to care for herself in any way but she lives in her own home with a Mon-Fri caregiver residing with her. The work this caregiver does is supplemented with daily and frequent in-house visits and assistance by my retired wife and retired brother-in-law. The family decided for home care for a number of reasons. Firstly, the patriarch of the family, my father-in-law died at home being cared for by his wife. I will never forget being able to have a grappa with him and humming old military tunes as he reminisced in the last week of his life. He died with dignity and with as much propriety as that can be attained with one’s demise. So caring for my mother-in-law in her home was not an option. What was needed was consideration of how in-home care could be made practical and viable, the nuance of which is not implied in Nira’s article.

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Society today: uncaring? self-centered? irresponsible? Who cares?

Does our government really care about old people? Do our politicians work on their behalf? Do our pillars of society care for others? Does our society care about its older members?

Do our authority figures really give a damn?

Years ago institutional welfare was non-existent: no welfare subsidies, no unemployment assistance, no seasonal financial support, no food banks. Did we have poverty? Likely comparable to what we have today. But people felt responsible and lived that way. Our churches thrived and we supported them in their works of charity. The parish priest, the rabbi, the minister…each cared for his flock in constructive and practical ways assisted by his parishioners. Now even the parishioners are disappearing, entering retirement homes.

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Our politicians today…now here comes a mouthful…they reflect the  unprincipled value system of the society as a whole; self-centered, self-serving and interested in personal gain from the society they were elected to serve. The corruption, scandalous, misappropriation of public funds never ceases to amaze. But our law interpreters, law analysers, our great legal minds can distort the truth, bend the laws so much that the guilty are cleared of wrong doing. The judicial ‘Solomons’ do not claim their clients’ innocence, no, …instead they claim that they are ‘not guilty’ of criminal behaviour. Is our society warped? A sexually bent celebrity who admits to violent physical acts against women is found ‘not guilty’ of sexual misconduct. Something is wrong when we seem to condone behaviour which would never have been tolerated or found acceptable in any way by our parents’ generation. This is the society that will provide for our older citizens. Heaven help us all !

But this dedication of self-service permeates into the lower levels of our society, into associations and memberships of institutional groups, of organization administrations where leaders prioritize their own agenda with little consideration, if any at all, to honesty, ethical integrity or judicious principles. Institutions cheat; organizations steal; societal infrastructures exploit and is it declining? Look at our politicians; consider the presidential candidates in the United States. Watch how campaigns have become nightmares of abuse, lying, and demagoguery. 

Nira Rittenberg is intentionally uncaring or outright wrong in what she writes: deciding to home-care an aging parent is a monumental decision. However, she has slipped sideways in hopes of assisting those faced with that gut wrenching decision, one which should actually be based on “How can we take care of mom/dad at home?” This is the positively slanted view to the question, a slant that has more responsibility and love in it than does “Before taking in parent, think things through.”

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Before taking in parent, think things through

My widowed mom believes in the adage that you must “take a parent into your home as they age:” My family is not sure what to do. In or out?

This decision is very complicated and specific to each family and situation. I do know it is critical you consider all the issues involved and how they may impact on all of your lives.

A healthy relative can share in the household tasks as well as assisting with child rearing. Some families arrange a financial agreement with a parent that can offset some additional incurred costs. Consider what type of relationship you all have with the parent in the past. Yes, this may be an opportunity to start ever but if you have never gotten along don’t expect things to magically fall into place. Even if it feels like the “right move” you may end up feeling unhappy and not doing the right thing for your parent.

Her care needs are a key consideration. This includes issues such as the physical setup of your house. Accessibility, privacy and the potential need for other supports must be considered. Not everyone can, or wishes to, renovate.

You need to have a frank discussion with siblings about this, and determine if they support you. This can especially occur if mom is contributing financially to your family.

The key players, your partner and/or children, must be on board; which means having an honest discussion with them about some changes that may occur.

Yes, your home can theoretically become a lovely intergenerational family, but if your spouse or your children don’t connect with your parent this may be a challenging situation. The adjustments may affect use of space, food choices, music and social options for you all. On the flip side, taking in a parent may also be a positive experience. They bring stories, new perspectives, valuable teaching opportunities and relationship building.

The reason you likely are considering this is because your mom needs more care. The logistics and the potential toll are not always obvious if you have never helped care for an aging adult.

An important question to ask yourself first: Are you aware of mom’s full medical status and prognosis? Even a parent who is currently independent may start to need care and supervision as time goes on. This may include medical appointments and coordination of care. Siblings can pitch in, but ultimately you are likely the primary coordinator. If mom has mental health or cognitive issues, your house may need to adapt in terms of routine and care. Job flexibility (working from home) can be of help, but caregivers often report a sense of strain and difficulty if they don’t have supportive employers. Check your work flexibility option out prior the move.

Your relatives may be more isolated from their social networks in your home. Map out how much time you are all actually around. Lifelong friends and neighbour may not be available, especially if distance is involved. Community programs can fill the gap and the stimulation of your home my offer alternate enjoyment.

A live-in grandparent can enrich a family’s life, but think it through. And most importantly – be honest with all the players.

Nira Rittenberg is an occupational therapist who specializes in geriatrics and dementia care at Baycrest Health Sciences Centre and in private practice. She is co-author of Dementia: A Caregiver’s Guide, available at baycrest.org/ dacg. Email questions to caregivingwithnira@baycrest.org

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