Parenting And Elder Care Can Be A Tough Balancing Act

Raising kids and a family can be a handful for parents. It can be especially overwhelming when also caring for an elderly loved one as many families discover that providing care for aging relatives can be challenging. In this week’s weekly parenting segment, Host Michel Martin speaks with author and veteran geriatric specialist Marion Somers about balancing family life with elder care. Also joining the conversation is Jolene Ivey, a regular parenting contributor and mother of five who also cares for her elderly father.

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MICHEL MARTIN, host:

I'm Michel Martin and this is TELL ME MORE from NPR News.

They say it takes a village to raise a child, but maybe you just need a few moms in your corner. We visit with a diverse group of parents just about every week for their common sense and savvy parenting advice. Now, normally we focus on caring for kids. But today, we want to focus on becoming a parent to a parent. That is, caring for elderly parents who are no longer able to care for themselves.

Now, they don't call this a squeeze generation for nothing. According to the Administration on Aging, there are an estimated 40 million Americans over the age of 65. That number is projected to increase to more than 72 million by the year 2030. So, 25 percent of U.S. households are already providing care to a senior. And as we know, many people are having children later in life, so many of the people who are caring for elderly relatives are also still in the process of raising young children.

So if this is not an issue for you now, I can tell you it may very well be down the line. And I've also disclosed that this has become an issue for me. So I'm happy to have a chance to talk about this with Jolene Ivey, a TELL ME MORE parenting regular. She is caring for her elderly father at home. Also with us is Marion Somers, who's worked in geriatric care for more than 30 years. She's the author of "Elder Care Made Easier." And welcome to you both. Welcome back to you both, I should say.

Ms. JOLENE IVEY: Hey, Michel.

Ms. MARION SOMERS (Author, "Elder Care Made Easier"): Thank you, it's my pleasure.

MARTIN: Now, Marion, many people think that taking care of kids and taking care of seniors is similar, but with kids we know that they can't raise themselves, but with seniors it can be a tricky thing to determine when a parent or relative can no longer live on his or her own. So how do you go about figuring that out?

Ms. SOMERS: Very carefully. Yes they are adults and yes they may need some very definite care-giving apparatuses to help them maintain their independence. But you always have to include them in the process. You can't take over for them.

MARTIN: So the first message I think you might impart is seniors are not kids.

Ms. SOMERS: No, they're adults. And the conversation between the adult child and the older senior should always be adult to adult, no matter what stage they may be at, even if they are in early dementia or advanced dementia. There is always the basic courtesy of adult to adult and they will know if you're talking down to them in any way, shape or form.

MARTIN: And based on your experience, even when people are at advanced stages of dementia, you feel that that distinction still can be made and has to be made?

Ms. SOMERS: Yes. I feel very strongly about that. But when somebody is early dementia or advanced dementia, I also add a lot of tactile elements to it. Like, I will wear some outrageous color so that it's easier for them to focus on me. Like the color red is the last color in the eye spectrum to go. So an older person can always see the color red. So that's one of those things that I wear a lot of when I'm dealing with the elderly.

I also sit in front of them with the light shining on my face because they may not be aware of it, but by and large, they are lip reading as well as whatever else is going on with them. Also, in communicating, no matter what stage theyre at, ask one question, wait for an answer because they are a little bit slower in their processing. Theyre listening to your question. Theyre processing their answer, then they're processing their answer so that it takes a little time. It may take 60 seconds, it may take a whole minute.

And most of us are uncomfortable with silence. But silence is okay when you're dealing with an older person because you're acknowledging that they need the time and you're giving them a time that they need.

MARTIN: Jolene, let's bring you into the conversation. Your dad, who is 91, who we've actually had the pleasure of visiting with, he's talked about some of his experiences serving in the military on this program, and we appreciate that. You're also the mom to five boys. How did you come to decide that your dad would live with you? And I do want to ask, if you don't mind, was that a difficult decision for you both?

Ms. IVEY: It wasn't a difficult decision at all, for me or for my husband. We had already decided years ago that if we got to the point where any of our parents needed care, that we'd bring them in to live with us. And we set up our home that way years ago. We have a full bath with a shower and a, you know, a bar to help you up. Right on the first floor, a room that was available. So we were ready.

My dad was not so much ready. So we had to trick him into it a little bit, I have to admit.

MARTIN: How did you know? Or how is it that you came to the decision that it was time - at least you felt that it was time?

Ms. IVEY: I could see that his driving was getting more dangerous. I could see that it would be a bad idea for him to continue to be behind the wheel. He was becoming a hazard to himself and others. He would keep having these little minor accidents where some car just jumped out in front of him. Just jumped out. I thought, oh God, there's a lot of cars just jumping out in front of people these days.

So my stepmother had also been in decline and finally passed. And we'd had care for her that kind of helped him out too. But when we got to the point where she had died and he no longer had that full-time care that was available for her, I could see there was nothing else to do. He'd burn the house down. I mean he knew - he couldnt cook for himself and he couldnt go out and get the food anymore anyway. He'd be bored all day in that house for himself. So I didnt have time to drive out to where he lived at that time. I'd have to drive out three or four times a week and my life is busy. So I'd rather have him right here with me where I can see him, touch him, feed him, whatever he needs, I can do it right then but I can't drive a half an hour each way to see him.

MARTIN: You say that this was not a source of conflict in your marriage.

Ms. IVEY: Amazingly.

MARTIN: You and your husband were on the same page about this.

Ms. IVEY: Absolutely.

MARTIN: But Dr. Marion, I'm wondering if that is often the case. If you can see where that could be a major source of conflict, especially if it's unanticipated. I mean for some reason you all were able to sort of see down the road and you had a plan in place.

Dr. Marion, do you have any thoughts about that - how you can mediate that kind of situation?

Dr. SOMERS: Absolutely. One, it very rarely just happens immediately. You see it coming, the small things: they're not getting out of their pajamas, they're not answering their mail, they're not paying their bills. There are a lot of small things and the small things are really screaming, or should be screaming at you saying, pay attention. Pay attention.

Once you get to the point where you know you have to make some sort of intervention, figure out what is the best intervention that is not going to damage my relationship with my husband, damage my job, interfere with the life of my children and go through the process. And what I suggest to people is really write down on a piece of paper - two separate pieces - what is good and what can you do and what are some of the things that you dont want to get involved with? So that it becomes clear to you as the potential caregiver or the ongoing caregiver.

Because you move a parent into your home, it can very much affect your teenage kids who grandpa wants to go to bed at nine o'clock and the kids are playing, you know, video games and they want their friends over and you dont want to have those conflicts. Or there's a dog in the house. Will the dog, you know, knock the grandparent over? So all of these things, even though they seem very small, they are cumulative. So you want to go through all of these things.

Is it better to keep them at home and do safety things within the home? Putting grab bars just absolutely anywhere they may need them, not just in the bathroom. Does the lighting in the home need to be upgraded so that the 25 watt bulb that's been in that lamp for 50 years, maybe it should be a 45 or a 65 watt bulb?

MARTIN: And let me just jump in just to say, if youre just joining us, youre listening to TELL ME MORE from NPR News. It's our weekly Moms conversation. But today, were talking about the challenge of caring for elderly relatives.

I'm joined by Marion Somers, better known as Dr. Marion. She has worked in the geriatric care field for more than three decades. Also with us is our TELL ME MORE parenting regular, Jolene Ivey. And not only is she the mom of five boys, her dad - her elderly dad - also lives in her household.

You know, this is something I wanted to ask both of you about. Many families, particularly I feel I can say families of color, highly prize the multigenerational, you know, household so that can be good. On the one hand, lots of eyes, lots of hands. On the other hand, I think maybe there can be a stigma if you dont feel you can care for your parent at home. You feel immediately this cultural pressure.

I know I've had people say things to me about that and I wonder...

Ms. IVEY: Well, Michel, it really depends on your circumstances, as Dr. Marion was saying, because when my stepmother was very sick we couldnt take care of her at home, not very easily. We did have someone came in and help, you know, for periods of time but she also, she was in the hospital, she was in the nursing home, assisted living, you name it. She did it. And it was very stressful for all of us.

It just so happened that my father's situation is one where he's basically fine. I mean he would tell you he's not but he really is. He's basically fine and his biggest problem is he's a little bent over. I mean he's pretty sharp. If he gets to the point, and weve talked about this, if you get to the point I got to change your diapers I'm out.

MARTIN: Mm-hmm.

Ms. IVEY: I mean everybody's got their limits and I dont know that that's really my limit. That might not be.

MARTIN: But youre not a person who generally gives too much of a damn about how people feel about you, but some people do. And I find - I dont know if you have other siblings who have opinions, you know, too, but really Dr. Marion, I would be interested in your take on this. I mean I - part I mean, because Washington's a very international city. You often come into contact with people from all different backgrounds all around the world and some people can be quite free with their opinions I mean about well, you know, if you really cared about this person they'd be with you, that kind of thing. And some people feel a very strong cultural obligation to care for someone at home even if it isn't ideal. So I'm interested in your take on that.

Dr. SOMERS: The cultural understanding in many cultures is you take your seniors or your elders into your home, and not necessarily a relative but it could be somebody's who has been involved with the family. So there is that concept and it's a very strong concept, but we also are living in a very different time and that has to be factored in. We are living in a time when both parents are often working or youre living in smaller quarters, which would not accommodate another individual.

Also, our children are not used to that. I love it when a grandparent can move into the home, but it's not always the ideal situation and you really have to look at it is what is best for all of us, not just the senior? How can we survive? Will we survive? What are the finances involved? What are the time commitments involved? Who's going to be here to take that person to their medical appointments or their social engagements?

So there's so many factors to be considered. It's not straightforward anymore of you just move somebody into the home.

MARTIN: What's the biggest surprise or shock you think that many families have when they find themselves in the position of caring for a senior?

Dr. SOMERS: Just how time-consuming it is. How energy-consuming. How youre at work and youre thinking about oh, what are they doing at home? What's happening to them? So its a 24-hour job even if youre not with them 24 hours and the caregiver finds themselves so stressed for time and energy that they let go of their support systems. You know, they would go to their, you know, their reading club or they'd go to the gym, and they stopped doing those things because of the time constraints. And that will always have a negative effect eventually on the caregiver.

And so the caregiver must think of themselves. It's not a selfish component. You take care of yourself as a caregiver so that you can sustain this, because whatever youre involved with may go on for not just a couple of years but for a couple of decades and do you have the energy and all the resources that are involved to do this for the next 10 or 20 years?

MARTIN: The money aspect of it, speaking of resources, is a separate conversation which we are going to have in the next couple of weeks because that is a very serious issue.

Dr. SOMERS: Yes.

MARTIN: The whole question of the cost of care and I think many people misunderstand how much is covered by Medicare. For example, many people think that its covered by public funding sources and it is not. So I think that's another conversation we need to have.

But Jolene, I did want to ask you this question too about do you ever feel overwhelmed or burned out?

Ms. IVEY: Of course. Everybody does. I mean there's nothing special about me in that way. I'd say...

MARTIN: Was there a big shock for you? Was there something that was particularly surprising for you when your dad came to live with you?

Ms. IVEY: I think the big shock is that my father's always been the biggest, strongest, most competent man I've ever known and now our positions have switched. Even though, you know, of course, I'm always respectful, as Dr. Marion was describing, it's hard sometimes to realize that I really do have to tell him what to do sometimes. And he's gotten to the point where he listens to me, and that's kind of stunning too that now I'm telling my father what to do and sometimes he'll actually do it.

MARTIN: You know, what's been interesting for me is the degree to which - and I want to be careful here, because I want to respect people's privacy - but one of the things that's interesting to me is how opinions come out that were filtered before. Dr. Marion, you know what I'm talking about?

Mr. SOMERS: Yes I do.

MARTIN: It's like sometimes people become very free with their remarks in a way that youre not accustomed to and that you dont particularly agree with.

Ms. IVEY: Right.

Dr. SOMERS: It's called a social filter.

MARTIN: Yeah. And...

Dr. SOMERS: That's the real for it. And people who would not have said wow, you look terrible in that suit or that color all of the sudden will say - they will say what is ever on their mind because the social filter is now so thin or totally diminished that it's not there.

MARTIN: How about let's not talking about the color of clothing but race? I mean let's just get down to that, you know? You know what I'm saying. I mean...

Dr. SOMERS: They will say whatever is on their thought process.

Ms. IVEY: Yes.

Dr. SOMERS: There is no longer a filter, especially as they go further into early dementia or advanced dementia, the filter totally disappears and you'll see a part of their personality or their thought process that no one ever knew existed before, but we just have to accept that as this is who they are. This is who they are now for whatever the reasons.

MARTIN: Do you have any thoughts about when perhaps those points of view differ from the kinds of points of view that you would want your children to have? Dr. Marion, you have any thoughts about that?

Dr. SOMERS: I think especially when there are youngsters in the home, if you just explain to them what's happening with Grandpa, they will understand and just say this is another stage that he's going through. He has always been loving and kind. And for whatever the reasons he is going into a different state right now. But we can love him for what we know he is and that deep in his heart he loves people. And just leave it at that and not make it a major issue. Just a clear understanding that he is going into a different stage in his life.

But this also brings me to a point where seniors very often on the phone will give an enormous amount of information and there are a lot of people out there trying to get this information out of them. So now what I do is on all my seniors' phones I put do not answer. Do not give your name, address, telephone number or Social Security number out over the phone or to anybody. And I put that on every phone in the house.

I did a DVD called "Saving Our Parents," and it talks about crimes against the elderly and that is a subject that is very dear to my heart because they are a very vulnerable population and the crooks out there know it.

MARTIN: And it's not just buying stuff. Its also giving to charities, many of which they may not even agree with or support so...

Dr. SOMERS: Oh, the roster is so large that we could have a separate conversation about that for five hours.

MARTIN: Well, we are down to our last minute or so.

Dr. SOMERS: Oh.

MARTIN: So what is the next conversation we should have? Jolene, what's the next conversation you think we should have?

Ms. IVEY: Well, I have a deep concern for the cost of what it cost to keep people in a nursing home versus how much does it cost to keep them at home. It's actually cheaper to remain at home, yet the government is much more willing to foot the bill for Medicaid patients to stay in a nursing home.

Right now in Maryland, there is like a 17,000-person waiting list for this assistance. But if you wanted to go in a nursing home well, go ahead. I think that that's a problem.

Dr. SOMERS: Well, I think how to protect your senior whether they're living on their own or living within your own home, or even if they're in a facility where you think they're safe, what are the signs to look for?

MARTIN: Well those are good topics and we will try to take on them all in the coming weeks.

Marion Somers, better known as Dr. Marion, is a geriatric specialist. She's author of "Elder Care Made Easier: Doctor Marion's 10 Steps to Help You Care for an Aging Loved One." She joined us from our studios at NPR West in Culver City.

Also with us is Jolene Ivey. She's a state delegate in Maryland. She's a regular contributor to our parenting roundtable and she joined us here in our Washington, D.C. studios.

I thank you both so much for speaking to us.

Ms. IVEY: Thanks, Michele.

Dr. SOMERS: My pleasure.

(Soundbite of music)

MARTIN: And that's our program for today. Im Michel Martin and this is TELL ME MORE from NPR News. Lets talk more tomorrow.

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