Parenting Passages
When adult children care for their elders
by Clea Simon
“No matter how old you get, you’re still my baby.” How many of us have heard just such a line from a doting parent, or said it ourselves? But even though the underlying bond between parent and child may remain the same, everything else about this relationship is subject to change. As we age, and our parents become older still, we experience an evolution of the parent-child connection through stages that may be both rewarding and challenging.
For many of us, the years of maturity can result in a golden time of re-connecting with parents. As adults and often parents ourselves, we may rediscover our own parents as interesting, engaged grownups. Without the need to discipline or protect, ideas can be exchanged more freely. Travel can be shared, and tastes discussed. “A lot of people can be surprised and delighted to find that they can be on more equal footing with their parents,” says Nancy Costikyan, the social worker who manages Harvard’s Office of Work/Life Resources. “Really mature friendships can flourish.”
That time of equality may not be a recent development, but its current duration is. Thanks to improvements in healthcare and education, our time of competent adulthood is expanding and may last decades. “If you look at AARP The Magazine, you will see that many people are active well into later life,” says associate professor of psychiatry Robert Waldinger ’73, M.D. ’78, of Brigham and Women’s Hospital, who works with professor of psychiatry George Vaillant ’55, M.D. ’59, on the landmark, long-term, Study of Adult Development (see “The Talent for Aging Well,” March-April 2001, page 45). Waldinger interviews men who are now in their eighties. “We thought they’d be home all the time,” he says. Not so. “Some of them have tremendous difficulty scheduling time for us because they’re so busy. Many are extremely active and vibrant.”
This period may bring revelations. When one parent has died, for example, the remaining parent may be more free to forge a different kind of relationship with family members. Notes Costikyan, “Getting to know a parent after the other parent has died can be lovely.”
Even as aging begins to wear down our parents’ abilities to handle day-to-day responsibilities, options are available to help them retain a certain degree of autonomy. “In the 1970s, my grandparents came here right from their own apartments,” says Adena Geller, a social worker with Hebrew Senior Life, a multifaceted residential facility and teaching affiliate of Harvard Medical School. “There was no assisted living. Now,” she explains, noting the development of many day programs that provide care, meals, and activities for the elderly, “people can come for the day and go home at night.” Furthermore, in-home services such as Meals on Wheels, and public or private vehicular arrangements such as the Massachusetts Bay Transportation Authority’s program, The Ride, are extending the time during which older adults can remain at home. Continuing-care retirement communities and assisted-living facilities allow continued autonomy in safe settings, without requiring adult children to change their level of responsibility.
Yet for the vast majority of families, this period of equality may be limited. As we age, the probability increases that our parents will become less able to take care of themselves, and that adult children will need to assume a guardian or caregiver role. The shift may happen suddenly and directly, through a health crisis such as a stroke or heart attack, or the death or illness of a caregiver spouse may in turn throw the care of one or both parents onto an adult child. “Overnight,” says Waldinger, “a child may move into the role of caregiver for a parent who has previously been that child’s primary source of emotional and even financial support.”
In other families, the shift may be gradual, which puts its own strain on the relationship. Deborah Goode, a social worker who handles admissions at Hebrew Senior Life, describes a common dilemma. “Adult children will see that something is happening, and their struggle is always whether or not to intervene,” she says. “You respect [your parents’] autonomy, and at the same time, you are a son or a daughter and you feel a certain level of responsibility.” Common stress points, notes Costikyan, involve driving, particularly when children feel that their parents are no longer safe on the road. As we age and our ability to metabolize alcohol changes, drinking may become another source of worry or contention.
This evolution can be especially difficult if all the family members have previously enjoyed a period of adult friendship. “Children of aging parents can be deeply conflicted when they have to make decisions that are seen as intrusive,” Costikyan says. “Having conversations about these things can be really painful.”
In such cases of gradual decline, it may take a crisis—“a hip fracture or an episode of profound confusion and wandering out of the house,” says Goode—before this ambivalence is resolved. But at some point, most adult children end up assuming at least a partial caregiving role for their parents, whether coordinating medical services, providing home care, or simply driving elderly parents on errands.
Ann Bookman, Ph.D. ’77, began studying geriatric healthcare-provider teams as a project for the MIT Workplace Center, where she is executive director. But as she interviewed doctors, social workers, and other health professionals, she and coauthor Mona Harrington, LL.B. ’60, Ph.D. ’65, the center’s program director, became aware of the profound role family members play in geriatric care. Fragmentation of the healthcare system and corollaries such as shortened hospital stays have forced more responsibility onto family members, whom Bookman has dubbed a “shadow workforce.” For them, the center has recently produced the Family Caregiver Handbook: Finding Elder Care Resources in Massachusetts (www.familycaregiverhandbook.org).
Open communication can ease this transition. Adult children can ask their parents how they would like to live as their health declines. Topics such as durable powers of attorney, healthcare proxies, and financial planning may be difficult to broach because parents may resist relinquishing control. In such cases, advises Deborah Goode, be creative. Try bringing up the situations of relatives or friends who have endured declines, as a way to begin the conversation. At the very least, she says, read up on your options. “Be educated, so you’re not learning about these topics at the height of emotional crises.”
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