95909_000_013As parents grow older, many families face choices about caring for them. These suggestions can help make the decisions easier.
Sam, age ninety, and Wanda, age eighty-eight, have been married for sixty-six years. 1 They have four children, twenty-two grandchildren, and twenty-eight great-grandchildren. Sam, who retired at age sixty-five from the auto dealership he’d managed, has been a temple ordinance worker for twenty-eight years.
Wanda and Sam served together in the temple two nights each week. Their temple service was interrupted only by an eighteen-month mission to England following Sam’s retirement. However, five years ago Wanda was diagnosed with Alzheimer’s disease; and after her condition worsened, she requested a release from her temple calling. The disease is an incurable, degenerative brain disorder that always ends in death and is the fourth largest killer of adults in the United States behind heart disease, cancer, and stroke.
Two years ago Wanda was admitted to a nursing home with a secured Alzheimer’s unit. Sam was forced to make the difficult decision to admit Wanda when her lack of control sometimes became a threat to his life. Today she cannot talk coherently. Soon she will be unable to swallow, and death likely will follow soon after. Sam faithfully visits his sweetheart of sixty-six years every day.
Recently, Sam lost his driver’s license because he has a degenerative visual disorder not uncommon in those age eighty-five and over. Twice a week, one of his coworkers at the temple drives him to and from the temple. However, Sam’s hearing, which has been deteriorating for years (he wears hearing aids), has reached the point where he can just barely hear what people say in the temple.
Sam was living alone after Wanda entered the nursing home until he invited his granddaughter Susan to move in almost six months ago with her newlywed husband, Jim. Jim was completing his studies at the nearby university, and the two helped out with the yard work, cooking, and cleaning while living in the home rent-free. But Jim and Susan recently moved to an adjacent state where Jim has found employment following his graduation.
So Sam is back to living alone again, and his children are concerned about him. He doesn’t eat his meals on a regular basis (even though he is a good cook), and he lacks the care he was accustomed to when Wanda was in the home. They are worried that he might fall while alone. Sam is in need of knee transplants because of severe arthritis, but surgeons are reluctant to perform such surgery on someone so advanced in age. Sam’s children are also concerned that in the very near future Sam might be released from his duties at the temple because of his severe hearing loss.
Sally, the youngest of Sam’s children, lives only ten minutes away and has Sam to dinner on Sundays with her family. She also maintains daily contact with him. Linda, another daughter, lives an hour’s drive from the nursing home and visits her mother at least once a week. Then she spends the afternoon and early evening with her father. She prepares a good meal for him, changes the bed linen, does the laundry, and cleans the home.
But it is apparent to Sally, Linda, and their two brothers, Sam Jr. and Tom (who live in neighboring states and visit their parents every four months or so), that their father will soon need to live with one of them to get the care he needs from those who love him. Each feels strongly that Sam needs to be an integral part of a family group where his needs can be met on a daily basis. Each has offered him a room in his or her home.
Sam resists the idea of moving. The home he lives in is the one he and Wanda built in the early years of their marriage and in which they raised their four children. Sam is a former bishop of the ward he attends. People in the ward know and love him, and he knows and loves them. Several widows are Sam’s neighbors. He wonders who would put their garbage out for pickup once a week if he moves away. The produce from his vegetable garden each summer often ends up on the tables of his neighbors, including the widows, as well as on the tables of his own children.
A New Significance to Honoring
“Honour thy father and thy mother: that thy days may be long upon the land which the Lord thy God giveth thee” (Ex. 20:12). This is one of the ten commandments given through Moses to the children of Israel as they wandered through the Sinai Desert. It is still as much a commandment today as it was when given more than three thousand years ago. However, honoring our parents takes on new significance and meaning with more people living beyond age sixty-five (the normal retirement age in many countries), who, because of physical disabilities associated with advanced age, will need part-time or full-time care from family members.
Many are honoring their parents by frequently visiting their loved ones in their homes to attend to their needs or by caring for them in their own homes when their elderly parents can no longer independently meet their own physical needs.
At the turn of the century, the average life span was age forty-seven. Today it is almost seventy-six years of age. 2 In the United States alone, over thirty million people (12 percent of the entire population) are age sixty-five or older. Only 5 percent of these people are living in a nursing home at any given time. But a much higher percentage are receiving care in their own homes or in the homes of their children. 3
In caring for loved ones and making decisions about their welfare, caregivers may find the following suggestions helpful.
1. Give them opportunities to participate actively in determining what care they need and where they will live.
Sam’s children recognize that he needs someone to live with him. They prefer that he live in one of their homes. However, Sam must be the one to make this decision. The children might meet with Sam, possibly after a pleasant and delicious meal, to lovingly discuss his current needs and how they are being met, his needs in the future, and where he should live.
Besides voicing their concerns, the children would do well to listen carefully to Sam’s reasons for wanting to stay in his own home. He has lived there for a very long time. If he moves, it means making new friends, establishing completely new routines, getting accustomed to another way of doing things, and perhaps regretting those changes. Life is very predictable for Sam right now. His children need to recognize how important it is for him to have as much independence as possible and a routine he can establish himself. Sam’s children can discuss the possible consequences of each alternative and then let him make the final decision.
Although it’s not possible in Sam’s case, it is often helpful for grown children to discuss with their aging parents possible future caregiving needs and options before those needs arise. When such needs are not imminent, discussions may be less tense, less stressful, and less one-sided; and decisions can be made with more objectivity.
2. Include them in family conversation as much as possible.
All too often we are prone to speak in the presence of our loved elders as though they weren’t present. Although hearing is one of the first senses to weaken with age, usually the elderly are not completely deaf or incapable of participating in conversation. Engaging in social conversation is an important need for the elderly, who often have much to contribute in any conversation if given the chance.
In conversing with an elderly person, we may find it necessary to speak louder than usual or to put forth more effort to ensure mutual understanding. When people speak to Sam, they should get as close as possible and make sure he can see their lips move as they speak. It’s surprising how much better we can understand someone when we can see their lips move. Showing such courtesy is essential if the aged person is not to feel ignored or excluded.
3. Adjust surroundings to suit their physical or emotional needs.
Hearing and visual losses are typical of the very elderly. Sam has a serious hearing loss and also a visual loss requiring that he read in the presence of extremely bright light. Wherever Sam decides to live, his quarters must be equipped with adequate lighting. It is also important that people speak to him as distinctly as possible and that background noises such as television or children’s voices be minimized.
Lack of balance is one of the first things older people notice as they get older. Sam’s balance, like that of any elderly person his age, is impaired. His need for knee replacements makes his balance all the more precarious, so it is important that furniture not be placed in walking areas inside the home and that rugs on vinyl floors be anchored with rubber backing. Falling is one of the greatest dangers to elderly people. Those who assist Sam or others like him who have poor balance should never grab his arm—which can cause him to lose balance and stumble—but, rather, offer an arm for him to hold, which is much safer. Bathtubs and shower stalls should have a sturdy handgrip or other safety devices to reduce the chance of accident. These are simple, relatively inexpensive things to assist Sam as he copes with his physical limitations.
If possible, Sam’s favorite furniture and personal belongings should be provided for him wherever he decides to live. As needed, other aspects of his physical environment—the decor of his room, for example—might be adjusted to suit his taste and emotional needs. An attempt can be made to serve food that Sam enjoys. Sam is a “meat and potatoes” person who does not particularly like the casseroles and “fancy new dishes” so often offered him. He prefers foods he is accustomed to.
In short, anything that can be done to match Sam’s environment with what he’s used to will help ease the emotional upset he’s likely to experience as he adjusts to a change of routine and, to a certain extent, a change of lifestyle.
4. Provide maximum independence consistent with their physical and mental condition.
One of the greatest fears of elderly people is the loss of their independence. Sam is a very independent man. The revocation of his driver’s license was for him a major loss of independence. Now he must depend on others to drive him wherever he needs to go.
If Sam decides to live with one of his children, he needs the opportunity to do all that he possibly can for himself. When family members go to the grocery store, instead of asking Sam what he would like, they could invite him to join them, just as they might request his company for drives and walks. Sam has always enjoyed gardening; perhaps he could be in charge of the family’s garden each year.
Sam probably does many things that are not exactly the way his children would do them. But they are his way of doing things. He needs support from his children as he does the things he likes to do his own way.
5. Encourage participation in family activities of daily living.
The range of daily family activities, from helping with household chores to participating in family scripture study, fills a vital human need for social interaction and a sense of stability, personal worth, and accomplishment. Sam should be invited to join with the family in celebrating birthdays and anniversaries and attending reunions, weddings, picnics, and other events.
6. Provide opportunities for involvement in Church activities and service.
Sam has attended church all his life and has every reason to continue doing the same. If he wishes to continue attending his own ward, the family should try to accommodate that desire if at all possible. If he attends church with the family he lives with, he can be encouraged to become as fully involved as possible in meetings and activities.
Sam can benefit greatly from carrying out assignments and callings, such as home teaching, that bring blessings to himself and others. He is accustomed to helping his widowed neighbors and serving in many unsung ways. If Sam moves in with one of his children, he still needs opportunities to serve.
Sam’s children can discuss with him how he might help out with needs in the ward or broader community. The whole community loses out when an elderly person of faith and ability is “turned out to pasture” by his or her own children or fellow ward members. We are all creative when given a chance. Service involves not only willingness but a certain amount of creativity. Sam may need to learn some new patterns of service, but that likely will not hinder his desire to serve wherever he lives.
As Sam and his family contemplate the care that is needed and the decisions that must be made in his behalf, they should involve the Lord. The Lord knows best of all the needs, concerns, and fears of his children, both young and old. He can lead and inspire Sam and his children to be patient, unselfish, and wise. The scriptures remind us, “Counsel with the Lord in all thy doings, and he will direct thee for good” (Alma 37:37).
As challenging as caring for our elderly loved ones can be, it is an aspect of the commandment to honor our parents that we cannot afford to neglect or overlook. Just as our parents sacrificed to bring us into the world and rear us, we naturally should be willing to return that kind of loving care. We honor our parents when we consider their needs at least as much as our own and provide for them what we would provide for ourselves. In this sanctifying service of “succor[ing] those … in need” (Mosiah 4:16) and “strengthen[ing] the feeble knees” (D&C 81:5), we emulate the unbounded compassion of the Lord Jesus Christ.
Barbara Vance, a professor of family sciences at Brigham Young University, is a nursery worker in the Pleasant View Ninth Ward, Provo Utah Sharon East Stake.
These names are fictitious, but the information concerning the people in this article is based on several case histories.
Deseret News, 17 Dec. 1994, p. A12. The figure was reported by the Center for Disease Control and Prevention.
Senate Select Committee on Aging, Aging America: Trends and Projections (Washington, D.C.: U.S. Administration on Aging, 1991), pp. 144–45.