Ticklish Times

By Francine Russo

Three years ago, the personnel director of a New York City bank began to notice that things weren't quite right at her 85-year-old mother's home in Connecticut. "The house was in total disarray," she recalls. "There were piles of unopened mail stuffed everywhere, with bills months old and unpaid. But she was writing checks to buy magazines and knickknacks to enter sweepstakes."

The woman begged her mother to clean up the house and talk about her money situation. Nothing doing--until a year later, when the older woman learned she had cancer. With some urging, she agreed to move to a supported-living condo in New York, and her family found out that she had $20,000 in credit-card debt that she couldn't explain. Helping her was a struggle. "Mom's mostly competent, but not fully," says her daughter, 47. "She's very independent and stubborn and insists on doing a lot for herself."

Families everywhere will recognize the dilemma. How can children help and protect their parents yet respect their autonomy? What if the parents resist help when the children think they are in trouble? How do the children know when to step in, when to step back? The answers involve a renegotiation of parent-child roles that's happening in almost every family, especially with today's elders living longer than the generation before them.

"Often this comes with an epiphany: 'Oh, my God, Dad's getting old,'" says University of Southern California sociologist Vern Bengtson. A small event, like superorganized Mom losing her checkbook, may be the trigger. Or the recognition of parental decline may dawn gradually. Some offspring fight off the reality until a crisis hits, while others fret and nag long before their parents need any help. Many folks, Bengston points out, enter old age relatively healthy, still helping their kids with baby-sitting and financial support, but their offspring may overreact to small, normal signs of their parents' aging.

"Studies show that the height of death anxiety occurs in people's 40s and 50s," notes Karen Fingerman, a gerontologist at Penn State. "When you begin to calculate how many years you have left, it makes your parents' aging even more evident." In a study she conducted of 2,000 middle-aged daughters and healthy, aging mothers, she found that the daughters were more worried than necessary, often to the annoyance of their mothers. To help their parents, Fingerman urges, "kids need to confront their own emotions. Recognize that you're not just worried about your parent; you're worried about losing your parent, which is your worry."

The key is whether something is objectively wrong that requires an intervention--not always an easy call. Experts suggest watching for changes in behavior, especially sudden ones. Has a formerly sociable mom become taciturn and isolated? Does Dad suddenly find paying the bills stressful? Does he have trouble seeing when he drives at night? Have there been serious lapses of memory or judgment, a pot left unattended on the stove, a large check written to a con artist?

The Slocums, a family in the Washington area, have re-evaluated their 95-year-old mother's needs and renegotiated their roles since she was widowed 15 years ago. "Most things that happened, she became aware of when we did," reports her son Glenn, 60, a private consultant on African development issues. When the mother could get around only with a walker and the family felt she shouldn't live alone, a friend's trusted caretaker became available. When the Slocums grew concerned about her driving at age 85, they would probe gently, "Mom, are you still comfortable driving?" She would reply that she drove only to the grocery store, church and her women's groups. "It went in stages," recalls Slocum, "until she finally gave it up herself, which she hated to do."

Help with financial matters came next. Two years ago, Slocum found out his mother had been swindled by a door-to-door contractor: "I said, 'You paid $4,700 for that yard work?' She started crying." Slocum adopted a gentler tone and persuaded her to let him read all future contracts first. Throughout, her family has respected her independence, she says. She lets Slocum review her checking account, but not without some discomfort. They are worried about her fixed income, and she wants to buy birthday presents for her grandchildren and great-grands. "I half-listen," she says, "and I do pretty much what I want."

Even family members who live farther away from a parent can check in frequently. "Just a twice-weekly contact by phone or even e-mail can make a huge difference," says Margo Hamilton of Curtailing Abuses Related to the Elderly, in Riverside County, Calif. She has seen cases of caretakers of the elderly cheating them financially and even abusing them physically. Abusers succeed, she says, when they can isolate the parent. Kids who are alert and in touch can head off problems.

But having children nearby or in close contact doesn't guarantee that a parent will cooperate in his or her care. Take the case of the New York personnel director. After her mother moved to the nearby retirement condo, she became ill and needed 24-hour home care for a time. Her daughter found the perfect aide, but when the older woman felt stronger, "Mom took out all her frustration on the aide. She was mad that she needed help with things." There was no reasoning with her, so the daughter replaced the aide with someone to help her mom shower and do housework for an hour each day. "Mom wouldn't let her do anything. I had to fire her too."

Finally, the daughter used a tested tactic in such parent-child standoffs: bring in a trusted third party--a sibling, friend, doctor, lawyer or priest--to speak with the balky parent. In this case the daughter asked the facility's doctor to help. He told the sick woman that the facility had to send someone every day to supervise her medication; otherwise it would feel obliged to move her to its assisted-living section. "It was put to her as a choice," her daughter explains. "Finally she agreed."

It's important to pick your battles, the daughter has learned. "If my mother chooses to live with piles of mail everywhere--if she sleeps on top of her bed instead of in her bed--it's still her decision. As long as it's not unsafe, I let go of it." It's critical to make the parent feel in charge, she says, but it's much more work. "And it's psychologically draining."

But if a parent has dementia, doesn't that justify a child's taking full control? Not necessarily, says Dr. Juergen Bludau, medical director of the Joseph L. Morse Geriatric Center in West Palm Beach, Fla. A parent is still entitled to as much autonomy as is safe, says Dr. Bludau. For example, if a mother with early or middle-stage Alzheimer's still drives, he says, urge her to limit her exposure--avoiding highways or rush-hour driving, for example. Later on, some white lies may work, like taking the battery out of the car and pretending that there's no money to fix it. In some states a physician and child can notify the motor-vehicle department, which will call the parent in for a driving test. Only as a last resort should the family wrest the keys away from a parent.

The term role reversal is frequently used about adult children and infirm parents. No question: dependency shifts. Some children help parents with everything from housekeeping to daily physical care. But parents keep a parental role, Fingerman maintains, and being aware of this can ease resentment. "Your parents are still more interested in the minutiae of your life than anyone else," she points out. "They still give you love. What you do for them may have changed, but you are their kid, and you will always be their kid."