Thursday, May 23, 2013

Archive for February, 2008

Hard Rain

A question I get asked a lot is how to deal with the painful loss of aging parents. As one woman put it, “it is devastating to think about and I don’t want to create undo sadness by mourning so early. If we start doing that, how can we stay positive when we’re around them? How can we keep ourselves from becoming more depressed?” Indeed, how do we avoid this “hard rain” of aging?

The short answer is we don’t. It simply hurts too much and reminds us that at the core of our journey in this life is the unavoidable issue of loss. We face it at every turn. It can undo us; it can teach us. In most cases, it does both. So I don’t have a simple answer as how to cope with this reality, but I can tell you what I have seen over the last twenty years that helps “rebalance” the experience:

1. Gratitude. How we get here is a mystery. That we get here in the care of loving people is a miracle. Take careful note of the layers of blessings that have been delivered to you through your parents. Gratitude is a “stabilizer” for you and your aging parents. It calms everyone down. It sends a heart felt signal that the journey has mattered, will always matter. When in doubt, focus on gratitude.

2. Legacy. The last phase of life is meant to review its meaning. Helping your parents with life review will surprise both of you in terms of the stories and what they mean. I prefer to dig out the “sepia” photo albums and ask “who is that?” It is amazing how the past is really only a nano-thought off stage in our hearts and mind. Our stories and their retelling define us all. Give your aging parents ample room to tell theirs.

3. Connections. Shakespeare, among others, was correct in insisting that a “sorrow shared in a sorrow halved.” We all need the company of others who are trying to figure out the same issues. This may take some looking, but it will mean more than any of us could ever imagine. It may prove to be the number on survival skill for aging in the twenty-first century.

Step-Caring

We are the generation that ushered in widespread divorce. As a result, nearly forty percent of today’s adults have experienced their parent’s divorce. Now we are trying to sort out our feelings and obligations about our step-connections to aging adults who may or may not be part of lives. This is a never-before-seen shift in our social fabric that has been made more complicated by the fact we have no clear set of expectations of stepchildren’s responsibilities. Where does this leave us?

In the short term we are going to be waist deep in one ethical dilemma after another. The overriding issue will by our “uncertain obligation” to aging adults to whom we have an uneven “step-connection.” It may be a long-divorced natural father who is old, ill and alone but has been estranged from us for decades. It may be the death of a natural parent that leaves behind a “step-parent” that we barely know or simply dislike. It may be a step-parent we have come to love as much or even more than our natural parents whose own family resent our role in their life. All of these “once removed” connections share the common genesis of arising from divorce, or in many cases multiple divorces. Despite therapy and time, divorce inflicts a permanent wound. It is a reality that complicates how and when we get involved in “step-caring.” Accept the fact that trying to sort out this new complexity of aging in the twenty-first century is going to be messy. What can make it better?

1. Don’t predict the future. Things change. In most cases you will surprise yourself at what is possible as long as you haven’t declared a ridged position you may regret but need to maintain to save face.

2. Look out for ghosts. The past does not have a delete button. Things pop up and run us over with their intensity. But we are different now, farther along, seasoned in our understanding of the cycling process for resolving life’s trauma.

3. Set limits. Heroics always takes the hero down. Be realistic with a two-edged empathy for the step parent and yourself. You may be able to help, have a part, but in most cases you are not the total answer. Believing you have to pull off a miracle only adds another layer of regret to a social enigma you did not create.

4. Stay flexible. Even kind hearts can bomb. Your good intentions may make things worse for them or for you. Follow the wise words of The Beatles: Let it be. You are operating in a non-linear universe that defies rational sequencing. The process will find its own balance.

5. Don’t do it alone. This is a network operation and you need to stay connected. Bounce your thoughts, feelings, and intentions off a friend. Listen to how you sound and to your friend’s observations. It will reduce your burden and markedly improve your choices.

A New Kind Of Leaving

Before the advent of medical technology, leaving this life was fairly straight forward, though not always pleasant. The majority of interventions centered around comfort. That’s exactly what happened to my uncle Ed.

Uncle Ed was a bigger than life Norwegian fisherman with a red beard and an infectious flare for life. But out of nowhere, his robust life was brought to an end when he was diagnosed with terminal cancer and given only a few months to live. Wisely he retreated to the sanctuary of my grandmother’s house for his final days. The news of his leaving spread quickly in their immigrant community and a procession of family and friends began. They showed up at all hours to tell stories, drink beer, laugh, cry, pray and be part of his leaving. This daily ritual continued until he died.

Then they held his wake and for three days family and friends came to my grandmother’s house at all hours and told stories, drank beer, laughed, cried, prayed and comforted each other as well as his sister, my grandmother. Even as a child, I knew that this was the way to go, how I hoped my life might end, surrounded by the comfort of family and friends.

But leaving is not what it use to be given the reality of medical technology. A new metaphor has captured our focus and muddied our decisions about our aging parent’s final exit not to mention our own. Leaving has been usurped by lasting.

This shift in the balance of power at the end of life carries enormous consequences for adult children and their aging parents. Already feeling guilty about not doing enough, adult children are now confronted with a medical technology that haunts them with the question “is this where you stop?” Lasting has become the new benchmark for our collective efforts to fight the good fight. No one wants to let anyone down. While medicine is in the business of preserving life, no one really knows, amid machines, drugs, and heroic procedures that suspend leaving, when we have had enough.

This not a dilemma any of us can unwind; our generation owns it. But we can reframe how we think about the technology option to keep from being unfairly biased towards lasting at all costs. While the question of lasting, to what degree and at what cost, is vital to the discussion, an equally compelling question is “what is quality of the leaving?” This query reminds us that the final act is not just a battle against biology to extract more time, but a profound reconsideration of the entire journey. In leaving lies potentially the most important insights and conversations of a life time. As such, the question provides us a much needed counterbalance in the struggle to determine what is enough. It reduces the need for technological heroics to prove anything and champions low-tech conversations from the heart.

This is what uncle Ed’s passing taught me. It was the same lesson I was to learn years later in my medical career: cure when possible…comfort always. At middle age it becomes all to clear that there is no cure for leaving, and that the comfort of family and friends is what means the most to all of us.

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No Money: No Comment

I was recently asked what to do about aging parents who had little or no savings but refused to discuss any aspect of their “money issue.” It reminded me that our role as adult children is not necessarily about problem solving; it is about compassionate containment. So many of the issues we feel compelled to “fix” have no clear answers. The best we can do is sort out what to accept from what we can actually change. Here was the advice I offered:

The issue of money, like so many other issues in the last phase of life, is about control. The best way to approach it is to reframe money as means of maintaining control. Lack of money takes away control. This link will take you to an article I authored on “communicating touch choices” that offers a practical strategy for how to do this:http://www.aging.org/i4a/pages/index.cfm?pageid=2103&textonly=1

You may also want to consider three strategies that will help you “hedge” your parent’s financial risk:

1. Buy a long term care policy with a two years home care/two years nursing home benefit. This assumes they will cooperative with the process (i.e. signing the applications and answering questions).

2. Start funding a dedicated “side fund” for expenses that a long term care policy will not cover.

3. If you parents own their home, become familiar with how “reverse mortgages work and when they make sense.

Lastly, you need to began discussions with local area agencies on aging to determine what, if any, community resources can assist your parents if they run out of money.

This is a tough end-game, especially if you parents don’t want to talk about. The article will help you frame your conversations. Be patient but persistent in your discussions about control and your desire to help them maintain it.