Featured Articles

Founder, Jeannine Clark, frequently writes for local news papers and magazines, on Elder Care.  Below are a few of her articles.

Distance Caregiving

Have you ever heard the age-old adage,
“The cobbler’s children have no shoes”?
It is an illustration of a person whose life is dedicated to designing and
making shoes, but does not have the time or energy to make shoes for his own children.

I was recently reminded of this quote after going through the process of working with my sister on the planning of my father’s 70th birthday.  I discovered that my sister and I have some communication and processing differences when it comes to working together.

You may be wondering, how the planning of my father’s birthday relates to the cobbler?  Let me start by explaining that a large part of what I do as a geriatric care manager, is work with adult children who live out of the area, but whose parents live locally.  I act as a surrogate family member, and assist with the management of their aging parents/relative’s personal/medical care. The term used for this type of situation is, “distance caregiving”.

A long-distance caregiver is defined as a person who lives more than one hour’s travel time from the person receiving their help.   According to studies done by the National Alliance for Caregiving, and the AARP, there are approximately 34 million Americans providing care to an older family member, and out of those, about 7 million are long-distance caregivers, with 20% living one or more hours from the person they are caring for.

My parents, my sister, and her family, all still live in Texas; and I live in the Bay area.   Despite my experience in helping other families either prepare for the care of themselves, or their parents, the party planning with my sister made me realize that I hadn’t addressed this very issue in regards to my own parents.  Not only had my sister and I not discussed how we would handle our parent’s care, as they age; I hadn’t really thought about what it would be like for my sister and I to have to work together, or, whether we would even be able to work together…

Long-distance care may begin slowly with simple tasks such as listening to a problem over the telephone, or helping with household chores during a visit. It can also start suddenly in response to a medical crisis. Regardless of how care begins, the role of the long-distance caregiver is likely to evolve over time as the needs of their loved one changes.  And, can you guess what often ranks at the top of the long list of distant caregiving challenges?  Sibling issues.   Sadly, misunderstandings, differences of opinion, and hurt feelings often drive a wedge between siblings that can seem impossible to overcome and heal.  In particular, it is communication issues, and the division of labor, that comes into play when one or more of the siblings live at a distance from the parent.

Whether you are currently in the midst of figuring out your own distance caregiving issues, or have some time to be proactive to such a situation, I think this quote from one adult child caregiver, puts it perfectly –
“Don’t ever feel that you are on an island. You are never alone, there are tremendous resources available and you need to shore up your resources early on. You need the advice of physicians, nurses, social workers, financial and legal planners and clergy, and you need to pull together your entire family team. The whole situation would drive you crazy otherwise.”

Clearly long-distance caregiving presents an array of challenges, which can perplex even health care professionals like myself.  However, with thoughtful interaction between family, friends, and health care professionals in your parents area—and a willingness to accept support and intervention—it is an experience that can be managed without causing within the family.

Yes, I am in line to become one of those distance caregivers. But, thankfully, my wake-up call to this reality came in the form of a birthday party, and not in the form of a medical crisis.

I am happy to report that my sister and I did end up having a conversation about our parents.  We talked about how we would work together – and we accomplished this without any screaming or pulling of hair ( the way I recall many of our childhood discussions ending).

Return to top

Durable Power of Attorney for Health Care

As our parents age, some of us may have already been asked to act as a parent’s Power of Attorney; for other adult children, your time may be coming.  If this topic hasn’t come up yet, it is advisable that you ask your parents directly, “Do you have a Power of Attorney?” and if they do, “Who have you appointed as your power of attorney?”  You would be surprised how many people don’t realize that they have been appointed someone’s Power of Attorney.  Sometimes this news can come as a real shocker, especially if you don’t feel comfortable making such major decisions for someone, or perhaps you haven’t even spoken with the person for years…

First, for those of you not yet familiar with this subject, A Power of Attorney is a document that allows you to appoint a person or organization to handle your affairs while you’re unavailable or unable to do so. The person or organization you appoint is referred to as an “Attorney-in-Fact” or “Agent.”

People often confuse a Power of Attorney with a Living Will, or use the two interchangeably – but there is a difference between the two. A Power of Attorney is a document that allows you to appoint someone to make health care, and/or financial decisions for you if you were to become incapacitated.  A Living Will only allows you to express your wishes concerning life-sustaining procedures. These two documents can be combined.

Both Powers of Attorney and Living Wills are considered “Advance Health Care Directives”, because you’re giving instructions on what you’d want to happen in the event that you become unable to make health care decisions in the future.  These two documents are important for all adults to have, no matter your age.

The assignment of a Power of Attorney is something to take very seriously, both in appointing someone, as well as in accepting such an appointment.  When considering a person to serve as an “agent”, you want a person that can make hard medical/financial decisions without interjecting their own emotion, personal preferences into these decisions.

But, what happens when you appoint a person to be your Power of Attorney for health care, finances, or both, and they turn out to be the wrong person?  Or your agent becomes ill themselves.  Often times people assign Powers of Attorneys when they are well, and the person they appoint is also still in good health – take for example a couple.  It is common for married couples to appoint their spouse as their agent, not thinking about what would happen if their spouse becomes incapacitated.  One way to solve this problem is to appoint an alternate – which should be done anyways.  In the case of older adults, it is recommended that the alternate be someone younger than your spouse, often an adult child will be an alternate to the elder parent’s spouse.

I can’t emphasize this enough, when appointing someone as your Power of Attorney, make sure that the person you appoint, does not hold any grudges against you, and that they are mentally stable. Family history can make a huge impact on relationships.  If you are considering a family member, you need to look closely and honestly at your historical relationship with this person, and that person’s own history – both familial, as well as mental/physical health.

Changing your agent can be an easy thing to correct – you just revoke the person’s appointment, and appoint someone new – pretty simple.  The problem arises when you are sick, or your an elderly person who has developed dementia, and you are unable to understand that the person you appointed isn’t making good decisions for you, or turns out to be unfit for the role.  What happens then?

I have had the experience of working with individuals who had appointed the wrong person for the job as Power of Attorney, and it can create some major issues.  Unfortunately, in situations that involve someone already incapacitated, in order to make any changes to the Power of Attorney, you will need to seek the guidance of an attorney.

These documents, like all legal documents, need to be brought out and dusted off periodically – to make sure that they still are appropriate.  If your aging parents/relative has a power of attorney, take a moment to review it with them, and make sure that they remember who they appointed, that they still want the person, and that they do understand what this person’s role will be as their Power of Attorney.  Next, check who is the alternate, and that that person knows of their appointment and what such an appointment entails.

For more assistance, or information on this subject, the Legal Aide Society of San Mateo is a great resource.  They can be reached at (800) 381-8898 (toll-free), or http://www.legalaidsmc.org.

Return to top

Blended Families

Families, they come in all shapes and sizes…  In the course of a lifetime, a “family” can change in many different ways.   In fact, the number of variations that can make up a family is rather overwhelming, and is only further expanding.  But, to keep this down to a manageable piece, I am going to focus on only one category of family.  It is called the “blended family”.  In particular, the blended family who now is dealing with the aging of the parents that blended them.

A “blended family” is formed when two previously married adults, who each have children, marry, and join the two families together.

We all have heard the statistics of the divorce rate in the American home.  These rates have been rising since the beginning of the 20th century, and especially since the 1970s, when no-fault divorce was adopted.  Although the precise number varies depending on the source, you will find that the divorce rate for first marriages range between 42 and 49%, and then escalates to between 60 and 67% for the second marriage. With this rise in divorce and remarriage, blended families can regularly extend to as many as three and four marriages.

Blended families occur for a variety of reasons.  Today, there are many adult children who grew up in a blended family, and are now dealing with issues that can arise when the parents of these blended families begin to age, and need assistance.  In a well-adjusted blended family, there is no problem.

But what happens when a blended family has never blended?  Once the parents begin aging, and one or both of the parents need care, intense issues can arise.  So, when it comes to blended families, is there a difference in how care is provided, or regarded?

I recently met with a woman (call her Jane), who is an adult child of a blended family.  Her family blended later in life, when her father was 66, and his new wife was then 60. When the parents announced their plan for marriage, there were mixed feelings by all the adult children about the union, and whether the parents should be getting married at all, given their ages, and various other issues regarding the matter.

Before the marriage, Jane’s family consisted of Jane, and her brother and sister.  With the new marriage, an additional four adult children were added to the family.  This brought the new family to a total of 7 children, and numerous grandchildren.  That was ten years ago.

Now Jane’s father is 76, and his second wife is 70.  Jane’s father has been ill for the past three years, requiring full-time care in the home.  Because of the cost of the father’s care, and the drain on the parent’s finances, a terrible tension has been growing between the two sets of children.

It turns out that Jane’s father’s second wife came into the marriage with a substantial amount of wealth.  Her children are not pleased that Jane’s father’s care is being paid for out of the mother’s funds.  Jane’s father made a modest living before he retired, but has now almost depleted his savings to pay for his care; in addition, due to the economy, his investments have faired poorly.

Jane is shocked by her “step-siblings” behaviors and attitude.  The issue has become so heated that the “steps” have now started to seek legal counsel.  This, in turn, is creating quite a riff between the parents.

It’s a sad situation, but unfortunately, a fairly common one.  Once the parents of blended families begin to age, issues that may have been avoided, or ignored in the beginning, can no longer be ignored.

 

Some factors that can contribute to potential family conflict in blended families are:

  • the quality of the marital relationship between the aging parents
  • the financial holdings of the parents coming into the marriage
  • the length of the marriage
  • the adult children’s financial needs, their emotional stability, and the relationship between the “steps”

Few things will prepare you for the enormity of issues you may confront as you assist your aging parents.  And being part of a blended family can add an additional level of complexity to the process.  Often, in situations such as “Jane’s”, the best approach is to seek the advice of a person with no vested interest in the outcome.  An unbiased third person will be able to listen to your concerns and hopefully help the family come to some sort of resolution.

Depending on your circumstances, you may want to seek the assistance of an attorney that specializes in family law or estate planning; a family therapist; or even a mediator.  If locating these services appears difficult or daunting, you may want to start with a professional geriatric care manager; a good care manager will help you find and implement these and other appropriate services.

Return to top

Grey Divorce

Divorce – An upsetting experience for young children, but what about when it happens when you’re an adult child?  Is there any difference to the impact on the family, and on the now adult child, when parents divorce later in life?

The subject of late life divorce, or, “Gray Divorce”, as it is known within the family law profession, is slowly gaining more attention.  Why? Because according to census bureau numbers, and other studies on marriage and families, the number of older adults ending life long unions (we’re talking 40 years+ of marriage) is on an increase.

According to Andrew Cherlin, a Johns Hopkins University sociology professor who studies families, reports that divorces of couples in the 40+ years of marriage, has historically not been a common occurrence.

In 1990, the Census Bureau reported that 6.3% of all
Americans aged 65 and over were divorced. By 2002, that share had grown to 8.3%.  Statistics from the Center for Family & Marriage Research at Bowling Green University shows that the rate of divorce among those over 50 has doubled over the past 20 years, despite an overall decline in the divorce rate.

And, these numbers are expected to keep growing.  Reasons for this increase are being discussed, and some of the thoughts are: 1.) Americans on average are living much longer, beyond 80.  2.) More women are financially secure and can pursue independent lives.  3.) Aging baby boomers are still enjoying the benefits of their sexual revolution, and are not so frightened of making life changes to satisfy themselves.
In talking with adult children who have had first hand experience with this subject, there is an on-going debate as to whether the news of a parent’s divorce has any less of an emotional impact when experienced as an adult child, than as a young child.

Mary (not actual name), a 36 y.o woman, and stay at home mother of three, tells about how her mom stopped by her house one day for what she thought was her usual “grandma visit”, but instead proceeded to inform her that her father had left her.  Mary says,  “I couldn’t believe what I was hearing.  It just seemed impossible that these two people, who I had known all my life, who I never would have thought would even think of being without the other, where now talking about ending their marriage… Our family.”

There’s no doubt, that as adult child, going through the experience later in life of your parents’ divorcing, will bring its own particular traumas.  One being, that often times adult children have to weather the heartache, as they struggle with their own careers, kids, marriages, and, in some cases, breakups.

In addition, since the trend, known as gray divorce, is relatively new, the support infrastructure is less developed than it is for younger children of divorce.   Therefore, many adult children have to suffer without support.

For Mary, she says that her initial reaction was shock and sadness, but that she quickly moved into thinking, “what’s going to happen to mom if she needs care?  What about dad?  I just had always thought of them together, until death do they part…”

Mary said that she would then find herself “reverting to a child like feeling and fear of abandonment.”

When it comes to late life divorces, some of the issues center around financial security, long-term spousal support, how to maintain life long family traditions, and how to deal with the grandchildren.

For Mike (not real name), who, at the age of 64, decided to end his 43-year marriage, says that while he knew it would be hard on his adult children, he just couldn’t figure out how to deal with the grandchildren.  Mike says, “It’s been a family tradition to have our children and grandchildren come stay at our house for Christmas.  We all wake up early Christmas morning and open gifts and have breakfast.  With my wife and I divorcing, I realized that holidays would probably never be the same.”

While divorce is rarely an easy, pleasant event in life – perhaps on the upside of later life divorces, the adult child may be better equipped to handle the news, and to have a better understanding of why sometimes divorces happen.

Still, when it comes down to it, whether you’re a child or an adult child, the divorce of your parents is a difficult event.  Yet, perhaps a bit of good news is that many families have weathered this situation, and have come out of it reporting improvements in many areas of their lives/families.

Mary, whose parent’s marriage ended over 4 years ago, reports that since that initial shock, their family has actually become richer in many ways she never could have imagined, stating, “at the time, when I first heard the news of my parents’ divorce, I would never had thought our family would look the way it does now.”

Both of Mary’s parents have maintained a close connection to one another.  Mary reports how her mom recently went through a serious medical procedure, and how Mary’s dad was there for her mother, as was her father’s new wife – who happens to now be a close friend of her mother’s. “Who would have ever envisioned this?” says Mary.  “In the big picture we ended up gaining additional family and support.”

Return to top

Sandwich Generation

Odds are that many of you reading this article are either very familiar with the term “sandwich generation”, or are on the brink of becoming familiar with this term.  If you are not yet familiar with this term, you stand a pretty good chance of becoming indoctrinated sometime in the not-so-distant future.

The media has been talking about the impact that the growing aging population is going to have on our society and how, at this time, we are only just beginning to experience the effects of our fast growing aging population.  But, as the baby boom “age wave” grows, more and more adult children are going to find them selves needing to assist in the care of their aging parents.

Current reports say that 1 out of every 8 Americans aged 40 to 60, are raising children and caring for an aging parent, at the same time; thus defining the sandwich generation.  In fact, there is growing terminology just to describe the experience of caring for older relatives.

For instance, there is now the “Club Sandwich” which refers to those either in their 30’s and 40’s who are caring for young children, aging parents, and grandparents; or, those in their 50’s or 60’s that are sandwiched between aging parents, adult children, and grandchildren.  There is also the “open face sandwich”, which refers to anyone else involved in elder care.

What does this all mean?  Perhaps that we should begin taking a serious look at our own family systems, and if you haven’t already started having “the discussion”, it is probably time to start.  No, I’m not talking about the sex education discussion we all probably remember our parents giving us, and have had to now approach with our own children.  Instead, I’m talking about the discussion that none of us probably thought of having to have.  That being, “if mom or dad were to need care in their advanced age, what will that look like”?  Will they come to live with us, or, if you have sibling(s) – who will take on the primary role of caregiver?

Just as the sex education talk with our children can cause some discomfort, it is still an important topic to cover.  In the same way, having the talk about your aging relative’s long-term care needs can be a great benefit in the long run, and can help prevent some costly mishaps.

According to research by the National Care Planning Council, the government only covers about 16% of long-term care services.  The other 84% is being provided free of charge by family caregivers, or are being provided by services paid out-of-pocket by families or from those receiving care.

Bob Dole stated during his acceptance speech at the Republican National Convention in 1996: “… with all due respect, I am here to tell you, it does not take a village to raise a child. It takes a family to raise a child.” Well, I think it’s appropriate to add, that it also takes a family to care for our elderly.

Return to top