The sandwich generation. We have heard that term and know what it means, but we never really understand the impact of that label until we’re part of it. As adult children, we may not fully comprehend the extent to which our parents’ aging will affect them or how it will affect us. But aging is a fact of life and it affects all families. If our parents are already seniors and in good health, living independently, we may not feel any significant changes or develop any significant concerns. However, the time does eventually come when the effects of their aging become more evident and supportive care may be needed.
During the aging process, our parents may experience an overall decline in physical and/or mental vitality, resulting in visible and functional changes to their appearance, standards of living, cognitive abilities, physical endurance, and emotional well-being. The more aware we are of how aging can affect them, and what options are available to them as seniors and to us as caring adult children, the better for all of us. The good news is that we do not have to face these challenges on our own, as there are plenty of support systems and resources that can help us along the journey.
There are other compounding health issues that have the potential to affect one’s independence as one ages. Examples of some of these challenging issues include:
- The onset of dementia or other cognitive impairment
- Neurological diseases, such as Multiple Sclerosis or Parkinson’s Disease
- Hearing loss or visual impairment
- Chronic illnesses, such as diabetes or heart disease
- Suffering a sudden stroke
- Injuries from falls or other accidents
- Physical functional disabilities
Falls, in particular, are dangerous in the elderly, but they’re also highly preventable. According to the Centre for Disease Control, 36 million adults over the age of 65 fall annually, resulting in over 32 thousand deaths. Furthermore, one in five falls causes injury, including broken bones and head injuries.
It is difficult to plan ahead for this transitional aging process because we just don’t always know, or want to know, what to expect. A great way to start is to take inventory of current health states, taking into consideration a parent’s emotional, mental, and physical well-being.
Activities of Daily Living (known as ADLs)
These are the tasks needed to ensure the dignity and physical and emotional well-being of our elderly parents; the tasks needed to meet their daily living requirements. If there is impaired mobility and/or health issues that make it difficult or impossible for them to achieve these ADLs independently, then you will need to engage the required assistance, whether from a care provider or from the use of supportive equipment. The basic ADL activities are typically listed as:
- Functional Mobility (able to transfer oneself, such as in/out of bed or a chair)
- Bathing or Showering
- Personal Hygiene (brushing/styling hair, shaving, grooming, dental care)
- Toileting (access to the toilet, self-cleaning, transferring on/off the toilet
Instrumental Activities of Daily Living (known as IADLs)
These are the tasks of daily living that are not considered fundamental but are related to independent functioning. Again, it is important to the overall well-being of elderly parents that their IADLs are taken care of effectively and consistently. IADLs most often refer to the following types of activities:
- Meal Preparation
- Cleaning and Maintaining the Home
- Running Errands
- Managing Money and Paying Bills
- Use of the Phone or other devices for Communication
- Managing Medications
It is important to look at what our parents call ‘home’ and discuss with them if it is the best and safest place for them to continue to age. There are lifestyle and financial issues to consider, but also safety and socialization issues that are important too. This can be a stressful, but very necessary, conversation as we work together to provide the best care possible for our parents. Some living options include:
- Aging in Place – Independent living and aging in their own home. Not surprisingly, this is the first choice of most seniors.
- Living with Family – multigenerational residences are often beneficial from a financial, safety, and companionship standpoint.
- Independent Living (IL) Communities – Independent living in a rental or purchased home within a community with other seniors and with shared amenities such as gyms, clubhouse, housekeeping, security, maintenance, laundry, meals.
- Assisted Living (AL) Communities – Relatively independent living but our parents may need some assistance with their ADLs or IADLs and they can get it here from qualified caregivers on staff.
- Skilled Nursing Facilities (SNFs) – a living environment with medical observation, 24-hour nursing staff, and professional caregiving, usually indicated for chronic conditions or short-term rehabilitation.
Assistance and Caregiving
Regardless of the living arrangements deemed best for our parents, there are a number of ways in which to further assist them in their daily lives; support that can be provided wherever they call home. Some of these are financially provided through insurance or government agencies, others are only available through private payment arrangements.
- Companion Care – companionship, meal preparation, socialization, errands, light housekeeping
- Personal Care – hands-on care with ADLs from a qualified provider including medication reminders and the companion care activities
- Skilled Nursing Care – nursing care to include wound care, medication management, medical oversight
- Skilled Therapies – Physical/Occupational/Speech Therapies
- Home and Access Modification – installing shower bars, ADA compliant ramps and stairs, non-skid floors, light sensors for nighttime movement, etc.
- Durable Medical Equipment (DME) – walkers, canes, raised toilet seats, bedside commodes, etc.
- Wearables for Fall Detection and Standby Assistance – discreet wearables that are non-stigmatizing, encouraging our parents to wear them around the clock, can provide intelligent fall detection as well as provide standby assistance for medication reminders and as a way to get emergency help. These give our parents, wherever they live, the added assurance that they can get help or support when needed as they live their best lives possible.
There are financial implications that need to be considered when making the necessary changes and choices that we need to support the well-being of our aging parents. They may be eligible to receive financial support from government programs to offset their living expenses, but it takes some time and effort to investigate these options. They may also need some assistance in managing their finances and retirement funds and estate planning. Consider hiring a professional financial planner, especially one with “eldercare” as part of their offering, to review their current financial state and work with us and our parents to create a plan for the future.
Further, if we become a primary caregiver, we may be eligible to get some tax relief by claiming an elderly parent as a dependent or deducting medical expenses. There are various federal, state and/or independent groups that provide free tax assistance to seniors that can be further investigated.
Education and Resources
The official benefits website of the US Government, Benefits.gov has information on over 1000 benefit and assistance programs covering health, disability, income, wealth/owned property: https://www.benefits.gov/
Area Agency on Aging is a federally mandated agency in your county or city that is staffed by professionals that know every senior program, service, and funding in your area. It’s a great starting point to gather information: https://www.n4a.org/
The National Council on Aging is the nation’s most comprehensive web-based service where you can search benefits and programs for seniors with limited income and resources: https://www.benefitscheckup.org/
As adult children, we now find ourselves in a position of being as committed and devoted to our parents’ well-being as they have been for us all of our lives. It’s a strange changing of the guard, and few of us are ever really prepared for the process, but it shouldn’t be a burden or responsibility to bear alone. There is support, and hopefully, this article provides some ideas and information on where to start planning for the inevitable. The take-away should be that there are many choices and options available to allow our parents to age well and happily.
Cheri McEssy is a Nurse Executive and former owner of BrightStar Care of Chicago. She has extensive healthcare knowledge and experience, both clinically and in the senior care space.