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When the Roles Are Reversed 

Baby-boomers face tough decisions when it comes to caring for aging parents.

We call it the "Sandwich Generation," middle- to late-middle-age adults trying to raise their children while also caring for aging parents. This issue of caring for the elderly has always been around, but has become more complicated over the past few decades by changing lifestyles. There are more households with two working adults, whereas in earlier generations there was someone at home to tend to the children and care for the aged. Mobility and a diverse economy have resulted in an increasing older population that does not live near their children.

Fortunately, there are more options available to those sandwiched between the rock of realizing aging parents need more care than they can provide themselves and the hard place of trying to decide whether to find in-home services or move the senior into an institution.

"It's extremely difficult to decide where to move an elderly parent," says Edward Smith, administrator at Woldenberg Village on the West Bank. "It's difficult enough when parents are making [the decision] themselves, but it's worse when the children are making it for the parents."

Woldenberg is one of only three institutions in New Orleans that provides a complete range of options for elderly care, including an independent living retirement community, assisted-living residences and a nursing home on the same property. The set-up provides a host of professional caregivers, nurses and doctors, activities and services as well as a familiar framework for seniors who need to move from one level of care to a higher one as they age.

"Nursing homes have always had a stigma, and often children feel like they've failed when they have to look at placing their mom or dad in a retirement facility," Smith says. "That's not the case. Usually it's the best place for the mother or father in terms of where the best care can be rendered."

How to care for older adults depends on their physical and mental condition, mobility and personal preferences. Some can stay in their home or move in with their children with only the help of non-medical in-home caregivers, but adult children should make certain those they hire are well trained and trustworthy. One such local operation is Home Instead Senior Care in Metairie, which provides professional caregivers who can take the elder parent shopping, prepare meals, clean the house, run errands and take the parent to doctor appointments or just provide companionship.

If in-home care is a viable solution, the National Family Caregivers Association recommends adult children conduct personal interviews with the applicant as well as contacting references and making a criminal background check. If an in-home care business is being hired, contact the Better Business Bureau to find out whether complaints have been lodged against them and why. By law, independent caregivers (those not employed through a home-care agency) must be paid minimum wage or more and the employer must contribute to Social Security as well as paying federal and state taxes. It also is a good idea to buy Worker's Compensation insurance in case the caregiver is injured on the job. Those who select an independent caregiver also must make alternative arrangements for days when that employee is sick or on vacation.

The first step, of course, is to determine what kind of care is needed and the best environment for its delivery.

"If you go to a full-service retirement campus, the staff can talk with the family and get a better idea of what level of service is most appropriate: skilled nursing care, assisted living or independent living," says Woldenberg's Smith. "If the individual needs around-the-clock professional nursing care, then in all likelihood a skilled nursing facility is the most appropriate. If the individual needs around-the-clock caregiving, but not on the level of a professional nurse, then assisted living may be the best choice. If what they need is an emergency response capability, transportation, activities or meal services, then an independent living facility may be the most appropriate."

Some of the toughest decisions come when the geriatric parent develops Alzheimer's disease or dementia, because the adult children sometimes can't deal with the fact that it's happening to their parents. "When you throw in dementia, it throws open a whole other realm of decisions," Smith says. "Very often, families don't see the symptoms or are in denial. Dementia has so many negative connotations that individuals don't want to deal with it directly and (want to) deny that it's happening to a loved one."

Even when it comes to dementia and Alzheimer's, however, there are options such as Touro Infirmary's Buckman Center and the Greenwalt Center in Kenner, an adult day care that caters to those with dementia. These and other programs at hospitals and community centers help families who want to keep their parents at home but also want them to have contact with people their own age and in similar situations.

No one facility is right for every person and families must evaluate each home or program based on the specific services their loved one needs.

"Up until 20 years or so ago, when an elderly person needed a structured environment, they were all classified as needing nursing home care," Smith says. "As people began to live longer, the young elderly began to cry out to society that not all the elderly should be treated the same in terms of what their needs are. With that, we began to see the advent of assisted living and independent living complexes.

"Different homes offer different services, so you have to look at individual facilities," he says. "Some facilities may not even have the capability to care for people with dementia."

Because people are living longer and age differently, the range of needs must be based on the individual and their particular physical and psychological needs as opposed to a chronological age.

Also in response to consumer demands, facilities for the elderly try to address all of a resident's quality-of-life issues from planning activities to stimulate them physically and mentally to helping them to remain as independent as possible.

"The personal guilt is a real problem with adult children," Smith says. "The best way to soothe adult children is to let our actions speak for themselves. Once they see their parents are flourishing in the structured environment, they're stimulated, they're interacting, then (the adult children) feel better about the decision they've had to make."

It's difficult enough to make an informed decision about caregiving when you live near an elderly relative, but the anxiety can increase when trying to make decisions for someone who lives 500 miles away. First, Smith recommends, get a Lifeline, an easy-to-use system that summons medical care with a push of a button in the event of an emergency. It also is a good idea to hire a geriatric care manager to check up on the senior, report anything relevant to family members as well as services ranging from companionship visits, running errands with them, paying bills, making doctors appointments and coordinating transportation. The manager also can let the family know when higher levels of care, monitoring and medical services are needed.

"None of the decisions are easy for a family," Smith says. "It takes a lot of thought, planning and tender loving care to get through it."

click to enlarge Some seniors can maintain an independent lifestyle with in-home caregivers who help with light chores, companionships and other needs.
  • Some seniors can maintain an independent lifestyle with in-home caregivers who help with light chores, companionships and other needs.
click to enlarge Assisted living centers allow older Americans to live alone but in a center that provides assistance with meals, medications and other tasks.
  • Assisted living centers allow older Americans to live alone but in a center that provides assistance with meals, medications and other tasks.
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