It was December of 2015, but I remember it like it was yesterday…
Our mom was out for the evening and our dad was home alone. He always loved tinkering around the house, and he decided to hang a picture above a credenza in the living room of their condo. Doing so required climbing a 10-foot aluminum ladder. The ladder tipped over and he came crashing down, shattering his ankle in the process.
Looking back, it was what we often call a watershed event — a single occurrence that changed everything for our family.
Dad needed surgery, leading to a hospital stay, changes in his medication, and rehab. When he finally returned home, he required 24-hour care and the house had to be retrofitted with a ramp.
Over time, he got a lot better. But he never returned to the baseline of what he could do before the accident. Practically overnight, our mom went from being a wife to a full-time primary caregiver. Alyson and I had to become intimately involved in the daily coordination of his care and began our journey as adult children caregivers.
A Loss of Capacity
None of us would leave an 8-year-old home alone. Kids at this age are capable of doing all kinds of things independently, but they simply don’t have the judgement or awareness to stay safe all by themselves.
For many older adults, that same safety awareness is lacking. The difference, of course, is that unlike a child who progressively improves, the change is moving in the opposite direction. That’s a hard thing to witness in our parents, and there really isn’t much guidance or support out there to help us prepare.
Add in the fact that as children of older adults we don’t have the ability to put our foot down and declare certain activities unsafe or off limits (unlike caring for our own children), and it’s no wonder these kinds of changes in capacity can be so stressful.
Aging in Place
Most of us want to stay in our homes as long as possible. But it’s important to recognize the difference between aging in place and aging in place well.
For example, we have a client who is sharp as a tack but very frail. His wife has dementia and has delusions in the afternoons. They live at home by themselves; most days, they can manage. Recently, though, their son discovered that his dad was slowly sit-climbing up the stairs (sometimes while carrying things) to attend to his wife throughout the day.
We hear these kinds of distressing stories all the time; diminished safety awareness is a type of capacity loss that touches many older adults. And it’s not just about physical safety, either. It also relates to things like getting scammed financially, not paying bills in a timely manner, or not managing medications properly.
Whatever the specifics, if you find yourself in a constant struggle between an older adult’s insistence that they are capable, and what you are witnessing with your own eyes, a lack of safety awareness is likely what’s showing up.
What to Do
As with so many of the challenges that arise when caring for the older adults in our lives, there are no magic solutions. Here are some things, though, that will help keep your loved ones safe.
Often, there is a need to involve professionals, whether in legal, financial, medical, real estate, or other specialties. But you can’t do any of that unless the older adult has given you prior consent to act on their behalf — consent that can be hard to obtain if things start going downhill.
For example, we have a client who had stopped paying the mortgage and the bills, or even getting out of bed each day. After a fall, her income couldn’t cover the care she needed; she had to sell her house to raise the funds necessary. But she lacked the capacity to make that decision and didn’t want to go. In the end, her daughter had to go to court to obtain the legal right to make decisions for her. No family wants to go through that — it’s not simple, fast, inexpensive, or pleasant.
Hopefully, you will never need these documents. But it is better to have a plan in place and not need one than to need a plan and not have one.
In-home Safety Evaluation
Having someone like an occupational therapist perform a safety evaluation can reduce the potential risks associated with aging in place. This would include doing things such as removing throw rugs, installing grab bars in the shower, and switching out round doorknobs for levers.
Of course, none of these things take the place of proper judgement, but they can help lessen in-home risk.
If your loved ones are not local, it can be difficult to make sure they are staying safe. Neighbors can be wonderfully helpful in this regard, letting you know if things don’t seem right or if a parent has not been seen outside recently.
Many towns offer a formal version of this through the local police department in the form of an “Are You OK?” program. Here, an automated call is made daily. If nobody answers after a few tries, someone is sent to the home.
Hiring a companion to check in a couple of times a week can be helpful. Companions can take people to appointments, shopping, banking, help with meal preparation, cleaning, and just spending quality time together. Some agencies employ retired people who can better understand what it is like to be getting older.
You are not alone if you find this topic hard and uncomfortable. As Alyson and I have learned firsthand (!), your parents might be mad about losing some of their independence and that anger may very well be directed at you. Having to “parent our parents” is a new role for most of us and it requires time and patience to adjust.
But as I wrote last month, stepping up to ensure the safety and wellbeing of those who spent so much of their lives taking care of us, is the “right kind of hard.” It’s a dynamic that we all need to navigate and certainly better than doing nothing until it’s too late.
You have my support and admiration as you work through the hard choices.