Taking Care of the Greatest Generation: Are Baby-Boomers Ready for the Challenge?
Are Baby-Boomers Ready?
By Peggy Peck
Reviewed By Charlotte Grayson
April 20, 2001 -- About a year ago, Hazel Anna Thompson, 85, discovered water seeping through the basement walls of her 80-year-old home in northern Buffalo, N.Y. She mentioned the problem to some friends at church, and one of those friends referred her to a local handyman. "A good Christian man," Hazel says. Six months and $1,500 later, Hazel still had damp basement walls and the handyman was spending time in a drug treatment facility.
In Cleveland, Ohio, 200 miles west of Buffalo, Hazel's 57-year-old son, Leon, groaned when his mother related the story to him. He and his wife resolved to once again broach the subject of "the move." The younger Thompsons, themselves the parents of three twenty-something children, want the elder Thompson to sell her two-story house and move to an assisted-living facility. "We understand that she wants to stay near her friends," says the son. "We've investigated assisted-living apartments in Buffalo and looked into facilities in our neighborhood as well."
The problem, however, is that Hazel Anna Thompson doesn't want to leave the house where she raised her two children, Leon and his sister, Ellie; she doesn't want to leave her dear friend Aggie, or the church where she has worshipped since she was a teenager.
Leon points out that one of her friends has already moved into the assisted-living complex. "In response my mother lists a number of 'problems' with housing complexes: you have to use elevators, which are dangerous; apartments are usually infested with bugs, especially cockroaches, which she couldn't stand; and the biggest objection of all is, "What would I do with all the things I have in the house?'" Meanwhile, Leon and his sister regularly confer about ways to "encourage Mom to move," he says.
Both of the younger Thompsons say they have a number of concerns about their mother living alone. "We worry that she will be taken advantage of by unscrupulous people like the handyman who was supposed to fix the basement, and we also worry about her health," says Leon.
Although generally in good health, Hazel had colorectal cancer in the 1970s. She also has a significant hearing loss in one ear, and although she has a hearing aid, she dislikes using it. In more recent years, she has also been diagnosed with a blood clotting disorder and with arthritis in both knees. "She can get around but she is a lot frailer now than she was five years ago," says Leon.
Experts tell WebMD that the Thompson family is on the right road because they have initiated some discussions about future needs. Many others have not. In fact, a recent AAPR survey shows that 67% of elderly Americans have never talked about future needs with adult children. So what's the best way to bring up the subject in your family?
Timing Is Everything
Robert Butler, MD, professor of geriatrics, Mount Sinai School of Medicine, tells WebMD that communication between adult children and parents varies greatly by region and ethnicity. "When asked about this, I always think about the remarkable nature of American society. In particular, I think about a recent trip in which we visited family in Minnesota, Oklahoma, and Washington, D.C. In Minnesota there was a totally open discussion, in this instance dealing with a 95-year-old father. In Oklahoma the discussion was more restrictive, and in Washington everyone was really uptight in terms of freedom to discuss one's plans. So I don't think there is any one uniform way to have this discussion in America." Butler was the first director of the National Institute on Aging and is currently president and CEO of the International Longevity Center, which is headquartered in New York.
Robert G. Kramer, executive director for the National Investment Center for Seniors Housing & Care Industries, says that many times these discussions can "create enormous fear. The parent is likely to worry that their quality of life will be so compromised by a move from their home that life will, literally, not be worth living." Kramer's organization has conducted several surveys dealing with aspects of planning for both medical care and assistance for elderly.
Harvey Singer, who is research director at Kramer's Baltimore-based organization, says that his latest survey of more than 1,500 adult children indicates that in most cases "discussion or decisions are postponed until a crisis occurs. Typically, it's something like Mom left the stove on for the third time and they are afraid the house will burn down."
Singer says that another difficulty with "crisis-based discussions" is that adult children say the degree of difficulty that they experience in discussing long-term care options with a parent increases in direct proportion to the severity of a parent's condition. Singer says that only "10% of the respondents who had healthy parents who moved into an assisted living facility said the discussion prior to the move was difficult or very difficult. But about a third of the adult children with parents in skilled nursing facilities -- indicating a real need for round-the-clock care -- said the discussion before the move was difficult."
Eileen Chichin, PhD, RN, co-director of the Center on Ethics at New York's Jewish Home and Hospital, says a crisis "is the worst time to making these decisions." And Chichin tells WebMD that one of the most frequent statements she hears when meeting with adult children is "My mother always made me promise not to put her in a nursing home and now I had to do it."
Chichin says, however, that in her own life it was a crisis that opened the door to discussion. Her elderly mother had early stage Alzheimer's disease and had a serious fall. "I thought, we haven't made plans," says Chichin. "So at the next holiday when we were together, we all sat down together and we filled out advance directives. All of us."
Talking Points: "Just Do It"
Butler says that the best advice is "just do it. Just talk about these issues and the sooner the discussions take place, the better." He says that in this regard doctors can be very helpful. Patients, he says, are very open to discussing not only care options such as nursing homes, but also end-of-life issues with their doctor.
Nancy Williams RN, JD, LLD, executive director of risk management at the University of Connecticut Medical Center, tells WebMD that the easiest way to initiate discussions about end-of-life decisions or future needs is to "have the discussion when everyone is at a healthy baseline." For example, she says that adult children might simply tell their parents that they are beginning some future plans for themselves. "Tell your parent, 'This is what I'm planning to do. This is what I would like done.'" She says that adult children should also tell their parents that they would like their support in those decisions. That approach, she says, opens the door for the parents to discuss what their own plans.
Butler says that if you plan to take this approach, be prepared to follow through.
Gerontologist Michael J. Salamon, PhD, and author of Home or Nursing Home, says that his research has led him to conclude that older adults tend to do better when they are in more supportive environments. For that reason he suggests that the "discussion" should be phrased in a way that addresses the older adult's concern about receiving needed care and support. Something like, "What can we do to help you? We see that you are having trouble with some tasks." Salamon says that he discourages adult children from using themselves as examples to initiate discussion. "In my own family if I started saying that I'm making some plans about nursing homes or assisted living, I would be told to cut it out," he says.
Although Butler says the best approach is to simply forge ahead, he warns that adult children will do more harm than good if they "sound too authoritative. Elderly people don't like to be told that it's time for a role reversal, that the child is now going to be making the decisions." In the best scenarios, the parent and child have forged a new relationship that includes many aspects of friendship. The child, he says, can then approach the parent as a thoughtful friend offering assistance.
Be Financially Savvy
While there is plenty of good advice about ways to initiate communication, the bottom line in many families is that the "discussion" never occurs.
Kramer says that his company's research suggests a number of factors behind the reluctance to discuss future needs. "First, a lot of people think there is no need to talk about it because they wrongly believe that Medicare will take care of it. Wrong. Wrong. Those who know Medicare doesn't pay for long-term care think that Medicaid will take care of their parents' needs. Wrong again." Medicaid, the joint federal-state program that covers some health care services for the poor, requires that its recipients be just that -- poor. That means that elderly parents will have to divest themselves of the bulk of their assets in order to qualify.
Chichin says that she, too, is often surprised by the lack of knowledge about the financial aspects of long-term care. She says that children are often shocked to learn that their parents will be billed for the cost of nursing home care.
Singer says this ignorance is particularly striking when one considers how many adult children will find themselves paying at least part of the bill for long-term care. For example, he says that his latest survey of adult children found that one in four children with a parent in an assisted living facility was paying part of the monthly costs. Kramer says that on average children were "paying about $600 of an average monthly bill of $2000.
But several experts say that as the baby-boomers -- the oldest of whom are now in their 50s -- age, this information gap may disappear. The boomers, says Kramer, are already having an impact. He says that they are behind the growth surge in assisted living communities, a boom that now has the industry saying it has overbuilt.
Kramer says, "This is the generation that looked at the Vietnam War and said, 'Hell no, we won't go.' Well, now they are looking at nursing homes and they don't like what they see. So they are saying, 'Hell no, my mom won't go to a nursing home.'"
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