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Reverse Parenting

What is “Reverse Parenting?” This upside-down family configuration occurs when an adult child must assume care for a parent because the parent can no longer care for himself or herself. To my way of thinking this is the hardest type of parenting on the planet.

We are living longer, often beyond the point where we can care for ourselves. We have fewer children to share in this kind of parenting so the burden is often borne by a single child. Intergenerational families who live together are very rare, and it seems as though more of us live geographically far from our parents than live close to them. All of these factors contribute to the rising numbers of grown children who need to parent the person who parented them.

Parenting a parent is a very difficult task because it is a role reversal for both parties. When a parent needs help, you walk on a narrow tightrope between allowing the parent to have autonomy even though it is no longer safe (you must accept and be able to live with the consequences) or taking away autonomy in the name of safety. A tough choice. Especially in those aging parents who are able to make their own decisions but are making unwise and dangerous decisions. I am not wise (or foolish) enough to pretend there is a one-size-fits-all solution. But ideally the children and aging parent will make this tough decision together, before it becomes necessary.

Hard to believe that a pediatrician gets questions about this issue but I do. Many questions deal with the basic and painful dilemma: how can I assure my parents’ safety without diminishing their dignity?

“I’m 65 and my mother, almost 95, who has extreme short-term memory loss and vision problems, lives 1500 miles away. My younger brother lives very near her. My mom lives alone in her own home only because my brother does virtually everything for her. He and his wife buy all her groceries, take her to doctor appointments, wash her clothes, clean her house, and bring her supper every night. My brother handles all of her finances and pays her bills and puts all of her pills into a weekly pill box. My brother is fairly well off and a wonderful, giving person. However, this tremendous responsibility is taking a toll on him and his family. Mom loves her home , is very attached to her possessions, and is proud she is “independent” (when in reality she is not). We’ve tried to talk about assisted living or at least getting in-home help but she adamantly refuses. What do you think would be a way of handling this situation so that my mom wouldn’t feel forced out of her home? My sister said that we just give her an ultimatum, ‘Either you accept outside housekeeping and nursing help or we will have to move you somewhere else.’ I am losing sleep over this and don’t know what is the best or right thing to do.”

Your brother has the “geographical burden” because he lives so close to your mother. If he or your mother can afford it, a home health aide could do the household tasks (meals, shopping, medicines) leaving him to supervise her care and do the finances. But that may not be enough. With memory loss come loss of judgment and physical frailty so that continuous help may be needed. Vision loss adds to these needs.

My mother, who lived to be 99, needed round-the-clock help for many years because physical infirmities interfered with mobility and self-care. She was cognitively intact and definitely compos mentis. She had an autocratic streak and refused to leave her home or even talk about the possibility because she wanted to be where her painting studio was. Like many of us oldies, she refused to even think about saying goodbye to the familiar.

I understand that attitude; it can be frightening to contemplate leaving a nest of many years. But remaining in one’s home has consequences. My mother outlived all her friends and could no longer paint so for many years she sat lonely and alone, except for the caregivers. Her daughters visited as often as they could but I lived 2000 miles away and was my husband’s caregiver. My sister had the geographical burden in spades and did an incredible job until she became ill herself.

My mother not only outlived her friends and the health of her younger daughter but she also outlived her resources. 15 years of round-the-clock help was generously paid for by a grandson who could afford it. Neither my sister nor I could have covered even half of the costs.

Longevity can be a special blessing or a horror depending on health and resources. Think about a person trying to live on just Social Security or a person in poor health who has no children. I once heard these referred to as “geriatric orphans.”

Children of still independent parents need to ask their parents many “What if” questions? What if one of you becomes ill? Both of you? What if neither of you can drive any longer? What if caring for the house is too difficult? The children must make themselves aware of options and eldercare services. The children and parents must be able to communicate well and be both honest and understanding. It is important to have these talks before there is a crisis, update tentative plans periodically, figure out how to share the financial costs equitably, and avoid sibling squabbles by having clear and realistic expectations. Siblings should find ways to help the one who has the geographical burden (I did all of the medical supervision of my mother long-distance and also talked to her and her caregivers every day.)

Avail yourself of community resources such as social agencies devoted to aging. (Pima Council on Aging is an excellent example, I used their services myself.) There are lawyers who specialize in the legal aspects of eldercare, care managers who can supervise an elderly parent living alone at a distance, home health care agencies that provide people to help.

If adult children recognize their parent needs help and are willing to take charge if needs be, if the family started talking about the “what-ifs” years before it was necessary, and if there are sufficient financial and community resources to make the decided-upon plan work, it is possible to provide parents with both safety and dignity.

Finally, enjoy your parent and appreciate every day together. I once asked my father when he was in his 80’s what it was like to grow old. He thought a minute and said, “Every day over 75 is pure velvet.” This taught me to appreciate my days as I grow older.