The Care Conundrum

Think you’re ready to deal with your senior parent’s needs? Trust us, you’re not.

The care conundrum - YAM Magazine City Issue - May/Jun 2023

BY JOANNE SASVARI

Not so long ago, my friends and I would sit around chatting about our relationships, or our jobs, or our travels. These days, all we talk about is our aging parents, about long-term care versus assisted living, about the medications they are on, about trusts and POAs, about dementia and hip fractures, and all the other realities of caring for seniors.

Everyone I know, it seems, is going through some variation of this. You almost certainly will, too, if you haven’t already. And even if you think you’re prepared, you really aren’t. 

One friend, who’s a lawyer and whose brother is an actual rocket scientist, is still struggling to untangle his parents’ estate months after they died. Others have found themselves fighting with their siblings and their spouses and yelling at parents who refuse to leave family homes that are no longer safe. “We’ve never recovered,” says a friend whose siblings are barely talking these days. “And,” her husband says sadly, “they used to be like the Waltons.”

Caring for our senior parents is so all-consuming, my friends and I have found ourselves giving up our holidays, missing social engagements, sacrificing our jobs and ignoring our own health and emotional needs. Before that happens to you, here’s what we learned.

The Call

Last August, early on the Sunday morning of the long weekend, I got a call from my mom. She was in pain and couldn’t get out of bed. Could I come help?

And so it began.

Mom is fiercely independent. “Spiky,” her neighbour calls her, admiringly. “Quite the individual,” says her hospital nurse. “Inspirational,” her doctor says, adding, “I hope I’m like her when I get to that age.” Not surprisingly, mom was determined (“will of iron,” my sister and I would mutter to each other) to keep living on her own, which was great, until it really, really wasn’t.

That first day, we waited eight hours for an ambulance to take her to St. Paul’s Hospital in Vancouver, where she was surrounded by people overdosing on opioids. (Don’t, whatever you do, get sick or injured midway through a long weekend.) The people working there are absolute heroes, but it was not the ideal place for a senior with a pelvic fracture.

That was just the beginning of months in and out of hospital, then setting up home care and trying to find residential care, of dealing with banks and lawyers and her strata council, and of waking up in dread every day, waiting for the next emergency, because it always, always arrived, and just at the worst possible time.

The care conundrum - YAM Magazine City Issue - May/Jun 2023
Photo By: Michela Ravasio/Stocksy.

The Health Stuff

If you find yourself stepping in to help your parents, it’s almost inevitably because of a health crisis. That could mean something catastrophic like a heart attack or a fall resulting in a broken hip. Or it could mean something chronic, like dementia. Or it could be both. Several of my friends are in the tragic situation where the healthier parent died after a sudden stroke or heart attack, leaving the frailer one struggling on their own.

In any case, when the crisis comes, your parent will often still be in a family home that is poorly designed for their new needs.

And so you will find yourself whisking away rugs they can trip over, installing grab bars in the bathrooms and swapping out door knobs for levers. You’ll be contacting the Canadian Red Cross for walkers and wheelchairs, seating in the shower and railings for the bed. You’ll get a medical alert device that will contact the paramedics if your parent falls. (And you will only be slightly annoyed when they never wear it.)

You will also find yourself responsible for their medications, for keeping a list of what they are taking, for monitoring allergies and adverse reactions. You will be shocked by how many pills they are on and horrified when you clean up later to find jars and jars of extra meds hidden all over their home.

You will put your parents on every wait list you can find for residential care, but, in the meantime, you will have to set up home support. At some point, you may find yourself crying with the frustration of dealing with a complex public bureaucracy that is understaffed and not always great at communication, or weeping at the cost of private home care. Or maybe you’ll be laughing in disbelief. Keeping your sense of humour isn’t easy, but it is helpful — after all, they say laughter is the best medicine.

The Legal and Financial Stuff

Even as you’re dealing with the urgent medical and safety issues, you will also find yourself juggling financial and legal ones. After all, your parents’ bills still need to be paid and taxes filed. But if things aren’t set up so you can access bank accounts, lines of credit and investment funds, you can find yourself in a very bad financial situation indeed. 

If you can, have those conversations about finances well before you need them because there is nothing like money to cause conflict. And that’s the last thing you need when you are already in the middle of an emotional crisis. 

Gather essential information like personal health and social insurance numbers, COVID vaccine records and doctors’ contact information, and keep it easily accessible but secure from fraudsters and identity theft.

Make sure your parents’ wills are up to date. Make sure you have signed powers of attorney, and know who the executors are. Make sure you know what your parents’ wishes are if they are incapacitated or if they die, and make sure everything is written down, witnessed, signed and stored somewhere you can find it. 

And whether you are dealing with home care or a residential situation, prepare to sign lots and lots and lots of other legal documents. 

Chances are you will also find yourself responsible for selling their home, for packing their things, decluttering decades of possessions and cleaning out the fridge. Brace yourself for a whole other layer of time, paperwork and emotional turmoil. 

The Emotional Stuff

“The worst thing,” a friend said the other day over brunch, “wasn’t even all the bureaucracy, though that was bad enough. It was fighting with my siblings, resenting my parents for making us go through all of this, and feeling guilty all the time. It was awful.”

Oh, yes.

Caring for senior parents drags you through the whole emotional gamut of grief, love, loss, anxiety, frustration, resentment and anger. Dealing with the bureaucracy of aging takes time and energy that you cannot spend on your job, your family, your friends or taking care of yourself. And you know all those unresolved childhood issues? Well, plan to face them full on now.

The care conundrum - YAM Magazine City Issue - May/Jun 2023
Photo By: Michela Ravasio/Stocksy.

In our case, by the time we finally got everything set up in Vancouver, Mom decided to move to Victoria, where my sister and I both live. We were vastly relieved, and we have, I am happy to say, found her a place in private long-term care. Everyone has been so kind and compassionate, it’s given us great peace of mind. Still, the stress has been enormous, and we know there is still more to come. 

My best advice? Plan as much as you can ahead of time. Get informed and have some honest conversations with your folks and with your siblings. Gather as much information as possible so it’s ready when you need it. Be forgiving of your family and yourself.

And remember: One day, if all goes well, we’ll be the ones who need care, too.

At some point, you will almost certainly find yourself crying at the frustration of dealing with a public bureaucracy that is understaffed and not always great at communication.

Care vs Care

Home Care

Public system: Many costs are covered by the government. Services include nursing, personal care, physical therapy and occupational therapy. However, there are long wait lists and challenging hoops to jump through, and staffing shortages mean carers have limited time and unpredictable schedules.

Private care: Easier to set up, but if you don’t have time to shop around, can be surprisingly expensive. Private home-care services are often limited in what they can do — for instance, they may not be able to change bandages or give medication.

Residential Care

Public seniors’ housing is available — and priced — based on need, with the government picking up at least some of the cost. Wait lists are long and the application process cumbersome. Private seniors’ homes also have wait lists, but they are often much shorter; however, government does not pay for these, and the costs can be significant.

The care conundrum - YAM Magazine City Issue - May/Jun 2023
Photo By: Michela Ravasio/Stocksy.

There are three levels of residential care, and some properties allow seniors to transition from one to the other.

•  Independent living: For those 55-plus who are able to enjoy an active lifestyle. These communities typically take care of domestic details like cooking, cleaning and home maintenance, while offering social amenities. Private only.

•  Assisted/supportive living: For those who need a bit more help, but are still fairly independent. In addition to meals, cleaning, etc., help is available for grooming, bathing, medication management and mobility challenges. Private only.

•  Long-term care: For those who can no longer live safely on their own. These places offer 24/7 professional nursing and medical care, as well as meals, housekeeping, exercise and physical therapy programs, pain and medication management, and social programs and activities. Both private and public; private options start at around $6,000 a month before adding on medical care.

My best advice? Plan as much as you can ahead of time. 

5 Ways to Be Prepared

Emotionally, you’re never truly ready to become your parents’ caretaker. But practically there are a number of things you can do to prepare for whatever lies ahead.

1. Do the paperwork

As much as possible, set up automatic payments so you’re not worrying about keeping the lights on while also dealing with a medical emergency. Make sure your parents’ wills and other important documents are up to date. Know who the executors are. Take note of any special requests they may have (such as do-not-resuscitate orders). Know where important documents are kept. Morbid as it seems, it’s also a good idea to contact a funeral home and pre-plan for when the inevitable happens. 

2. Gather essential information

Whether you’re in an emergency situation or helping your parents move into a retirement home, you will need quick access to a wealth of personal information. That includes: their personal health, social insurance and drivers’ licence numbers; contact information for their doctors; medical data such as medications, known allergies and COVID vaccine records; insurance policies and banking details; and contacts for friends, family, neighbours and colleagues. Gather as much info as you can ahead of time and keep it in a safe, secure place.

3. Have the hard conversations

No one wants to talk about decline and death, but knowing what your parents want before a crisis happens can reduce a lot of stress and anxiety later on — and, most importantly, ensure their needs are met. So have the talk, even if no one wants to. On the agenda: finances and how they plan to pay for their care; preparing their current home for aging in place; under what circumstances they will move into residential care; wills, funeral plans and other wishes around their deaths.

4. Update their home

While your parents are still at home, make it safer and more accessible: install grab bars in the shower and by the toilet; replace door knobs with levers; if needed, build ramps, install lifts and widen doors to accommodate mobility devices; replace outdated light switches and faucets with easier-to-use ones; remove rugs and other obstacles that can lead to falls; get them a medical alert device. You may also need to set up home care. At a certain threshold, there is government care available, but, in the meantime, you may need private options, which can be quite expensive.

5. Look into residential options

Privately operated retirement homes offer built-in community and compassionate care for everyone from the fit and spry senior to those who need round-the-clock nursing. Take time to explore the options, put a plan in place and budget accordingly — the more care your parent needs, the more expensive it becomes. Government options are available for long-term care, but there are significant wait lists, so if that is the option you want, get on those lists as soon as you can.  

Finally, don’t forget to look after yourself. This is often the hardest thing to do, but it is essential to eat well, rest up, get some exercise and consider counselling if you need it.