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Talk to Your Parents About Eldercare Before It's Too Late

11/05/2013 05:41 EST | Updated 01/23/2014 06:58 EST

If you're a woman, aged 45 to 64, I'm surprised you have the time to read this. You're probably at the peak of your career, perhaps raising kids, possibly managing a home, and working hard to keep your significant relationships afloat. Then suddenly, boom, your parents or your partner's parents fall, get sick, or reveal themselves to be in obvious decline.

So what do you do?

"If you wait for that first fall or stroke, you will end up having a panic conversation and that's when you make panic decisions," says Bart Mindszenthy who, with Dr. Michael Gordon, wrote Parenting Your Parents: Straight Talk About Aging in the Family. Though aging and its consequences are a global reality, they write, it's a subject too many of us choose to ignore, neglect or avoid.

But numbers tell the story. According to one 2009 report, about one-quarter of Canadians aged 45 and older are providing in-home care to a family member or friend with a long-term illness. The 2011 Canadian census told us there were nearly five-million people aged 65 and older in Canada; projections indicate that seniors could account for more than one-fifth of the population as soon as 2026.

And who will look after them? Women, most likely.

"Women have a particularly difficult role," Mindszenthy told me. "All the statistics show that men are doing more than they used to in eldercare. But they still do the safe things, the banking and the legal stuff. Men don't yet know how to get out of their comfort zone when it comes to eldercare."

Caroline Tapp-McDougall agrees. The chair of Canada Cares, a national group that supports caregivers, told me that men handle "the non-emotional administrative kind of stuff, but we see much more on the ground activity from women in caregiving."

Women have spent their lives caregiving in one way or another, so they take eldercare very seriously, says Mindszenthy. "They see it as something that has to be dealt with; they are in less denial and avoidance than are men. But for women it is very hard. In many families the aging parents expect the daughter to cook and do the shopping but the son to do the banking. It is the female who often carries the burden but does not have the power."

To help address the burden that many caregivers feel, Tapp-McDougall has launched a toll-free Caregiver Support Line for her organization (www.canadacares.org). "Studies show that of the five-million family caregivers across the country, many don't have the support they need to care for their loved ones and don't know where to turn to find it." That support line, now open at 1-855-619-5021, provides advice and also access to a list of home and residential care services across the country.

Even so, Tapp-McDougall urges family caregivers to "avoid trying to be a super-hero" (delegate tasks to family and friends), and to try not to live in crisis mode: "Caregiving can be a long journey," she explains, "and if you panic and make rash decisions, you may regret them later on."

All the more reason to start the eldercare conversation before you have to. But when Mindszenthy suggests this to people, they often say they tried to talk to their aging parents but couldn't get anywhere. "I know what they mean because when I had tried with my own parents, my father steamrolled over me. 'No, we are not doing that!' he said. 'We don't need anything' But I went back. It took me a dozen conversations to even get to the subject of a power of attorney."

You can't blame parents: They feel good and think they are doing OK. They don't want to have the conversation, says Mindszenthy. "And whether it is trying to get to them to stop driving, or talking about a power of attorney, if you push them the red flags are going to go up. Instead, you could try saying something like, 'See what happened to cousin Bertha. If something like that happened to you, what would you want me to do?' You want to try to empower them to make the decisions and to outline their wishes."

Mindszenthy's co-author, Dr. Michael Gordon, a geriatrician and medical program director of palliative care at Toronto's Baycrest Geriatric Health System, experienced caregiving issues first hand with his own father who died om 2011 at the age of 99. He said that the challenge in writing the book was "to make sure that every adult child knows there is a need to anticipate and plan for the day when an aging parent will need their help, so they're not caught off guard when the day comes." Adds Mindszenthy: "In fact, we now caregive our elders for more years than we do for our children."

One of the great things about their book (now in its third edition) is the "vulnerability index" which allows readers to evaluate the state of an aging parent (or loved one.) Included is an interpretation of the score so that there is a roadmap of sorts, including action points, which can help identify what, if anything, needs to be looked at. A chapter on financial considerations and an extensive North American resource directory completes the book.

The fact is that nursing homes can be less than ideal, home care is strained, yet our population is in an aging crunch. Until we develop a new social contract, women still get the short end of the stick, says Mindszenthy. "They tend to have the caring, nurturing edge that is kinder and softer than what men come to the table with." It's not fair, he adds, and it has to change. When and how is an ongoing story.

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