An agonizing decision: When it's time to move parents

I am hosting Thanksgiving dinner this week.

For most of my adult life, my father and stepmother have cooked Thanksgiving dinner, and my family and I have spent the holiday enjoying a feast at their house. But, earlier this year, we moved my father and stepmother, who both suffer from dementia, into an assisted living facility that specializes in memory care.

There will be no more Thanksgiving dinners at their home.

So, when I realized that November is Alzheimer's Awareness Month and National Family Caregivers Month, it resonated deeply with me.

Prior to his moving into assisted living, I spent many weekends caring for my father. I summoned patience to answer the same questions over and over. I tried not to get frustrated when he would ask about my children, especially after my daughter had just visited him the day before, but he didn't recognize her. When he would get scared or angry, I would try to soothe him and calm him down.

I would do this for a weekend and be emotionally spent. Those who are 24/7 caregivers … I honestly don't know how you manage.

Is it any surprise that the theme for National Family Caregivers Month is "Respite: Care for Caregivers"?

In fact, research shows that the role of caregiving can lead to its own health issues, creating a significant amount of stress and strain for the caregiver.

"That stress can come in many forms," says Marylee MacDonald, a caregiver advocate and writer whose debut novel, "Montpelier Tomorrow," was inspired in part by her experience helping care for her son-in-law.

"There is emotional stress, physical stress and even financial stress. Sometimes there's also additional stress from the guilt that caregivers feel when they find themselves resenting the people they are caring for."

A recent study by the AARP Public Policy Institute and the National Alliance for Caregiving revealed that 22 percent of caregivers felt their health had gotten worse because of caregiving.

"I don't think that's all that surprising," MacDonald says. "If anything, it's a wonder that the percentage isn't higher."

Other findings in the study included:

• Nearly one in five caregivers (19 percent) reported a high level of physical strain resulting from caregiving, while 38 percent considered their caregiving situation to be emotionally stressful. Those percentages go up significantly for caregivers who provide 21 or more hours of care each week.

• When people feel that they had no choice in taking on their caregiving role, the stress becomes even greater. More than half - 53 percent - of those people report high levels of emotional stress.

• Caring for a close relative causes more emotional stress than caring for another relative or nonrelative.

I can see how caring for a close relative is harder … who can push your buttons more than a person with whom you have a long personal history?

I can't adequately describe the array of emotions I went through in caregiving. For instance, a relatively simple act like helping my dad - who taught me to tie my shoes as a child - get dressed and put on his own shoes would make me emotional.

I have friends and co-workers struggling with similar issues … either caregiving or deciding when it is time to move a parent out of their home. And in these friends and co-workers, I have seen my own bewilderment and anguish echoed in their eyes and words, as they try to come up with the best solutions.

Is anyone ever really ready for the heartbreaking role reversal of child/adult with their parents?

Aging and elder care authority and legislation advocate Carolyn A. Brent, author of "Why Wait? The Baby Boomers' Guide to Preparing Emotionally, Financially & Legally for a Parents' Death" says there are often warning signs. Sometimes these indicate an elderly parent just needs help in the home - perhaps someone to stop by and cook, provide company and make sure they take their medicine.

But for many of us, it becomes a matter of safety. A medical issue or other emergency makes the decision clear.

As much as I mourn the loss of my parents' independence and their beloved house, I am grateful that I know they are well-cared for and safe.

As families get together for holiday gatherings, this is a good time to look for warning signs that might indicate older relatives need help.

If you are a caregiver, or know one, the Alzheimer's Association has created a webpage to honor caregivers and also provide links to support for caregivers: www.alz.org/honor/honor.asp.

Warning Signs

Here are 10 telltale signs, offered by aging and eldercare authority and legislation advocate Carolyn A. Brent, that might indicate it's time to evaluate if an elderly relative can continue to live independently.

<span class="fact box text bold">Cleanliness:</span> Mom or Dad has always been a great housekeeper, but today the home is decidedly cluttered and not nearly as clean as normal. Keep a keen eye to discern if the clutter and filth is getting worse with each visit - it's often a key sign.

<span class="fact box text bold">Mail piling up:</span> While we all get busy, basic tasks that were often dealt with quickly and easily when younger, but that are now falling by the wayside, is a sign that your older parents could be getting overwhelmed and not able to manage their daily affairs. This may also indicate some signs of forgetfulness and memory issues.

<span class="fact box text bold">Bills unpaid: </span>If the checking account balance is wrong or in arrears, or there are notices that bills aren't being paid, these can be signs that your parent is having memory issues or difficulty with simple math cognition. It can also indicate a general apathy.

<span class="fact box text bold">Losing weight: </span>A parent who may have lost his or her partner or who is generally depressed often loses interest in eating due to a reduced appetite. Also, check their refrigerator and pantry to see if there is an appropriate supply of food and that what is there is fresh and edible. If the cupboard is bare and your parent's frame is shrinking, living alone might become problematic.

<span class="fact box text bold">Basic hygiene: </span>If you notice that your parent is wearing the same clothing day in and day out or that their hair or skin appears dirty on a fairly regular basis, they may have lost the motivation, ability and/or forethought to look after themselves.

<span class="fact box text bold">Wearing inappropriate clothing:</span> There is cause for concern if your parent dons summer clothing in the dead of winter or leaves the house in a nightgown and slippers for a trip to the store. This often happens when the elderly are suffering from confusion and lose the ability to have discretion in social situations.

<span class="fact box text bold">Signs of forgetfulness in the home:</span> Confusion can also show up in the kitchen and can prove to be deadly if not dealt with quickly. All too often there are stories of older people who accidentally burned their houses down because they left a pot on the stove for hours. Or, perhaps more subtly, the milk is in the pantry and the bread is in the refrigerator.

<span class="fact box text bold">Missing appointments: </span>Forgetfulness, absent-mindedness and memory issues may also show up when it comes to keeping certain appointments, recognizing key dates, or, even more importantly, maintaining medication dosages on schedule.

<span class="fact box text bold">Acting plain weird: </span>You may notice that your parent's behavior has taken an odd turn for the worse. If you see signs of paranoia, fear, strange phone calls and conversations and nervousness, this should not be overlooked as it's a blatant sign that living assistance is in order.

<span class="fact box text bold">Signs of depression:</span> Classic signs of depression include a loss of interest in caring for one's self; a lack of participation in socialization; or no longer pursuing once-loved hobbies. Sometimes, depression comes from a sense of loneliness or the realization that they can no longer do things for themselves.