Difficult Questions about Aging
I recently had to assist my 78 and 82 year old aunt and uncle, respectively, who were dealing with some pretty typical issues – fear of losing independence, an awkward reliance on family members and their changing status in their own community. As a professional fiduciary, I do this for a living and thought I would be able to jump right in and give them the benefit of my experience.
My aunt and uncle have no children, but do have community support from friends. In my conversations with my aunt, she shared that my uncle, not her, was getting more forgetful. These conversations went on for about six months.
When I actually visited them, I discovered that they were not coping as well as they had said. For example, my uncle is a Methodist minister and still had a small congregation in a neighboring town. I discovered that he would get up to preach and halfway through the sermon forget what he was discussing and end up preaching on three or four subjects. Because he had been a stable and positive influence within his community for over 50 years, people overlooked his ramblings. Ironically, his congregation continued to grow during this period.
The most revealing incident that showed me the extent of his lapse of short-term memory occurred at a local restaurant when he introduced me to a resident. In the course of the conversation, he asked how her mother was doing. The woman was a little taken back since my uncle had conducted her funeral the previous week.
If one individual is having physical or memory problems, usually a spouse will fulfill the role of caregiver in order to maintain some semblance of their previous life style. But what happens if that individual is having problems as well?
In my infinite wisdom, I contacted the aging services within their county to see if there were support services available. What I found was one caseworker for the entire county. Because my aunt and uncle had some assets, they were not eligible for help. I went to Plan B and contacted the Oklahoma Chapter of the National Association of Social Workers to obtain names of qualified individuals to provide case management. I located an individual 50 miles away and had her begin the process of getting my aunt and uncle on the right track. I thought I had it all under control.
When individuals have the right to determine their own destinies, they sometimes will not cooperate. My aunt and uncle decided they were quite capable of taking care of themselves. Something I had learned several years ago is that individuals have to experience a crisis before they accept help. The crisis came about six months later.
My aunt contacted an uncle in Oklahoma, saying she was having a nervous breakdown and asked him to immediately come to help. When he arrived, she was unable to cope any longer with my uncle or herself. Arrangements were made for admittance to a geriatric unit at a local hospital for a full evaluation. What we found was a person with severe depression and anxiety. This crisis started a process that would not have been carried through unless a plan had been created earlier outlining their wishes.
How can we help our elderly family members with medical and financial decisions? Where do we begin?
First, sit down and ask who they trust to make medical and financial decisions.
Second, visit an attorney to assist with documents that will answer these questions. If cost is an issue, there are a lot of free services available through Legal Aid and senior centers. Their attorney will discuss living wills, durable powers of attorney, and durable power of attorney for health care.
Third, make sure that you know the answers to the following questions in the event that you have to step in to make decisions on their behalf:
- The person’s current health?
- Level of trust with doctors? Is the person comfortable with their doctor making the final decision concerning any treatment needed?
- What makes the person laugh or cry?
- What is their attitude toward death?
- What are the wishes on the use of life sustaining measures for terminal illness?
- If the person could not care for himself any longer, how would living arrangements change?
- What is the level of worry concerning the amount of money required for care?
- Have funeral arrangements been made? What are the wishes for funeral, burial, or cremation?
- Who can be trusted to make medical or financial decisions if the person were unable to?
These are tough questions to answer. I have friends who have ended up in therapy after trying to answer them, but they need to be asked. Luckily, I had conducted the exercise with my aunt and uncle and executed the necessary documents to ensure their desires and needs would be met.
Individual self worth and dignity are important factors as we age. We need to allow the individual the dignity and privacy we all want through this process. If the individual does not want to discuss the specific issues, honor that. The old saying, “all things work out in the end” really is true. It might not end as you envisioned, but when an individual reaches a crisis state, situations tend to resolve themselves.
One last piece of advice that I hear over and over for older individuals is to live life to the fullest each day, doing what you want now. Their biggest regret is not what they have done, but what they haven’t.