If the senior citizen you are caring for is dealing with a terminal illness that lingers, those demands will become virtually overwhelming.  When the end is near like this, your need for assistance will become acute.  This is no time to try to be stoic.  Dealing with a dying senior citizen is something that is usually outside of the abilities of caregiver children.

If you see that time coming, now is the time to make arrangements for additional help.  If funds are in his estate, you can arrange for in-home nursing care.  These outstanding organizations can be with the senior citizen for as many hours as day as you need them to be and provide skilled medical care to minister to the demands of your parent’s terminal disease.

But once your doctor confirms that your parent is terminally ill, waste no time in getting hospice involved.  This is a federally sponsored program that is part of Medicare and they are trained specifically in dealing with death and the dying with skilled care, equipment and medications that will cost your parent nothing and take a huge amount of stress off of you.  Hospice has been a lifesaver for many a weary caregiver who is worn out from months or years of care giving and is incapable of dealing with the extra demands of the patient’s final months of life.

But there is an adjustment you as caregiver will have to make as the nursing care personnel and hospice begin to surround your parent more and more in preparation for his or her final days.  You have been so intensely involved with every aspect of your parent’s needs.  And you have done a good job of getting them this far.  But now you have to step away and let these skilled professional caregivers provide the comfort and medical care that only they can give.

This may be difficult because your parent will still call for you to be nearby especially during these weeks.  This is a time to bring in clergy, and to alert your siblings who may have to travel to be by mom’s bedside in her final days.  While there will be tears, if they can be with her a little bit before the final moment comes, that is a closure for the family that is tremendously valuable.  And it helps your ageing parent to have her children close to her as she approaches her final transition to another life.
Hospice will help you go through the transition in your own mind and heart to accept that the passing is near.  It will take some emotional courage to begin preparing for the funeral even though your parent is still with you.  But this can also be a bitter-sweet time of sharing because if your parent accepts what is to come, she can have some say into what she wants to have happen at the funeral and about other final arrangements.
Perhaps the strangest transition that you alone as the primary caregiver will go through will happen in the days just after the passing.  There is always a shock when your loved one dies even if it was very much anticipated.  But you will go through another drastic set of emotions that can only be described as “separation anxiety”.

When you get that news that your parent has passed, you will suddenly feel the lifting of a burden that may have been on you for months or years.  You no longer have to worry about your parent any more.  You don’t have to go there, take care of her food or medicine and comfort her any more.  The lifting of that pressure can be liberating and disorienting for you.  You will feel strange throughout the funeral and the family times as well.  But keep these feelings in your heart as well because they will be sensations that only you and others who have been primary caregivers will ever be able to understand

Of course the phrase “adult day care” can be upsetting because it only goes to reinforce the image of your adult parent becoming an infant and having to be treated as such.

So when you suggest that you work together to find a place they can spend time at during the day, don’t refer to it as an “adult day care” if you can.  Immediately the senior citizen will feel that you are just “putting him away” somewhere so he won’t be a nuisance to you.  And you don’t want him to get that idea.

But many seniors are open to going to a senior citizen’s center or to a church program for the elderly that serve the same function.  The best way to find the right adult day care situation for your parent is for you and your elderly parent to take a tour of what is available locally and make the decision together.  To do that, you will want to come armed with some pertinent questions for you to get some peace of mind about letting your mom or dad spend time there each day.   Some questions to include might be…

• Do they provide transportation to the different assisted care facilities in town?  Does that transportation continue to run all day?  You don’t want your parent going to the center and “getting stuck” there.  If there is transportation, that wont happen.
• Do they have qualified medical people on hand should any problem come up?
• How many seniors are there on any given day?  Too few implies that the center isn’t providing good service.  Too many and your parent could get lost in the shuffle.
• Do you provide food and beverages if the stay is all day?  Are your food services sensitive to diet issues if your parent is diabetic or has other diet restrictions given to him by his doctor?
• What are the costs?

Of course for your mom or dad, the activities that the day care center offers will be a big part of their willingness to go there.  During football season, if the center just provides a place where elderly men can cheer for the game or have other sports programming available, that is a lot more fun for your dad than sitting alone in his apartment and watching those same sports.

If the day care center has a variety of activities that appeal specifically to each gender and then others that everyone can enjoy such as card games or puzzles, it could be an upbeat and fun place for your parent to pass the day.  By spending some time there, you can get a feel for the friendliness of the staff and the general atmosphere of the center to determine if this will be a warm and welcoming place where your parent will have some fun and meet new people or a place where he will feel alone and out of place.

But if you can find a good day care center for your senior citizen, it can take a big load off of your mind.  And if you know he is having fun each day and getting out with people, you know that will be healthy for him and be invigorating so he will eat better and sleep better that night.  And that solves a lot of problems all at once.

This is never a healthy way to take on the challenge of care giving.  Not only would it be terrible for your family, job and friends to see you vanish into the task of care giving and never be available for anyone else, its also a bad idea for both you and your elderly parent for you to obsess that much.

This is a formula for caregiver burnout which can lead to medical problems, loss of sleep, eating disorders and maybe even a nervous breakdown.  So the healthy approach to being a caregiver is to keep the demands of that part of your life at arm’s length so you can establish a balance between your life with your senior citizen and work and family life as well.

One way to begin laying the groundwork for keeping that balance in right ratio to your life is to have an honest talk about the issue with your elderly parent who you are caring for.  Sometimes the force draws you in to want to give it all to the task of care giving is coming from them.  But if you talk about it in a rational way when both of you are rested and thinking calmly, your parent will see that she does not want you to give up your life to be her caregiver exclusively.  Oh sure, sometimes when she is sad or lonely, she says things like “I wish you could stay here all the time.”  But that is not rational and she knows you need to be a mature adult and take care of your job responsibilities and your spouse and children as well.

Another person you should have a frank discussion about the demands you are going through as a caregiver for your elderly parent is your boss at work.  In the modern world, businesses need hard working and well trained individuals like you.  And this is a time when a lot of baby boomers are becoming “sandwich generation” people and have that additional demand of caring for an elderly parent along with home and work responsibilities.  So your work will want to work with you to get through this rather than lose you entirely.

Your employer may be able to work with you to give you some flexibility so that if you have to have time during the day to take your parent to the doctors or attend to some other need in your parents life, you can make up the time or attend to your work in other ways.  Many employers will even allow you to take work home with you and split your time between the office, your family life and your care giving responsibilities.  There are even extended leave programs that some larger companies have where you can take a few months off to care for your parent during a time when you must give her all of your time.  This is invaluable during time when you are moving her from her own home to the assisted living center or if your parent is terminally ill and you need to be constantly available in those last months of her life.

Above all, solicit the support and love of your spouse and kids.  If mommy has to be over at grandmas every evening for a few hours, it may call on the dad and kids to whip up some macaroni and cheese or just get in the car and go get some fast food to cut mom some slack to take care of the needs of that aging senior citizen.  Your family, your work associates and your friends can handle giving you that time if you are open with them about what is going on and they see the need.  But do make time to see them and be with other so the job of being a caregiver doesn’t overwhelm you.  You need them as much or more than they need you during this time.

For one thing, the caregiver’s friends, family and coworkers are affected.  Becoming the primary person responsible for the care and well being of a senior citizen is a peculiar job because it is tremendously demanding and completely unpaid.  Caregivers are for the most part children or close relatives of the senior citizen being cared for and they have jobs, families and a full life outside of the time they put in taking care of their parent or parents.

So when that responsibility falls to you, those around you also have to give a little to help you accomplish that goal.  But for those who are related to a caregiver, there is a demand on you as well.  If mom has to go over to Grandpa’s apartment every night for two or three hours, that means mom isn’t home helping you with your homework, making supper or just being available if her little girl needs someone to talk to.

If dad is gone thirty or forty hours a week taking care of Grandpa, that is time he is not home providing guidance for his kids, fixing the garbage disposal or making those corny but fun jokes the kids groan about but love.  Similarly, the friends and working world of a caregiver are also asked to give up a little or a lot of the mind, the emotions and the time of that caregiver so he or she can go and care for that elderly parent and divert that energy and time in that direction.

For those of us who have a caregiver in our family or part of our social or work circle, in addition to the sacrifices, you can become concerned for your friend or loved one because of the demands of caring for a senior citizen.  It’s a job that is taxing to even the strongest adult and one that take a lot out of your friend or family member.  Caregiver burn out is a common syndrome and it doesn’t just affect the caregiver.  If your parent, spouse, coworker or friend undergoes a break down from the stress of caring for her mom or dad, that will have an impact on everyone.

So there is a compelling need for all of us associated with a caregiver to learn to care for that caregiver to help her and support her in what she is doing. Some specific things you can do are…

• Let them know you believe in what they are doing.  Caregivers often feel very alone and guilty that they are not attending to family and other relationships.  By letting her know you are 100% behind what she is doing and that you are doing fine, that guilt is removed which makes her know she can make it.
• Let her know she is missed.
• Pick up the slack.  Each evening if dad and the kids can pick up the house, then mom can get some sleep and know that you are taking care of business at home so she doesn’t have to worry about it.
• Let mom sleep in.  Maybe even bring her breakfast in bed every so often.
• Pitch in.  Go over and help grandma out yourself so it’s not all on mom.
• An unexpected surprise. Every so often do something to surprise and totally delight mom and give her a fun break from her worries of care giving.  A movie out or a limo ride around town can go a long way for a weary caregiver.

If the spouse, the children and friends and associates of the coworker can keep and eye on her to look out for those signs of burn out, it may be our responsibility to jump in and give her some support before everything falls apart.  By caring for the caregiver, she is better able to give attention to that senior citizen she is caring for.  So in a way we are all becoming part of the effort to give the caregiver’s mom or dad the best care possible.  And that is what community is all about.

But a corollary to that axiom is that if mom and dad are going to age, at some point you are going to begin helping them with the daily affairs of life.  And that occasional helping will escalate as their needs grow strong until you will become a full-fledged caregiver for an elderly person.

For many, the time when you suddenly become a caregiver is just that – sudden.  It happens often after the death of a parent and the widowed parent suddenly becomes needy because of the loss they are experiencing.  For married couples who have been together for decades, that loss is equivalent to the loss of a limb and far more devastating so that may be the time when you suddenly go from having few concerns for your aging parent to having many.

It might be strange to look at it this way, but the more you can ease into care giving, the more time you have to get used to it, for your elderly parent or parents to get used and for your family, forefends and coworkers to get used to it.  And if you can step in and make some minor changes to the environment of your aging parent, you may be able to delay the time when they become very dependent on you.

If your parent or parents are still living in their own home, there are things you can do to make their living space more accessible and safe including…

• Create a lifestyle that is all on one level.  Stairs can become a hazard for an elderly person.  So early in your plans to adapt their living space, move them into a ground floor bedroom and put all significant rooms, including the kitchen, the pantry, the laundry room and the living room are on the same level.
• Take some of the work out of daily chores.  Most local grocery stores will deliver food to the elderly so you can make those arrangements for your aging parent.  You can also find services that work by the hour that come in and clean the house, do simple repairs and chores and take care of the business of home ownership for your parents.
• You can make arrangements with home  health care professionals to drop by for an hour or two a week just to make sure your parents medications are still safe to use, that all prescriptions have been filled and that your parent understands their medications and when and how to take them.
• Reorganize the kitchen so things your parent will use every day are on an eye level shelf and are easy to get to and to put away after washing.  Make sure the toaster oven, microwave and other important appliances are also easy to get to and that your parent is comfortable with these units if the models that may have come with the assisted living center are not familiar to them.
• Go through the house and make it easy for your parent to use.  You can put in those walking and grab bars along the halls and in the bathtub and other places where your mom or dad might need the additional support.  You can check the lights so there are plenty of visibility for what your parents have to do.

To really take the preparation of your parent’s living space for their ease of use and safety, look at pulling emergency pull ropes in every room.  These units are used extensively in assisted care units and they make it possible for your parent to pull that cord if she is in trouble and set off an alarm or call to you or to emergency care, should there be a sudden medical need.

By working to make your parent’s work area easy to use and safe, you can do a lot to put off the time when your mom or dad may have to move to a retirement village or nursing home.  And you keep them independent which allows you to slowly ease into care giving which is much easier on everybody.

It’s easy to just shrug at this need in your employee population but just as the demands of parenting can have a huge impact on the workplace, the personal needs of your employees to take care of their aging parents will have an impact on the office and the productivity of your business.

Business can no longer be cavalier and declare, “Well they can just quit and we can find new employees.”  The brutal truth is that skilled, trained and mature employees don’t, as they day, grow on trees.  With the work force shrinking, it’s foolish to think that if you have a solid and hard working employee who knows his job and does good work for your business, that employee can’t just be replaced with a kid right out of school.

The cost to your business can be devastating if you have a policy of running off good, hard working and smart employees because they are becoming caregivers in their personal lives and replacing them with younger, unskilled employees who are less informed about the ways of business.  The costs of training and the learning curve of the job alone will easily be more than any costs of accommodating existing employees.  Moreover, you cannot just replace judgment, relationships, market savvy and wisdom which many of the employees in the age bracket bring to your business.

So how do you accommodate the needs of this new group of caregivers who are beginning to become a regular part of your workforce?  The first step is to understand what they are going through.  These people are going to take care of their loved ones whether you are aware of it or not.  So if you can partner with them to make them successful at home, they will work extra hard to make you successful in the marketplace.

Start with some seminars and brown bag lunches where people can come and share the demands they are going through as caregivers for elderly parents or loved ones.  Invite everyone to these lunches because there will be many in your business who know that is coming up for them and want to learn all they can about what is ahead.  By making an open discussion of elderly care issues part of the discussion at work, you are communicating that you want to help and not hinder what your employees are facing.  And that will endear you to them and get you the reputation of being one of those “good employers” in town.

Not all employees who are caregivers will need accommodation all the time.  If their parent’s needs are not that demanding, it will be more of an emotional adjustment than a demand on the schedule.  But encourage each employee who is entering into a time of being the primary caregiver for their parent to communicate that to you both through meetings with the Human Resource department and to their boss as well.

There is a practical side to getting inside of what is going on with your employees.  To your workers, they see you as family and feel more bonded to the workplace because you are concerned about their parents.  But for you, the business will know in detail what is going on with that situation so you can anticipate if that worker will see sudden interruption come up at work and adjust schedules accordingly.

Be sensitive and be communicative with your employees and you can truly become their partner in dealing with this tough part of their lives.  And in doing so, they will feel that you support them and their loyalty to the company will skyrocket.  That loyalty will translate into better productivity and longevity in your workforce.  That stability translates into a more efficient organization which is a more profitable organization.  So in the long run, partnering with your caregivers in the workplace just makes good business sense.

There are other adjustments that are a huge drain on you emotionally.  Balancing work, home and private life with the demands on your time being a caregiver requires is a juggling act that will involve as many “dropped balls” as successes before you ever get it right.  And about the time you do get a good balance, the demands of your elderly parent might change and you are again pulled back into that stressful situation.

So you have to think about ways you can offset the demands on you and try to take some time for you and for your family.  These are all difficult emotions which may be why it takes a real adult to be a caregiver for an elderly person.  But there is one emotion you may wish to foster and dwell on as much as you can to offset the worry, the anxiety, the anger and the resentment.  That is the emotion of thankfulness.

Now it may seem impossible to even ponder how thankfulness could become part of your emotional reaction to this demanding situation you find yourself in.  But if you can find ways to be thankful that you are the caregiver for your parent, that positive emotion can do wonders to drive out those negative emotions in your heart.  And when you think about it, there are quite a few great things you can be thankful for BECAUSE you are the primary caregiver for your aging parent.  Some of those are…

• You are able to give back a bit of the sacrifices they made to raise you.  The amount of time and money and emotional effort your parents used up on you as a child is something that can never be repaid.  But you are giving a little bit back in caring for them when they are old to say, “Thank you for raising me and never giving up on me.  And now I am not going to give up on you.”
• There would be anxiety if you were not here.  If you were far away in another state, you would be a basket case if you didn’t know your mom or dad’s medical condition.  So by being close, you can get the facts quickly and get them right which cuts down on all of those “what if” bad dreams about your mom and dad.
• You always know what’s going on.  There are a lot of “false alarms” with an elderly person.  The need someone that can say, “It’s all right.  It’s under control” to them.  That someone is you.
• You are needed and you are important to your elderly mom or dad.  If ever there was a time when you felt needed not just every so often but every day and every hour of the day it is when you are there to help your parents through this tough time of their lives.
• Celebrate those little times of laughter and joy.  Celebrate when you enjoy a movie together or laugh at those “insider” family jokes that always bring a smile.  Those times will be precious to you when your parent go on to their reward some day.

There is something deep inside us that feels a sense of completion when we are able to stay with someone we love through a very tough time.  Your love for your parent and between you and her will deepen and grow stronger in a way that will stay with you for the rest of your life.

And even after your parent goes on to their eternal reward, you will be able to look back on those months when you gave all you could to make those final months of her life happy and peaceful and you will be able to say, “I did the right thing.”  And that is one feeling that is irreplaceable and something you will be able to be thankful forever.

Once you have gotten mom or dad on board to make that big move, the next major step is to find a facility that would be just the right thing.   There are a number of factors that go into this choice.  So when you set out to find the next home for your parent, you should have a fairly detailed check list for what you are looking for.  And when you enter that facility, don’t be ashamed to be darned fussy about that checklist.  This will be your parent’s next home and a place you will be spending a lot of time at during your visits.  So make sure that when mom or dad move from their home to this facility that they truly are going to a better place.

The design of the facility.  This criteria is where your checklist will get quite specific.  An assisted care facility for an elderly population is different from a run of the mill apartment complex.  And how the facility is designed both in terms of the physical plant and the way the facility is run will tell you if they are a good place for your parent to live.  Some items to include on your checklist are…

• Safety
• Food service
• Emergency preparedness
• Ability to respond
• Look and feel

The society.  One of the selling points of moving is that your parent will be around other seniors and have more human contact to combat loneliness.  The facility can do a lot to speed that process by holding regular social events for its residents.  So interview some of the residents and get a feel for if they are friendly and if there are people there your mom or dad would enjoy becoming friends with.  You can even arrange for your parent to spend a day or a weekend at the facility to get a feel for what it will be like to live there.

Proximity.  Where the facility is physically located is a qualification for which assisted care locations will make the short list.  Those close to where you, the caregiver, live should get a priority look.  You are going to be running back and forth to this place dozens of times each week.  So if mom or dad live close, that proximity will help your care giving efforts tremendously.

Even before you began talking about this big step with your parent, you no doubt have been thinking about it and discussing it with family and those close to your parent.  You may have even done some preliminary walk throughs to get a feel for what kind of facilities are available in your area.

When you start the formal search for the next place for your parent to live, it’s vital that you take your parent with you on those visits.  After all, no criteria will be more important than whether your mom or dad will like the facility.  And if they get out there looking at facilities and interviewing the staff and management of  different places around town to be considered, your parent will begin to get enthusiastic and begin to see this move as their next great adventure in life.  And once they cross that threshold in their minds, you will be well on you way to being successful in this move and making it a reality to help your parent go to a better place.

You know that part of your job as caregiver is to take care of chores and do the things your aging parent cannot do any more or just doesn’t do because of fatigue or general lack of attention to detail.   So when your parent wants you to forget all that work and just sit and talk, what is aggravating to you may be very important to your parent, maybe even more important than the apartment getting cleaned up.

It’s good for you to think about your role as caregiver because you really are not just called to be a maid, chauffeur and cook.  Anybody could do those things.  The reason you are perfect for the care giving role is you are close to the heart of your aging parent and you are the one that will understand when she talks about things she is thinking or feeling that day.

So don’t downplay the value of just being a companion to your parent during your visits.  The emotional and family support you provide to your parent is central to his self esteem and feeling of who he is in the world.  He will be storing up dozens of little anecdotes and stories to share with you when you come over.  So in order to let him get all of that sharing “out of his system”, its important for you to be a good listener.

A good listener doesn’t just let the other person talk and say “uh huh” every so often.  If you are just tolerating your parent as she shares little things with you, that will become apparent and be worse than if you didn’t talk to her at all.  The best way to fit your fellowship and relationship time around work time is to start out each visit with some time together just to talk.

Perhaps you might make it a habit that every time to come over, you and your parent will sit down and just talk about a half hour over coffee, a snack or tea.  That is when you can focus all of your attention on what mom or dad have to say.  Listen with focus and attention so when something is funny, you laugh and you can ask questions and explore the concept or situation being discussed in some depth.

Then at an appropriate time, you can say, “Gee Mom, I would like to tidy up those dishes.  Can you sit at the table and we can keep talking while I do that?”  That is a nice easy transition to starting your work and keeping the lines of communication open.   And you can continue to let your mom or dad “follow you around” as you do chores chattering away the whole time.

Don’t censor the topics or insist that what you talk about are only the important things.  You should know from talking to your kids that you have to be ready to talk about the trivial things in their lives to prime the pump of communication about the hard issues and ones that will take some mature understanding to deal with.  So be patient and open with your aging mom and dad and once they know you have good listening ears, they will open up about important things going on in their lives.  And that is when your listening skills will really pay off.

That was an observation the grandson of my adult parent observed about his Granddad. And while that may be a bit of a crude way of making that observation, it is certainly a correct observation.  The truth is that senior citizens sometimes to find themselves taking a vast array of pills and medications.  Sometimes the diversity of medications can become hard to keep track of.  That is why so often your aging parent may have a pill dispenser kit which allows him to measure out the drugs for an entire week to try to keep it all straight.

The real concern with that much medication being used at the same time is medicine interaction.  If your retired mom or dad takes five, six, seven or more pills at a time, it’s easy to imagine that one of those medications might get into conflict with another.  This is not an idle concern.   Many drug related overdoes or interaction problems happen to senior citizens every year because they combined their many prescription medications with over the country drugs or with alcohol and the chemical reaction in their bodies became explosive.

So because you are the caregiver to your aging mom or dad, it’s up to you to come up with some strict rules that you have to insist become the law of the land for your mom or dad to assure that there is little or not possibility of a drug related reaction which could lead to hospitalization or death.

Knowledge is power when it comes to managing your senior citizen’s medications.  And the two key people you should turn to for that knowledge are your parent’s doctor and pharmacist.  Sometimes the problems that arise of medicines that conflict come from the influence of many doctors in prescribing drugs.  So be sure there is one doctor who is in charge of your parent’s health in general.  Have him or her review the current crop of medications, their frequency and ingredients to assure that there is no potentially dangerous interactions.

Your pharmacist can perform the same function as he is trained in understanding the way drugs work.  So, as with the doctor, it’s good to pick one pharmacist for all of your parent’s drugs and schedule a time to go over the entire medication picture with the pharmacist to look for potential problems.

The next important area of focus to avoid potential medication mistakes is the home.  There is a lot you can do to prevent your aging parent from accidentally taking the wrong medications or the wrong dosages, either of which can cause potential problems.  If the medicine cabinet where the meds are kept is full of similar looking bottles and the only way to tell them apart is fine print on the bottles, do your part to make them unique.

You can buy multicolored bottles to transfer the drugs into.  Then you can write out your parent’s medicine schedule in clear understandable terms like, “3 p.m. take 2 from the blue bottle, 1 from the pink bottle and 1 from the green bottle.”  You can even take the next step of using a label maker to mark each bottle in clear, large print type so there is no possibility that what is in that bottle could be misunderstood.

Take proper care to keep track of medicines and their expiration dates and stay ahead of reorder cycles.  A great way to save money is to use online pharmacies or reorder services that can provide you with generic equivalent of prescription drugs.  But make sure the medication provider is legitimate so you know you are getting exactly what you ordered.

By staying on top of the senior citizen you are taking care of and his or her medication situation, you are being the brains of the operation.  Your retired mom or dad may no longer have that kind of attention to detail and poor eyesight and mental fatigue can cause him or her to fail at staying on top of a complex drug situation.  So you fill in that gap for your parent and in doing so, you will the peace of mind that they are getting the medications they need and only the medications they need.