Matriarchy Report is two journalist moms writing about family issues from a feminist perspective. Research, interviews, personal stories, and geriatric mom pride. Click the button below to subscribe and get this newsletter in your inbox, free.
There was a period in my life, a while back now, when friend after friend got hitched, either through marriage or commitment ceremonies or just finding themselves still living together. I once raced across Massachusetts to catch parts of two weddings in the same October weekend.
Then came the Age of the Babies, which I remember as a time of MealTrains, swaddling, and sharing Google Docs with links to everything from favorite footie pajamas to favorite all-natural nipple creams.
And now, we’ve entered the Age of Aging Parents.
It’s not a surprising turn, of course. There are 42 million adults -- 1 in 6 people -- caring for someone age 50 or older in the U.S. today, according to a study from the National Alliance for Caregiving and AARP. And those numbers will continue to grow, as our elders continue to age.
But just like giving birth and having kids felt like entering a world that no one had told me much about but had been there all along, this age of aging has felt like similarly foreign terrain.
I first spoke with Dr. Eleanor Feldman Barbera over a year ago, when she was still reeling from her work in nursing homes during the height of the pandemic. A psychologist and expert on aging and caregiving, she has written about the experience of “cascading” collective trauma among residents and staff of long-term care facilities in the months following the COVID-19 outbreaks, and has keenly observed changes in long-term care for the elderly in the U.S. for over 20 years. She’s paid close attention to places where they do things better, and has written about the importance of “family-centered” care: focusing on the needs of the entire family, rather than just servicing the elderly.
She’s since launched a private practice, and we spoke recently about some of the ways that members of the so-called “sandwich generation” can prepare for and respond to the needs of their parents.
“As the younger person, you have to understand that you're in a constant state of flux,” she told me. Basically, get ready: Change is the only thing you can count on.
Our conversation has been edited for length and clarity.
What are some of the things that people who have aging parents should be thinking about when it comes to their parents’ emotional and physical well-being? What kinds of conversations should we be having?
It's very hard to just come right out and have these big conversations without dropping little breadcrumbs, or starting to create openings for conversations.
So, for example, when they mention that something's going on with a friend, you can say, “Well, how are you? What are you thinking about this?”
My father had a friend who said his kids think he should stop driving. My dad told him he should take one of those safe driving classes or get evaluated by somebody who's an expert in senior driving, so he could see if he actually is safe on the road. His friend wouldn’t do it, but that gave me an opportunity to ask him if he was feeling safe on the road. Which he is.
So transportation is one thing. Then, making the home as safe as possible. There's plenty that you can do in terms of adjusting a home: putting in grab bars, picking up throw rugs.
People might not live near their folks, so when they go home for the holidays, they should start seeing what's going on in their parents’ home and watching how their parent is getting around.
But the thing is: Parents want to be parents. They don't want you, the younger generation, taking away their independence. So it can be fraught.
I'm the parent of a young child, and I have older parents, and it's sort of feels like a similar scenario: I'm worried about my parents’ futures, and I'm worried about my child's future. Of course, older people are not children. So I want to respect that and also participate in helping them plan and anticipating what their needs might be.
Well, it depends what kind of scenario there is. Ask: “What do you see for the next five years? Do you think you're going to stay in this house?” Some parents want to. And so then you say, “I wonder how I can help you make it more livable?”
But what happens, usually, is that people procrastinate. Everybody procrastinates and then there's a crisis. Somebody has a fall, or some sort of health crisis, and then a lot of decisions need to be made in a hurry.
Sometimes you get parents that are more practical. Look at my family: My mother wanted to downsize. My father was not ready. It took my mother five years to convince my father to let go of the house. And now they're in this two-bedroom, two-bath apartment with a balcony and a swimming pool. They have neighbors. My father says it's one of the best decisions they ever made.
It's much better to make these decisions when you're capable. You have time to adjust, rather than waiting until there's a crisis.
How does a child help, say, when they have a parent who's starting to get more and more forgetful? This seems like something a number of people I know have been talking about.
Sure. So, if the parent doesn't want any intervention, it becomes extremely difficult. You might want to check in, make more phone calls, or have somebody come by. You can keep a closer eye on things, like maybe they would let you become a co-signer on accounts.
Or, you can say, “I'm doing my own will. I have an attorney. Why don't we do it together?” Sometimes you can get parents to do things as if they are helping the child or you’re doing it together. You can keep them in the parent role in some way. You can say, “This is making me really worried or anxious,” or “I had this friend whose parents did XY and Z, and I don't want that for us. Can we do something now?”
I remember when I first started working with people who were very ill and dying and, really, it freaked me out. I took a course in thanatology, which is the study of dying.
The one thing that I remember so much from that course that was really helpful is this: People die the way they live. So if your parent has been fiercely independent, and doesn't want help, that's not going to change. They're going to go into this last phase of their life, mostly in the same fashion.
There’s a really good book, “How to Say it to Seniors: Closing the Communication Gap,” by David Solie. One thing he says is that older, aging people are in a different phase of their life. Younger people are still in the striving phase, but older people are not in the striving phase anymore.
A lot of times, the younger generation wants to rush in and fix it. That's not where their parents are at. “It's not that bad. I can deal,” they say. And the kids are like, “No, this is terrible. We have to fix this.”
That sets up a natural opposition. Especially when you have little kids or if you're in the sandwich generation, you're busy: “I’ve got to take my kid to daycare, I have to get meals on the table and work my job, and I’ve got to get this all set up with Mom and Dad.”
But Mom and Dad are not going to be pigeonholed. They're not in that place, and that pressure is not going to help.
You talked earlier about keeping the parent in the parent role in some way. Are there other ways that you've seen that happen? It’s an interesting observation about the roles we're all still in, even as we're all aging.
One thing that I tell aging parents: You are showing the next generation how to age. The actions that you are taking now are a template for them to follow. So, what are you doing, as a parent, to help prepare your kids for this phase of life?
Some people will still say, “We want you to be a power of attorney. We have prepared our living wills, and here's a copy.” That's being, in my opinion, a really good parent: to show how to handle that part of life.
If you're in the adult child role, and your parent is not taking those steps, there's a resource called The Conversation Project. It has a lot of templates and ways to start conversations about these kinds of things.
Could you just say a little bit more about your own experience of having a young child and having older parents? How old were you when you adopted your daughter?
I was 45 and she was one. She was in the intensive diaper phase. My parents are 25 and 27 years older than me. Thank God, they're been in good health. I said at the time that I really need my parents to stay well until my child could be by herself. I’d say, “Please let them stay well, until she's 13 or 14, and I can leave her for an extended period of time and go help out my parents if I need to.”
Well, she's going to be 15 in a couple of weeks. So, we made it.
What has that meant to you over these, these years? Have your parents been very involved with her?
It's been pretty good. My parents are not the “Let's stay over” kind of parents, but they did babysit for her when she was little. I think it helps them to feel more vital to be in that life phase, just as it's helped you and I, I think.
When my father died, my daughter was two and I had just tremendous grief and sadness. And I also felt so much like, “Wow, I have to really, really stay healthy.” Not just in a general way, but she's going to be seven when I'm 50. So that just feels really clear that my own health and well-being is so important.
When my daughter was five, I was 50. My knee was hurting. I went and got an X-ray and I’m like, “No, I cannot have arthritis.” So I started a vegan diet, and that helped my knee. Then after a few years, I switched to vegetarian because it's easier with three people, different diets.
And while my parents have been healthy, my husband's family is a much older family. We have a picture of my daughter as a one-year-old, with her grandfather who was probably 90 or 88 when they met. He lived to 97. They had a very nice relationship. But there was a period when he passed, and then his wife passed, who we were really, really, really close with. And then there was my sister-in-law's husband. And then my husband’s mother passed. There were all these people, and we were constantly going to Florida for funerals. That was really hard.
What was hard about it?
Well, it was really sad. It was just depressing and sad, and a big loss. And we didn’t have gobs of money, and these were the trips we were taking. We were visiting elderly relatives who were quite ill. So we had to try to build some fun into these fairly dismal trips. That was challenging. If we were all younger, that wouldn't have happened until my daughter was much older.
I want to talk about the future of elder care. Where do you think you're headed? What is the best possible future for our elders, and for how we care for elders? Not just in our own families, but also systemically.
Nursing homes are financially on the verge of collapse. They are being propped up by corporations that are purchasing them, I think, largely as a real estate transaction. It's just not the same as it was. It's heartbreaking, because the people in these places had amazing missions. Now, the mission is to make money.
On the other hand, they're not really the best places for most people to be cared for. So we will transition into much smaller homes, either Green House, or otherwise. I do believe that we should be spending much more as a country on services in the community. There's a program called PACE, Program of All-inclusive Care for the Elderly. It's all based on community services in the home.
We need senior centers. We need adult daycare programs, and respite care. We need to pay our caregivers, whether they're family caregivers or professional caregivers. We need to pay them more and train them and support them. Everybody wants to age at home. That's not feasible for everybody, but we should support all those people that want to and have the family support. It's super, super hard to manage at home without family support.
What does family support mean? Children, or younger relatives?
People need someone to take them to the doctor. People who can make sure they're taking their medication, or can help them with a telehealth appointment with their doctor. Telehealth is huge. And I don't know if you've ever needed to be in the role of a patient in the medical setting, but they often don't actually listen to the patient, even when it's the younger person.
So people need a patient advocate?
You always need an advocate, and a significant portion of the population does not have an advocate.
Often women will take care of their husbands, but then, when it's their turn, there's nobody there for them to be that advocate. It’s a huge women's issue. With the caregiving burden, there are definitely men that do it, but it often falls to the woman and, these days, who can afford the caregiving? You're taking time out to take care of your kid, and then taking time out to take care of your parents, then all of a sudden, you don't have money in your retirement or your Social Security.
Much of the frame for our conversation has been a frame of someone who's pretty financially stable and employed, with some retirement and some savings. And even that is a precarious position. For anybody who has lower income, or is unemployed, or is in any way financially strapped, the idea of caring both for older parents and for small children is just incredibly overwhelming.
There are programs where you can be a paid family caregiver, which is great, because then that's your job, which is how it should be. It's a job.
Is there anything that I didn't ask you about that you want to shed a little more light on, with regard to any piece of this: the interpersonal stuff we started with or any of the structural issues that you’re really paying attention to?
My dad's going to be 86 in December. And I am just like everybody else: pretty much petrified about what will happen, because I know how difficult it is to get help and navigate the eldercare world.
What I want to say is that if your readers are feeling at a loss, it is not because they are doing something wrong. It's because the system is currently so callous, and uncoordinated and unhelpful.
That's what we're dealing with. It's so unfortunate, but it does leave a lot of room for improvement. Maybe with Biden's efforts to improve the social safety net, some things will be done. But we really, really need to address it on a systemic level, because we have more and more people heading into the zone.
This article is so timely for me. My father-in-law passed away recently at the young age of 70. And my husband and I are the only two on the same coast as my mother-in-law. While it happened rather unexpectedly, I don’t know that even another ten years would have prepared us for what we just inherited (and she doesn’t even need full-time care yet). She has her own pension to live on, but she lost her husbands pension overnight (which was almost double hers). The economy of care (or lack thereof) is a colossal systemic fail. One that will hit our generation hard over the next 20 years.
I find this sentence, “Basically get ready: change is the only thing you can count on” absolutely, aggravatingly true. Only talking with a fellow mom at kindergarten drop off did I learn about my new phase coined: the sandwich generation. She is in it too. I was left thinking about our interaction for days afterward. While it was a relief to talk with someone that understood, I have to think (hope?) there can be more than those 15 minute commiserating chats at drop off/pick ups.
I so enjoyed reading this--and many of us are in, or approaching, this phase of life with so little preparation. As you say, kind of as with having children, our culture lets us enter these milestones really pretty blind and with little support :( I would love a follow-up on this that picks up where you and Dr. Barbera left off with some solutions angles, which I know you are good at :)