The sandwich generation: How we can help our parents prepare for their future.

As our children grow and become more independent, our parents inch toward increasing dependence on others, often their adult children. Many of us — one in eight — currently raising our children are also acting as our parents’ care providers. The combined responsibilities can be overwhelming. But they don’t have to be.

We sat down with Kathy Cox, the regional marketing manager of Country Meadows Retirement Communities of Hershey, Lancaster and Wyomissing, to learn how to start the conversation  with our parents about their future care early, while they’re still young and active. And we also discussed what to do if our aging parents need help now.

Central Penn Parent: When should someone begin looking for a retirement community? And how can we support our parents in that effort?
Kathy Cox: We definitely advise that one start looking before there’s a need. And don’t wait until something happens. These days, there are so many free educational seminars for seniors and also for adult children to learn about retirement living options. And the way I look at it is we have planned, through our different stages of life, important things. Where we might go to school, our education, what kind of career we like, if we’re going to purchase a house and things like this. This stage of life or retirement living is just like that and needs a plan. I definitely recommend that couples, if one has a partner, do this while they’re together. Let’s make this decision together and start gathering information. So it’s really a matter of education, gathering information. And as adult children, they can be a resource by helping to gather that information as we start the conversation with Mom or Dad.

CPP: When there’s an immediate need, the landscape changes. What are some signs that it is time for our parents to move out of their home and into a safer  environment?
Cox: Distance plays a major role in it. If mom or dad do not live close by, you might just be talking with them on the phone and maybe just speaking with Dad, who might be saying everything’s fine. But it’s really hard to get a pulse on what’s happening in the home if you’re not there close by and stopping in.
CPP: You’re not seeing rotting food in the fridge.
Cox: Yes. As far as couples, when one loses a partner, the remaining partner will be lonely, sad, depressed, isolated. So that’s often time for families [to realize they] really need to do something. Or also at that same time, discovering that the spouse who just passed away was covering up. ‘We had no idea Mom was so confused.’ So losing a spouse is a big one. Someone who might have had to give up their driving — which is such a major loss of independence — now becomes isolated. And the physical changes. One might have a new diagnosis that’s going to be indicating to the children that [they] should plan something now. My mother was widowed when she was in her mid 50s. Did quite well. Mid 60s, she probably said to me, ‘Oh, I’m never going to leave my home.’ Okay. So early 70s, she’s diagnosed with  Parkinson’s. She was still good living alone, still driving, doing things with her friends locally. But the house was 40 or 50 years old. Things are breaking down. She was able to say, ‘I think I want to look for something else,’ which was wonderful.

CPP: So that was the best-case scenario. What about when you’re witnessing someone whose condition is getting worse. She’s on her own. But she continues to says she’s fine. What can adult children do to open their parents’ eyes and say ‘No, please; it would be so much better for you to go elsewhere?’
Cox: Have conversations early and often. If there are siblings, get the siblings to talk about things in advance. There might be other family members involved, as well. Try to get everyone on the same page of compromises that need to be made in approach this. Get that out of the way first. And just get out to look [at retirement homes]. People have misconceptions about retirement living. My grandma was in a nursing home and it was horrible. If you can, visit, because communities now look like fine hotels, not nursing homes. I think it helps that adult children understand their parents’ perception of what’s available to them and what that next step moving out of their home looks like. Then take them out and visit, show them brochures, say, ‘Mom and Dad, it’s not like maybe you remember with your grandparents or even your parents.’ There’s also being able to assist Mom and Dad in the case of an emergency with a power of attorney. Should we be talking to our parents about living wills? What are their wishes as things change with them? We have guides on “Talking about Touchy Topics with Your Aging Parent.” I’m sure AARP has a lot of things on their website, as well. Just what to look for when you’re visiting. This is a great guide to getting through the maze.

CPP: What are the different types of retirement communities or homes out there?
Cox: There’s a continuing care retirement community, referred to as a CCRC. A CCRC has the tiered levels, starting from independent living, then personal care, and then skilled. It is almost always a buy-in situation. Most folks enter a CCRC for independent living and would purchase their patio home or even their townhouse or condo, and then have a monthly fee that they pay. And as they need other levels of care that are there, their monthly fee might change; it depends on the contract.
I usually find the younger senior looking at the CCRC. The older seniors — mid 80s, late 80s, even 90s, who have stayed in their home and now things are changing for them — they’re looking at the retirement communities that are month-to-month. Country Meadows is a month-to-month community. I like to refer to it as pay-as-you-go. If you’re fine for independent living, you’re paying for independent living. You may or may not need additional care in the future. You’re not paying for that ahead of time, if you need more care. Country Meadows does have continuing care, so that you can move to the next level of personal care. And then several levels and specialty care within personal care.

CPP: There are many seniors out there, grandparents, who are very healthy. Maybe they’re still working. But for others, this can be such a daunting prospect for them. I think it helps that we, their adult children, understand that they may be overwhelmed, and so their stubbornness might just be that they’re scared. It’s a huge decision, and one they have no idea how to make.
Cox: I think we all lose sight of this. Think about what is that older person going through. Feel, be empathetic and think about all the loss. There are so many losses. Certainly a diagnosis that their health is changing. More aches and pains every day, and then a diagnosis that really hits you, and wow. Boom. So it’s your health. You’re losing your spouse, your friends. There’s also the changing relationship roles as adult children assume more responsibility for their parents. The parent may feel that their now-grown child is overstepping bounds and resentment may grow.

CPP: For the adult kids trying to help their parents find a retirement home, what are some things that they should look at in the beginning? How should they start?
Cox: Talking to friends who may have gone through the situation is great. If you know that a coworker or trusted advisor has gone through this situation, what did they experience? Get their take on it. Do research on the web. Often adult children narrow things down first before actually bringing mom and dad out. Then scheduling a visit. Talk to the marketing director. At Country Meadows, for example, we try to help advise through some of these things, what others have gone through.

CPP: What’s the biggest mistake you see people make, either the seniors themselves or maybe their adult children or their loved one who is assisting them?
Cox: Not coming together for a decision, a compromise in what we feel is best, rather than having that turmoil go on. For the seniors themselves, just waiting too long. As things happen with one of the spouses, if one passes away, it’s so much easier if they’re already established with us. They have that connection of friends. They have that support system when one of them dies. We recently had a lovely couple who joined us in independent living. They took a couple of years to make the move. But they eventually moved in and spent some time with us together. Unfortunately, he became ill and passed away. And she now says ‘Oh, my gosh, I’m so thankful that we came when we did.’ Now she has a wonderful support system of friends and she can remain active.
CPP: I think one of the worst things for the sandwich generation is you’re busy raising your kids and then you worry about your parents. So that scenario of that resident settling in and then reflecting that it was the best move ever for her, is the ideal one. I’m sure that her kids are thrilled. That peace of mind.
Cox: Mom and dad are safe.

CPP: What — other than perhaps your parents saying this is the best thing ever, I’m so happy I’m here — are some signs that adult kids can look for to make sure that the place where their parents have settled is great for them?
Cox: I would say first of all, the adult children should understand the adjustment period. It’s a major change for them. I usually recommend that continue your visits to them at the same frequency as before. Luckily, you don’t have to come and fill the med box or check it every day.
CPP: Or bring meals.
Cox: Those burdens are relieved from you, which is wonderful. You now have time for nice visits to sit on a bench outside, take a walk, take a drive, continue some of the things that you and Mom like to do. Go out to eat. Go to the spa. But kind of maintain your same amount of visits. It doesn’t have to be daily. Let her get adjusted. Let her meet people. But be a part of that. ‘Oh, let’s sit with mom at happy hour.’ We have happy hour at Country Meadows every day but Sunday. We see a lot of families then. And we like to ask families to check with the staff about what Mom or Dad are doing because they may tell you they haven’t been out of the room all day. We will make special effort to let you know she did come out. She was out watching the movie, or she went to the exercise class this morning, to make you feel better about her being there. If you have concerns, don’t hold them in. I tell families, talk to us right away.

CPP: When you’re dealing with dementia, it’s a whole different level of care, of finding the right facility. What does the ideal memory care facility look like? And if it’s a memory care facility, the onus is going to be on the adult children to help look for that, depending on the level of dementia your parents have. What are non-negotiables?
Cox: You would know pretty well when you walk into the unit. It doesn’t have to be the newest building. We can’t all be newly built with all the bells and whistles. But it should be clean. And looking at the residents and are the residents — do they look well-cared for, groomed, dressed? Of course in a dementia unit, you could be surprised with what you find. Look at the staff, the coworkers. Do they look happy? Observe them caring for residents. That’s what’s most important to me. And make sure you’re looking at a memory unit. There are communities that will have a resident join them who has dementia, but there may not be programming. At Country Meadows, we have a safe, secure area. But what’s more important in that area is the staff is trained. We have a particular technique called the Validation Technique that we use to work with our residents. So you want to find out is it definitely a specialty care area where staff is trained, and what kind of training do they get. And then I would say multiple visits, not just a one-time visit, if you can. Visit in the evening.

CPP: The bewitching hour for Alzheimer’s patients. When the most agitation that can happen. So you can see how the staff might react, or help calm a resident?
Cox: Yes. And as you’re looking, I might actually want to have a meal in the unit. And certainly we do recommend you look at various places and compare.

CPP: What happens if family members have some serious concerns about the facility where our loved ones are residing? What are our options?
Cox: I would again say bring it to our attention immediately. Hopefully you have a good connection with the staff and a manager. If that does not seem to be resolved, there’s an executive director at each building. Every community should have a complaint process. Hopefully it doesn’t get to that point.

CPP: For those grandparents who are still relatively young and healthy, very active — maybe even taking care of their grandkids during the week— what’s one thing that you would recommend that they do now to prepare for 20 years down the road?
Cox: They want to make the decision. They should be proactive in gathering information and think about what might be in their future. And when you’re looking — especially for younger seniors looking at CCRCs — look at the other levels, as well. And keep open communication with your adult children about your future plans.