The Cincinnati Enquirer from Cincinnati, Ohio • Page 56

HIE ENQUIRER SUNDAY, JANUARY 8, 2006 E9 Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the government for a redress of grievances. The First Amendment to the United States Constitution f. Editorial Page FOUNDED 1841 A GANNETT NEWSPAPER Margaret Buchanan President and Publisher Thomas Callinan Editor, Vice President David Wells Editorial Page Editor Jim Borgman Editorial Cartoonist Byron McCauley Associate Editorial Editor Ray Cooklis Assistant Editorial Editor Tony Lang Editorial Writer Krista Ramsey Editorial Writer Editorial Tburt il a Prepfflig fw the aft fwldssb, ph M- the. As a nation we're 'not very adept at dealing with aging family members' declining health or facing up to our own possible dependency someday. Our indi- resist or put off major care decisions, which then end up being made later during an emergency, perhaps by others.

Instead of a strategic con- versa- 1 V. i MurL to MAI RFPflRT CARING 947 tion, it's more plan add likely then to be a negotiation or worse. This isn't just an "old people's issue." A car crash could reduce any of us at any age to dependency, whether it's for transportation, food, bathing, housing or medical support It's in everyone's interest to lay out personal preferences in advance. When you're negotiating with an aging parent on how to re-settle them, it's not too soon to sit down with your children or other trusted relatives for a heart-to-heart on plans for your own fourth stage of life. Strategies that pay off When a dependent relative's mental functioning also is slipping, safety becomes a chief concern.

Family members need to take responsibility and make the tough decisions. There is no single formula that fits all caregiving plans. That frustrating fact only adds to policy-makers' anxiety, as an aging wave of 77 million baby boomers approaches at the same time resources are dwindling. But as today's Enquirer special section makes clear, after listening to family caregivers and researchers, some strategies clearly are superior. Families should try to maximize the ability of the declining family member to help make his or her own care decisions.

Elderly relatives especially need time to decide. up to costly disruptions later -for families, employers and government at all levels. It's a blessed and probably rare family that smoothly handles the transition of a loved one into what Kathryn McGrew, a Miami University associate professor with the Scripps Gerontology Center, describes as "the fourth age." This fourth stage of life beyond childhood, adulthood and retirement may require such profound life changes as giving up driving, obtaining in-home help, or moving in with family or to an assisted-living home. McGrew has done extensive research into why so many of us resist planning for long-term care. Her findings not only give clues on how to overcome inertia in family decision-making, but also could help state and federal lawmakers struggling to control Medicare and Medicaid costs and fund alternatives to nursing homes.

The cost of doing nothing Families that do finesse these life transitions very likely are ones in which the aging relative either helped decide in advance what should be done, or can still make his or her wishes known. It's usually much easier with consent "Planners" have the foresight to discuss arrangements for their care before a crisis develops. "Non-planners" either Alzheimer's disease is just one major challenge facing many families, as this 2000 cartoon by Jim Borgman reflects. riously self-indulgent boomers. Members of this retiring generation are unlikely to support massive public investment in options they see as unattractive (nursing homes, for example), and more likely to respond to financial incentives that promise some sense of mastery and self-worth.

One starting point for fami- lies negotiating major care de- cisions might be to get all to a-' gree that whatever's decided, it won't be perfect Another good start, since we're all candidates for dependency, is for all to chime in on our care preferences if we could no longer care for ourselves. sions. Some families find it helps, when at an impasse, to bring in a dispassionate friend or some other neutral party. Unfortunately, some aging Americans consider it a threat to their healthy, optimistic attitude just imagining themselves as dependent They are repulsed by the thought of investing in any plan for an "unworthy" frail self. They balk at the idea of paying, ahead of time, for some stranger years from now to change their diaper or feed them in a nursing home.

McGrew calls this the "ick factor." She argues in a book she's writing that most of us need to plan for this fourth stage of life, and that even if long-term dependency looms in our future, it still can be "very meaningful, satisfying and enriching." McGrew also argues, in the case of heterosexual couples, the woman's preferences on such decisions as where to live should be given a little more weight, since statistically speaking, she is more likely to outlive the man by five to six years. No solution is perfect Lawmakers, insurance companies and others eyeing the age-tsunami approaching should study our psychological aversion to long-term planning, particularly among noto Avoid using scare tactics. They tend to backfire. Some of us, especially those of us with middling assets, should consider long-term care insur- ance. Family caregivers also need to know their limits -when first offering help and later, as conditions change for them or the dependent relative.

Know to ask for help In Cincinnati and Northern Kentucky, most caregivers are unpaid family members; most are women, and also employed. That's tough enough, without also trying to resolve competing family interests over such major care deci Letters Your stories of tough life decisions Father's last years were heartbreaking er Editorial Page, 312 Elm Cincinnati, OH 45202. Please include your name, neighborhood and daytime phone. To read more: Go to Cincinnati.Com to hear caregivers, see photos and find links for where to get help. Keyword: care We asked readers to share with us examples of the kind of wrenching choices they've had to make regarding care of ailing relatives.

Tell us: Want to share your own story? E-mail us at lettersenquirer.com; fax to (513) 768-8569; or send a letter to Letters, Enquir and hard work, too -I PwTV)v Li it I Oi TV iv I had vprv emotional decisions when caring for my father Gerald, who had Alzheimer's disease. I denied that he had the disease and to this day am not certain he did, although through the 2 years that I had him, he did get progressively worse. I think back now and say, "Wow, that was the hardest job emotional and physically I've ever had." When my dad came into my home he couldn't communicate verbally, but he had died a few years before and my sister lived out of state, I was die only relative to be with her toward the end of her Efe. She was a strong woman who spent more time caring for others, especially her grandchildren, and always wanted to make sure we were doing well. 1 could tell Grandma was fighting to and the home had many recreational activities.

I called and visited her as often as possible. Grandma was there for about eight years before she had a stroke that left her helpless. Some of the staff said we could remove her feeding tube, but that was not an option I could even consider. What 'I volunteered to postpone college so that I could stay with her more. Grandma strongly refused my offer saying, "Hived a long and full life.

And I want you to do the same." So with that we looked for a suitable nursing Debbit Bttai still had a anv- license and 'You really need to take 1 stay here, but 1 would a car. I took him to a parking lot to see if he could in fact still drive knowl-edgeably, so I care of yourself tell her I'm OK. I 5 would miss her, but 1 emotionally, times a day, and I also had to bathe him each morning. That last day I had gotten up and given him a shower and gave him his breakfast Then I gave my handicapped daughter a bath, then I showered myself and then my son showered and got ready for school. My dad ate and went to the bathroom in his pants and threw it on the floor in my living room.

I gave him another bath. My husband kept an eye on my dad while I took my son to school. I came home and he went in his pants again and threw it on the living room floor. He was out of control, and I was about to lose my mind. I gave him another bath, and he didn't want me to; there was a huge struggle with him to get him cleaned up.

That's when I knew that I couldn't take it any longer. I had to call the police so they could call an ambulance and take him to the behavioral unit at the hospital. There he was placed in a nursing home and remained there until he died March 3,2005. My input on this is: You really need to take care of yourself emotionally, or you cannot begin to care for anyone else. I learned this the hard way, but I learned it well! Klmberty Harris Walton Caring for Grandma was an act of love My grandmother, Eleanor Hattendorf, lived with me while I attended college.

She was in her 80s but was still spry and mentally alert We got along very well and enjoyed each other's company. or you cannot or you begin tO Care not safely. He diought she should go and be with her husband and son. I would always love her. so much.

On New Year's Eve 1992. just 25 days before her 95Ui birthday, my grandmoth- er joined her husband and son in heaven. Debbie Bolerr Price Hilt we did agree on was stopping all of Grandma's medications, except for the ones for pain. I sat with Grandma many days, talking softly about all the tilings 1 remembered about what she had taught me and all the good times we had. Since my dad (Grandma's only child) scared me really badly, and I never gave him the keys back to his car.

I for anyone else. KmlMriy Harris Provided photo Klmberty Harris of Walton is moving on with her life with her daughter Madison. Harris' father died of Alzheimer's disease last March. During the summer of Grandma's 85th year she became very ill and required hospitalization. When she was strong enough to leave the hospital, her doctor advised she should not be left alone for extended periods.

Since I was going to college and working, a decision had to be made immediately. Because Grandma had raised me since I was very young and I loved her so much, I volunteered to postpone college so that I could stay with her more. Grandma strongly refused my offer, saying, "I lived a long and full life. And I want you to do the same." How can you live when you have to baby-sit an old woman? So with that we looked for a suitable nursing home for her. She enjoyed the company of others close to her age, For more of your stories, see Page E10 I1! sold the car a week later and it didn't really bother him because I was there to take him any-where he wanted to go.

I also gave him money to put in his wallet and that was very important to him. I put up with a lot of stuff with my father, while he wa9 living with me. He tried to push me down the steps, and he tried to hit me. But the worst thing was the last day my dad was in my home. In the end, his bathroom habits were horrible.

I had to change his diaper about 20 Send letters to: Letters, Enquirer Editorial Page, 312 Ebn Cincinnati, Olti 45202; fax (513) 768-8569; e-mail lettersenquiaT.com (a form is available at enquirer.comeditorletters.html). 7 Please send e-mails as plain text without attachments. Limit letters to 100 words. Include your name, address (including community) day phone and a return ad- dress. Letters may be edited for space and clarity.

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