The Complete Caregiver's Organizer. Robin Porter

the person who tries to hide an unsteady gait and refuses to use a cane or walker when needed is much more likely to fall and break a hip. By the same token, the person who is starting to forget things is a prime candidate for leaving a pan on the stove or becoming dangerously disoriented while out walking or driving. Being observant and stepping in can often prevent serious problems down the road.

      Signs to Watch For

       Not getting dressed—may indicate difficulty dressing due to dexterity issues, back problems, or depression.

       Not bathing regularly (body odor)—may indicate difficulty getting in and out of the tub/shower, fear of falling, or depression.

       Not eating well (weight loss)—may indicate loss of appetite, difficulty preparing meals, handling pots and pans and utensils, or depression.

       Spoiled food in the refrigerator, groceries not being eaten, or large amounts of uneaten food in the trash—may indicate general loss of appetite or difficulty cooking.

       A normally tidy house becoming messy, laundry piling up, dirty toilets/sinks, unwashed dishes, etc.—may indicate difficulty with household tasks or dexterity/mobility issues.

       He or she seems depressed or despondent; loss of interest in normal activities.

       Signs of memory loss—leaving things in odd places, getting lost or disoriented, forgetting to take medications.

       Bruises, cuts, or burns—that may be a result of falls, banging into things, or having trouble lifting pans off the stove or putting things away.

       Items left on countertops/dressers—which may indicate trouble bending or lifting.

       Is It Really Role Reversal?

       When an adult child begins to care for their aging parent, it’s often referred to as “role reversal,” but that’s not accurate. While it’s true that you begin doing things for your parents that they once did for you as a child, the dynamics are much different. I used to jest that it was much easier caring for my 8-year-old than my 80-year-old, because my son would listen to me (well, most of the time), while my mom rarely did. I may have joked about it, but there was really nothing funny about the situation. In fact, it could be exasperating! As a parent, you have authority over your children; you can tell them what to do and have the expectation of them following your directions or be punished. That is not how it works with your aging parents! Let’s face it, your parents will always be your parents and you will always be their child, which means there is a certain amount of respect and deference that comes with these roles. In simple terms, it makes it difficult to tell them what to do. You can strongly suggest, for instance, that your mother or father use a walker to avoid an accident, but you cannot force them to do so. You can reinforce the importance of following doctor’s orders or taking medications as prescribed, and even assist with the administration, but again, you cannot order them to comply. This makes caregiving especially frustrating, because you have all of the responsibility for someone’s well-being, but none of the authority.

       Similarly, many spouses caring for a husband or wife find themselves in a precarious position. Adults are not children, and even when they are unable to care for themselves, they do not want to be treated as such (would you?). Trying to force someone to do something against their will, even if your intentions are noble, will create nothing but resentment and hard feelings. Unless someone is suffering from diminished mental capacity or declared mentally incompetent, a caregiver can only do so much.

       After my mom’s second hip fracture, the social worker at the hospital told me in no uncertain terms that she should not be living alone. Her tone was accusatory—in her mind, I was obviously neglecting my mom. What the social worker did not know was that I had been trying to get my mom to move in with us or consider an assisted living facility for years. In fact, I had begged, pleaded, used guilt, and in my less proud moments, resorted to threats—all to no avail. She adamantly refused to give up her independence, even after several accidents and surgeries. Was I happy about her decision? No. Was I constantly worried about her safety? Yes. Was her stubbornness slowly driving me crazy? Absolutely! But, what could I do? So, I looked that social worker in her eyes and said “I agree completely; she should not be living alone. You try telling her that!”

       The social worker spent over an hour talking to my mom about why she should change her living arrangements, and when she finally left, she looked like she wanted to tear her hair out. (Welcome to my world, I thought.) She actually stopped and apologized to me for her earlier tone. I understood her point of view—there are many seniors who are neglected by family, and I’m sure she sees many sad cases. However, short of having my mother declared incompetent and assuming guardianship, there was very little I could do to change her mind. In the meantime, I considered certain concessions as major victories: My mom had moved into a small condo a mile from our house; I had convinced her to use a walker, wear an emergency alert necklace, installed safety bars, and made other adaptations that she didn’t really like, but to which she finally agreed. I visited daily, checked in numerous times a day, and helped her with many ADLs. Still, I was worried about her living alone.

       At one point, as I was sharing my concerns and frustrations with my mom’s doctor, he took my hands and told me “You are doing the best you can. That’s all anyone can ask.” When I inquired (half jokingly) if he thought my mom was mentally incompetent, he answered with a grin, “Not unless stubbornness is considered a mental disorder.”

       The bottom line is caregivers walk a fine line between providing care and taking over completely. Having someone declared mentally incompetent and assuming guardianship is a drastic measure, and one that’s difficult to obtain legally (see chapter 2). It should only be used in circumstances when the care recipient is truly unable to make decisions on his/her own, such as those suffering from dementia or Alzheimer’s—not just stubbornness!

      Assembling a Team

      Now that you’ve become a caregiver, what does that mean? You are responsible for another person’s well-being, which is no small undertaking. In many cases, you will be a chauffeur, nurse, housekeeper, accountant, patient advocate, and companion—not to mention daughter, son, husband, wife, or parent. No doubt, you will also have your own family and work obligations. There are no easy solutions, but one thing is certain—You cannot do this alone!