I’ve been noticing that when I get caught in the undertow of feeling like a failure at parenting, it makes me really angst-y and hyper-controlling with my kids, especially my 15-year-old daughter, Grace. This happened last week when, mid-stream in spring softball tryouts, she suggested that maybe she wasn’t really all that keen to play softball after all. Turns out the practices were sort of grueling and boring and she’d rather be hangin’ with her girlfriends at Starbucks.
This made me worried. Inner dialogue: “Does this mean colleges will think Daughter is lazy? She needs to play softball! I’m going to talk to her. I am going to point out how to her how important it is to be involved in activities!” I love watching her play but I also love how it makes me feel — like a rock star mom — when I see her out there tearing up the field. And, if she’s just sitting around every afternoon, what does that say about my competence as a mother?
Fortunately, I left my inner dialogue inside my head. When I got the text from her about this, I was attending a conference on “person-centered” geriatric care. Person-centered care is about making aging services more attuned to the person receiving them and allowing the frail older adult autonomy and control over their health care.
That day, a very smart expert at the conference said that person-centered care is hard – especially for many nurses and physicians — because it is about relating to another human being through a decision-making process that honors the person’s preferences and goals. Even when the decisions run counter to what would make the care provider feel competent and comfortable.
The word, “competent” got to me. Essentially, we were talking about how doctors shouldn’t control their patients’ decisions in order to make themselves feel like more competent doctors, but it occurred to me that this applies to families too. I realized that I wanted to control my daughter to feel better as a parent. And, I know many women worry that if they don’t exert control over their frail parents’ lives, the outcome of that will make them bad daughters.
So, instead of insisting that my daughter continue with softball, I loosened my grip a little and told her that I trusted her judgment and supported her decision, and that I love her. It hit me that, in this situation, it was more important for her self-worth to practice making a decision on her own, possibly getting it wrong than for me to make it for her.
And, so it goes for how we relate to frail elderly, whose physical or cognitive abilities have created a concern for their safety and the impression that they cannot be trusted to make decisions — that their safety is more important to us than their autonomy is to them. But as with parenting or with our own choices, when safety and control win, freedom loses. And, freedom to choose our destiny is the precursor to creating a meaningful life.
This is hard though. Also, let me say that there are some bright lines. We need to intervene when our parents, children or spouses are putting other people at risk. When it’s time to stop driving a car, for example, there’s no room for autonomy to make the decision to keep driving.
Please know that there are many providers working valiantly to change the practice of medicine and elder care so that it respects the decisions that frail older adults make about their lives. As daughters, we can support this process for our parents by using some of the same concepts and tools that they use.
Learning What Our Parents Want and Making A Plan
Just to state the obvious, it helps to respect your parent’s choices when you know what they are. One of the things that enlightened elder care teams do is take an inventory of what an older person needs, their resources, and goals for their life. And then, they put a plan in place to get the person the care he or she needs that supports those goals.
There’s a lot that goes into an official geriatric care plan and there’s a whole profession of people (naturally called geriatric care managers (GCMs)) who can help you and your parents develop goals and a plan. You can find one by going to the website of the National Association of Geriatric Care Managers, clicking on “find a care manager” and then typing in your zip code.
I’m a big fan of getting help through GCMs so you should seriously consider it. But, if you are like me and the word, “plan” makes you break out in hives, just do this: try and elicit from your parents what is most important to them for their life, keep it front and center in the priorities, and talk to the doctor about whether the care they are receiving works for or against what they want.
For example, if your 90- year-old mom’s top priority is to not fall and to stay as mobile as possible, you, she and the doctor should discuss the trade-offs of her being on the medication that makes her dizzy, even if it’s treating a life-threatening illness. She gets to choose a shorter life lived upright and independent than a longer one bedridden. It’s hard for physicians to accept these choices sometimes so you might have to be pushy.
A Team that Communicates
This is a topic that warrants several blogs all on its own. Great person-centered care is often delivered by what we call a “multi-disciplinary team” which just means that no one type of provider gets to be boss and everyone talks to each other regularly and has a say in what happens to the patient or client.
Right now you are wondering on what planet this actually happens.
Well, it does happen on our planet, but just very rarely. There are great programs that do this and I’ll be creating a “resources” page on my website very soon that gives you that information. For now, though, I recommend you take advantage of some of the new tools available to support and enable communication between everyone involved in your parent’s life. If there’s a neighbor, and you and a sibling or another parent and a home care aide: Congratulations, you’re a team!
Now, make time to huddle everyone together and decide how to signal to each other for the hand-offs. I am in the process of checking out a few of the tools that support inter-family communication, including Making Care Easier, Saturing and ecarediary. I haven’t fully vetted these or exhausted reviewing the options yet but that’s coming soon too. I love the idea of them and you should definitely check them out. Let me know if you have other ideas or suggestions.
Get out of the way
If you are feeling inadequate, triggered, and neurotic about how you are doing, this is completely normal. But please know that your worth as a daughter does not depend on keeping your parents safe at all costs. Know that this is messy and hard and control is an illusion anyway.
Also, if you’ve never been in counseling, this could be a good time to start. In getting support and perspective from a trusted outside person, you can make decisions that are not inadvertently all about you. For example, good therapists get “supervision” from other therapists to make sure they don’t bring their crap into client relationships. It’s not easy but you have to do the same thing now for your parents.
Knowing what’s in your control and what isn’t can be hard when the responsibility is weighing on you. But it’s the key to surviving this experience and getting comfortable supporting your parents’ decisions rather than fighting them for control.
By the way, my daughter decided to stick with softball.