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The ties that bind families (cont.) The right thing to do More than with money, though, adult children help elderly parents with time committed to the daily tasks of life – driving, shopping, cooking, checkbook balancing. When illness or frailty enters the picture, so does the real hands-on work of personal care — two-thirds of the dependent elderly who receive help at home rely solely on unpaid assistance from family and friends. Even when they become ill or frail, most older people want to remain at home as long as possible. Social policy encourages this because it’s more cost-effective than institutionalization. Medicare covers a variety of in-home health services such as visiting nurses and therapists – although those benefits could be curtailed as the baby boom ages and Medicare trims costs to stay afloat. Also, more non-medical programs such as home-delivered meals and adult day care centers make staying home more feasible. "Twenty years ago, physicians would say, ‘This person has to go to a nursing home,’ and Medicare would cover it," said Marianne Hogg, director of seniors and special needs at Jewish Family and Children’s Service. "Today, we have the drugs and support services to help people manage in the community. And Medicare won’t cover anything outside very specific guidelines, so nursing homes aren’t the option they used to be." Which is just as well, she added. "Keeping people out of institutions as long as possible is the right thing to do." But not always the easiest. Coordinating the support services, handling the paperwork, working or fighting with doctors and insurance companies, can be a demanding job for relatives. "It’s quite impressive, the extent to which families go to maintain their elderly members in the community," said Morycz. What family means Stories have abounded in recent years about stressed-out, guilt-ridden children, usually daughters, being pulled in opposite directions by the simultaneous demands of children and parents.
Jo Ann English, 43 and separated, knows the feeling. She lives with her widowed mother, 91, who has dementia, and her daughter, Michelle, 10, who intercedes with grandma when English’s patience wears thin. Athene Wade was once a French teacher who loved good music, elegant manners, her mechanic husband and their only child – actually a grand-niece adopted as an infant, when Wade was 55. Today, Wade has trouble with simple conversation. And while she walks with a cane, looks impeccable and keeps her room neat as an army barracks, she has to be watched to make sure that she doesn’t brush her eyes instead of her teeth, or turn on the stove burner instead of the light. Each weekday, Wade goes to Vintage Adult Day Care in East Liberty, while her daughter teaches parent education to mothers in drug rehabilitation, and her granddaughter attends the fifth grade at Homewood Montessori school. Nights and weekends, though, can be trying. Wade cannot be left alone, so English either stays home or takes her mother wherever she goes. The older woman gets depressed a lot. She can be stubborn, refusing to eat or dress. Last summer, when English and her daughter went away on the first vacation of their lives, Wade went on strike, refusing to cooperate with her caregiver. Sometimes, the older woman says she wants it all to be over. Things got a lot more difficult this month, when English had complications following a hysterectomy. She had returned home following the surgery, but a sharp pain in her shoulder indicated possible blood clots. The paramedics came to take her to the hospital. As they carted her out, her mother began screaming in fear. The second hospitalization lasted seven days. During that time, English worried about Michelle worrying about her mom. In addition, she worried about Wade, who refused to go to Vintage. Instead, she sat home all day long, staring out the window. Now English is home again, taking blood thinners and recovering. But the whole experience magnified the tenuous nature of her family life, and the difficulty of being all things to two loved ones 80 years apart in age. "If I put my mother in a nursing home she would lose the will to live," English said. "She needs me. So I’m taking care of all three of us, but my patience wears thin, and then I feel guilty." Michelle’s future worries her, too. "There’s not any money to put away for Michelle right now, and I refuse to take a second job because there’s not enough of me to go around as it is." Wade’s pension pays for Vintage — a program that English says "saved my life" — but she surpassed her health insurance limits this year, so her daughter is paying $300 a month for two prescriptions. English takes her rewards where she can find them – her mother’s occasional flashes of clarity, the times she eats her dinner or takes her medicine without a fight, the moments of laughter – and, most of all, the knowledge that Michelle is learning what the word "family" really means. "Working where I do, I realize how many mothers don’t know how to love their children. But I know how to love mine, because I was lucky to have a family that took care of me and taught me. I pray my daughter is learning the same lesson." A long commute Children can feel stretched thin even when finances are not an issue, as homemaker Jean Paladino has learned. More than once, in order to spend the weekend with her frail, widowed mother in the family homestead in Portage, she has left a sick son’s bedside or peeled crying, clinging children from her leg as she got into the car. "It wrenches your heart; you feel guilty that you can’t be everything for everyone," she said. Still, she says, "I’m not complaining. I do this because I want to." Catherine Kristofko, 74, has had rheumatoid arthritis for 40 years. She has to be lifted from her bed to her wheelchair, and cannot stand unaided. The steroids she takes for lymphoma have turned her skin to tissue paper; the blood-pressure cuff turns her arm black with bruises. She gets up three times a night for 20-minute trips to the bathroom, and can’t be left alone except for the quickest of shopping trips. Kristofko’s husband, a banking executive, cared for her until his death in 1995. He left her well-fixed enough to afford round-the-clock nurses seven days a week, but her daughters have elected to cover the weekends themselves. So come Fridays, Paladino and her two sisters, who both live in the Pittsburgh area, take turns making the two-hour commute to Portage. There they not only care for their mother, but also clean, shop and cook for the coming week. "It’s hard, but we want to do it," Paladino said. "My sisters and I get along extremely well, which is amazing considering the stress. " The sisters have families of their own, so the schedule takes both planning and flexibility. Husbands have charge of the children who stay home. In the Paladinos’ case, the youngest child makes the commute with mom. Paladino doesn’t have a paying job, but she has plenty of other duties — Cub Scout leader, homeroom mom, fund-raising chairwoman for the middle school. Occasionally she looks in on her in-laws, one of whom has Alzheimer’s disease. "My friends keep telling me this can’t go on forever, but I hope to do it until it’s impossible for my mother to stay home," she said. "Yes, it’s difficult and it requires sacrifice on my part and my family’s. But I feel I owe it to my mother — and more."
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