On parenting your parents

When we decided to become parents, my husband and I thought we had a clear idea of what we were signing up for: a roughly 20-year contract with add-on options (graduate education, wedding, grand-parenting, etc.). But as the only child of elderly parents, now in need of parenting themselves, the terms of service have never been less clear. I am fortunate to have parents in their 90s (and married for over 60 years) still in my life. But I would be lying if I said that parenting my daughter prepared me for the unique challenges and difficult conversations that come with parenting one’s mom and dad later in life.

Healthcare and hospitals

As a new parent, each day brings new experiences and developmental firsts – starting with those well-baby visits to the doctor to check in on how your child is advancing. Parenting a parent can also involve a lot of trips to doctors’ offices and can be the first place a parent asks for your help, either with transportation or being a second set of ears. Unfortunately, chronic health conditions worsen with age, and recurring appointments can quickly balloon into full-time personal care coordinator responsibilities. In 2021 alone, I accompanied my dad to more than 40 appointments plus another 10 for my healthier mom.

• Get information access early. Before progressing too far, request that your senior parents sign HIPAA (Health Insurance Portability and Accountability Act) and HCPOA (Health Care Power of Attorney) authorizations. These documents grant you access to vital healthcare information and the ability to participate in decisions regarding their medical care. A national standard governs the first; the latter varies by state — and the priority order matters if multiple names are listed.
• Advocate and ask questions. When it comes to significant healthcare decisions, don’t be afraid to do your research and be assertive in asking questions of rotating physicians and specialists. Your familiarity with your parents’?complete?health history is a resource you need to share. I helped my father-in-law avoid the painful side effects of radiation by pointing out that the doctor’s logic suggested immunotherapy alone would provide a solution for more than his expected remaining life span.
• Monitor medications & sign up for supplemental coverages. The daily medication routine (even if only vitamins) are a bellwether for cognitive issues: empty or unused prescription bottles can signal a decline. Keep a watchful eye on your parents’ prescription and over-the-counter medications for irregularities. It is easier for you and them to use a service like CVS Simpledose that bundles them into daily/time-of-day packages. If your folks haven’t already done so, help them enroll in prescription drug coverage and supplemental medical insurance immediately. Standard Medicare does not cover most prescriptions and only a portion of hospital and outpatient costs.

Money matters

As a parent, you do your best to teach your children about money to become financially independent as they reach adulthood. It is far more challenging to identify the moment when your parents hit an inflection point and start to struggle to manage their finances independently. Don’t expect mom or dad to ask for your help regarding financial affairs, but don’t be afraid to offer until they accept. Otherwise, you may be in for a surprise when you realize they have lost the ability to differentiate smart investments from those offered by scam artists.

• Check checking accounts. Even if you have Power of Attorney, request that your parents add your name to their bank accounts now to simplify access without the delay and bureaucracy of probate issues later. This step can be critical when there are multiple children, or there is distrust among heirs. Checking account irregularities can also indicate age-related or other cognitive declines early. My father is a highly organized individual with a Ph.D. in Economics who has always been a meticulous bookkeeper. But that didn’t stop him from double-paying bills, over-drawing an account, and giving to the same suspect charitable and political organizations multiple times weekly. He had even extended a favorite magazine subscription for seven years when their misleading postcards convinced him it was lapsing. Setting up online account access and automated bill paying helped avoid many unnecessary headaches.
• Revisit retirement portfolio. Be sure to review investment accounts with parents as they age. The equity-heavy portfolio they set up when they were middle-aged becomes a high-risk bet a couple of decades later. Imagine my surprise discovering my father had three online brokerage accounts and was essentially day-trading penny stocks (if he could remember his passwords!). Consolidate custodianship, rebalance holdings to ensure they are age-appropriate, and implement ongoing oversight measures.??

Getting around

Few milestones signify freedom to a 16-year old like the ability to drive. And few milestones signify the end of freedom to aging parents as losing that ability, which is why they hang on to that freedom way beyond what their mental and physical abilities allow.?

• Deal with dangerous driving head-on. Take necessary steps to prevent impending road tragedy or other destructive outcomes. This step could be as simple as making the car keys disappear or taking away the driver’s license itself. For many, this will be the first significant conflict you encounter being a responsible “parent.” Many states (and medical professionals) have very little interest in taking dangerous seniors off the road – often allowing them to renew by mail for years without vision or cognitive tests.?
• Get professional advice about ambulatory aids. Getting around inside the home often presents challenges of its own. Canes, walkers, rollators, scooters, and other ambulatory aids can be invaluable tools for preserving your parents’ sense of independence. Ordering these devices online can make it too easy to think of them as another consumer purchase. I ordered the top-of-the-line rollator for my dad thinking it was the best. Only later did I learn from his physical therapist that it moved too quickly for his slowed gait, creating a fall hazard. Be sure to consult with a physical or occupational therapist to identify the right mobility aid and obtain proper training on using it safely.?

Leaving home

We raise our children to become independent and successfully leave the nest. But with aging parents, those very same freedoms can become an impediment to living safely and comfortably in their sunset years. The burden of maintaining a house and yard can signal time for a change, especially for long-term homeowners in homes that do not age well (e.g., stairs, high door sills, narrow hallways, tight bathrooms).

• Don’t wait to relocate. My parents grew up on farms and built their life together in a small town. Our career aspirations took my husband and me to the largest metro areas. They enjoyed visiting us but were always glad to head back home. My biggest regret in parenting my parents is not having used the arrival of their first (and only) grandchild as an incentive to move them closer while they were still in their prime. Only in hindsight is the pattern clear: the distance allowed their needs to grow gradually in my peripheral vision. Modern technologies can help bridge the space, but there’s no substitute for being physically close enough to drop in on them regularly.
• Learn about the care continuum. Negotiating with Mom and Dad regarding their independent living arrangements was one of the hardest things I've ever done. I finally convinced each that the other needed more support — but, even then, they only committed to a “trial” move to the retirement community a couple of miles from me and kept their home intact. Had Covid not locked them down four days after move-in, I am still not sure they would have stayed. The distinctions among senior living options are hard to appreciate until fully immersed. Each step in moving up the “care continuum” from independent living to assisted living to memory care to skilled nursing offers more support but further erodes their independence. If your parents’ individual capabilities (mental or physical) diverge over time, the challenge multiplies when you must choose between their separation or compromising one’s care. Whatever the realities of your situation, help them feel like agents of their future rather than victims. With my parents’ recent move to assisted living, I was clear that staying in their independent apartment was no longer an option, but we visited multiple assisted living communities to see which felt right.?

Whether or not you have children of your own, the odds are that sooner or later, you will find yourself in the position of parenting a parent. At each inflection point, I have remarkable clarity on what I should have done differently or sooner in the prior stage. I share these parenting tips in the hope they can help others on their journey. Ultimately, the most remarkable similarity between parenting a parent and nurturing a child is looking back at how quickly the time passed, wishing you could slow the clock and relive the best moments.