Excerpt from Chapter 1

Step 7 — Consider hiring a geriatric care manager if you find that you need assistance in identifying resources or that you are simply stretched to the limit.

If your parent lives in a city or town with which you are unfamiliar, or even if you live nearby but simply do not know where to start in terms of looking for services, a geriatric care manager will be of immense help. Many of us think we can do it all, but we find ourselves in what is called the Sandwich Generation, a term that has been around for decades. It refers to people who have to care for their own families, meeting the needs of their children, while caring for a parent. Today the demands are even greater as people are working more and have less free time. If you find that you simply cannot add one more thing to your plate, or that your parent requires daily monitoring, or that you live in another state or on the other side of the country, then if you have the means you may want to hire a geriatric care manager. (Their fees range between $50-$200/hour.)

A geriatric care manager (GCM) is a professional with specialized knowledge and expertise in senior care issues. (See
page 158 for a full description.)

Step 8 — How to navigate delicate waters.

For years, my mother said that she hoped she would die in her sleep. This is what most of us would like. After all, if given a choice, we wouldn’t sign up for a long protracted decline. But the reality is that only a small percentage of people die suddenly. The vast majority of us will have to deal with end-of-life issues.

As your parent ages, it is important to know what she wants you to do in case she becomes incapacitated or suffers a life-threatening event. Does she want to be resuscitated regardless of the situation, or only under certain circumstances? If your parent does not have a Do Not Resuscitate (DNR) order and has an event, such as a heart attack, that requires cardiopulmonary resuscitation (CPR), it will be administered. However, what you and your parent must know is that survival statistics for people who receive CPR in their 80s and 90s are grim. A 2002 study published in the journal Heart found that fewer than 2% of people in this age group who had been resuscitated for cardiac arrest at home lived for one month.6 If your parent, like the vast majority of seniors, wants to die at home, then she should be amenable to having a DNR.

We live in a culture that touts that everything that can be done will or should be done. Often life-altering decisions are made in haste instead of having heart-to-heart discussions that look at the bigger picture, that examine the odds and provide realistic expectations and consequences of certain procedures.