| Family First Feature |

King to Pawn?

As elderly parents age, adult children usually become increasingly involved in their parents’ care. A sensitive look at a challenging situation

One morning after breakfast, Yosef decided to run some errands. He took the car. Under normal circumstances, this would be unremarkable, but Yosef had cancer, and he was taking pain medication that impaired his cognitive ability. He ended up in a fender bender and was taken by ambulance to the hospital for minor injuries. Thankfully, no one else was hurt. After that, his wife refused to be in the car if he was driving, and she offered to be the designated driver.

“He was outraged,” recalls his stepdaughter, Bayla. “He insisted he was perfectly capable of driving, and refused to capitulate, even though it was downright scary to drive with him. His reflexes were so poor that he made jagged, abrupt moves while driving, and sometimes slammed on the brakes in the middle of the highway.”

Bayla’s parents fought for weeks about the car issue, with her stepfather insisting he was still competent behind the wheel, and her mother claiming the opposite. It fell to Bayla to convince her stepfather to give up driving.

“I had to play the bad guy,” says Bayla. “I had little ones at the time and I told my stepfather, very gently, that I loved him dearly but that I was terrified of his driving and and that if, chas v’shalom, anything happened while my kids were in the car, I didn’t know if I’d ever be able to forgive myself for letting him drive them. So I made a firm rule that if we were all together, only me, Mom, or my husband could drive.

“Dad was so upset, he almost started crying. I wish I knew a better way to go about it, but how are you supposed to communicate with someone who refuses to admit that he’s no longer capable of doing what he’s done so well and so masterfully for decades?”

This is a conundrum experienced by many people with aging parents, many of whom have health issues that cannot be ignored. As the aging population continues to grow — in the United States, more than 10,000 people turn 65 every day — we can only expect these questions to become more prevalent and urgent.

Many adult children already play an active role in the lives of their aging parents. According to a 2015 Pew Research Survey, 60 percent of respondents with a parent over the age of 65 have helped out with errands, home repair, or housework. But a situation could become increasingly complicated when parents ignore medical advice, and put their health in jeopardy, or, like Yosef, make decisions that can place others in danger.

What is my role in this? many adult children wonder. Is my priority keeping my parents healthy and safe? Or is my role to respect the boundaries of my parent, and take a step back?

It takes sensitivity and skill — and guidance from a rav — to know how to navigate the hurdles. And the first step is trying to understand what it feels like to be in the parent’s shoes.

Autonomy and Connection

Every Shabbos, a certain elderly man in his nineties was invited by the neighbors on his block for meals. The neighbors were happy to have his company, but one of them wondered why the nonagenarian wasn’t at his children for Shabbos, and called the man’s son.

“My father wants his independence,” the son explained.

“We want to be cared about, but fear being cared for,” says Claire Berman, who wrote Caring for Yourself While Caring for Aging Parents in 1996. Now that Berman is 83, she finds herself looking at the matter of parent care from a different perspective. In an interview for the Atlantic, she said, “I nod in agreement when the son of a friend expresses concern to me about his dad driving after dark, but I also understand when my friend, his father, complains of ‘being badgered by my kids about my driving.’ ”

As people age, they want to maintain their independence. They don’t want to feel as if their children are checking up on them — checking if the house is clean and the food in the fridge is fresh, performing less-than-subtle memory tests. But although elderly parents want autonomy, they also want connection, which can lead to conflicted feelings about their child’s involvement in their lives.

According to a 2004 study from the State University of New York at Albany, aging adults “define themselves as independent but hope that their children’s help will be available as needed. They are annoyed by children’s overprotectiveness but appreciate the concern it expresses. They use a variety of strategies to deal with their ambivalent feelings, such as minimizing the help they receive, [and] ignoring or resisting children’s attempts to control….”

This research resonates with Muriel Mehlman, MSW, who facilitated the Neshei C.A.R.E.S. support group for caregivers for 15 years. “While many parents appreciate their children’s concern, they feel their knowledge and understanding of their circumstances are more cogent than their children’s, for they use life experience to navigate their lives,” she says.

Yaffa, the only child of Holocaust survivors, has been on both sides of the fence. Growing up, caregiving was woven into the fabric of her family life. She recalls her parents caring for an ailing aunt, and then their ailing parents. When Yaffa’s own father grew ill, she saw the toll it was taking on her mother and begged her to get extra help.

“My mother wouldn’t listen to anything. I lost it at one point, and my father, who suffered cognitive decline because of his medical issues, said, ‘Is that how you talk to a mother?’ But that was the only way she would listen.”

Yet even with these memories etched so deeply, Yaffa dislikes when her daughter offers advice; she views it as meddling. “My daughter is not a caregiver,” she says. “Yes, she lives close by and sees me more often than her siblings. Maybe she feels more responsible. But I’m too young, I’m mentally competent. I can handle things.”

Sometimes parents choose to withhold information from their adult children because they don’t want to worry or hurt them. “In that case we have to respect their opinion,” says Mrs. Mehlman. “They’re looking out for their children’s welfare.”

Still, it remains a difficult situation to be in. Chaya’s father passed away two years ago, but you can still hear the frustration in her voice when she speaks about her dad’s last years. Although she’s from a small, close-knit family, when her father received his cancer diagnosis, he withheld this information from all but one child, Chaya’s brother.

Even after her father finally shared his diagnosis with the rest of his children, he wasn’t always forthcoming with the treatment protocol his doctors recommended.

“He picked and chose how he wanted to be treated ,” says Chaya. “He had all sorts of cheshbonos.”

In hindsight, she says she realizes he was an independent and strongminded man, and he carried those personality traits into the way he chose to manage his disease. “He didn’t want people taking care of him. He didn’t want people to know. He didn’t want to burden the children. Lots of times parents make these decisions thinking they’re protecting us, which is noble, but on the other hand, it left us all reeling and in shock, confused and overwhelmed.”

There are also situations where elderly parents may refuse medical treatment, causing their children anguish. Angel Joy is director of social services at Palm Gardens, a nursing home in Brooklyn. She says when a patient with dementia refuses lifesaving medications, she’ll reach out to the family so they can help, but in the case of a mentally competent patient, they have a protocol.

“We try to counsel them. We tell them, ‘You want to get home, so you’ve got to work with the team.’ We try to explore the real reasons they don’t want to comply.”

Getting to the root of why is key. There are mental health professionals, nurses, social workers, and other staff trained to pinpoint underlying issues. Many seniors suffer from depression and anxiety. Some feel angry that they’re in a nursing home, or they have negative feelings about getting older and losing their independence. Some feel that because they’re in the dusk of their years, there’s no point to taking medication.

“You must be understanding,” says Ms. Joy. “It’s easy to feel angry, but that isn’t understanding.”

Halachah On Call

Rabbi Shmuel Lefkowitz is president of Chayim Aruchim, an organization dedicated to providing halachic guidance to families who have a family member who is seriously ill.

“Adult children should be a part of their parents’ lives before a crisis unfolds,” Rabbi Lefkowitz emphasizes. He knows a grown man who eats breakfast with his mother in her home, every morning. “His mother still works, and yet he’s there every day.

“Visiting, calling, and being involved is an obligation, especially when parents are frail, and certainly when a parent is seriously ill. If a parent has a serious illness, it’s important to be there, to be in touch with doctors,” he says. “It makes a difference between what will be and what won’t be.”

Some adult children may abstain from getting mixed up in their parent’s affairs, claiming, “It’s not my business.”

But Rabbi Avrohom Neuberger, rav of Shaarei Tefillah of New Hempstead, says that children are obligated to go through tremendous effort to be mechabed parents. And that includes getting involved when their health is declining. “It’s never kedai not to get involved. It’s just a question of how to get involved in the right way.”

So what’s the proper protocol when a significant health issue arises? Should the adult child step in or step back? What if the child disagrees with how the parent is handling something?

The general rule of thumb is, if parents are mentally competent, an adult child cannot force them to do something against their wishes. Indeed, legally, no adult child can force a parent to accept a treatment against his will. “They are adults with the right to make decisions — even poor ones,” says Suzanne Modigliani, a Boston-based geriatric care manager.

If a parent has a mentally competent spouse, “it’s largely the spouse’s job to decide when and how to intervene,” says Virginia Morris, who wrote How to Care for Aging Parents. “Don’t usurp her role. It is your role to support her, nurture her, and help her do what she thinks is best. Offer information and advice, prod when necessary, but remember that you’re in the backseat.”

This was the case for Chana and her siblings, who chose to take a step back when it came to their parents’ health. Although her parents lead an unhealthy lifestyle — her father smokes and is overweight — they made the decision not to say anything, even after her father suffered a heart attack.

“My parents are very intelligent. They’re aware of ramifications of their choices. Talking to my parents, telling them to modify their lifestyle — it would only upset them, and they wouldn’t change anything anyway.”

Ruchie had a similar experience with her mother. In the past, her mother used to be vigilant about her health — she’d walk everywhere and make healthy food choices. Now, as she’s aging, she has let go, and recently, her doctor diagnosed her as prediabetic.

“She’ll come visit, and I’ll see her take a fruit or a piece of cake and I’m hyperventilating,” says Ruchie. “My mother is accomplished, smart — she runs a successful business. Do I gently ask her not to eat that piece of cake? She doesn’t like it, and told me so, several times.”

Rabbi Neuberger says in this case, interference wouldn’t help. “There’s no tachlis. You’re not a spouse. You’re just being a nudge.”

However, there are some situations, considered crisis situations, where the results of a hands-off approach could be dangerous, even catastrophic. In that case, intervention becomes the responsibility of the adult child, even if there is a mentally competent spouse.

“When you’re dealing with sakanah — that overrides anything,” says Rabbi Neuberger. “You can’t stand by in a situation of danger. You have to get involved. The fact that it’s a parent has no bearing on the situation.”

The most obvious example is unsafe driving. If a parent’s reflexes have slowed down, or he has trouble seeing in the dark, it may be time to discuss giving up driving.

“If your father insists on driving and he’s a danger on the roads, absolutely step forward and speak up. Right away,” says Ms. Morris. “This is not about his life or his needs, or even your mother’s needs. This is about the lives of other people. Be compassionate, but get involved.”

Mrs. Mehlman stresses the importance of being sensitive: “Taking away the car keys from a parent means the loss of his independence. For many seniors, it’s downhill from there.” She advises diplomacy, bearing in mind that it may be a process. When you raise the issue, be empathetic: “I know it’s hard giving up the keys, but I don’t want you to hurt yourself or someone else.” Consider talking about the hassles of maintaining a car, or the advantages of using a taxi or car service.

What if a parent refuses to stop driving? Mrs. Mehlman knows a woman who removed the batteries from her parents’ car to prevent them from driving. Other people have “borrowed” their parent’s car and put off returning it, or hidden their car keys.

Rabbi Neuberger says that when his own father lost his peripheral vision, and almost injured someone, they convinced him to give up his license. “The question is, at what point is it dangerous,” says Rabbi Neuberger. “But once you think it’s dangerous, kibbud av v’eim is a non-issue.”

The same applies if your parents’ house is no longer safe for them. For instance, if there’s been an increase in falls and calls to Hatzolah or 911, an adult child should consider changes to the home environment, like eliminating throw rugs and installing safety bars.

“There are many ways to make a home safer without imposing upon or upsetting your parents,” says Ms. Morris. “Talk to them. Explain the dangers — a fall is likely to lead to incapacity and a nursing home, and could be fatal.”

Sometimes a parent may take the incorrect dosage of prescribed medication, or skip his medicine entirely, both of which can be dangerous, and result in a hospital visit. When this is the case, an adult child should consider scheduling an appointment with his parent’s doctor, and together with the parent and his doctor, review each medication and dosage.

Depression is common in seniors, and many people brush it off as a normal part of aging. But it shouldn’t be ignored. “If you think your mom is depressed, and your dad is ignoring that, talk to her, talk to him, talk to her doctor,” says Ms. Morris. “Depression is treatable, and is not ‘normal’ just because someone is older.”

When there’s serious cognitive decline — if a parent gets lost in a familiar place, has memory issues, trouble problem solving, or handling money — it behooves adult children to get involved immediately.

Can We Talk?

When Chaya’s father’s situation progressed to a point she describes as unmanageable, the whole family felt they needed to be more involved in their father’s care. They consulted with their father’s rav, and based on his advice, they sat down and had a difficult conversation.

“We told him things have to change, but we said it with love and respect. We made sure it wasn’t done in a patronizing way. “

Her father was very upset. “I think many older people are of the mindset that they’re the patriarch or the matriarch of the family, and consulting with their children in some way diminishes them,” she says. Her father was very resistant to allowing his children to take part in what he saw as something so personal. It took considerable convincing before he allowed his children to help with medical decisions.

“He was still our father, but he was nogeia b’davar. We never took away his control, but every time a decision was made or a doctor was called, we’d sit down and have a conversation,” says Chaya. “We told him how much we loved him and wanted what was best for him.” (See sidebar.)

Chaya says that she and her siblings presented a unified front, and they established a hierarchy between themselves so they could pursue decision-making with more clarity. “A hierarchy causes some discomfort, but, if at the end of the day, the goal is to be mechabed a parent, we can’t become absorbed in our own pain, and become controlling and opinionated,” she says. “It was easier to get along when we were mindful our goal was l’sheim Shamayim.”

There were times that Chaya and her siblings had to let go, even once they became involved in their father’s medical choices. “At one point, we wanted to move our father so that we could be closer to him geographically. He refused,” she says. “We respected his choice.”

It turned out that he had a chavrusa that he met weekly, and a goal he set for himself in his Torah studies. He was afraid that if they moved him, he wouldn’t be able to continue learning with his chavrusa and meet his goals before his petirah.

Two years after her father’s passing, Chaya looks back with no regrets. “Even though it was hard, we respected his wishes, and we respected him. There is so much underlying a person’s refusal to get help. It’s easy to say he’s old, he’s set in his ways.

“But this is a human being who is multi-faceted and has a whole lifetime behind him. It’s important to recognize that, and respect that, and validate it. There has to be compassion not just for his physical well-being, but also for his choices.”

(Originally featured in Family First, Issue 680)

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