To My Children

When I spill some food on my nice clean dress
Or maybe forget to tie my shoe,
Please be patient and perhaps reminisce
About the many hours I spent with you.

When I taught you how to eat with care,
Put on your shoe and tie your lace,
If you think of these when my age you bare,
You may not notice my messy face.

If I tell the story one more time,
And you know the ending through and through,
Please remember your first nursery rhyme
When I rehearsed it a hundred times with you.

When legs are tired and it's hard to stand
Or walk the steady pace I would like to do,
Please take me carefully by my hand,
And guide me now as I did for you.

In November of 1997, John Stevens led an excellent seminar on "Caring for Your Aging Parents." What follows are the notes from that seminar, which will be very helpful to anyone who is dealing with this particular season of life. John Stevens is a Christian counselor. He is a member of Mt. Ararat Baptist Church and an excellent presenter. We highly recommend John and these notes for your edification . . .

Caring for Your Aging Parents

I. Our Aging America

A. Life expectancy in 1960 was 69.7; 1990 is 75.4

B. Three categories of "old"

"young old" - 65 - 74
"Middle old" - 75 - 84
"old" - over 85

C. "Old" Americans over the age of eighty-five are the fastest-growing age group in our population, and persons over seventy-five make up the next fastest-growing group.

D. Thirty-one million Americans are now over the age of sixty-five. This age group is growing at twice the rate of the general population.

E. Seven million older Americans suffer from some form of chronic illness that requires long-term care.

F. Twenty-five percent of all Americans over the age of sixty-five (and 50 percent of those over the age of eighty-five) cannot survive a week without outside help, usually from children or relatives.

G. One-third of all working Americans also care for parents or relatives thirty-five or more hours per week.

H. One-half of women care for young children and aging parents at the same time.

I. By 2000 A.D. persons over sixty-five will account for 20 percent of our total population.

II. Jesus' Example of Filial Caregiving

When the rich young man asked Jesus which commandments to obey in order to gain eternal life, the Master chose "Honor your father and mother" among the six which He highlighted.

A. The Principle of Filial Obedience - Luke 2:48-51

- A disrespectful child will not become a respectful caregiver when parents grow old.

B. The Principle of Filial Responsibility - Mark 6:3

- financial support and relational support system.

C. The Principle of Filial Independence - Matthew 12:48-50; Matthew 10: 37-38, Luke 14:26

- Jesus was establishing the principle of filial independence that sets children free to be themselves and put Christ first in their lives.

D. The Principle of Filial Stewardship - Mark 7:9-13

- Jesus' purpose in this passage is to condemn the Pharisees and scribes for inventing religious regulations that become more important than responding to human need.

- The principle of filial stewardship teaches us that we cannot justify neglecting our parents, even on spiritual grounds.

III. God's Promises of Honor to the Aging Person

A. Long Life: 1 Kings 3:14 And if you walk in my ways and obey my statutes and commands as David your father did, I will give you a long life.

B. Youthful Vigor: Job 5:26 You will come to the grave in full vigor, like sheaves gathered in season.

C. The Symbol of Gray Hair: Proverbs 16:31 Gray hair is a crown of splendor; it is attained by a righteous life.

D. The Assurance of Salvation: Psalms 91:16 With long life will I satisfy him and show him my salvation.

E. Divine Presence to the End : Isaiah 46:4 Even to your old age and gray hairs I am he, I am he who will sustain you.

F. Joy in Accomplishments: Isaiah 65:22 My chosen ones will long enjoy the works of their hands.

G. Respect and Relaxation: Zechariah 8:4 Once again men and women of ripe old age will sit in the streets of Jerusalem, each with cane in hand because of his age.

IV. What God Wants Us to Know About our Parents

A. Proverbs 17:6b - Parents are the pride of their children.

- Parents are worthy of Kingly appreciation

B. John 9:2-3 - His disciples asked Him, "Rabbi, who sinned, this man or his parents, that he was born blind? Neither this man nor his parents sinned," said Jesus, "but this happened so that the work of God might be displayed in his life."

- Our parents role in our lives was provided by God so that we may become the person God wanted us to be. Our parents should not be blamed for our shortcomings. "You're 30 years old now! It's time to stop blaming your parents and start taking responsibility for your own choices!"

C. Psalms 92:12-15 - The righteous will flourish like a palm tree, they will grow like a cedar of Lebanon; planted in the house of the Lord, they will flourish in the courts of our God. They will bear fruit in old age, they will stay fresh and green, proclaiming "The Lord is upright, he is my Rock, and there is no wickedness in him."

- Do not deny your parents of the abilities they still have to serve God.

- Do not deny them of their opportunities to be productive.

D. Isaiah 46:4 - Even to your old age and gray hairs I am he, I am he who will sustain you. I have made you and I will carry you; I will sustain you and I will rescue you.

- God does not leave in one's old age. He will carry us, sustain, and rescue us!

E. Leviticus 19:32 - Rise in the presence of the aged, show respect for the elderly and revere your God. I am the Lord.

- Rising is not a passive act. Respect is more than a state of BEING respectful - it is DOING respectful acts.

- God commands us to respect the elderly.

F. Isaiah 49: 15-18 - "Can a mother forget the baby at her breast and have no compassion on the child she has born? Though she may forget, I will not forget you. See, I have engraved you on the palms on my hands; your walls are ever before me. Your sons hasten back, and those who laid you waste depart from you. Lift up your eyes and look around; all your sons gather and come to you. As surely as I live," declares the Lord, "you will wear them all as ornaments; you will put them on like a bride."

- Even though our parents may suffer a memory loss, our position and responsibilities do not cease.

G. Proverbs 10: 1 - A wise son brings joy to his father, but a foolish son grief to his mother.

- Our parents are effected by our choices.

V. What God Wants Us to Know When Making Choices Concerning Our Parents

A. The Choices You or Your Parents Make will Effect the Entire Family

1 Corinthians 12:26 - If one part suffers, every part suffers with it; if one part is honored, every part rejoices with it.

B. Your Parents Burdens are Also Your Burdens

1 Timothy 5:8 - If anyone does not provide for his relatives. and especially for his immediate family, he has denied the faith and is worse than an unbeliever.

C. Your Parents are Worthy of Your Best Caretaking Now.

1 Peter 3:8-9 - Finally, all of you, live in harmony with one another; be sympathetic, love as brothers, be compassionate and humble. Do not repay evil or insult with insult, but with blessing, because to this you were called so that you may inherit a blessing.

D. Your Caretaking is an Extension of God's Care

Mark 9:41 - I tell you the truth, anyone who gives you a cup of water in my name because you belong to Christ will certainly not lose his reward.

Colossians 3:17 - And whatever you do, whether in word or deed, do it all in the name of the Lord Jesus, giving thanks to God the Father through him.

E. Listen to Your Parents

Proverbs 13:1 - A wise son heeds his father's instruction.

F. Listen to Others

Proverbs 19:20 - Listen to advice and accept instruction, and in the end you will be wise.

G. God Will Speak to Your Heart Concerning the Needs of Your Parents

2 Timothy 2:7 - Reflect on what I am saying, for the Lord will give insight into all this.

VI. Scriptures for Caring

Exodus 20:12 - Honor thy father and thy mother.

Galatians 6:3 - Bear one another's burdens and so fulfill the law of Christ.

Ephesians 6:1-2 - Children, obey your parents in the Lord, for this is right. Honor your father and mother.

Job 12:12 - Is not wisdom not found among the aged? Does not long life bring understanding?

Ephesians 4:29 - Speak what is helpful for building others us according to their needs.

VII. Caring for Yourself

If someone were watching your life, how would they label your priorities?

A. Your relationship with God must come first

Isaiah 43:2 - When you pass through deep waters, I will be with you; then your troubles will not overwhelm you.
Isaiah 40:31 - But those who hope in the Lord will renew their strength. They will soar on wings like eagles; they will run and not grow weary, they will walk and not be faint.
Psalm 18:2 - My God is my rock, in whom I take refuge. He is my shield ... my stronghold.
Isaiah 41:13 - For I am the Lord, your God, who takes hold of your right hand and says to you, Do not fear; I will help you.
Psalm 121:2 - My help comes from the Lord.

B. After God, your spouse comes first

Genesis 2:24 - A man will leave his father and mother and be united to his wife, and they will become one flesh.
No married person should take on caregiving without the approval and support of their spouse
Plan for time alone together
Get away as often as possible. You need time together.

C. Caring for yourself

Pay attention to your own needs as well as the needs of the parent. If you don't you will be unable to serve your parent.
Schedule time for yourself
Care for your physical body
Do more laughing - Proverbs 17:22 - A merry heart doeth good like medicine.

D. Other Guidelines

Be clear about your reasons for involvement
Accept the fact that you cannot do it all. Leave room for God and other people to work.
Learn to set limits. This is often one of the most difficult areas for us to do with our parents.
Assess realistically

What are your parents' needs?

How many of these needs can you meet, taking into account your responsibilities to God, others, and yourself?

Who besides yourself can meet some of these needs?

Request cooperation from family members as needed or desired
Seek support from friends and groups - Galatians 6:2 - Carry each other's burdens.

E. Support Groups

1 . A good support group:

provides information on the illness, including how to manage it.
helps combat the stigma of the illness
permits you to say things that you would not have the courage to admit elsewhere for fear of being judged.
allows you to laugh.
relieves stress
provides some perspective.

2. What to look for in a support group

Before you attend a group, be sure that you have some knowledge about what the group is like and who is in the group.
Look for a group where the leader is trained.
Inquire into the frequency of meetings. The more often a group meets, the more cohesive it's going to be.
Once you attend, trust your intuition.

3. How to locate a support group

Children of Aging Parents (CAPS)
Contact an organization that deals specifically with the illness or condition in question.
National Support Center for Families of the Aging, P.O. Box 245, Swarthmore, PA 19081; 215-544-3605.
Start your own support group
Check out hospitals, church groups, geriatric centers.

VIII. Siblings

A. At Times You Will Need to Call a Family Conference

Come together to make decisions
Give and get information - How is mom doing? Talk to doctors, friends, etc.

B. Caregiving Siblings

Ask for help when necessary, and be specific - "I need money for medicine." "I need someone to drive mom to the doctor."
Learn to function without sibling assistance when necessary.
Keep other siblings informed.

C. Non-caregiving Siblings

Show support and appreciation to caregiving siblings - cards, phone calls, funds.
Other ways to help
Offer periodic respite - Give caregiver a week off.

IX. Single Children

1. Enlist the cooperation of spouses and children

2. Be clear about your priorities

3. Seek out medical specialists for information and guidance

4. Find stimulating outside activities

5. Turn to friends as family

X. Active Loving

A. Active Listening - Job 34:28 - He heard the cry of the afflicted.

Acknowledge feelings
Step out of arguing pattern
Important Don'ts

don't correct

don't attempt to argue your parents out of their feelings

don't judge

don't feel you have to solve the problem

don't give advice

don't try to cheer them up

don't say, "I know just how you feel"

It may be painful - we may not always like what we hear
Short circuit the hot buttons

step back from your habitual reactions

let go of things you can do nothing about

B. Give love before it's demanded - take the initiative. Be proactive.

C. Use nonverbal touching

D. Give Positive Reinforcement

Allow her to give as well as receive - encourage what they can do
Help her adapt to handicaps
Show your parent she is valued
Allow them to give memories
Capture your parent on tape
Share life stories

E. The Importance of Life Review - a crucial stage and the last stage of life is to think back over and review your life: regrets, successes, areas where forgiveness is needed.

F. The Tasks of Aging

Adjusting to Losses - obituaries, hearing, eyesight, "productive" work, freedom.
Achieving Integrity - emotional closure - "It is finished."

XI. Living and Care Options

Psalm 71:9 - Do not cast me off in the time of old age, forsake me not when my strength is spent.

A. Living with you

1 . Should it be done?

The overwhelming majority of older Americans wish to remain in their own homes.
Ideally, your parent should be the one to make the decision to change her living arrangements herself.
A move away from familiar people, places, and things can be traumatic for the older person,
Having a parent come to live with the caregivers can be completely disruptive to life's everyday routines and rhythms.
The Family Leave Bill (1993) allows eligible employees up to 12 weeks of unpaid leave to care for a child or aging relative.

2. Questions to Ask

Does your parent really want to come?
Do you really want them to come? Why?
How does your spouse feel?
Do you and your parent get along?
What does God want?
How does he/she get along with husband and children?
Will they fade into woodwork?
Is your house big enough?
Can they adjust to new social environment ?
Can lifestyles mesh?
Can you continue living your life?
What responsibilities will they have?
Can you afford it?

3. Making the Move

Try a trial period
Independence
Home changes

B. Adult Day-Care Center

1. A wide-range of programs offering community-based services in a group setting.

2. Offers participants the opportunity to spend their days in a stimulating environment of their peers at the same time that they receive supportive professional attention.

3. Services provided

supervision
hot meals and snacks
transportation
exercise
occupational therapy
counseling
ongoing medical and social evaluation
health screening

4. What to look for

Clean and safe
Conducts an assessment of individuals prior to admission
Develops an individualized treatment plan
Provides a full range of services
Qualified staff
Transportation

5. How to find one

National Adult Day Services Association, 409 3rd St. SW, Washington, DC 20024; 202-479-1200.
CareGuide - an extensive database of elder-care providers.

C. Living in Their Own Homes

1. There are a lot of "switches you can turn on" for your parents. How can you help?

Calls
Visits
Identify a trusted observer
Service providers
Arrange for programs like Meals on Wheels
Contact local office on aging
Geriatric care manager
Financial help
Support to parent and caregiver

2. Available community services

Nutrition sites
Home delivered meals
Transportation
Senior centers
Financial assistance
Safety checks
Health services
Home health care
Legal Assistance
Housekeeping services
Referral lists
Case management
Adult day-care
Home delivery services
Contact Area Agencies on Aging - See your yellow pages or local library.

3. In Home Care - Different levels based upon the need:

Homemakers, who provide housekeeping services and general cleaning.
Home health aides, who provide personal care and assist with household chores, meal preparation, and daily living activities.
Registered nurses, who evaluated care, keep records of the patient's medications and progress, and administer the required treatment.
The National Association for Home Care, 519 C Street NE, Washington, DC 20002-5809; 202-547-7424.

4. The Geriatric Care Manager

Assesses the parent's needs and the family's situation, identifies problems, eligibility for assistance, and needs for services.
Arranges for and monitors in-home care
Reviews financial, legal, or medical issues and offers referrals to geriatric specialists.
Provides crisis intervention.
Acts as a liaison to faraway caregivers, and alerts families to problems.
Assists with a move to or from a retirement complex, care home or nursing home.
Offers counseling and support
Initial assessment over $200 - supervision and care $50-150 hr.
National Association of Professional Geriatric Care Managers.

D. Living Elsewhere

1. Group home or Senior housing

Residential housing complexes for basically independent older people.
The National Shared Housing Resource Center, 6344 Green St., Philadelphia, PA 19144; 800-677-7472.

2. Retirement Communities

For independent living
Provides housekeeping, cleaning and maintenance, and sometimes meals
Social stimulation and planned activities
BUT 1 in 10 go bankrupt

3. Residential Care (Board and Care) Facilities

Offers more assistance but not as much as a nursing home

4. Nursing Homes

When is the parent ready?
The parent is Never ready for a nursing home. The right time is determined by when the caregiver is ready.

XII. Finances

A. Questions to Ask

Where is your parents' financial information, including everything from hidden documents in lock boxes to complicated contracts, agreements, and trusts?
What is their financial status - assets, liabilities, and net worth?
Who is their attorney, tax accountant, and financial consultant, if any?
Do they have an up-to-date legal will on file?
Have they developed a financial "nest egg" over the years? How are the funds invested? Has the financial plan been adjusted for retirement?
Have they given broad and durable power of attorney to a family member or a professional confidant?
Have they made plans for their assets to minimize estate taxes?
Are they receiving full entitlement for their Social Security benefits?
What are the provisions of their pension plans and life insurance?
Do they have adequate medical and hospital insurance, including catastrophic coverage and long-term care?
What are the monthly budget requirements to sustain a reasonable standard of living for them?
Are they eligible for Medicare? Medicaid? Do they carry Medigap insurance?
Have they made funeral arrangements and purchased a cemetery plot?
If worse comes to worst, what are the contingency plans for financial shortfall or catastrophe?

B. What Can We Do?

Know your parents' financial situation
Take over bill paying for the anxious parent
Arrange with utilities for third-party notification of late payments
Establish a method for payment of as many recurring bills as possible
Seek professional advice about programs and policies that help the elderly meet their obligation
Arrange for parents to qualify for Medicaid assistance, if appropriate.

XIII. What Can Churches Do To Help?

A. Interpret and embody the true meaning of life through Jesus Christ

B. Expand pastoral care

C. Develop a strategy for ministering to older people in your congregation

D. Provide Seniors opportunities to serve

visiting older people
mentoring younger people

E. Develop a day-care program

F. Organize a senior citizens center

G. Adopt a nursing home

H. Provide telephone reassurance

I. Provide a list of people available to give respite care

J. Provide transportation, shopping, chores.

K. Hold seminars like this one!

See also Eldercare Web which has more than 1,00 links to sites concerning elder care.

For nursing home information see the Nursing Home Database, a national directory of every Medicare and Medicaid-certified nursing home.