Ask HN: Advice about aging parents
Hey HN,
I know some of you have been down this road already. My dad is 86, my mum is 79 and my dad refuses to leave his house until he dies. It's our family home from when I was growing up, 2 stories and my dad currently crawls his way up the stairs each day to use his computer. He won't even consider moving down to the first floor (stubborn).
I have my own young family and my partner and I have jobs, so I'm basically looking for how you juggled your way through this part of life and if you have any pointers. I'm 41 btw.
242 comments
[ 3.3 ms ] story [ 251 ms ] threadAn older uncle I had insisted on stepping stairs everyday. One day he fell off the stairs, and died.
Her wife, my older aunt, had help. Three hired people took turns to keep an eye on her around the clock. She still died because she fell off the bed several times in spite of that.
See a therapist yourself, try to remind family to help (usually a failure), pay for the help you can.
In the past I used to tell my mother that I would send her to a retirement home when she couldn't be independent. She shortened the discussion everytime until it was just a two word answer "F U" Now it is a running joke but I acknowledge she prefers any other alternative if I want to help. And since I want to help she probably won't end in a care home.
Both siblings were close enough to react to the alerts if they needed to, but the cameras allowed them to see if they needed to go in person, or just call or just wait until the next time they visited.
Good luck.
It helps to put things at waist height minimize reaching easier (essentially apply heuristics from Human Factors Engineering like we do in factories). For example, in her 80s my grandma started keeping a small trash bag on the countertop at waist level so that she doesn’t need to bend as much or walk all the way to the larger kitchen trash while cooking or doing dishes.
Another focus area is weight reduction. For example, buy pints of milk or bottles of water instead of gallons (or transfer from large containers into smaller, reusable ones to help your elders and the environment at the same time).
Recently, my cousin got my grandma an Alexa speaker. He also put a large text note up on the wall next to it with phrases my grandma can use. Stuff like “Alexa, what time is it” or “Alexa, play classical music”. I thought it was silly, but then I realized it’s actually pretty cool. Plus, Alexa games give the great grandkids something fun to do in grandma’s sitting room.
Once people stop driving, grocery delivery can make a big difference.
Think about flooring. My grandma seems to have an easier time on wooden floors than carpet. It’s easier to slide a walker. Of course, if the floor has too much slide that can become a problem.
If you can afford it, a walk in bathtub is a game changer. My grandma is 98 and has used one for 15+ years. Late in life, even a 6-inch step up to a sidewalk curb can be a challenge.
Edit: I bet there’s a YC startup hidden in your question, especially with people investing more in their homes again now that they live and work at home.
Motivation and exercise is what keeps people alive and happy. I once knew a 92 year old who benched 140lbs and who’s grip was a vice. He worked out every day for ~2 hrs. Was one of the most impressive things I’ve seen.
All that said, perhaps ask them what they want? For instance, their motivation might not be meals or cleaning. Getting a maid or food service can lighten their load. Similarly, consider a cleaner for yourself! And give yourself more time to spend with them and your young family.
At the end of the day, they’re their individuals. I suspect they’ll have some thoughts. It’s honestly hard to watch sometimes, but all you can do is try to spend time and enjoy each other’s company.
How does this work exactly? Medically speaking.
It's also underappreciated how often depression in the elderly can lead to confusion or even psychosis. Which can also lead to a fatal accident.
Good thing society banned people from visiting their relatives in nursing homes and assisted living facilities. We sentenced the oldest in our population to die in what amounts to solitary confinement.
But it is dismissive to those people with nobody at all in their lives, to equate "got calls instead of in-person visits" with "nobody knows or cares about you and you will never receive a call from anyone for the rest of your life".
The GGP conflated those experiences but they are qualitatively different.
I'm fully in favour of visiting the old people in your life.
But I wish people would also spend some time brightening the lives of other old people as well.
My wife worked with geriatrics. She directly saw the impact of having friendly people around the elderly. Even if you aren't visited by your family, any visitors can help. The pandemic made this especially difficult. My wife worked to overcome this: she partnered with a local "sniff" (think: old people left the hospital, but they need some help before they go home, so they go to an old-people hotel) to have fun events where people from our church would visit the elderly and just have fun.
Please visit the old people in your life.
It was about older people in nursing homes who were sent to pre-school, with unrelated children a few days a week.
The effect on these senior citizens heath and quality of life was profound.
Old People's Home For 4 Year Olds https://www.youtube.com/watch?v=13_rJVvxx_g
Consider, also: not all old people are mobile enough to leave their home (or even bed!). They need friends and happy people.
If you work with elderly, please be friendly. If you know elderly, please be friendly to them.
When old folks break a hip, it sets off a chain of consequences that are really, really bad for their health and quality of life. To begin with, it immediately requires hospitalization and major surgery. Then, a period of immobilization starting with a "short term" stay in a nursing home followed by weeks of rehabilitation. During all that time, they're susceptible to many different complications. It's basically the beginning of the end for many.
This happened to my mother. In the course of 3 years: broken hip, stroke, and UTI followed by near-fatal sepsis (which precipitated dementia). After all that she lost the ability to walk and we had to put her in a skilled nursing facility for the rest of her life.
Best thing you can do is to make sure you get advice from an elder-care attorney about end-of-life problems and financial planning. There can be dire financial consequences for the family if any money is transferred from the elderly to family members within 5 years of going on medical assistance (thanks to George W Bush's "deficit reduction act" of 2005).
My mom also had a (non-hip-related) fall and that resulted in a hospital and nursing home stay (fortunately she seems to have recovered for the most part).
I read this illustrated aging-parent-focused autobiography lately https://www.theguardian.com/books/2014/jul/13/cant-we-talk-a... (by Roz Chast, a New Yorker cartoonist) and it was very much about these issues, and her mom had several falls as well.
Here's one company I found but I think there are others offering solutions too: https://en.helite.com/hipguard/
- western way: use tech. some people have floor detectors, doesn't avoid the fall but helps saving people early. Maybe soft floors help too
- easter way: daily taichi .. so then you just roll and never fall
Saw this earlier this year (it's a body airbag for old people in case they fall. Invented by a Chinese so eastern way haha), reminds me of the bike helmet some Swedes demonstrated a few years back
https://www.youtube.com/watch?v=p9W6wNfzsIE
I also thought we should have cushioned sports area for 60+
places you can just try shit and never fear shocks
Older individuals eventually need to accept that their autonomy is going away. They're mentally declining, they're already physically declined. They're not in a fit state to decide basic things like: how to prevent falls. While it may be your father's right to stay in his home stubbornly, I don't think it's ridiculous to ask him to minimize the potentially deadly fall risk of a staircase at 86.
Do family members really have the right to tell their own nuclear family: I am correct to risk my life, you are wrong for trying to keep me safe? I think if your nuclear family suggests such a slam dunk win, it's best to just accept it.
I'd say yes, absolutely, family members have the right to risk their own lives. Have you ever driven too fast on an interstate? Climbed a mountain? Gone skiing, bungie jumping, skydiving, or even swimming? Then you have risked your life. You are proposing a huge double standard if you argue that youth are allowed to have risk in their life while the elderly do not.
I would also suggest a visit to an estate lawyer to make sure that wills are in order and that there's a plan for all major assets.
All of this can be difficult if your parents are in denial and plan on living forever, but the more you can do now, the better off you will be later
Multi-generational households really seem like the way to go. Everyone gets to play an age-appropriate role and (in an "ideal" family) everyone is taken care of.
My dad and step mother, mom and step father, and my mother in law, step father in law, father in law and step mother in law are not going to be living in a shared household ever. And if that somehow happened, I wouldn't want to be anywhere near it. :)
Here’s a semi recent article to give you an idea of the prices https://www.theobserver.ca/news/local-news/home-prices-conti...
The lake is nice in the summer and you’re close to Detroit for a weekend of cheap entertainment.
Good luck!
After witnessing my mom waste her prime years caring for my dad's old parents, I pity other women (and anyone else in the same situation) who have no choice due to lack of economic opportunities and are essentially forced to live as maids.
I also suspect the people who could choose to migrate but choose to stay in India, Pakistan, etc are rich enough to hire cooks and maids and drivers. The people who have no option to migrate are the ones you should be wondering about.
I hope that my children do not spend their prime years chronically taking care of me, just like I would not want to do it for someone else. Note the use of the word "chronically", which for my mom, between both paternal grandfather and grandmother, lasted 33 years.
I have spent about a decade of my life being the primary caregiver for my aging parents so far; I'm in my mid 40's. And yes, I hope my kids do the same for me.
We don't outsource raising our children (homeschooling) or caring for our parents; having tutors, coaches, or domestic help is fine on occasion, but not wholesale replacement of family care.
Slinging ads for Meta and Alphabet affords you the ability to go on vacation. My mom was not getting anything for cooking and cleaning and taking care of my non driving, non English speaking, non working grandparents. On top of my mom having to work and help my dad try and operate a small business. In fact, she regrets not being able to spend more time and resources after her kids because so much of her time and energy was spent after two 80+ year old babies (one grandparent died at 99, after 7 years on dialysis. Why the hell are we giving 90+ year olds dialysis? The other grandparent died at 95, but was 15 years younger).
And I saw what my aunts lives who had old and disabled in laws to take care of was like versus aunts who had young and helpful in laws. I have seen tribes that tilt too far in providing resources to the elderly and infirm, to the detriment of the young. I do not see any point in that.
Try to talk them into some changes, if they don't agree, make sure they're certain and leave them be.
It's their choice, and treating them like senile idiots like the other commenter said is just a major dick move.
Whatever you do, don't stick them in the hospital on their death bed if they tell you they want to die at home.
Imagine being 80-90, waiting to die and wishing it happens in your bed and your family sticks you on life support among strangers so you can "live" another week or month or goddamn year.
No one deserves that.
I'm more worried about other things. How do you take his drivers license away? I know far too many old people who keep driving even while they are a real danger to others. If there is bus system in town get him a schedule and post it by the door, even get him a monthly pass. Or he might qualify for the local disabled transit (don't call it that in front of him) to get rides wherever.
As others have said, work to balance your desire for their safety with their desire for independence and resisting change. Where they live, driving, all of these things might be a struggle. Perhaps start with changes while they’re accepting, things like grocery delivery, transport help, etc. and empathy, don’t forget the empathy.
Finally, remember that work will always be there. Family and friends, however, will not.
Finding housing that works better (an apartment on one level) is one approach - sell them on the benefits of independent living for longer.
But eventually it was finding a home with 24/7 nursing care they weren’t too opposed to.
It’s not easy and as the parent of a young child I realize how being the “parent” happens twice in life - one with your kids and once with your parents.
My grandmother resisted going into a home for a long time. When she finally did, her quality of life improved considerably. She was much more socially active just because she was around so many people. She played cards, sang in a choir, and ate meals with friends every day. She even found a boyfriend.
She was too stubborn to ever admit such a thing, but I think she would have been happier if she had moved a decade earlier.
Falling is a risk even with normal walking. But if you don't have some movement in their life, they degrade faster and die sooner. There is risk from all choices
Like seriously if your Dad is crawling up the stairs, he has already decided that He Will Keep Using Both Floors Of His House Until He Physically Can't Anymore. Apart from completely destroying his agency, you are not going to stop this.
Just in case, I mean it's obvious that his Dad doesn't need it, but maybe one day he will ;).
I don't say you shouldn't reason with them, plead with them, and explain the dangers to them. But never forget to respect their wishes. They know what comes next and accept it. Do you?
1) Change in ability to walk, which triggers 2) Inability to take care of and feed themselves, which triggers a slew of medications to try to combat 3) Inability to go to bathroom by themselves
Keep people moving. Build strength early - strength training is great (people begin losing strength as early as 50's and it dominos). Eat more healthily earlier in life and continue (when a person cannot cook for themselves, they tend to eat high salt, high fat, frozen foods - which becomes less healthy). Also, look into assisted policy care insurance.
Frozen processed foods like pizzas, ready to eat foods loaded with preservatives are bad as one can imagine.
It was counterintuitive to me that frozen veggies can be better than fresh looking ones from supermarket. Same goes with tomatoes from supermarket shelves versus tomatoes in a tin - apparently the tin ones have better nutrients because they were more ripe when they went into the tin, while supermarket tomatoes were picked well before they were ripe.
https://xkcd.com/1616/
I do think there is science to back up the idea that as your parents get older it is really helpful for them to have younger friends. For my Dad this came through work, for my Mom through friends who enjoyed concerts and plays. The point is to try to get them to have a connection with younger people. It's depressing, but my Mom says all her original friends have died off. For your parents it could be a hobby, taking care of grand kids, etc.
One of my parents died a terrible, painful death; we found out too late he'd missed key treatment appointments and his GP had prescribed a drug that undermined his cancer treatment.
https://www.economist.com/books-and-arts/2014/10/04/helping-...
Does your father gets dizzy or does he sometimes loose sense of stability?
Also limit damage from possible fall. Cover sharp corners. Ad rails on both sides.
If he falls, you should know about it. Some smart watch should be able to detect it. Or cameras with motion detection. Monitoring can be probably outsourced to India.
And some neighbour who lives nearby.
I wish we talk more about those difficult topics, parenting, or in this case aging parents, sex, childhood, or right to die over certain age. All the things we are all too afraid to ask and no one told us what to do. ( But as with every thing in life I do think not knowing has its own sets of benefits ) And Even in the example above, we are suppose to be adult and over 40, and we are just as hopeless as a child.
And on the subject it also offer different set of lens and views on aging population, instead of mostly an economics angle. Personally I have no idea because I fall out with my parents a long time ago. It is sad.
* find local help for parents to do chores like groceries,meal prep, help with personal care if they need it, etc.
* make sure there's a way to pay their bills, manage their finances. You may have to do some of this for them by making sure they have access to their money, pay their bills, etc.
* if you are able to connect with their doctor, this would be great to keep a pulse on their medical needs. If you aren't able to drive them to doctor appointments, etc, funding help to do so would also be good.
* be prepared to drop everything and help them for emergencies. This meant letting managers know a bit about our situation.
If you have siblings, see if you can share responsibility for these things.
There is no single correct way to handle these situations so do what works for you and your family. Remember to take care of yourself and your family in the midst of this! Talk to a therapist if it helps.
I also suggest reading the book _Being Mortal_ by Atul Gawande that goes into some ageing related issues, which I found helpful.
Good luck and take care!
My suggestion would be to seek out an elder-care specialist. They not only know what kinds of support are available - including issues or options you might not have thought of - but they have contacts with all the different sorts of service providers. My brother and I engaged one briefly when we needed to find a nursing home for our mother. Both of us had already tried and mostly struck out on finding anything decent; she was able to get us a spot at a much nicer facility than anything we had even been able to look at. This was especially valuable when COVID hit; the peace of mind from knowing that they were on top of things was invaluable. Money very well spent IMO, and not even all that much.
From what I hear, quality in-home care can be even harder to find, so those contacts become even more valuable. If you can't find such a specialist on your own, your parents' doctor(s) might be able to give you a referral.
One things you can try: Did one of your parents' friends enter a retirement home? What about one of your childhood friends parents'? Start visiting them, with your parents, occasionally. Sometimes, just visiting a retirement home for a social visit (and no agenda on your part) can plant the seed that older people are very happy in retirement homes.
My grandfather lived alone after my grandmother died. He had a stroke a few months before his 100th birthday. Instead of calling 911, he called my uncle, who fortunately was only a few minutes away.
That was when my dad and his siblings forced the issue and placed him into a retirement home. He was quite social, so after a few weeks, he made a lot of friends and adjusted. The vibe was kind of like freshman year at college, only for geriatrics. (Among his children and my cousins someone checked in every few days. This was how we were sure the retirement home took good care of him.)
Even when we had to move him to a nursing home, he was very happy. Again, he made friends.
You sound a bit younger than me, but take a look across your family connections. There might be somebody who could use a gig, and could benefit from close contact with an aging relative's wealth of life experiences.
Best of luck!
[1] "Being Mortal — Medicine and What Matters in the End" — http://atulgawande.com/book/being-mortal/
It definitely has reduced the risk of falls, but like other people in the thread have said.. maybe it's decent exercise?
You have my pity
I just went through this with my mom. She needed 24/7 care that I couldn't give her. Thank God we had the resources to get her into a "good" place. It was $5k/mo for 300 sq ft in a very low cost of living metro.
And just because the building is new and the grounds are beautiful does not mean you get better care.
Personally I feel its insanity to be experimented on with a cocktail of medicines in the last parts of life when there are more important concerns to spend money on for people at the beginning of their life and I think its selfish to hang on if you are not contributing in someway but I'm sure others will see things differently.
I fully support the work of Dignitas http://www.dignitas.ch/?lang=en and I see other countries are slowly beginning to make euthanasia legal. Unofficially some Dr's do give lethal cocktails in hospitals in some circumstances but its not spoken about because laws prohibit Dr's from doing this. Alot of people I have spoken to think its the Church and religious followers preventing euthanasia from becoming legal and thus creating this perverse situation where people are tortured on a cocktail of drugs keeping them alive.
I also know Nurses have been known to meter out their own justice to patients in nursing homes and hospital wards based on rumours or gossip and many blind eyes are turned because these are Nurses!
Another interesting development being seen is "no fuss" or direct cremations are becoming more popular with the elderly. Basically, no service at a church or crematorium, its just a simple collect the body, paperwork completed and then the body is cremated.
Personally, if I had a cremation service when I go, when the curtains go down and the coffin disappears off to the burners, I'd want this tune playing! https://www.youtube.com/watch?v=wmin5WkOuPw LOL
I'm in my late 30's and my parents are in their early 60's (Dad will be retiring next year). Two years ago we decided move into a multi-generational home. We found a place big enough for our family of 5, in addition to an "in-law" apartment big enough for my parents.
This was born directly out of my parents' experience dealing with a very difficult aging/end of life process for my grandfather. We realized that the best approach would be to get well ahead of things (assuming a normal aging progression, we're a couple decades ahead of the issue).
Obviously this was hugely specific to our situation, and wouldn't be an option for the majority of families, but it has worked very well for us so far, and hopefully will simplify a lot of the future.
Just a handful of the specifics that have allowed this to work for us:
* Both my wife and I have a very good relationship with my parents (my wife and my mom especially are very close)
* I have a background in healthcare and don't have any concerns about participating in end-of-life care when the time comes (we certainly plan to bring in external help for day to day stuff)
* We have young kids and my mom especially relishes being able to spend time with them. Obviously we're not accounting it for it hourly or anything, but the general approach we're taking is "You're helping us take care of the kids now, and we'll help take care of you when the time comes"
* We live in Central New York, a place with pretty cheap real estate, so it was reasonable for us (on a single software developer's salary) to buy a big enough place (4 bedroom home on our side, in addition to their apartment). The home we found was pretty ideal, with two separate living spaces/kitchens/etc. The only common area that connects the two is the laundry room.
So yeah, pretty specific circumstances that allowed us to do this, but I'd be happy to chat with anyone considering a similar plan.
If you're going into it with a "give it a shot" attitude, be sure to do it early enough that changing plans is still an option.
For example, I see no mention and not even a consideration of wife's parents - very convenient.
I also made it clear that my comment wasn't intended to cover every single detail (like my wife's parents... and thousands of other details). I would have exceeded the max HN comment length several times over if I tried to cover everything. That's why I said I was happy to talk if anyone had any questions.
Regarding my wife's parents, they also live close by, and I suspect we will be involved in their care as well, but they also have other (adult) kids in the area, so it makes sense for us to divide and conquer a bit. Our relationship with my wife's parents would not have worked in this setting though (which isn't to say we aren't close... we see them at least a couple times per month, but living in close proximity wouldn't have worked). This was absolutely a conversation we had with everyone involved though (including my in-laws) before we moved forward with the plan.
https://news.ycombinator.com/newsguidelines.html
"Please respond to the strongest plausible interpretation of what someone says, not a weaker one that's easier to criticize. Assume good faith."
https://news.ycombinator.com/newsguidelines.html
Usually when people react like that to a comment, it's because they have some important experience of their own that doesn't match with what the comment is describing. In that case a good way to respond is to share the relevant parts of your own experience, so the rest of us can have access to both. This is the best way for us to learn (which is why we're here) - and it also helps us learn at a meta level, that life is big and we need enough space to hear about all experiences.
It's interesting how much the conversation around this has changed. Twenty years ago you could believe you could find a nursing home that you could afford and that your parents could have a good enjoyable life in. Now I kind of figure that when they need more care than we can provide, the best institutional care we can afford, even at our income level, may well be a neglectful hellhole, so we're concentrating on keeping them with us right to the end if possible.
Working as a paramedic definitely influenced my desire to do this. Even the best nursing homes are... not great.
I thought the opposite, due to increasing average age and the population pyramid inverting from people having fewer kids.
If I recall, there were quite a few articles even back when I was in late high school of college in early 2000s about the solvency of social security and the problem of baby boomers all retiring and living to older ages without a bigger population of younger generations behind them to keep up the labor supply. And my perception of nursing homes was terrible when I was a kid, so I cannot imagine what it will be like in the future.
It is also why I have been so conservative in my estimates for how much I would need to accumulate during my working life to live my target retirement quality of life.
My parents moved into my mom's childhood home with her parents, and renovated to build out a second floor with separate living/sleeping space (no extra kitchen). This was great in that the property became the de-facto gathering place for a large and geographically distributed family, and in a crunch the house could comfortably sleep 10 while my grandparents kept their comforts.
That said some things were not smooth:
* My parents and grandparents had trouble directly addressing uncomfortable topics. A significant example of this was when it was time for my grandmother to stop driving. The car would start to show surprise scratches and dents. My parents did not want to challenge my grandmothers stated sense of independence, and also had not budgeted a way to allow her to run her errands while they worked without driving (a driver a few hours a week, essentially). I consider this a high-liability failure.
* I got the sense that money was also not talked about directly enough, and there was frequently an undercurrent or sense of resentment about who was footing what bill, and whether said bill was even necessary.
* My mother, very sadly, started to deeply resent her parents after a long while for her perception of being trapped by the situation and unable to move on to other lifestyle choices. Part of this was due to my father taking a job out of state and being flying back for weekends, and my mom wanting to just join him in the new city full time. This resentment really soured their final years together, and is a real shame. Know going in that the decision you're making may go a decade longer than you initially calculated, and that your goals and priorities may shift in that time too, I guess.
* My younger sister moved in with the four of them in her early 20s while trying to re-figure out how to launch. The result was a lot of arrested development and strange regressive relationship behavior - my sister literally started acting like a pre-teen around my parents again, they started talking to her like a child, and my grandparents went back to the scorn-filled gramp-grumps they'd been with little kids. Everyone leapt backward 10+ years in terms of their adult relationships and communication methods with each other.
In the end, my grandparents were well cared for in their final years, and everyone did have more together time. The main benefit was the central gathering place for the extended family, and the house would fill for a few weeks of each year across all the holidays. I bought a house with room to build out a first floor en-suite that I hope my parents or in-laws will someday use, but I'm also keenly aware of the hiccups above. I think the main thing is clear communication about expectations, finances, and boundaries. Which I guess isn't different from normal life :)
We talked a lot about money going in, and one of the requirements was that the house had to be something that my wife and I could afford entirely on our own. We own the house (my parents aren't on the deed). If my parents moved out tomorrow, we'd have to tighten up a little bit, but we wouldn't be at any risk of having to move if we didn't want to. My parents pay us monthly based on a sq ft percentage of the house (utilities, taxes, etc), and they have invested a fair bit in their side of the house out of their own pockets (renovating the kitchen, building a small addition, etc... things that also benefit us in terms of value of the property)
As far as your second two points... time will tell... We're not far enough in to run into those issues yet. I think we're all on board for the long haul (3+ decades), but that's easy to say now. We do have regular intentional check-ins about how things are going to make sure we all still agree on where we're at and where we're going.
Your summary is spot on. If you nail expectations, finances, and boundaries, I suspect you'll be in good shape.
All in all, it has been a huge quality of life increase for us. It's really great for our kids to have such a close relationship with their grandparents, and there are significant practical benefits for us as well (my wife and I are able to get away for a weekend every few months, something made much much easier by the fact that we have "live in childcare")