How to Care for Aging Parents ... Without Burning Yourself Out.

What to do when caring for your parents' needs affects your health and family

* Marie is an accountant in the Boston area. Each week she struggles to squeeze in a few hours to make telephone calls, because she handles her widowed mother's finances, Medicare forms, and makes certain all bills are paid on time.

* Toni is a Midwestern public relations writer. She has been taking more and more time away from her work so she can drive her father, who recently suffered a major heart attack, to the doctor's office as well as back to the hospital for ongoing physical therapy.

* Ron, an electrician in Oregon, is using up his vacation days so he can attend to both parents. He divides his days between the hospital to be with his mother, who broke her hip, and his parents' house to care for his father, suffering in the early stages of Alzheimer's disease. Ron knows that soon he will have to make arrangements for his father to be placed in a nursing home.

Here's a fact:

Not everyone has children, but everyone has parents. And as parents grow older, their health can decline, making them increasingly dependent on their children. A growing number of adults find themselves not only parenting their children, but providing care for their parents as well. Statistics indicate that caregiving for an elderly parent will become an increasing reality for more and more adult children. Currently more than 6 million seniors require assistance with such basics as getting out of bed, dressing, cooking, cleaning, and handling money. On any given day an estimated 5 million Americans spend some time caring for a parent--a figure expected to double within the next two decades.

Also, a recent Travelers Company survey of its employees over age 30 revealed that 20 percent of those employees spend 10 hours per week in elder caregiving. Tasks involved assistance in household chores, personal care, providing transportation, managing finances, and selecting medical services. Eighty percent said that duties interfered with their social, emotional, and family needs some or most of the time. In addition, 18 percent said they had not taken a vacation from those duties in two years.

Often this care is motivated by love. Yet giving care to an aging parent can exact a tremendous physical, emotional, spiritual, and financial toll, not only on the caregivers but also on their spouses and children. Here are some ways to help aging parents without burning yourself out.

Begin with a family conference.

Many such family councils are called for the first time when faced by an imminent decision--typically, should mother or father be placed in a nursing home? In order to make caregiving a healing rather than a hurtful experience for your family, call for a conference with the principal people involved long before such a drastic decision must be made.

Those involved in the conference should include the aging parent(s), siblings, and other extended family. Understanding everyone's expectations early in the caregiving process can eliminate problems in the months ahead. During the conference, try to establish how many others will want to be actively involved in caregiving and the level of their commitment. If there are financial implications, establish some agreement as to how those will be shared and met. A key point during a family conference is to find out what the aging parent envisions. Does he or she plan to live alone, get a roommate, or move to a retirement community? Do not assume that a relative expects a place in your home. According to a recent American Association of Retired Persons (AARP) survey, a whopping 84 percent of respondents aged 55 and older wanted to stay in their own homes.

Don't make promises you won't be able to keep.

When Bonnie's 72-year-old mother began to express concerns about her future care, Bonnie quickly responded: "Mom, don't worry about ending up in a nursing home, because I'll always be able to take care of you." However, as her mother's health declined dramatically, it became clear that the elderly woman needed 24-hour care.

"Because I work full-time, I could not provide Mother with the constant care she needed. Reluctantly, and with great guilt, I found a good institution that provided my mother with full-time professional care. In spite of the fact that the nursing home was an excellent facility, my mother resisted being placed there, and I felt as though I had abandoned her. She died two years ago, and I'm still feeling guilty that I didn't keep my word to her." The lesson from that sad experience: Don't make promises you may not be able to keep.

Find out what social services are available.

Some families are able to afford to pay for the services of a social worker or nurse who specializes in geriatrics. However, for those who cannot bear this expense, there are many lower-cost services available for the aging supplied by governmental and nonprofit agencies.

When calling for information and help, don't become frustrated by the large number of calls you may have to make. The network of social agencies is constantly changing and being refined in order to meet human needs better. Be patient and persistent. Your effort will result in better knowledge and access to aid.

Ask the church to help.

Many of the needs of elderly people do not demand highly skilled or experienced people. Those needs can be filled by ordinary people willing to give their time by visiting, fixing meals, cleaning, offering companionship, gardening, performing home repairs, making telephone visits, and providing transportation to markets and medical appointments. An excellent source of volunteer talent is a church where your parent attends. Religious leaders and their members are eager to help and respond willingly when they know that assistance is needed.

Tap into the power of a self-help group.

There are three compelling reasons for turning to a self-help group. First, while extended family members and friends can provide practical advice and emotional support, sometimes such informal networks are inadequate. Second, there may be relationships within a family that are part of the problem rather than part of the solution. Third, people in a self-help group offer each other not sympathy but empathy.

In her book Caring for Your Parents, author Helene MacLean explains: "Whether you're being worn down by the unpredictable behavior of a father functionally impaired by Alzheimer's disease, or you're trying to juggle the demands of a recently widowed mother with the needs of your own children, you can connect with a group of people living through the same experiences. As soon as you arrive and begin to talk about your feelings, the other group members can identify with practically all of them. Especially refreshing to anyone who has felt isolated and helpless is the sense of security that comes from this type of group participation."

Be sensitive to the primary caregiver.

Geriatric specialists note that no matter how many adult children make up a family, the responsibilities are not equally shared when parent care becomes necessary. Often one adult child emerges as the primary caregiver. If you are not the primary caregiver, maintain a sensitivity to the one who handles most of the responsibility. Here is a sad, but common, lament from a woman writing advice columnist Ann Landers:

"This is for all the sisters and brothers of caregivers who are `too busy' with their own lives to lend a hand," she begins. "A few years ago my life changed when my mother became ill with a progressive disease, I put all my plans on hold and little by little gave up visiting my friends, doing volunteer work, socializing, attending night school, and spending time with my husband. I now must use all my `free time' to take my parents to their doctors' appointments and tend to their needs. I am not complaining. My parents are wonderful people, and I consider it a privilege to care for them, but I am upset because my siblings do nothing to help me."

If another member of your family is carrying most of the load, do whatever you can to pitch in and help. If you are geographically distant, consider using some of your vacation time to provide care for the aging parent, giving the primary caregiver some time off. Or if you live nearby, call the primary caregiver and offer your services a few hours per week.

Finally, as caregiver to an aging parent, be sure you know and respect your own limits. Otherwise you run the risk of becoming exhausted, sick, depressed, and burned out. In that condition you will not be helpful to aging parents or anyone else. Do make time for yourself and find ways to nurture your body and spirit,

Victor M. Parachin, M. Div., writes from Claremont, California.