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HANDLE WITH CARE HOW FAMILY MEMBERS CAN WORK TOGETHER WHEN ELDERLY PARENTS NEED HELP.

Byline: Mariko Thompson Staff Writer

Three years ago, John Hart got a phone call from his oldest sister in Philadelphia. Their 79-year-old mother, Stella Booker, was forgetting to eat meals, take her medications and bathe. She could no longer live on her own.

``Johnny, come and get her,'' his sister said.

Even though he lived the furthest away, Hart didn't question why he had been chosen over his three siblings. As a musician, his work schedule was flexible. With his son about to go off to college, the family had an extra bedroom. And most importantly, the one-story house in Van Nuys didn't have stairs.

``I wasn't surprised,'' he said. ``We were best enabled to care for her.''

With that phone call, Hart entered the emotionally fraught terrain of elder care.

As the American population grays, nearly everyone will be faced with the challenge of caring for an elderly relative. Every decision comes with loaded questions. Has Dad's behavior become erratic? Does he need assistance in his home? Should Mom move in with one of the adult kids? Is it time to place her in a facility, and if so, which kind? How easily the topics can be broached and a plan of action made depends on the relationships among family members, psychologists and geriatric experts say.

All too often, adult children must make difficult decisions in the face of crisis - after the elderly parent has broken a hip or descended into dementia. Denial that the parent has a problem, discomfort with the role reversal of parent and child, disagreements over the course of care, resentment that not all siblings are doing their fair share - all of these can tear at the fabric that holds a family together.

``You have to take into account what the relationships are, what the personalities are,'' said Celeste Bocian, program director of Specialized Ambulatory Geriatric Evaluation at Sherman Oaks Hospital. ``There's denial. Oftentimes there's conflict. It can get pretty ugly.''

In Hart's family, cool heads prevailed. Practical matters such as space and schedules governed where Booker would live. After Hart received the phone call, he flew to Philadelphia for a family meeting. He and his siblings explained to Booker - who suffered from heart disease and diabetes and later would be diagnosed with dementia - that they were concerned about her health. They asked her how she felt about moving to California.

``We tried to let her feel in control by asking her permission,'' Hart said.

Who are the caregivers?

Estimates vary on how many Americans serve as caregivers. The Family Caregiver Alliance has found that 22.4 million American households - 23 percent - provide care to an adult age 50 or older. By 2007, that number is expected to jump to 39 million households.

Some surveys have found an increasing number of American men bear the responsibility of caregiving. But Family Caregiver Alliance says the average caregiver is a 46-year-old married woman who also works outside of the home. According to the group's study, daughters represent 26.6 percent of all caregivers, while sons make up 14.7 percent.

Culture also holds strong sway, the study found. By ethnicity, Asian- Americans over the age of 18 are the most likely to care for an adult over the age of 50. Thirty-two percent of Asian-Americans serve as caregivers, compared to 29 percent of African-Americans, 27 percent of Latinos and 24 percent of whites.

Like Hart, Norma Adams figured that she was best equipped to care for her 89-year-old stepfather, Milton Ammons, after her mother died in February. Her older brother, Edward Thompson, wouldn't have the patience to deal with the dementia. Her stepsister, Barbara Smith, works as a receptionist and was faced with caring for another elderly relative.

Adams' parents had prepared both legally and financially to ensure that there would be no inheritance squabbles or burdensome costs to bear. Still, the siblings had to come up with a plan for his day-to-day care. Wanting to give Ammons some semblance of independence, Adams proposed that he live with her in Van Nuys during the week and attend adult day care at the nearby ONEgeneration Senior Center. On the weekends, Ammons would stay at his home in South Los Angeles with a professional caregiver.

Thompson and Smith agreed with the plan and found other ways to contribute. Thompson does the gardening and repairs on their father's home. Smith handles Ammons' rental property and business affairs. On the weekends, the three siblings rotate who's on call should Ammons' professional caregiver need to reach them.

``We never had a conversation about what each of us can bite off,'' Adams said. ``It's recognizing personalities. We know what we're good at. I'm good at the day-to-day.''

``Norma has the heavy duty,'' said Smith, 66, of South Los Angeles. ``The rest of us have to step up and do our fair share.''

The first month was the hardest. Some days, Ammons asked for his wife. Some days, he mistook Adams for his wife. Other days, he accused his three children of conspiring against him.

``He was constantly asking to go to his house,'' Adams said. ``He felt everyone was trying to take advantage of him. He was afraid someone would put him in a nursing home. He was very insecure.''

The day-to-day aggravations escalated. Ammons insisted that he was 50 years old. When Adams corrected him, he said she'd better check her math. When they reviewed his monthly bills, he demanded to know who had made a long-distance call for $2.12 from his phone. He insisted that Adams reimburse him for the call. These small but constant frustrations pecked at her.

Then Ammons' neurologist passed on a pearl of wisdom: Nobody wins an argument with a person suffering from dementia. Adams started to take the path of least resistance. She stopped reviewing the bills and just let Ammons drop the sealed envelopes in the mailbox. She also realized there was no harm in Ammons thinking he was 50 rather than 89.

``I stopped and changed my behavior,'' Adams said. ``When my behavior changed, Dad's behavior changed.''

A little help from friends

Over the past seven months, Adams has built a circle of friends who also are caring for elderly relatives. They exchange information. They carpool. They go on family picnics.

``You're making a network,'' she said. ``It's no different than when your kids are in kindergarten.''

Most of the time, Adams stays upbeat. But there are days when she feels tired. There are times when she feels alone.

``You do have times where you're saying, 'Why is it always me?' '' Adams said. ``Then you balance that. It isn't always you. I don't ask for help as much as I probably should.''

Adams stays focused on the joyous moments. Ammons has made them closer as a family. They eat dinner together at the table, something that happened only sporadically before. At a Fourth of July barbecue at Smith's home, Ammons held court in the back yard surrounded by grandchildren and great-grandchildren. Adams is making plans to take Ammons on a three-day cruise.

She says that tomorrow, next month or next year, everything could change. If Ammons becomes bedridden, Adams knows she will not be able to continue as his caregiver.

For the Harts, the inevitable decline came this summer. Booker died on Sept. 6. By August, she had become so ill that she required a feeding tube. The family had no choice but to move her to a skilled nursing home for rehabilitation. It was a heart-wrenching decision. The family strongly believes that elderly relatives should be cared for at home.

``That was my promise to the family,'' Hart said. ``But realistically, you can only do that while you have the ability to take care of her - until the medical need goes beyond your skill level.''

Mariko Thompson, (818) 713-3620

mariko.thompson(at)dailynews.com

How to broach geriatric aid

Some people aren't ready to admit that they or a loved one can no longer care for themselves. Here's what experts in geriatric care have to say about navigating the decision-making process.

Planning ahead

The best time to discuss elder care is before a catastrophe strikes. Jennifer Watson, a clinical psychologist who works with the Northridge MS Center and the Alzheimer's Association, suggests broaching the conversation at a time when family members are relaxed. Ask parents about their wishes and preparations. Do they have advance directives, such as a living will or power of attorney? What will their finances allow? Parents should inform a trusted family member about where important records and documents, such as insurance policies and wills, are kept.

Great communicators

Elder care reverses the traditional parent-child relationship, which is a difficult psychological adjustment. Issues of denial on the part of parents or adult children can create conflict. To facilitate communication, Dr. Gary Small, director of the UCLA Center on Aging, offers the following tips.

When family encounters put you in a sour mood, reflect on the cause. Are you overreacting now because of unresolved conflicts from the past? What strategies have you employed in the past that have defused stressful family situations?

If a family meeting has been called to discuss your parent's care, determine in advance what you're willing to give and what you're willing to give up. During the discussion, don't just talk but employ active listening. Finally, be prepared to compromise, Small said.

If family discussions become contentious and reach an impasse, experts recommend bringing in a neutral third party or mediator. This can be a trusted family friend, a minister or rabbi, or a social worker affiliated with a multipurpose senior center.

When to seek help

When is it time to intervene? Experts say to look for signs of change or decline. Mom no longer practices daily hygiene habits. Dad gets lost in his own neighborhood. Your parent has lost interest in cherished activities and appears depressed, irritable or anxious.

The next step is to take your parent to the doctor, preferably a specialist in geriatrics. Check your community for geriatric evaluation centers. At Specialized Ambulatory Geriatric Evaluation (SAGE) at Sherman Oaks Hospital, patients undergo a comprehensive two-hour exam to assess physical, cognitive and emotional health.

Adult children who live in another city may want to hire a geriatric case manager to conduct assessments and coordinate services. The local Area Agency on Aging, multipurpose senior centers and other senior service organizations can provide referrals.

Supportive environment

When addressing a problem, allow your parents to maintain a sense of dignity. Don't make them feel incapable.

`Focus on the positives, not the deficits,'' said Celeste Bocian, SAGE program director.

Maybe Dad's vision is starting to deteriorate and you don't want him driving. He's likely to get upset if you threaten to take away the car keys. Try explaining that his eyesight is a concern and note that his friend down the hall was able to get cab vouchers.

``You're solving the problem together,'' Small said. ``Empower the older adult with some degree of decision making so that the balance of power isn't completely shifted.''

If needed, enlist allies - influential family members or friends - who can help persuade your parent to accept assistance.

Healthy relationships

Not all siblings are the best of friends. Geographic distance, child- rearing and careers may have caused you to drift apart. To weather the demands of parent care, try to engage in enjoyable activities with siblings outside of care-giving obligations, Watson said.

``Reconnect with each other, solidify the goodness of the relationship,'' she said.

Care-giving can be both time consuming and stressful. To avoid burnout, caregivers should strive for balance in their lives through hobbies and friendships, Watson said.

``It's very important to maintain the positive aspects in your life when you're trying to help someone,'' she said.

- M.T.

To learn more

Specialized Ambulatory Geriatric Evaluation (SAGE), (818) 990-2573, www.shermanoakshospital.com:

The Sherman Oaks Hospital center provides comprehensive geriatric health evaluations as well as community education programs and support groups.

ONEgeneration, (818) 708-6625, www.one4seniors.org:

This multipurpose senior center in Van Nuys offers a range of programs including adult day care, family support groups and services for home-bound seniors.

UCLA Center on Aging, (310) 794-0676, www.aging.ucla.edu:

The center conducts research and educational programs on aging.

Family Caregiver Alliance, (415) 434-3388, www.caregiver.org:

San Francisco-based support organization for caregivers provides online consultations, online support groups, fact sheets and other informational resources.

Area Agencies on Aging: state and local agencies that offer a broad range of services to seniors, adults with disabilities and caregivers.

California Department of Aging, (916) 322-3887, www.aging.state.ca.us/index.html

Los Angeles County Area Agency on Aging (800) 510-2020, dcss.co.la.ca.us/aaa/aaa.htm

Los Angeles City Department on Aging, (800) 834-4777, www.lacity.org/doa

CAPTION(S):

3 photos, 2 boxes

Photo:

(1 -- cover - color) Norma Adams is the primary caregiver for her stepfather, Milton Ammons.

(2) Milton Ammons, 89, participates in an exercise class at the ONEgeneration Senior Center in Van Nuys. Ammons, who suffers from dementia, lives with his daughter Norma Adams on weekdays and spends the weekend at his home in South Los Angeles.

(3) ``I stopped an changed my behavior. When my behavior changed, Dad's behavior changed,'' says Norma Adams of caring for her stepfather, Milton Ammons, who suffers from dementia.

David Sprague/Staff Photographer

Box:

(1) How to broach geriatric aid (see text)

(2) To learn more (see text)
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Date:Sep 15, 2003
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