The Oldest Daughter Dilemma

One of the most well known advocates for elder care, who worked for a prominent national health center, was talking with me about a year ago.  When I asked him what his plan was for he and his wife, as they aged, he replied “ I have four daughters”.

This was pretty shocking to me, given that he worked in this industry, and specialized in helping adult children and their parents to talk about future health care planning. I thought he of all people would be a bit more enlightened as to other options he could choose.

Yet this is a common response and expectation by my parents’ generation.  First, our parents assumed that they would not live much longer than their late 60’s, similar to their parents’ generation.  Second, they assumed that one day, they’d “wake up dead” – just pass away in their sleep, another expectation from their own parents. And finally, if they needed help, they’d call on the daughter.

Now maybe my specialist friend had talked to his daughters, and they were ok with the plan. All I know is that these days, when I get together with my women friends, the topic of their parents’ care has come up.  Every. Single .Time.  I am the poster child for the adult daughter solution, and they have no interest in repeating my experience.

You see, I am an oldest ( and only daughter), and am an example of the “oldest daughter solution”. Although I worked in the aging industry for 18 years, and had a wealth of knowledge about options, my parents weren’t interested in my expertise.  They rejected the idea of a non-profit Continuing Care Retirement Community out of pride (“we don’t want to live with old people” said the 80 year olds).  When they decided to move closer to me, they didn’t choose a one floor condo in a friendly neighborhood; they chose a large 1800s Victorian that needed extensive renovations, on a busy street.

When my father became increasingly ill, the management of health care, doctor’s appointments and medication management fell to me, as my Mom has cognitive loss.  We started getting in-home care, which I managed, and when we had call outs or no shows, I left work to cover the shift.

It’s wonderful that we now have longer life expectancy, and most people are seeking a long health span, not just a life span.  As they say, people want to “live long and die short”, not live many years with chronic disease. Yet, as we know, 80% of older adults have at least one chronic disease; 68% of them have two chronic diseases, and the management of medication and symptoms can be challenging. Dementia is a chronic disease that can last many years.

Back to me.  At one point, it became apparent that even being 10 minutes away in the same town was too far, given the ever-changing roster of caregivers.  A few years ago, I sold my home and moved in with my parents, to more directly mange the growing number of midnight ambulance calls, hospitalizations and no show caregivers.  I am not the only sibling – my four brothers all helped and continue to help, but it remains a clear familial expectation that this is my responsibility.  As it turns out, I am not unique – I am one of 53 million Americans who are working and providing unpaid care to an older adult. Today, one in five working adults are also caring for an older family member, and that number is expected to continue to increase, as 10,000 people a day turn 65, and the cost of personal caregivers has escalated, while the availability of such caregivers has decreased.  For many people, there is no other option than family.

What most people don’t realize is that there is a defined decrease in the caregiver’s health.  Recent studies have shown that family caregivers experience an increase in mental health issues, such as stress and depression, along with an increase is physical challenges such as obesity, asthma and COPD, among others.  They are often passed over for promotion, due to the “distraction” of caring for someone outside the home.

In many cases, due to the cost of caregiving, the only option is for family to step in.  But when finances are not an issue, it seems foolish not to make a plan with your partner, family or friends, as to what you would prefer to do when you need care.

A friend of mine has started a “Pre-Dead Social Club” to get people to talk about what they wish for and what their intentions are when they pass away.  I love her theme – she says that most generations have approached death “ unprepared, in denial and unable to advocate for themselves”. I think that describes most people’s perspective on aging and poor health – that they are unprepared, in denial and often unable (in a crisis) to advocate for themselves. I believe that we can do better than this.  We can do more about our future health care needs than say “I have four daughters”.

Do yourself, your daughters, your sons, and your friends a favor – begin to think about your own plan today.  We can do better.

Catheen Toomey is a consultant on aging for individuals planning their best future life.  Host of the podcast Seniority Authority, she is passionate about helping people get smarter about growing older.  She is a TEDx speaker and has close to 20 years of experience in long term care, as well as a career in marketing for brands such as Timberland, Stonyfield Farm, Babson College and Bentley University. She can be reached at cathleen2me@gmail.com.