Payback time, the time period when the parent/child relationship changes and the roles reverse, is a very difficult experience when dealing with an elderly parentâs final illness. The original parent-child relationship plays a big role in this new experience for parent and child. When children are young, parenting requires structuring and nurturing the child in many ways so the child can learn appropriate behaviors that lead to his or her success in dealing with society. If the relationship stays positive, eventually parent and child can develop a friendship that emphasizes and appreciates their adult relationship. This connection can last for many decades, until the scenario changes. However, if the relationship is permeated with difficulties throughout the growth period and issues during adulthood, the bond can become antagonistic or even hostile. Nevertheless, payback and role reversal can be both challenging and threatening.
Role Reversal Rejected
Parents may refuse to accept the new role reversal, yet expect payback for all they had done for their children from birth to advanced adulthood. In one family with positive ties of affection and trust, the elderly mother, a very strong-minded parent, absolutely refused to release her role of matriarch, making it very difficult for her children to take care of her needs with medical treatment to enhance her quality of living. They pointed out that the caretaker spouse could have worse physical problems than the spouse being cared for. She stridently reminded her children that she was still the mother, that they were the children, and that she would tolerate no role reversal. She managed her household, which included 24/7 home health aides for her ailing husband, making sure they took superb care of him. When the mother knew she was feeling very ill, she hid her childrenâs phone numbers from the home health aide so that the children âwouldnât be bothered.â The next morning, when the aide could not wake her, she could only call the ambulance, saving the motherâs life, until finally locating the numbers to alert the children. Complicating this situation, the father, also a strong personality who was suffering from carotid artery dementia, was agitated because his wife was his security and he could not quite comprehend why the ambulance was taking her away. All of a sudden, the children were in the very difficult position of caring unexpectedly for both parents at the same time.
Difficulties in Payback
That basic scenario is probably experienced by many families, giving the adult children an immediate new family dynamic to deal with. Although accustomed to helping their parents continue a lifestyle that was comfortable for them, that changed instantly and radically.
There are two important aspects to this circumstance. On one hand, the concern is whether or not the parents have prepared for this time in their life, setting up power of attorney and health proxies earlier, enabling the children to make important decisions in the care of the parents. On the other hand, how the adult children relate to each other, including married-in spouses, is pivotal. This new situation depends on whether or not the adult children can respect and accept each other as individuals who think differently after living separate lives. They have to make decisions together that impact their parentsâ lives as well as their own.
In addition, they have to deal with their own emotions and personal relationships with the declining parent. If their relationship has been positive, they will feel kinder and more responsible for as much quality of life as possible. If the relationship has been negative in many ways, their emotions may cloud their ability to feel charitable to the parentâs struggles. Mixed in with that are feelings of guilt and anger that interfere with what has to be done. If any of the children are totally overcome by emotion, that also puts a burden on other children who are not allowing themselves to be overwhelmed by the family situation. An only child has unshared challenges dealing with these issues. Although the parentsâ illnesses may be terminal, that lingers in the background as health proxy decisions take center stage.
Emotions vs. Intellect
Dealing with the emotions that naturally become part of the family responsibilities at this point, heralds the onset of the grieving process. In sudden death, the grieving process begins at the moment the information arrives. In prolonged terminal illness, the grieving process evolves as the family members become aware that this is it â this person is leaving and there is nothing to be done to prevent that from happening. The people with a positive outlook usually feel terrible sadness, some relief, and abandonment. The people who have strong negative feelings often experience a mixture of anger, abandonment, relief, and guilt. âWait,â everyone thinks. âIâm not ready to deal with this.â Of course intellectually each one knows that the progression of the illness follows its pattern, regardless of who is or is not prepared. Furthermore, no matter how much an individual has studied this topic, no one is prepared for the stark reality confronting them at that moment.
Absolute Finality
In the family mentioned above, the mother lived another three months, unable to return home because hospital infections kept her there until she could not fight them anymore and finally expired. Just before that, the doctors pulled her children aside to tell them that they were now the âadults in the roomâ and that their parents were no longer functioning in that capacity â total role reversal. The father could not always remember that his wife had died, grieving anew whenever he remembered. He died five months later from the progression of his illness, after receiving home hospice care. The guidelines the children followed for the care of their parents during their final illnesses continued in the ensuing decisions. Their parents made it easier for the children to take care of them by preparing documents and setting up the legal channels necessary to enable the essential responsibilities. Fortunately, the adult children were able to discuss their points of view with each other and to compromise as necessary.
Further Reading:
Angel, Rabbi Marc, The Orphaned Adult, Jason Aronson, Northvale, NJ, 1997
Calllanan, M. and P. Kelley, Final Gifts, Bantam, New York, 2008
Callanan, Maggie, Final Journeys, Bantam, New York, 2008
Marlene Greenspan, MA, LPC, is currently in private practice, and the director of Counseling for Better Living. Formerly, she was the guidance counselor at RYNJ, where she also taught English, created a social skills program, and wrote weekly Counseling Corner articles. She has given workshops and published professional articles for Nefesh, the ACA, the ASCA, and the OU, among others. Marlene can be reached by calling: 201-833-0688 or by emailing: [email protected].