Ask HN: Advice about aging parents

Macabre tangent warning. Related to this, and having seen several cases where elderly people had very unhappy end years for various reasons (dementia, incapacity, etc.) I am starting to wonder not for our parents bur for myself - how could I make sure I don't live past the point where I stop adding value and become a drain. It's an interesting engineering problem. Presumably this would be when I lose mental capacity to make certain decisions, so it would need to be some kind of automated dead-man switch type mechanism, that is undetectable so the descendants can have a warm and fuzzy "grandpa went in his sleep" type experience, instead of "grandpa hung himself" or "grandpa pressed the accelerator instead of brake by accident."

Maybe an implant that needs to be re-armed every month or so, and if not it releases some toxin that causes a natural-seeming shutdown. Or ironclad ream of paperwork to make sure plugs get pulled.

This likely isn't relevant to you OP, but perhaps for someone else who is a little earlier in the process here.

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.

My advice is to keep your parents moving for as long as possible.

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.

I'm a realist. I told my parents (one retired but active and one preparing to retire) that they needed to get their end of life plans and elder care plans in place because I wasn't going to do it for them. My wife and I don't have children and are hoping to spend our retirement being semi-mobile around the globe. We simply won't be available to take care of them in their old age. I threatened (only half joking) that if they didn't arrange things and they got sickly I would put them in the cheapest elder home I could find an afternoon of calling. They're grown-ass adults. They need to figure out their life--not lean on me to figure it out for them.

Similar boat with aging parents. It is really tough with few solutions. In a very HCOL area and parents own a condo. So stairs are less the issue but there a ton other challenges that emerge. Simplest solution would be to do a joint-family system with the parents. That is not feasible because single story houses are pretty rare in our area and spacious housing is stupidly expensive in general (Toronto); moving my family with them just would not work. Back in the old country, houses were designed for this scenario .. 2 stories (old parents can live on first story and not have to deal with stairs; second story where the younger generation lives. Things like kitchen and dining were replicated on both stories. My spouse and I sometimes wonder why so many people who could choose to migrate to the west still stay in India, Pakistan, etc. It is a reminder that those societies do a few things better than the west.

Your dad crawling up the stairs is helping to fend off muscle atrophy. There's a risk of course. Falling down the stairs could lead to death after complications. But it's not as out-right bad as you might assume, and crawling reduces the fall risk a bit.

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

This hits home for me… my parents are about the same age as yours and I’m 43.

We’re both part of sandwich generation [0] - the link provide general overview of how common it is and tips.

I’ll add that what you can do truly depends on your culture (and even tribe for me) - Americans or Westerners to generalize can simply put their aging parents in elderly care and call it the day - life moves on. If you’re foreign-ish then that a sensitive thing to do and even not an option to consider.

Luckily, for me, my parents live in rural Kenya - so it’s cheap to hire help and provide them with all the care they need in multigenerational setup.

While my parents are relatively healthy- my dad is starting to have recurring medical issues that needs close attention. He’s as stubborn as it gets - I cannot even mention the need to prepare for eventuality with stuff like a will because it a taboo.

My experience thus far has me thinking how I need to prepare myself so my kids don’t get sandwiched as well.

[0]https://en.m.wikipedia.org/wiki/Sandwich_generation

Can you make the home more accessible? i.e. put in a chair lift for the stairs

I speak from experience. Aging parents, especially the stubborn type, will be a massive health drain on YOUR health. For little in return. They are still going to die. Don't put them before your own family, even a little bit. It will end you. They lived their lives, you're entitled to the same.

With birth rates decreasing, there will be less people like the OP to take care of their elderly parents. I wonder how people with no children will fare in a world with no support system in place for them. In 40 or 50 years things will be very dire if nothing changes.

The best thing you can do is realize these are unique individuals. They’re your parents, sure, but it’s not your responsibility. Live your life, let them live theirs. It’s ridiculous the way we as a society have normalized the idea that we need to care for our parents.

Hey, I'm 42, Father 81 and every time we visit his doctor (now it happens no less than 10 times a month) he refuses to use elevator and insists on walking to the second floor on his own feet (in fact also his hands - one for the stick and the other for the railings). He says: "I must train as much as I can".

I personally respect that and consider it to be the a sound choice. Not only this helps him to get some physical activity, but also a sense of control over his body and life which is a crucial thing to have in his age/situation. I really can't overestimate how important that is for his is deteriorating self-being. That allows him to keep some measure of self-respect and pride. At my 40 I started to understand that old people (I mean OLD, like 80+) are not strange yoda-like creatures from outer space (like I suspected when I was younger) but actually not different from us except for their bodies not working right anymore in many different ways and w/o any hope for getting better. Most of the time men feel pity and shame in such situation, no different from somebody younger. Whatever they can do to prove themselves their ability - I appreciate that.

In Indian and Asian culture in general you will take care of your parents just as they have taken care of you when you were a child. Old age is just like childhood age where you have to look after them just as much as you would look after a young child. Having your parents move in with your family is an option so that they don't feel lonely. They can also see their grand children and not feeling lonely at home. Loneliness is one of the main reasons to loose hope in life if they do not have good neighbors or support system. Once hope is lost then motivation to live long also goes away.

Not sure what other think of my opinion but I am living with at my parents at their home currently and just bought a new place and moving with my parents and wife/kids. There is attachment to the home we lived in for this long but we are looking forward to better life in new home together. There can be small disputes living together that may urge you to live separately but I feel if you look past them you all will feel stronger as you all know there is someone in the house to look out for each other.

For my grandparents it came down a combination of persuasion (hard when cognitive condition declined) and just making decisions for them.

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.

Based on personal experience, one might not know how much more pleasant a (good) elder-care living experience can be without experiencing it personally.

It has been a godsend for our family that my parents were able to move into a retirement community that offers a progression of care. My Dad has progressive supranuclear palsy and requires relatively constant care, while my stepmother is better able to live her life with some of the chores/maintenance handled by professionals.

I don't know if there are eldercare places that let potential residents try retirement living/assisted-living out for a month or so, but the community and amenity experiences can yield a flowering of life after elders have though that they were condemned to almost home-isolation by their mobility.

The fact that your Dad has the fortitude to crawl up a flight of stairs every day is truly admirable -- the key is helping him find his way toward a situation where that kind of effort is optional and safer, rather than a requirement and a risk. As @crispyambulance says in a nearby thread, falls are the big risk.

Good luck -- none of this is easy, but with experienced assistance, it need not be a series of unexpected calamities.

You're saying his bedroom is on the first floor and he only goes upstairs for computer? If so, I'd go ahead and move his computer down for him.

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 feel you. My father just passed at 86 last year. I told my family the only way he was leaving that house was feet first, and he proved me right. As others have said, get your parents' financials in order. You don't mention where you live. In the US, offering to do your parents' taxes for them is an easy way to get a handle on all their finances without hinting your concern about how long they have. Here's the challenge we are facing, all of us, these days. Modern medicine has extended life, but has not extended quality of life. Our parents really did not have to deal with their own parents spending decades in decline. In particular, they did not have to deal with their parents' cognitive decline. If they had, they might have a very different perspective on the burdens and worries they impose upon their children. My mom and dad kept each other company. Yes, they were frail, and my mom's cognitive decline has been progressing slowly over the last decade. But they had each other, and could watch out for each other, and call for help when needed. Your biggest concern, at this point, is your parents driving, if they've gotten to the point where driving is dangerous. It's a much bigger deal when one of your parents passes. The other one is then alone, with no one to call out if something happens. About a year after my dad passed, my mom was able to acknowledge that living alone was no longer viable. My brother took her on a tour of several independent living facilities near his home. They found one where the residents seemed happy and friendly. Included in her lease is a spacious one bedroom apartment, three meals a day in a group dining room, scheduled shuttle service to church, stores, and the occasional outing. She gets a little wrist buzzer she can press that alerts the central office if she has a problem. This makes me feel a lot better than services where, essentially, EMTs will have to break down her door to get to her. And she has company. The cost of her lease is covered by a combination of social security and income from the rent from her house. This facility also has an assisted living wing. When the time comes, we are hoping they still have room in that side of the facility. I will tell you one of the challenges, which perhaps your father is aware of, on some level. My mom has been in her new facility less than half a year. Already, she cannot remember what the house she spent 50 years in looks like. She confuses the place she raised a family with the place she grew up. Losing anchors like this can be quite disheartening.

We got one of those stair lifts installed. My grandfather (Also 86) got new hips some 4 years ago, but had been pretty much bedridden for 4 years prior to that. He'd basically live on the couch, and struggle his way throughout the 4 story house.

Unfortunately, he had a pretty serious stroke during rehabilitation, which left him with dementia-like symptoms - luckily not deteriorating, just very poor short-term memory. He never regained his prior strength, so he's mostly walking inside the house now. Grandma is still alive, and they live together. They, too, absolutely refuse to even consider the alternatives.

When she started experiencing dementia, we started to use meals-on-wheels services - but unfortunately, most of the food gets ignored and just spoils. They've been incredibly independent and DIY all their life - just 10 years ago, they remodeled a rental unit they own. Changed the windows, flooring, walls, etc.

Right now, we're kind of lost. They sort of refuse to accept that doesn't involve us (family) directly, so the whole family is doing shifts on helping them. My aunts/uncles are regularly there cleaning, taking groceries, etc.

Tbh, I think it's going to continue until one of them passes away, and the remaining one becomes too senile to function. It's hard to watch, but that's just the course of life.

No direct answers, afraid, but wanted to mention a related book on this topic: I recently got Being Mortal[1], by Atul Gawande, that tackles the difficult topic of how to gracefully navigate end of life / palliative care discussions.

[1] "Being Mortal — Medicine and What Matters in the End" — http://atulgawande.com/book/being-mortal/

Loads of sensible comments. I would like to add that you should address the stubbornness. Now its about stairs, but soon it will be about driving, or other contentious issue. Speaking from experience, this requires persistence, might take a year++ to come round.

If you haven't done so already, think hard about how you feel about being a care giver. Think hard about how you'd feel if that arrangement extends 10-15 years. Talk with you wife about how she feels about those topics. If you feel one way, don't assume she feels the same. Marriages can be destroyed over this very scenario.

Then I'd have exactly the same conversation with each set of parents. If the parent's won't talk about it, you're going to have a very hard time.

Medicine has made it possible to string out catastrophic, debilitating geriatric conditions way longer than might seem possible or just. Your parents are going to die, and it may not be quick. You need to be prepared for that possibility.

Remember, there's nothing that says you must take care of anyone in old age (unless maybe if you live in Japan). You parents are adults making their own decisions and taking the consequences. Your Dad refuses to listen to you. Think about it from his perspective. Would you want to admit that you're headed for an unknown future of progressive degradation, having had a lifetime of experience seeing people on that path? Would you not want to hold on to independent, full-powered adulthood as long as possible?

He's made his choice. But the consequences of his choices only become your burdens if that's what you want. This is what you'll find being a parent as well. Ultimately, your loved ones make their own choices. But where you have no control, you also have no responsibility.

I highly recommend to book "Being Mortal". It tackles this exact problem and gives some real examples of approaches and how things turned out.

http://atulgawande.com/book/being-mortal/

My grandmother struggled with Alzheimer's for a few years until she passed. The entire time, she stayed with my grandfather in the house they had always lived in. There were falls, there were too many stairs, it was far too big, we all had many conversations about them moving out (which would've made the Alzheimer's worse.) They were both quite old (late 80s/early 90s)

I don't think anything wrong or tragic happened. My grandmother got to live her life out at home and my grandfather spent his time taking care of her until she passed away in his arms. He said he wanted to take care of his wife until he couldn't.

The only advice I have for you is the same I had for my mother (their daughter): Try not to over-focus on the living situation and all that. Focus instead on your parents. The end of life and death are crucial and beautiful and you don't want to miss out on it due to a cloud of worry. Be present.

Has anyone looked into shared support resources on a friend/intentional community level. Obviously, this wouldn’t be practical in HCOL areas, but buying/building properties in a close space and sharing a privately employed nurse/caregiver doesn’t seem so far fetched for the period between fully independence and full-time care needed.

No good advice to share on the juggling bit, and I apologize if this sounds ghoulish, but plan now for their eventual incapacity. If they haven't done so already, get all of their financial info together in one place while they are still able to help you. Mortgage/deed, car info, credit cards, major recurring payments, investments,and insurance policies. Also all email and web passwords.

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

This is becoming a common quandary for GenX(ish) folks - how to care for both parents and children at the same time. Especially hard when so many of the former didn't plan well.

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.

You might need to wait for something to happen, and then force the issue.

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.

Make sure they have a will and whatever end of life medical forms are appropriate for their jurisdiction. This will greatly simplify handling legal matters unless there’s a single child to do it all. Remember that (in the us anyway) powers of attorneys end in death so do everything that is necessary “in time”. Even mundane things like collecting the contents of safety deposit boxes. Finally, if you’re not somebody interested in accounting, make sure you have somebody lined up who can wrap up an estate.

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.

Life is hard for honest people. Just so you know. Good luck

An 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.

I recommend reading 'Being Mortal' by Atul Gawande for some good insights into dealing with end-of-life issues. My wife & I found this very helpful in making decisions around the care of her aging father.

https://www.economist.com/books-and-arts/2014/10/04/helping-...

Your dad makes his own decisions. There's nothing you can do about this.

I had a similar story with my grandmother. Eventually, she fell in the stairs (93 years old). At that stage, she had to move to the first floor but after her accident, she lost her autonomy fast and had no other choice for her other than going to a retirement home. She declined and died within a year. Quite a common story I believe.

I've been through this the last few years before losing my parents. First the easy and cheap things. Get them a Ring to see who's coming and going. Get an Alexa video device for each floor - go with the Alexa ones because they are the only ones that let you to check-in without the recipient accepting the call. Get them Apple watches. Knowing that they just need to yell "Alexa, call johnny" and that you can peek in provides quite a bit of peace of mind.

Get a Power of Attorney for each. Make sure your understand their finances.

Go to Home Depot and get the bars for the bathroom. Check into the stair lifts, they aren't super-expensive and some Medicare plans cover them.

Do they still drive? If feasible, get them comfortable with Uber while they're still driving and the transition will be easier.

Talk to their doctors. See if you can get the doctor the prescribe home nurse visits and PT visits. It's another care vector that's covered by Medicare.

Start cleaning the house out now. I really didn't go through dad's stuff when he died, and then when mom died, I had to sort through everything. Figure out what's important while they're still around.

It's definitely tough to juggle these roles. A few things that helped me and my partner -

* 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!

There are very few real communities left. Human communities, tribes, clans, whatever you want to call them, knew how to take care of each other. Of course most humans back then didn’t live till the age we do now, but still. We try to distance ourselves from death as much as possible, whereas past communities had more stories and rituals around it, likely making it more acceptable and in some cases celebrated. Obviously there was the burden of grief, but it was spread across the community instead of concentrated in a few.

Honestly friend, my Dad struggled with this before my Grandma died and while I'm blessed that both my parents are still in good health, I'll likely be in a similar place. Knowing my Dad and how he struggled, the only advice I can give is that you have to stay healthy through this process. My Dad has running, curling and riding his bike - those hobbies and social outlets really helped him through the kinds of necessary decisions that only have bad options.

Aside from that, I'm sorry and wish you the absolute best.

Movement is good, let him move around. Keeping the movement safe is harder, a broken hip at that age takes a long time to recover from. Are the stairs unsafe? Slippery? Too steep? Insufficient handholds (not enough support, large gaps)? Those things can be fixed. In addition to those fixes: 3M makes an anti-slip tape that you can install at the lip of each step to prevent slips and falls [1]. There is a clear variant available too.

[1] https://www.findtape.com/3M-Safety-Walk-Non-Skid-Tape/p1217/

Parents are a bit younger (late 60s), but the biggest thing I keep watch for is their mobility and anything that affects it. My relatives that passed away all had one great correlation in their decline -- the loss of mobility, which really caused everything else to spiral out of control.

Body movement affects a lot of how the entire system works, and also gives them a lot more options to the outside world. Make exercise as fun and frictionless as possible. My parents joined an all-ages ping pong club, a gardening club, and a hiking group... so it covers both physical upkeep to an extent + social/mental one.

Probably off topic:

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.

The single most important thing that an older adult can do to stay independent and aging in place is strength train. Period. We all lose muscle mass as we age, and this is ultimately what robs us of our independence. But you can actually do strength training at any age and rebuild muscle mass and regain strength and function. If there is a fountain of youth on this planet, it is strength training - no joke. The benefits are so numerous, it's incredible.

The biggest challenge, of course, is convincing an older adult to do strength training and to do it consistently and challenging enough so that they see outcomes. One way to facilitate this is to do it with them. Their greatest motivation is likely to spend time with their adult children, so if you can use that as the primary motivator, do it. I'm actually the CEO of a program called Vivo (teamvivo.com) that provides this service through online, live and interactive classes. I've been doing Vivo twice per week for the last 18 months with my dad. We live in different cities but participate in this class together, and over this past 18 months my dad has NEVER missed a class. It's crazy to see the difference in his life as a result.

Whether it's Vivo or anything else, find a strength class or personal trainer that your parents can participate in and that will hold them accountable. And if you need to participate with them to get them started, do it. It will provide the motivation they need to start and will ultimately improve your relationship, as well.

Best of luck and I'm happy to answer any questions!

When he is at home he is only a harm to himself. At his age if that is the risk he wants to take... (though do make him wear an emergency call button in case he survives a fall)

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.

This isn't entirely relevant, but my dad passed away a couple years ago, he was only 67 and I was 30, and during the course of his illness, I had ample opportunity to think about aging and dying. I think the most important thing to remember is that people grow old and die. This fact seems so obvious that people nearly roll their eyes when you tell them, but I've seen people in their 60's and older just torn apart by the very normal things that happen as their parents die, mostly revolving around really not wanting to believe that their parents are dying. I remember someone in their 70's saying that it wasn't fair that their father, who was in his 90's, had cancer. What should have been gratitude for such a long life was replaced by bitterness that it had to end at all, which seems unfortunate.

It's hard to handle mortality gracefully, but really, fully internalizing that you have a finite amount of time with your parents makes it easier to deal with the frustrations of daily life, and also helps you keep a clear head when it comes down to it and tough decisions need to be made. As much as it sucks, you will be the one holding their hands through the end, and it can be a profound experience if it's not just a giant cloud of negativity and overwhelm (which is totally understandable, but not necessarily the only way!).

Do not rely on them to take care of each other. Get involved in managing their health care and finances.

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.

I don't have specific advice for the original question. But I have been exceedingly happy with what my own parents have done, they're both in their early 70s.

During the last 10 years, all 4 of my grandparents have passed away. They lived long good lives, and did my parents the service of "taking turns". Though one had 3 kids and the other 6, it fell to my parents to do the majority of the work during each's final years due to many issues, geography being one. It was a LOT of work for my parents. Many times they joked that, just when they got the kids out of the house and on their own, it was time to start taking care of grandma and grandpa.

Having been through that, my parents have taken some steps to avoid some of the pitfalls they experienced. Once a year, we have a family dinner (us and their children + spouses). It's usually a sort of joint anniversary dinner. And after dinner, we have a "state of the union" type chat. At least an hour or more. Our parents talk about how they're doing, how their finances are doing, how their health is doing, even their mental health, what's bumming that out, etc. We ask questions. It's all very candid.

This discussion is never had without everyone present. My Mom's explanation is that she doesn't want there to be any sort of "well, when I was talking to Mom she said, and what I think she'd want is..." There won't be arguments about when or if to put them in a nursing home. We know how they want to be buried. Kind of service, etc.

There will, I'm sure, be surprises and we'll have to adapt. But we've tried, and it's a together effort, because they kicked the ball off that way. Before it was too late to have these discussions. Their biggest frustration with their own parents had been that they didn't want to talk about it, and when it came time to have to talk about it, it was too late. People's faculties and emotions were compromised at that point.

My wife and I have compared this to her parents who are in their late 80's. It's going to be a mess. They won't talk about it. Don't want to. It's uncomfortable. And the kids all have their own viewpoints on thing.

If you can, before it's too late, start having the candid discussions now, together as a group. It makes things way better in dealing with the downhill years.

We are dealing with the same issues, but not with a multi-story home. My in-laws are roughly the same age, have medical issues ranging from fall risks to severe dementia, yet drs won’t remove drivers licenses. In-laws live in another state, yet still rely heavily on us for many things, so we have made the decision to make the cross-country move to go live with them so they are able to stay in their home as long as physically possible. We will be their caregivers for as long as we are physically able to do so. All of us have discussed this in depth, what it will entail to make this happen, etc. In my opinion, it may be time to start thinking of doing the same, if the home is large enough to accommodate all of you, as it will give plenty of time to spend with your parents as well as taking care of your own family. It is difficult dont get me wrong, so take what necessary steps you need to do to make your life easier as well. I know I will be once we are there.

The only small piece of concrete advice I have for you is to do with online security. My 90-year-old mum was using a single password for all services, and had started to use it for places that allowed you to purchase things, like Amazon and PayPal. I added her to my 1Password account and helped her change all her passwords to 32-character mixes of letter, numbers and symbols, then taught her how to use it. All of her password are stored in a vault that is shared with me, so if she needs to set up an account on a new site, I can do that for her and add the item to 1Password so she can use it straight away. I always had this nagging feeling about her using the same password, and I'll happily trade the occasional 1Password support phone call for the peace of mind I get knowing she's not using the same password everywhere.

With the benefit of hindsight, my biggest priority would be finding someone you (or they) can hire to help them around the house, at least a few days a week. In my experience, as they slow down they will let more and more housekeeping tasks slip, and when pressed will have plenty of rationalizations that they themselves believe "we'll do that later" "doesn't need to get done right now" "we don't use that enough for it to get dirty" etc. Someone coming in once or twice a week for 2-4 hours at a time will make sure those tasks get done, bring a spark of young person energy, and give them a cadence to their week (much more important for people living alone after their spouse has passed). It will also build a relationship with someone you/they can trust for later. This is perhaps easier said than done based on the stubbornness and that both of them are still alive, but I think this would have added the greatest quality of life to my own parents' end of lives.

Also I'm going to say that you haven't described much of an acute problem. Assisted living is a middleground, but that's a personal lifestyle choice and it appears they're deciding against it. By the time they're old enough to need help, they're past the point of assisted living, from what I understand. Having seen it, I would never want to go to a nursing home for my final days. Nursing homes are ugly end games that mostly exist because euthanasia is frowned upon and we don't want people dying in the street.

Other comments have touched on the legal stuff, but you want them to have Wills, DURABLE Power of Attorney, Health Care Proxy, and Living Will. Estate planning will depend on their/your level of wealth, whether you have siblings, and the state they live in. It's not just about divvying up their stuff when they pass, but is important for their own well being. Some of these documents need to be definitively in place now (Wills), whereas others the right time to have the conversation may be soon, or it may be after something significant happens to one of them. FWIW your Mom probably already has some rough expectations for what her life will look like after your Dad passes, if it ends up happening in that order.

Stepping back, you might just find that helping them at all is mostly impenetrable until one of them passes. And if that is the case, that is perfectly fine as well. It's more work when you finally do have to pick up the pieces and come from behind, but IMO you won't get anywhere by trying to force things ahead of time.

1. Walking. 4-5 km per day or more. 2. A system of meds and supplies and checkup.

I be cared for my dad with Alzheimer’s fir the last 10 years.

Walking helps: 1. Keeping muscle tone 2. Healthy lungs 3. Aids digestion 4. Fixes knee and back issues 5. Creates a routine 6. Aids blood flow 7. Helps sleep

It probably won’t help in the OP case unfortunately but the faster you can make walking a Solid habit for your parents the easier it becomes to take Care of them.

I have a whole system to make sure there’s 3 month of meds and supplies available.

Plus doctors and nurses for checkups and daily care.

Hard but very doable. My parents are in india. In the US setting this up will probably be 5-10x more expensive.

Similar situation. I would suggest installing an implant that needs to be re-armed every month or so, and if not it releases some toxin that causes a natural-seeming shutdown. [1]

No, wait, that's _insane_. What the hell is wrong with people?

In this thread, SaltySloth's comment [2] is most prescient and provides the best practical advice.

[1] https://news.ycombinator.com/item?id=29430888 [2] https://news.ycombinator.com/item?id=29430583

My mum is 63 and single and almost no friends left. I can assure you I am worried of how the next 37 years will be for me as the closest family member.

Advice from this thread which I will employ:

- I will hire helpers to do chores

- I will hire helpers to do larger things like lifting heavy stuff, ie. when buying a new fridge

- I will hire helpers to do gardening chores

- I will go to see a psychologist

There is a tendency to need help for everything, when it could be solved on her own volition. This will not scale into the future. Therefore I will hire helpers. I will need to deal with this situation which will degrade, so I'll see a psychologist.

Thanks, good thread!

I currently struggle with a 80+ parent who does not want to move and does not believe they have cognitive deficits. If possible, get added to bank accounts so you can electronically pay bills and check if they are being paid if not on autopay. This is valid if your parents are local or abroad.

Some of the tension I have felt is around notions of "dignity". When I read about OP's dad crawling up the stairs my reaction was negative. However, reading farther down about physical strength, autonomy, agency, made me see this differently.

Possibly the hardest part of my life. Almost all of the other family members decided they were not going to try to help. Mother did not really want help taking care of father, resorted to yelling sometimes when he couldn't move and she didn't have the strength. She insisted on lifestyle choices that accelerated her death and refused medical treatment that could have extended it. After she passed, still close to zero help from most family members taking care of father or hiring help.

That type of behavior, crawling up the stairs, is not rational. If you have funds, I would start by looking for help such as on https://care.com. If you are lucky you may be able to find someone who can convince him to stop.

It's easy to say, but you can try insisting, or even physically blocking off the stairs. And if having hired help around the house does not seem like enough, do not feel guilty about putting him in some type of facility, as long as it's a good one. There are a lot of bad ones unfortunately. The hardest part of that is the cost.

I don't know a good way to handle it. It might come down to him having the choice of living downstairs or being dragged into some assisted living facility. Or the third option of just waiting for him to roll down the stairs and break his body.

But my suggestion is to get professional help if possible, and make it very clear to other family members that this is their burden also.

Watch Tokyo Story

https://www.imdb.com/title/tt0046438/

#5 on this list

https://www.theyshootpictures.com/gf1000_all1000films.htm

Not sure it will actually be helpful but I found it interesting both in its topic and its conclusion, message.

Note: My dad has alzheimer's His wife is taking care of him at the moment but we, my brother and I, can see he's mostly done and she's having a hard time. By "mostly done" I mean while he still seems like our Dad it feels more like he was replaced by a robot. He recognizes us and has lots of memories and can still have a conversation but he's got no "spirit", motivation, will. He does nothing. Apparently he'd have stayed in bed 24/7 if she hadn't moved the TV to the living room.

We don't really know what to do or how to help. I suspect if she left we'd put him in a home. Neither of us have the time or inclination to be there for him. It doesn't help that he moved 2000 miles away for ~30yrs so as much as we love him he hasn't been a part of our lives. He's now ~100 miles away but even if he was 1 mile away I'm not sure what more we'd be willing to do.

If you haven’t done so already, make sure you have the essential paperwork in order— Especially helpful, durable power of attorney. Don’t procrastinate on this.

Eventually, (and without warning) you may be called upon to make key decisions for them.

> https://moneywise.com/managing-money/retirement-planning/ess...

It is their life, they will die soon anyway. It may be better to have one good year, than five bad years.

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.

It was a couple years ago on maybe a FIRE subreddit, but in terms of expenses for aging parents who didn't save for retirement, or saved little and for the kids to pick up the expense, it works out to you needing 140% of what you think you'll need for your retirement to also help parents out. So = 100%(you) + 40%(them) of that for them. Luckily medicare helps out quite a bit, but long term insurances should be looked at and it may be worth a few bucks now to cover things later in their long lives. Originally social security was setup to give people dignity after retiring for a FEW years after 60. But now people are living a lot longer and simply are not of the generation to have planned for that. You too may live far longer than you expect. If you've made it past 30, you'll likely hit 80, if you make past that, it gives you something to think about.

I suggest adding grab bars to the bathrooms and shower, and see about improving the railing in the stairway. If the steps are slippery, you can install a carpet on the steps.

Install a device like Alexa where they can yell for help.

See about removing any obstacles from the floor that they could trip over.

My dad is 81, bricklayer by trade and had his own small construction business, he worked 6 days a week. The physical strength certainly helped him for a good while into his old age, but walking is becoming increasingly difficult (now using a walking stick, very slow). He also fell twice in the last few years.

In my research i found this clever stair-lift solution https://assistep.com It's mechanical, and helps prevent falling, also encourages to further "workout" and contnue to walk up and down by himself. I contacted this company to see how expensive it is - definitely way more affordable than a chairlift and a more "active" solution.

But here is the bummer: He doesn't want it. Too stuborn, and just turns me down.

If your dad wants to stay at his own house and crawls up stairs, I suggest you embrace it. Don't take it away from him. It is good for his mental and physical state to be doing things on his own terms. His autonomy is good for him, and it is good for you.

Fix what vexes him, not what vexes you!

If you're well off and the parents are not going to move until dead, then you can do a few things.

Some renovations to the house including a lift might work. You probably want to look for replacements to the bathroom shower / tub (think walk in tub). Its amazing how much a bench in the tub/shower helps. Putting in some pull down cabinets in the kitchen would be good. Basically, look for spaces that are becoming inaccessible and fix what you can.

At some point some service that does visits (nurse) is going to become a need if you cannot make it over there. Also, a security system with the elder care options is good. A mirror or similar exercise system (particularly with some competitive features) might be a good purchase.

I'm sorry this isn't much use to the parent poster, but I think these conversations really need to happen years if not decades before it's time for the change. 70-somethings can be lively and wonderful, but as a generalization they are going to be very set in their ways and extremely loathe to changing their valued routines. At their age, even something simple like getting acquainted with new neighbors (and losing decades-long connections with old neighbors) can be really intimidating. They can have emotional attachments to rooms of their house that they probably can't even verbalize.

Unpopular proposal: the animal world does it better. Older animals never slowly degenerate into nightmarish parodies of their former selves. When they slow down too much, they are killed and rejoin the circle of life.

When I think about slowly deteriorating into a dementia-ridden, wheelchair-bound elder living in a nursing home I am struck with horror. Old people are an enormously expensive burden to society and mostly live in misery and pain waiting for their next doctor's appointment and their next friends funeral.

I wish there was a societal mechanism for an easy and clean death.

I am sorry for this situation. My brother-in-law’s parents were also super stubborn and it cost my sister dearly until they passed away. I am very lucky that my own parents usually are very reasonable and accept that they are getting old. My mom stopped driving and they also moved into a smaller, easier to maintain place.

I don’t think there is an easy solution for your situation other than learning acceptance and tolerance so this doesn’t affect you too much. I bet people who live with alcoholics have a lot of lessons for how to deal with irresponsible people while maintaining your own mental health.

My mom has arthritis, so they bought an elevator chair.

It definitely has reduced the risk of falls, but like other people in the thread have said.. maybe it's decent exercise?

We had to deal with this; in our case, my daughter moved in with my mother as a (paid) caregiver. My Mom got to live in her home a lot longer, and my daughter had meaningful work. It was great to keep it all within the family.

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!

A bit of an aside, a fascinating video [0] that reviews a recent metastudy: "how many steps per day does it take to reduce all cause mortality".

Turns out the answer is between 3000 and 7000 steps a day. This is a sample of 30,000 people between the ages of 45-80.

Get yourself and your parents moving.

[0]: https://www.youtube.com/watch?v=J6nW55kH7Do

My Mother have some knee issues. I knew that bike exercise is easy on your knee so I bought her a room exercise bike. The type where you can lean lean back. I think it’s called recumbent type. She says she uses it while watching TV and her knee is getting stronger. I think it was the best gift I ever gave her. I really want her to stay healthy. It will benefit herself, but the entire family really.

There is no easy way around this.

> my dad refuses to leave his house until he dies

Fair enough.

> my dad currently crawls his way up the stairs each day to use his computer.

These could be solved by elevator chairs. Might need to look for a creative person/company to install them.

> I have my own young family and my partner and I have jobs

It does help if you have siblings. Otherwise, you just need to assign a part of your time to them.

I am in a similar situation, but we live separately. Now I don't have stories of nonagenarians lifting weights, but as long as they keep moving in the house and take a gander outside every once a while, they will retain their muscle mass and remain independent. If that means crawling up the stairs every day, so be it.

I know people think of Hospice as supporting your final months but their only criteria is a terminally sick patient that will never recover. They can come and do an in house visit several times a week and bring health care to your parents, and it’s free. I knew somebody who had hospice care for years.

I'm looking into reducing loneliness and providing companionship for aging parents with an AI powered talking companion. If you have faced any issues with providing companionship to aging parents, I would love to hear more about it!

You can offset some of the risk in the stairs with simple aids, like a secondary banister, better carpet (no trip hazards).

Ultimately you'll need to employ in-home carers in increasing numbers unless you're going to give up work.

It's his choice. Because it's his life.

It's not yours. Because it's not yours.

He and your mum are who they are.

Maybe he is open to the idea of installing a stair lift.

Good luck.

I don't know your specific situation (location, financials, etc) so I can't share specific advice, but will share what we experienced with my grandparents.

My grandparents lived to be 94 + 95. One of the biggest improvements for them and us was hiring in-home help aid as they aged. Someone to do laundry, cook a good meal, clean up a bit, etc. It took a lot of the time commitment off my parents to constantly be making sure they were ok. Not to mention it gave my grandparents some much needed social interaction outside of our core family.

Another important factor was attempting to get their financials in order before they passed away and became incapacitated. After some review, we found some... shady accounting from a family member who was managing their affairs without much oversight. I'm not sure who is handling your parent's finances or if you have other family members, but once money is involved, people can get weird about inheritance. I've experienced and heard multiple horror stories about families breaking apart because of mismanaged finances.

I'd also recommend keeping your parents moving, and trying to keep their brains engaged. Bodily health is a vicious cycle once you lose muscle mass. Falls are also a huge issue for elderly people. YMMV, but installing smart speakers in each room of their house that they can use their voice to call for help in an emergency after a fall might be smart. We tried to get a life alert bracelet for my grandmother, but she always took it off. You'd have to train them to use it, but it sounds like your parents are tech savvy enough to get it. My grandparents missed the window for learning how to use the internet, so Alexa was tough. My brother actually took this funny video which got featured on a few meme sites of my grandparents trying to use Alexa: https://www.rightthisminute.com/video/rtmtv-grandpa-doesnt-g...

Finally, I'm going to plug my older brother's service, nanagram.co. It allows you to sms photos to a phone number that get printed and shipped to your loved ones in the mail each month. He built it to get photos to my grandparents without the internet. It won't fix the core problems you're describing, but can be a convenient way to give older people something nostalgic to look forward to each month, especially if it's pictures of their grandkids in the mail that they haven't seen on a photo stream.

Full disclosure re: Nanagram - I helped get the product off the ground, but am not involved anymore. Just a proud younger brother sharing a relevant service.

[Update] Another thing you should do is record their stories sooner rather than later. Using old photos as a story prompt is a good way to get the synapses firing on old memories. Once they pass away, all that history in their heads is gone, but it's easy to document some of it with video nowadays. If I'm missing my grandparents, watching old video of them and hearing their voice also really cheers me up.

[Edit - grammar/typos]

Personally, I file what you're describing as something that's not my problem.

My parents are adults and I can't control the behavior of another adult. It's up to an adult to ask for help and if they won't they won't.

Walks, talks and time.

America is a terrible place for the elderly.

Read Atul Gawande's Being Mortal

I am 80 years old and live in a Continuing Care Facility (Independent, Care, and Memory Care) and will live here for the rest of my life. I will get progressive care as I need it. Right now I am in good health and live in the independent living part of the facility (600+ residents). Moving here simplified my life tremendously. No house to take care of. Good meals are provided. Housekeeping provided. We are surrounded by people in the same stage in life and a well-trained staff of people. I pay $4,600/month for my wife and I to live here. Social security and retirement checks pay for most of that. The rest comes from savings.

A few comments from my perspective: the #1 killer of older adults in loneliness. They become isolated and are, frankly, forgotten. I see people here where I live have their spouse of 50-60-even 70 years die and they go into depression. A friend here had his wife pass away recently. Everyone made sure to include him in daily activities and conversations. Here it is not as bad because there are always people around to talk to and do things with. That is so important to older people who are alone. We are a social animal and need contact with other people. People here have group meals where 6 to 8 people put tables together and eat. Lots of stories and laughing. There are lots of social activities and events here too. As people age they do not want to leave their houses - mobility issues or cannot drive as well, so living here means getting out and seeing people is just a matter of opening the door and walking (or riding) down the hall to a public area where there are always people. I belong to several groups (watercolors, table tennis, and ukulele) and my spouse plays mahjong and bridge every day. People meet down the hall 2 or three evenings a week for sing-a-longs someone organized. We use the beautiful gym and pool a few steps away where there are exercise classes everyday.

It was hard giving up our nice house that was full of memories and things we were comfortable with but it had become a burden. Something always needed fixing. It was a cluttered, disorganized, and sometimes dirty mess. There were people in our neighborhood that had no friends and relatives. They were utterly alone every day with nothing but a TV, a phone and maybe a computer that confused the hell out of them. Very sad. Life can be a hassle. Moving here lifted a huge load off my and my wife's shoulders.

Not everyone of course can afford living the way we do. But you can.

If you haven't saved a nickel for your retirement, it is time to do so. Our savings over the years has allowed us to do what we are doing now and allows us to travel extensively all over the world. We have never been rich. At the time, it was hard to save. Because we did not have top level jobs, we had to sacrifice but it was, looking back, worth it because now we live a safe, dignified, interesting, and healthy life. And our kids do not have to worry about where to put Mom and Dad or to dispose of a house full of what they would consider junk. That has all been done. Our kids fully support our decision to come here to live. We live very simply without a lot of material possessions that just clutter things up.

So save your money and pray that we get politicians that realize that inflation is the enemy, the real enemy of older adults. A few years of what these clowns lie to us and call 'temporary inflation' and our hard earned savings will be gone and they will still have their mansions, servants, boats, and air planes. Think about that when you vote the next time.

Let me extend my sympathies to you. I think a lot of folks hang onto a fantasy that as your folks get toward the end of their lives that you'll somehow be more ready to lose them. We're not too far off age-wise. I'll never be ready to attend my mom or dad's funeral.

That wasn't your question, and I don't have any direct experience, yet (both of my folks are in relatively good health at the moment), but I have some thoughts if it's worth anything.

Our Dads sound like they'd get along. Were this my dad, I'd save my breath before trying to convince him that he's too old to continue with the stairs. My Dad required back surgery about 15 years ago -- almost a year's recovery and was the worst medical experience of his life. He spent much of it barely able to move (complaining so little that you'd have no idea most of the time). You don't ever really "go back to normal" after surgery like that. You also can't stop my Dad from pushing someone out of the way to get on one end of a couch being moved, or keep him from bringing over his tools when he finds out one of his kids is working on their home. It's a losing battle. And I've learned that while I may believe he's doing more damage (and he probably is), at his age, he knows his limits and will exercise them. One way to guarantee he sets those limits too high is to hint that maybe his body can't handle it.

The bedroom thing is interesting, though. I'm assuming your parents mental health isn't declining enough that you suspect the stubbornness is caused by dimentia. If that's not the case, are there other reasons that you haven't shared (or maybe you haven't thought about?) Is there something of sentamental or emotional value about that room that keeps him wanting to remain upstairs or is it just conveinece? Either way, the incredible inconvenience of having to crawl up and down stairs has apparently been judged "worth it" to him.

And I get the unwillingness to move. Even at my age, I've my elderly grandparents/great uncles/aunts and some other extended family have moved from "the family home" to "the home they're going to die in" (usually something smaller, sometimes assisted living). Most passed away within two or three years of that move. Even though I can rationalize that "of course they did -- many of them were moving because they were too frail to remain where they were", when you've watched the progression from "home->condo->grave" happen so quickly for so many, it's hard not to ignore the other variables. If your Dad has lived in this home for a lot of his life, it's the home he's "lived in" -- the next one is the home he'll "die in". I believe it would be impossible for me to make that move without feeling like the only thing you're saving up for anymore is a funeral you won't be conscious to attend.

Unlike you and I (hopefully, anyway), however, your Mom and Dad have probably not gone very many months without a person they know/knew/grew up with ending up on the obituary page. You're literally confronted by your own mortality all around you -- moving to "that last house" makes it part of the rest of your life in a way that accepting "I'll die where I lived" does not.

... when I was younger, I always wondered why people go through the expense of installing stair-climbers in their homes -- the inconvenience/grief of strapping yourself into a chair and having a machine take you up/down because you're too frail to manage the stairway and the expense of having one of those installed seemed crazy compared to the benefits of just selling the place and moving somewhere without stairs. As a younger guy, I would always weigh the cost of upgrading my home against the cost of moving somewhere that already met my needs -- especially if moving would result in me making money (as such a move from owning a larger to a smaller house in about the same location would cause).

So twenty or so paragraphs to summarize with this: Recognize that your father's motivation is almost certainly a combination of: fears about his own mortality, unwillingness to move to "the death house", unwillingness to accept that at some point people will need to take care of him/he will not be able to take care of himself, unwillingness to leave the memories of his life behind from within those walls. If you can help him to understand that moving/correcting some of these issues means having more of that life to enjoy with his family and loved ones, you might be able to convince him to choose circumstances that are easier for him to live with.

Either way, enjoy the time you have with your folks for as long as you can.

[0] Well, those who came from stable family upbringings and have strong relationships with their folks; obviously there's many exceptions, there.