A Local Perspective on Life in Tsukuba, Ibaraki, Japan.

Parent Care When You Can’t Be There

Marcia Johnson from Binocular Vision contacted me to ask if I would publish an article about taking care of elderly parents from abroad. I felt that this was a topic that some TsukuBlog readers would be interested in, so here it is. If you have any questions about this topic, please contact Marcia through her company’s website.

Demographics and aging parent care
Perhaps you came to Japan thinking you would stay for a year or two, enjoy the life of an English teacher abroad, and then resume your “real life” back home. Two years stretched to five, and five into 10. You built your “real life” in Japan and now feel more at home here than in your native country.

Perhaps your spouse accepted an overseas appointment and you followed. Now you are balancing a family life with long hours in the world’s most demanding workplace.

Here in Japan, consumed with the details of managing day-to-day life, expatriates can feel far removed from political, community and family life in their native countries. Time can seem to stand still. But time waits for no gaijin.

With increasing longevity worldwide, many people in midlife and even late midlife have at least one living parent. “Mid-lifers” who postponed childbirth into their 30s and 40s, may now find themselves “sandwiched” between school age children and aging parents.

When is the right time to begin making parent care plans?
Through clues picked up during phone conversations with parents, and from first-hand observation during infrequent visits, longterm expatriates begin to notice signs that their parents “back home” in their native countries have begun the inevitable journey into old age.

Deep down you may know that, at some point, your parent will probably need help and that you may be the one called on to direct your parent’s care.

You may sense that it would be prudent to make some arrangements in advance, but don’t know when or where to begin. Age takes its toll at different rates for different people. People in young old-age (50s and 60s) can experience strokes and heart attacks. During the 70s problems with multiple chronic health conditions can increase. In the 80s diminishment of physical capabilities slows or even restricts an elder’s day-to-day activities. By the mid-80s, even elders for whom aging was slow to take a toll, will notice loss of previously taken-for-granted health and physical abilities.

“Falls are the leading cause of both fatal and non-fatal injuries among older people – common everyday types of falls like a slip on a patch of ice or a rug, a stumble on the stairs, or a brief loss of balance. Each year one of every three Americans 65 and older falls-and almost a third require medical treatment.” (AARP November/December 2008)

The short answer: It is never too early to begin planning ahead, but overnight it can become too late. My own story is a good example.

My family’s parent care plan and its limitations
In their 70s my parents took me into their confidence about their wills and financial matters. Dad had always handled finances. He and mom executed legal documents designating me to hold power of attorney (POA) to ensure that I could step in and handle finances if dad couldn’t.

When dad was 81, he suffered a massive stroke. My brother and I both rushed “home” from out of state to join our mother and sister in handling the emergency. We took turns sitting with dad in the hospital; ministering to mom’s needs as she faced loss of her life partner of more than 50 years; handling communication with concerned friends and family; and handling communication with physicians and decisions related to dad’s care. Because we had made arrangements in advance, I immediately took responsibility for finances.

Since their mid-60s, my parents had lived in a condominium in a senior retirement community. Prior to dad’s stroke, they had never talked with either me or my siblings about arrangements for long term care should either of them ever require it. After just a few short weeks of post-stroke care covered by healthcare insurance, dad would need complete care 24-hours a day for the rest of his life, either provided pro-bono by a family member or at the family’s expense by professional caregivers at home or in an extended care facility.

Mom, my brother and sister and I were faced with navigating this unexplored and scary terrain. Would we move dad to my sister’s house, in a nearby town, for care? If so would my sister quit work and care for him at home? Would we hire and manage a caregiver to take care of dad in the house during the hours that my sister worked? Would mom sell the retirement condo and move into a retirement community closer to my sister? Or would we move dad into an extended care facility, aka nursing home. If so, would it be near my sister’s town where she could visit him frequently, or would it be near mom’s retirement community. But mom did not drive and would need rides to visit dad. We anguished over the final decision to place dad in extended care near my sister, sell mom’s condo, and find a retirement community for her near my sister.

By planning ahead how to handle day-to-day finances, healthcare decisions in the hospital or doctors’ office, and end of life matters, our family had taken some important steps. Dad’s need following the stroke, for complete care for the rest of his life, unleashed an overwhelming tsunami of logistical and financial challenges and emotional stress for which our family was completely unprepared. Like most people who have made no long term care plans, we had no choice but to react and handle decision making as best we could in a crisis mode.

Making a plan that will work for you and your family in a crisis
My experience with parent care inspired my late mid-life decision to leave the corporate world and launch Binocular Vision Advisors. In the years since founding Binocular Vision, I have witnessed numerous examples of eldercare crises that could have been gracefully handled or even completely averted, if only grown children had become involved earlier and helped their parents engage in at least some degree of planning.

There are myriad books and internet resources that contain information about parent care. With research it is possible for grown children to glean the information they need in order to manage the process of planning ahead for parent care. But most people never go through the process.

In an October 28, 2008, in the New York Times “New Old Age” online blog, Cindy Cabrillo, CEO of Work Options Group, sums up the reality for most grown children of aging parents, “. . . few of us plan in advance for the time and money we may have to spend on eldercare, arguably because we don’t want to think about it and are hoping it will never come up. We close one eye, look the other way, handle one hurdle at a time and don’t realize how much trouble we’re in until it accelerates. Nobody wants to think about it beforehand. When you’re in the throes of it you don’t have time. And when you’re done, you don’t want to go back there again.”

For people who do want to plan ahead, I saw a need for a tool that brings together the pieces expatriate grown children (of any nationality) need to plan ahead, and walks them through a doable process for carrying out the plan. I created The Five-Step Long Distance Care Strategy to meet this need. For more information, go to my website (http://www.binocvision.com) and download Your Parent Care Plan.

About Marcia Johnson & Binocular Vision Advisors
Marcia Johnson launched Binocular Vision Advisors in 2003 to connect grown children caring for older parents from a distance with eldercare services they and their parents need. Based in Tokyo since 2007, she consults with English speaking expatriates caring for aging parents from overseas. Through programs for groups and consultation with individuals Binocular Vision helps expatriate families (regardless of nationality) cope with long distance caregiving and supports corporate productivity by helping expatriate workers address parent care challenges. Expatriates, whose parents live in Canada or the USA, can engage Binocular Vision to select qualified geriatric care manager candidates their near parents.