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Monday, October 3, 2011

What Are the Boundaries of Care?

I overheard a conversation the other day.
A lady with an elderly father was vehemently denying she would ever assist her father with his toenails. She said "there are some things that are just too personal."

Well it got me thinking about elderly care in the family.
I asked myself, if Dad had surgery would I be prepared to look after him and assist with showering and dressing? 

As for his toenails! 
I used to show my love for him from about 8 years of age by doing his toes and massaging his feet when he was tired from work. I appreciated that he went to work all day to provide for the family.

Now looking back I could not deny care to someone who cared for me.

I had not thought about the limits before.
Is it because my mother was a nurse and care for the elderly was something that we were more attuned too?
I watched her care for my grandmother until her death.
Am I just de-sensitised to age and personal care?
Is it a cultural thing?
My Italian friends and Asian friends place no boundaries on parental care.
Is it a class thing?
Is it a sign of economic progression? We have all sorts of people we can pay to do these jobs.
Obviously there comes a time when the level of care required is not always able to be provided in the home environment. There is a lot of other "stuff" before that time though.
Because of the work I do, I see more and more elderly couples trying to maintain nursing care of each other when they really are at their limit already. One of the reasons is that families are more far flung these days. Once it was that children moved interstate but now it is common for them to re-locate to different countries all together! 
I'm not judging here, just making an observation. 
Have you ever thought about the day your elderly relative may need care?
Have you had experience with elderly care?
I would really love to hear your thoughts and experiences.


  1. I honestly think it's just that old toenails and feet can be icky. My Mum who had no problem doing anything and everything for my dad was completely freaked out by doing his nails for him. She did do them but I remember her saying that it was something she never thought she would do for anyone apart from her own children and grandchildren when they were young.

  2. I would hope to look after my parents, but realise that there are times when you just can't. I am a little lucky in that I am a nurse.. There are so many services out there to help..

  3. For instance, can you see yourself dressing, brushing dentures, cutting hair? For years I had to go over to the lady next door who lived by herself but had arthritic knees and put her stockings on and hook them to her suspenders. Is that still the norm or do we (society) pay for someone to go and do that?

  4. It's something I think about often, and have discussed many times with my sister. My dad is 84 and still lives alone and does everything for himself, but we know the day will come when he requires more help, he is very definite about not going into any sort of home. My sister works in community health and is prepared to become his carer when that time comes. Me I'm so glad we have her to fill that role. I'm not a nurse at all, I can be there for him and I'm a great emotional carer and good at listening, but way!! I really don't like feet at all. I guess if it was only me I would do what I had to for him, but it would be very difficult for me and for him too.

    cheers Kate

  5. My Dad is aged and still lives at home with Mum. Almost all his personal care is done by carers now, as far as grooming and washing and the like.

    I think the level of personal care that families take on could be a reflection of the nature of the relationship they had with that person before they aged. My Dad was always fiercely independent. I never had the relationship with my father where I would have touched his feet or washed his hair.
    Now we hug fiercely and I help a little to wipe his face or, help with his mobility, but to do more personal care would feel alarming, for both of us, I think. It is kind of the same for my Mum. Their relationship was very independent in a way. The personal care is very difficult for her physically and emotionally. Emotional expression is not her forte.
    Do I feel terrible that strangers care for my father, that he spends time in respite care as his many offspring are unable or unwilling to care for him themselves? Sometimes the sadness is overwhelming. The practicalities of it all make sense, but it doesn't make it any less heartbreaking. Its sadness lies, in part in that it is a reflection of how we have always related.
    I'm trying to put in the emotionally expressive, holding hands, being together yards with my kids now. I think there does come a time where it just feels too late.

  6. I heard a woman say she wouldnt toilet her husband even though they had been together 40 odd years. I must admit to feeling a little horrified that after all that time she wouldnt do that for her one and only.

    But I am not in her shoes and I dont know how I would cope in that situation - my husband is a big man and if he needed that kind of care it may be physically impossible. However I would do the best I can and when I couldnt cope anymore I would ask for help.

    As for my parents they have always said that when the time was right they dont want to come live with any of us - they dont want to be a burden on our families. They have seen first hand how it can impact on sons/daughters who take on a parent. I could care for my mother - however eccentric she may became, but dad is another issue - we just dont have that sort of relationship - now - maybe then I would just do it - to his horror.

    Toenails arent an issue for me - toileting is something I would grimace at and prefer not to do but just do it anyway and block out all the head chatter!

  7. Gosh there is a lot of good stuff coming out here. Can I just thank you one and all for your candid replies, honest sharing and broad experiences.

  8. Have I ever thought about it????!!!!
    I'm living it!
    Grandma just turned 89, has seizures on a regular basis, and has a well-earned case of dementia. She's finally in an assisted care facility less than a mile from my house. None of her sons(including my dad) assist in her care at all, and all live in very far-flung states (intentionally). Her daughter (my aunt) lives locally part of the year, and spends the rest on the other side of the country.
    I spend a LOT of time taking Grandma to her doctor appointments, shopping, genealogy meetings, doctor appointments, meals at our place, doctor appointments, doctor appointments...
    I've changed her diapers, I can clean her up and remake a bed with her still in it. I cut her nails, I treat her hemorrhoids. I give her spending money, I pay her deductibles when she can't, I leave work to go to restaurants to pay her bills when she realizes her wallet is at home.
    I've told my folks NOT to look in my direction when they need help. I'm taking care of Grandma and I'll be damned if I take care of them, too.
    I count my blessings every day that she's in an assisted living facility. I don't know how others manage to do it at home, all the time.
    My fear is that my daughter will see my lack of caring for my own folks, and replicate that, rather than modeling the care I give my grandma.
    Sorry this went long. It's been an incredibly long day of taking care of grandma and packing house. I guess I'm venting a bit much.
    Oh well. That's what you get for asking!!!!

  9. Hey Tanya, although I work in the kitchen, being employed in aged care has certainly opened my eyes to a lot of things regarding the elderly, their health and care.........

    I have always said it takes a special kind of person to be a carer/nurse and that's why I am happy working in the catering side of things.........

    The older I get the more squeamish I am, could I undertake this care for my husband? If I had to I would, but I am sure it would be difficult for both of us. My parents have passed away long before any of these situations arose.

    The aged care facility I work for offers excellent care in a lovely rural environment. It's well run and staffed by caring people. If I ever got to that point in my life I would happily move in without a second thought and I think that's what is most important. That people make the decision while they are able to and not leave it to their families to deal with.

    What I find frustrating is when elderly folk refuse to give up their independence when it's obvious they are well beyond coping at home alone and are now a potential danger to themselves.

    A tricky question Tanya, such a personal thing, people need to be aware what services are available to them and their elderly parents to help at this time.

    Claire :}

  10. Hey Tanya, I have just read Kat's comment and I take my hat off to her and the wonderful job she is doing for her grandmother, but it's obviously quite stressful at times and causing difficulties.

    I guess it's a scenario we don't want to talk about until we have no choice. I feel it's something families need to discuss well before time. Like funerals we need to let people know our wishes before it's too late.
    Sorry for having a double dip at commenting, better get off my soap box now...........

    Claire :}

  11. I am a nurse Tanya so I guess it goes with my comfort zone.

    I think it is lovely you went over to your elderly neighbour and assisted her. That is probably what kept her at home longer.

    Yes it seems society is leaning towards people being paid to do that now. SAD I know. I hae an elderly neighbour across us. I often want to help him. Having him over for dinner and taking things over. Worrying about him when I don't see him for more than three days. Sending husband over to pretend he has a question to make sure he is okay.

    I think if we have the right type of neighbour than it can happen - or family who can do it. If not then... There are services to do this - though I know they are so stretched.

    I want my mum to stay at home as log as she can. I don't like nursing homes. SO I will do my best to keep her home when she starts to need help till it becomes detrimental...

  12. My Mum is 81 years old and in good health physically but her mental health is declining slowly. Her mother suffered from
    Alzheimer's so I can see that slowly creeping in. I have 3 sisters who live in our small country town (pop. 5,500) so between us we take Mum to the hairdresser,grocery shopping, doctor, podiatrist (she has her toenails clipped 6 weekly at our Community Health Centre - thankfully!) and trips to the regional centre 50 kms away for optometrist and any other shopping she requires. For the past 2 years she has a cleaner come in to vacuum, mop and to clean her bathroom and toilet. She still dusts and keeps a beautifully neat house herself. Originally she paid a private cleaner for this herself, now I believe it costs about $5.60/week through an agency (RestHaven). It's a fantastic service - after cleaning, the lady stays and has a cuppa and a chat with Mum which I think is really nice.
    If Mum deteriorates to the point where she cannot bathe herself, we have Domiciliary Care who can do that - Mum is a very modest person and even though she has 5 daughters, I don't think she would be comfortable with us seeing her body. That's just Mum. Dom care will also medicate people in the evenings and put the person to bed then arrive in the morning to get the person up from bed also.

    There are plenty of health care options out there in your community, you just have to enquire.

    Cheers - Joolz

  13. Great post, Tanya. Unfortunately, our 'cleverness' has resulted in a major casualty - ourselves. We seem to have lost our way in the secular society in which we live.
    Material wealth is no substitute for caring and sharing.

  14. Richard~ A secular society enjoys freedom from state-sponsored/state-mandated religion. I can't follow your train of thought as to how that impacts how we care for our elderly. Can you explain?
    I'm not being snarky at all--I'm quite curious as to your thoughts!

  15. I care for my father and sometimes mum needs help too. I have done far worse things than deal with dirty feet. He is my dad and he needs help. Simple.

  16. Such an important topic Tanya. I helped care for both of my parents before they died and in retrospect it enriched my life so much that I am glad it happened. In my mom's case, she had a massive stroke but didn't die for 2 1/2 weeks, so my sister and I did round-the-clock bedside duty for the entire time. In the last 2 days we moved Mom to my sister's house and she died with both of us holding her hands. My dad had cancer, and stayed alert and feisty in his own home until the very bitter and sad end. I visited him nearly every day for 8 years -- the period of time he lived after my mom died -- and became his wheels when he could no longer drive. He had wonderful hospice care for the last couple of months, and there are no more wonderful people on this planet than those who do that work.

    So, in answer to your original question, yes, I did my dad's toenails. And I helped clean him up when he became incontinent at the very end. I kept telling myself: he changed my diapers when I was an infant. I can help change his now.

    And I agree with Richard when he says 'our "cleverness" has resulted in a major casualty -- ourselves,' although I'm not convinced that it's because of our secular society. It's something I think about a lot: so-called technological progress (especially medical progress) is such a mixed blessing. Yeah, we can keep people alive longer with heart meds and cancer treatments but I'm not sure we're doing anyone a favor. I don't pretend to be a Luddite (how could I am clacking away at a computer!) but I think we overrate "progress." Oh no... I feel a rant coming on. Best to stop here.

    Thanks for making me think so hard!


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