Strength to Separate

Helping aging partners cope with declining physical and cognitive functioning is especially hard on the care-giving spouse, who may become isolated and depressed. Only children also have a difficult time managing their parents' care, accepting the need for enrollment in an assisted living facility, and finding support for these challenging issues.

When elderly parents develop chronic conditions, their adult children sometimes must make the difficult decision to separate them. [dial-up OR broadband]

Jane Castor urges her father to enroll his wife—her mother—in a long-term care facility.

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Walter and Brook Castor

Jane and Sandra, her parents’ CNA, sat in a car outside of the small brick bungalow, looking out at the overgrown yard. Her parents had resided at this address for over fifty years, she herself had grown up there, and the home conjured countless memories for Jane.

The rental had been parked for some time, but Jane still clenched the steering wheel with white knuckles. She exhaled loudly. “It’s just a matter of time before one of them gets hurt. I’ve got to keep reminding myself that.”

Sandra rested her hand on Jane’s shoulder. “Making the appointment at the gerontology center was the right thing to do.” She paused. “If it’ll make it any easier, your dad nearly chopped off his toe on Wednesday in the kitchen.”

“What?” Jane straightened and twisted towards Sandra.

“He dropped a meat cleaver out of the drawer when he was rooting around for a spoon.” Sandra said flatly. “I was in the other room with your mother when I heard the crash.”

“Alright,” Jane said as she opened her door and forced herself out the car. “I’ve got to do this. Thanks for backing me up.”

“Don’t mention it,” Sandra replied. “Just bring up the magazine article like we talked about and hopefully that’ll get the conversation going.”

“Right,” Jane said as she grasped the printout she planned to share with her father.

“Questions to Ask Aging Parents”

Inside, Walter was still trying to persuade his wife to prepare for their daughter’s visit. “So, Brookie, shall we go outside to wait for Jane?” he asked, placing her woolen shawl about her neck and shoulders for the third time.

“Yes, all right,” Brook said, as she slid her feet into her house slippers.

“Sit here,” said Walter, patting the recliner, “I’ll find your walking shoes.” A knock at the door interrupted Walter. “Hold tight, Brooks. I’ll be right back.” On the way to the door, he couldn’t help noticing that Brookie was looking around the room, bewildered, unable to differentiate what the knock was and where it had come from.

Jane and Sandra stood on the stoop wearing forced smiles. It was difficult to mask their unease about the intervention that they were about to carry out.

“There’s my little girl,” Walter said slowly. “We’ve missed you, come in.” As the two embraced, he cocked his eyebrow when he noticed Sandra standing behind his daughter.

“Hi Mr. Castor,” she said.

“How many times have I told you? Call me Walter; Mr. Castor makes me feel old.” He turned his attention to Jane. “Where’s Jim? How’re my grandkids?”

“Oh, they stayed home in Indiana, Jim couldn’t get any time off from work,” Jane answered her father as she walked inside and bent to hug her mother, who hadn’t got up out of her seat. “Hi Mom, I’ve missed you since the holidays.”

Sandra took a seat on the couch. “Walter, I wanted to let you know that Jane and I have been talking on the phone quite a bit lately. We’re concerned that Brook’s condition has progressed to the point that you may have difficulty continuing to assist her.” She checked Walter for a reaction, but he sat there stoically. “I realize that this isn’t easy,” Sandra continued, clearing her throat, “but it’s essential that we give Brook the care she deserves.”  Brook sat motionless and stared at the wall with a bemused grin.

“What do you think I’m doing?” countered Walter. “Brookie and I will always be together, we can’t live apart.”

A tense beat passed and Jane chimed in. “Dad, Sandra didn’t mean to offend you. All of us know how much you love Mom, but you can’t go on caring for her forever, given her incontinence. Sandra and I talk on the phone every week, and she keeps telling me again and again what a hard time you’re having.”

The link between incontinence and dementia

“And remember how scared you were, Walter, when you found Brook wandering around the house in the middle of the night last week.” Sandra interjected.

“Yes, of course I remember, but I doubt Brookie does,” his wife sat idle with a bemused grin on her face as the three took a moment to look at her. “Sometimes I think it’d be better if we were both gone.”

“Dad!” Jane yelled, “You can’t talk like that—you don’t mean that.”

“Seeing your mother’s mind slip away has been the hardest thing I’ve ever dealt with, Janey,” Walter said quietly. “I’d be a POW all over again to have Brookie back like she used to be.”

“Walter, you need to tell a doctor about how you’re feeling,” Sandra said sternly. “You’re carrying too much on your shoulders, and you’ve told me again and again how depressed you’ve been lately.”

Jane leaned over to console her father. “Dad, I’ve made an appointment to have you and mom checked out at the Akron City Hospital’s gerontological wing tomorrow. Sandra and I think its time we get a professional opinion about how hard this is on you and Mom.”

“Don’t you think it’s a good idea to at least get checked out, Walter?” Sandra prodded.

Walter silently nodded, and with that Jane quickly changed the subject in an effort to cheer up her father who was visibly depressed.

Walter Castor undergoes an evaluation to determine cognitive function and the severity of his depression.

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Walter works with a nurse to determine if he is well enough to care for his wife.

The next day, the Castors met with an interdisciplinary team of caregivers at the Metro General Hospital’s Center of Gerontology. Upon their arrival, Walter and Brook were guided to separate examination rooms, and Jane was asked to wait in the reception area. While Brook was being assessed down the hall, the Folstein Mini-Mental Status Examination was administered on Walter.

More information on the Folstein Mini-Mental Status Examination

Walter’s results from the Folstein Mini-Mental Status Examination

Walter undergoes the Folstein Mini-Mental Status Examination. [dial-up OR broadband]

Walter admits to having suicidal thoughts. [dial-up OR broadband]

Following Walter and Brook’s examinations, the nurse who administered the Folstein test on Walter asked Jane to join her in a private meeting room.

“I think bringing your parents in today was the right thing to do,” the nurse said.  “Your mother is demonstrating severe signs incontinence and dementia, like you said she was, but it’s your father who I’m particularly concerned about.”

“Oh dear,” Jane said with a wince, “what’s the matter?

“Well, this may be difficult for you to hear, but during his evaluation, your father implied that he was having suicidal thoughts.”

“He wants to,” Jane strained to finish her sentence, “kill himself?”

The nurse rested her hand on Jane’s knee.  “His inability to care for your mother is really eating away at him.  I doubt he’ll ever really harm himself, but it would be a good idea for you and your siblings to talk with him about it.”

“I’m an only child,” Jane said with a trembling voice.

“I see,” said the nurse, “in that case, you may want to meet with our caregiver councilor here before you speak with him about it.  She can give you some ideas about how to approach the topic.”

“Thank you,” Jane muttered as she bowed her head.

“I’ll give you some time to decompress before we meet with the doctor,” the nurse said as she stood and walked toward the door.  “When you’re ready, just head back to the waiting room and hold tight until the doctor is finished assessing your parents.”

Jane reflects on her parents’ situation. [dial-up OR broadband]

Jane meets another only child with aging parents, facing a similar decision.

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Elaine must decide if her mother is capable of caring for her father, who has severe Alzheimer’s.

Following her interview with the gerontological nurse, Jane returned to the reception area to wait for her mother’s and father’s evaluations to wrap up. Having to verbalize her feelings about her parents left Jane feeling incredibly emotional. A woman nearby in the waiting room noticed her tears. “Need a Kleenex?” she asked.

“Yes, please,” Jane said meekly as she blotted her face. “Thank you.”

“Coming to a place like this is rarely fun, I know.” She took a seat and extended her hand, “I’m Elaine. I’m waiting for my parents too.”

After their greetings, Jane discovered that Elaine was an only child as well. She was dealing with a very similar problem; her father’s severe Alzheimer’s was leaving Elaine’s mother in a state of constant stress.

As Jane and Elaine commiserated, a nurse appeared in the doorway. “Elaine Tompkins,” the nurse called, “Dr. Inestez is ready to meet with you and your parents now.”

“Be right there,” Elaine replied as she stood and collected her things. She turned to Jane and pulled a printout out of her purse. “If they do decide it’s best for your mom to go to a nursing home, here’s a listing of the top rated nursing homes.”

Ohio Department of Aging Lists the Top 30 Nursing Homes

“Oh, thanks,” Jane said as she scanned the document with a sigh. “Maybe we’ll bump into each other again here—good luck in there.”

Elaine waved over her shoulder as she entered the examination room.

Elaine and her parents speak with Dr. Inestez about her father’s severe-stage Alzheimer’s diagnosis. [dial-up OR broadband]

Dr. Inestez speaks with the Tompkins family about adult day programs and lifeline pendants. [dial-up OR broadband]

Dr. Inestez speaks about the benefits of respite services at alternative care facilities. [dial-up OR broadband]