Chapter Ten Taking Care of Mom and Dad It has become the baby boom generation's latest, and in some ways most agonizing life crisis: what to do when the parents who once took care of you can no longer take care of themselves," writes Cathy Booth, a reporter for Time, who, in her words, "descended into elder-care hell, when my mother, then sixty-nine, was found to have Lou Gehrig's disease."' Talk to the children and most will tell you that their aging parents are a near-constant nagging concern in the background of their lives. In a 1997 New Yorker article titled "The Sandwich Generation," James Atlas, living in New York, tells of the pleasure—"a sweet moment," he calls it—of opening the door to his eighty-something parents when they arrive from California for a family visit. But a fugitive premonition occurs to me. This can't last forever. It can't even last very long— The Old People, as they call themselves, are always on my mind. When the phone rings, I think, This is it. Another stroke, a fall, a lab test with ominous results. I 112 Lillian B. Rubin worry about them the way one worries about one's children. Are they safe? Happy? Do they have enough money? If they fail to call on Sunday, I imagine calamities: They're in a hospital emergency room. They crashed the car..., At first, I was reluctant to bore my friends with these anxieties. No one wants to hear about your children's grades, so why on earth would anyone want to hear about the pros and cons of retirement homes____I was astonished when, droning on at a dinner party about my campaign to dissuade my parents from handing over their worldly goods to a still-under-construction "retirement community" out in the desert, I found that E had stumbled upon a cohort: the children of the elderly. Middle-aged sons and daughters chimed in with tales of their own.2 I thought, when I read his words, that it's something like finding out you have some disease ot disorder you never heard of and whose name you can't pronounce, only to discover that everyone you mention it to has either had it or knows someone who has. The cohort of anxious "children of the elderly" James Atias discovered a decade ago, has grown exponentially since then, and as the "elderly" get older and older, it will be an increasingly common problem for both the older and younger generations. The National Center for Health Statistics tells us that more than one-third of Americans over sixty-five suffer some physical ailments that limit their activities; among those over eighty, well over half need help in managing at least some of the everyday tasks of living.3 No surprise, then, that even a casual mention of aging parents is likely to open up a Pandora's box of anxieties, of stories told with tears, with exasperation, and sometimes, when they can take a step back, with Laughter. Not funny ha-ha mirth, but more like the hysterical laughter we all experience at those moments when Taking Care of Mom and Dad 113 we're forced to came to grips with the absurdity of life and our own helplessness. Even if their parents are still doing fine on their own, the children know that their concerns, the "fugitive premonition" Atlas talks about, will almost surely become a reality. True, some children manage to close their eyes to that knowledge, to deny it until it's no longer possible. Sometimes that denial is a response to a history of troubled family relationships; sometimes it's because the children can't bear to deal with the specter of their parents' death. But most of the adult children I spoke with actively worried about their aging parents, often long before their parents need any help. I see it with my own daughter, who wants me to be in touch when I leave town, even if only for a few days or a week, who calls when she's traveling though she never did before, whose anxiety announces itself over the phone lines when we haven't talked for a while: "Are you okay? How's Dad?" I tell her we're fine, ask her to stop worrying. "It's my turn to worry," she replies. She and the man she calls het "forever after" have regularly spent about a month a year in adventurous travel abroad. Now, she's reluctant to go away for so long and resists going anyplace where she'll be out of reach for more than a day or two. When I tell her that her anxieties are overblown, that her fears are unfounded, that I want her to go and enjoy herself, she looks at me and says, "It has nothing to do with what you want; it's what I need." A response that moves me to tears, while a little corner of my brain thinks, "Yes, 1 know, but that's your problem; it has nothing to do with what I need right now." When she reads these words in an earlier version of this chapter, she calls. "I think you left something out here, Mom." I'm quiet, puzzled, waiting for the rest, until she goes on to remind me that when she phoned to say they were back after their last over- 114 Lillian B. Rubin seas crip, my immediate response was one of great relief, "as if," she says, "you were holding your breath the whole time we were gone. You actually told me that you were relieved and that you didn't really like it anymore when I'm so far away for so long." 1 resist at first, wanting to tell her she's making more of it than I meant. Then I remember the rush of unshed tears when I heard her cheery, "We're home!" at the other end of the phone line, re-member, too, how comforted I felt to know she was nearby again, relieved of an anxiety I hadn't even fully known was there. "But I also meant it when I said 1 don't want my feelings about this to determine how you live your life," 1 remind her. "I know," she says, "but that's only because you think you always have to be the mom. I love you for it, but it can be a pain when I feel like I'm getting mixed signals and when you try to protect me when I don't need your protection." One reader, my daughter's age, writes a marginal note in the manuscript saying, "It would be nice to expand on what you do need. Parents tend not to say what they need, and we children are left to try to figure it out, which leads to problems when we make mistakes." I think about the question, but I'm not sure what I can say that's helpful, perhaps because I, like so many parents, am resistant to thinking of myself as someone in need. But it's more than that: I actually don't need help with the tasks of daily living. Maybe an errand once in a while, a trip to Costco a couple of times a year for the household paper goods I buy there. But that's because I hate to go there, not because I need someone to do it for me. Do I have the right to burden my very busy daughter with something I can do for myself? She says, "It's no problem; I go there anyway." I hear the words and appreciate them, but I don't take up the offer. Why? Because it's my job to take care of her, not the other way around, because I don't want to feel old and dependent, because I don't want her to think of me that way. Taking Care of Mom and Dad 115 But if not such things, what do I need? The answer, I think, is emotional support, a vague idea that I can't easily give content to and that's probably different for different people. I know that more than ever before I need her support and understanding as her father and I try to find our way through the thicket of this new stage of life. 1 want her to listen, to help me think things through without giving advice, to be present but not intrusive, to be avail' able but wait to be called, and most of all, I want her promise to let me die when I decide the time is right. And between now and then, I want more time with her because I'm so conscious of how little of it is left to us. These issues between parents and children, the mixed mes- < sages on both sides—children who say they want to help but have; no time, parents who say they don't need anything but clearly \ do—are an old story. It's not news either that adult children have always worried about their parents, that they've always cared for them in their old age, and that the tole reversal is inevitably a wrenching emotional experience for all concerned. But the cultural context in which this takes place is vastly different now than it was fifty years ago. Then, few women worked outside the home, so someone was there to care for an ailing parent. Now a changed culture combined with economic need have put most women in the labor force alongside their men, which means there's no one at home to take care of Mom or Dad when they need it. But the more important change lies with our newfound longevity. Then, when people died much younger, caregivers weren't likely to spend as many years on the job as they do now. Indeed, given our extended life span, middle-aged adults may well spend more years caring for a parent than for their children. "My father is ninety-seven years old and needs constant care," says a sixty-four-year-old woman wearily. "He's been living with us for fifteen years; it was okay at first because he could take 116 Lillian 8. Rubin care of himself. But for the last six years..." She looks away as tears well up and she struggles to regain control, "What can I say? I'm beginning to feel desperate. How long can this go on? "It feels selfish saying that, but I feel like I've been taking care of my parents forever. First it was my mother. She died of cancer after being sick for years, and I was constantly running back and forth to help. Now it's my dad. He's not poor enough for Medicaid to pay for a nursing home, and we don't have the money to pay for it ourselves or get full-time help for him." She passes her hands through her disheveled hair, then, "It's something, isn't it? My kids are gone; they don't need me, but I still can't just go live my life, because 1 have to take care of my father." She stops speaking again, then hesitantly, "I feel terrible talking like this; I love my dad, but..." Her words taper off as she struggles with the thought before she can allow herself to give it words. "There's not much of him left anymore, only the body keeps working—sort of." This is an overwhelming challenge for adult children of old parents. Those in their sixties and seventies who had looked forward to these years with their promise of freedom from the responsibilities that bound them before, are now asking: "When do I get to live my life for myself?" The younger ones, who at middle age are already stretched thin by their own financial problems, worry about how they'll provide for their children's education, whether they'll ever have enough for their own retirement, how they'll live the rest of their lives, and are asking: "How can I do it all?" No one wants to ignore parental needs, but unless there are financial resources well beyond what most families can dream about, how to meet those needs is a problem with no easy solution. For the children, it often means bringing their parents into their homes and, among other things, dealing with their teenagers' complaints about giving up their privacy, about hav- Taking Care of Mom and Dad 117 Lng to take care of Grandma or Grandpa, about the intrusion in their lives. "I've talked to my husband about bringing my parents here to live with us," explains a forty-seven-year-old mother of two teenage children. "He doesn't like it but says he'll be okay with it, although, God knows, I don't know where we'd put them or who would take care of them during the day. My mother can't really get around anymore, and Dad's mind is cloudy, so I couldn't count on him. The girls would have to share a room, but just mention it and they both begin to yowl. We both work, the kids are in school or busy with their homework or their friends, and all the stuff kids do every day. On the weekends, it's a mad rush to catch up with what we didn't do all week." She sighs, turns her eyes from me to her lap, and says wearily, "Oh, I don't know, I just don't know. I feel selfish, but... What do other people do? How do they manage it all?" It's a situation ready-made to stress some families nearly beyond endurance, sometimes leading to conflicts that fracture a marriage. "It was hard on everybody: me, my marriage, and my kids," says a fifty-two-year-old woman, her voice clogged with unshed tears. "I had no choice; I had to bring my mother to live with us, but she had Alzheimer's and wasn't easy to live with. God, it was hard. My husband and kids, they all felt like we'd lost our family because everything seemed to get centered around my mother. It got so bad I got depressed and was hardly able to get up in the morning and that only made it harder on everyone else. "After a couple years, my husband couldn't stand it anymore and left, which didn't make my depression any easier. In the end, I guess you could say we were lucky because my mother died about six months later. Not from Alzheimer's; she was killed by an automobile when she wandered away one day." She stops and stares into space for a moment, then turns back to me. "I've al- 118 Lillian B. Rubin ways wondered whether it was really an accident or she somehow knew what she was doing. I mean, did she know she was ruining my life? She was a good mother; she never would have wanted that." A few weeks after I met her, I spoke with her husband, who returned ro the family soon after his mother-in-law died. "It was like we had no marriage, no family anymore, just her mother and the problems," he explained. "The kids were still home then, and they were as miserable as 1 was. Someone told us about one of those old people's daycare places, and my wife finally took her there, but her mother refused to stay. 1 begged Joan to put her foot down and leave her until she got used to it, but she couldn't do it. I tried to understand, but I don't know, no matter what I said to myself, it didn't help. "Finally, she quit her job and stayed home to take care of her mother, which really did it for me. She knew it would make big financial problems for us, but she chose her mother over our family. I didn't know what else to do, so I left. Maybe you think I was being a heel, but I couldn't take it anymore. "In a way, I think Joan understood. I mean, she was mad as hell, but when her mother died, she was as relieved as I was, and pretty soon she asked me to come back home and says the whole thing was a mistake now. We never should have brought her here to live." He pauses a moment, then says reflectively, "Of course, I don't know what else we could have done; the fact is we couldn't afford anything else." If there's one word to describe the dominant feeling on both sides of the bridge that connects the generations at this stage of life, it's "ambivalence." "I love my parents, but..."—a line 1 heard spoken repeatedly as women and men struggled with the duality of their feelings: their love for their parents, their sense of obligation, the guilt they feel when, no matter how much they do, it never seems to be enough, the difficulty in coping with Talcing Care of Mom and Dad 119 their own needs, with their jobs, their families, their fears about their future, and not least, the inability to see an end in sight. "I love my parents, I really do, but there's only one of me," complains a fifty-ftve-year-old woman. "My sister lives two thousand miles away, so I'm the one who has to do it all, and I sometimes feel I'm being pulled apart by everybody's needs— my husband, my job, my parents. Even my kids; they're grown, but there's always something. My son got divorced last year and moved back home. It was supposed to be a month or two, but he's still here. My parents aren't that old, I mean, Mom's seventy-six and Dad's seventy-nine, but it's like they've suddenly lost the ability to make an independent decision, so they want my help. But it's never exactly right, what 1 give them. "I've been reading about how people need to do estate planning, and they said they were interested. So I found them a lawyer who does that, but they won't go back to him because they don't like how he talks to them. I think they ought to sell their house and live someplace where they can get care when they need it, but they don't like the real estate agent I found because she doesn't 'appreciate' their house enough. I spent days taking them around to those retirement places, but nothing is right: this one's too small, that one's too expensive, another one has too many old people. "You have no idea how much time I spend on these things. I say to myself, This is your life, Liz, so shut up, do what you have to do, and stop complaining.1' She stops, sighs deeply, "But it's hard to have that constant worry about them, and you can't see the end of it all." The parents echo the children in form but not content. "I love my children, I know they want to help, but..."—words I heard over and over as parents spoke of appreciating their children's concern while also struggling to retain some autonomy. "I love them; they're great kids, but it pisses me off when they treat i2o Lillian B- Rubin me like a stubborn kid who needs to be handled," is the way an eighty-one-year-old father puts it when talking about what he calls his children's "constant nagging." A week or so after I spoke with Liz, I met her patents, who, viewed from the outside in a two-hour visit, seemed to be perfectly reasonable and quite capable of making decisions. Their complaints were a mirror image of their daughter's. Where she talked about how difficult they are, they complained about her unwelcome intrusions. Where she assumed they needed help finding an attorney, they insisted they were only having a discussion about it and didn't need or want her help. Her father, especially, was incensed because, having accepted their daughter's referral, they found themselves being talked to as if, in his words, "we were kids who needed to learn the alphabet." His anger still boiling at the insult, he explains, "I don't know what Liz told him about who we are and what we need, but she must have said something to make him think he had to talk down to us as if we didn't have a working brain. It's what happens when you're old, you lose all credibility and people treat you as if you're half brain-dead. It's goddamn insulting, and I don't like it any better when my daughter does it. Take my word for it, you wouldn't deal with anyone who talked to you like that, either. Worst part of it was, when I told Liz why I wouldn't see the guy again, she was angry and blamed me for being difficult." His wife agrees but speaks with more understanding of the difficult situation they all find themselves in, welcoming her daughter's caring, while also resenting what she calls her "unnecessary" interference. "We appreciate Liz's concerns, but it's as if she wants to put us in a cocoon, and we're not ready to go there," she explains. "I understand; it's hard for her because she worries about us, but we're not children. We can still decide what's best for us, and right now living here in our house is best. 1 know she doesn't agree, but Taking Care of Mom and Dad 121 char's only because she wants us someplace she thinks is safe, so she doesn't have to worry." She hesitates a moment as if considering whether to go on or not, then adds, "I don't know exactly how to say this, but sometimes I think the kids ate selfish, too. I mean, I know they love us and want the best for us, but is it an accident that what they think is best is what will relieve them, whether it's really good for us or not?" An accusation that's not without some merit, but one also that doesn't take account of the complex and conflicting feelings the children juggle. Looked at from the parents' side, there may, in fact, be something self-serving in the way children push parents to give up their home, their cars, their lives so that they can stop worrying about them. Some even acknowledge it. "In a way I know I'm being selfish," says a fifty-eight-year-old woman who has been trying unsuccessfully to get her parents to move into an assisted-living facility. "It would be easier for me if I knew they were someplace where they're safe and will be taken care of. I wouldn't worry so much and feel as if I always have to be on call." But step into the children's shoes and the selfish label applies only if you think of what parents want without considering the price children pay. True, parents didn't count the cost, whether financial or emotional, when they gave themselves over to caring for their children. But parents chose that life; it wasn't forced on them by circumstances outside their control. Caring for children was their life at that stage, and the legitimacy of theit authority to do so was unquestioned. Taking care of Mom and Dad profoundly interrupts the lives of adult children, yet they have no authority to control or manage the situation unless parents willingly hand it over. "I had a Life before, now it's gone, and I don't know when I'll get it back—or if," cries a forty-eight-year-old woman who cares for her bedridden father. It's a no-win situation. Parents are irritated when childten 122 Lillian B. Rubin hover; they resent and commonly resist their interventions. Yet, they are often in denial about the depth of their decline and can't or won't see what's plain to others: they need help. If children back off from the conflict, their parents can fall through the cracks; if they don't, parents are often resentful and difficult. Ancient family dynamics reassert themselves: old conflicts surface ("I never could do anything right"); new ones arise ("My mother used to be a reasonable woman, but she's not anymore"). Where before children struggled to free themselves from their parents' power, now it's parents who are reacting against the power their children try to assert, listening but not hearing, seeming compliant but resisting. "My husband died and suddenly my kids behaved as if they could run my life," complains an eighty-year-old woman who, while mourning her husband, was also appreciating her first real taste of independence. "One of them wanted to pay my bills, another one was calling me up telling me when to go to the doctor and what I should eat. I don't need them to run my life; I don't want them telling me how to spend my money or how to live. They think because my husband did all those things before that I'm helpless now. It's ridiculous. How hard is it to learn how to write a check? I love them and I don't want to upset them and argue with them, so 1 finally just stopped listening when they talk. Sometimes when I know it's one of them calling, I don't answer the phone." It's an upside-down version of the familiar passive-aggressive parent-adolescent child drama: "Where are you going?" "Out." "Who are you going with?" "Nobody." "What are you going to do?" "Nothing." Just as parents must decide when to intervene and demand answers, adult children sometimes have no choice but to take control. "My mother is furious with me because I insisted she move into an assisted-living place," explains a seventy-year-old man. Taking Care of Mom and Dad 123 "For God's sake, she's eighty-nine years old and has arthritis so bad she can hardly move. How long should she be allowed to live alone? At some point you have to take over, which I did after I came over one day and found her on the floor because she fell and couldn't get up. "My sister and 1 tried getting her help in the house, but she either fired them or treated them so badly that they quit. I finally said, 'This is it; we just can't do it anymore; it's ruining our lives,' and I practically forced her to move. I don't think she'll ever forgive me, but there was nothing else to do. No matter what she says, 1 still think it's the best place for her." Listening to his story brought to mind a vivid recollection of the impotent frustration I felt when trying to convince my mother to give up driving voluntarily. She'd already had several fender scrapes because her depth perception was no longer acute and her reflexes too slow. But nothing short of taking the keys, which she would never have permitted, would stop her until she nearly killed someone. I don't know whether she would even have given up driving after that, but the question became moot when, much to my relief, the Department of Motor Vehicles took it out of her hands and revoked her license. Fifteen years later, I confronted the same issue with my husband, who was no less resistant to giving up the keys to the car than my mother was. I couldn't blame him; I know how much being able to go where I want when I want means to me, how much independence is lost when we can't drive anymore. It's one of the hardest issues for a family to deal with—second perhaps only to the decision to put a parent or spouse in a nursing home—especially in a place like California where, because distances are so great, the car culture is practically embedded in our genes. How could I not appreciate what it meant to him? Yet when my daughter said, "You have to do something; Dad shouldn't be driving and none of us should ride with him anymore, it's too dangerous," 124 Lillian B. Rubin I had the same momentary anger I've heard other parents express so often, the same instant internal response—What do you know about how hard this is? the same temptation to say to her, Keep out, while also knowing she had every right to step in, and that I had to act. There are no rights and wrongs here, no black and white; there are only shades of gray in situations so murky that it's nearly impossible for either parents or children to know just when it's the right time to take a step, make a move. Parents who tell themselves they'll know, who promise themselves that they'll take their own lives before they burden their children, often slip past the moment when they can make the choice. For a disease of the mind doesn't arrive like a head cold; it travels stealthily, taking little bits and pieces as it moves through the brain, each one seeming inconsequential in itself until one day the person has slipped over the edge. Children who think they see the line more clearly, whether physical or mental, push their parents to a decision, mostly out of loving concern but also because they need some relief from the worry and the burden. Parents resist as long as they can, not generally because they don't trust their children and their motives, although that's undoubtedly true in some cases, but because with each step of their decline, they fight ever more tenaciously to hold on to what's left. Their sense of self, their self-respect, demands it. I'll never forget the anger I met when I suggested to my eighty-five-year-old mother that she needed to move into an assisted-living facility. She paced around her small apartment in a rage, reminded me of every sin I'd ever committed against her, not least moving three thousand miles away, told me that 1 had no right to tell her what to do, and finally fell back on the silent treatment, an aching reminder of some of my worst childhood days when she sometimes wouldn't speak to me for weeks. Taking Care of Mom and Dad 125 It wasn't until a year later, after several illnesses and a couple of hospitalizations, that she grudgingly agreed to make the move. Seven years later, when she was ninety-two, the director of the facility phoned me to say she needed more care than they were able to give. Always a difficult person, my mother's physical decline, combined with increasing cognitive problems, made her, in their words, "impossible to handle." When does it end? I thought resentfully, as I dragged my seventy-two-year-old body out of bed before dawn the next day in order to make a 7 a.m. flight to Miami. I'd been making these trips across the country every two or three months for several years, and I climbed into a taxi wondering wearily if I'd ever have one day on this earth without the persistent worries about my mother that seemed to have established permanent residence in a corner of my brain. My daughter, who offered to accompany me, was waiting at the airport gate when I arrived, and I watched her, her head bent over a book, wondering if she would feel the same resentment I was feeling if the day came when this would be her task. I promised myself, not for the first time, that she'd never have to, that I would, in the words of a friend, "turn the lights out" myself before it became necessary. We spent two days looking at nursing homes, finally settled on one, packed up her meager belongings, and took her to her new "home." Surprisingly, she went quietly, knowing, I suppose, that she had no choice. I introduced her to the director, who showed her around and introduced the people who would be caring for her. After getting her settled and visiting for a while, we prepared to leave, stopping first at the nurses' station to give them final instructions about her care and where to find me. I turned back to her room for a last goodbye and saw her standing in the doorway. I smiled, waved, moved toward her, saying as I approached, "I'll be back soon, Mom." She just stared at me and finally, she whose usual mode was angry shouting, said in an almost 126 Lillian ß. Rubin eerily quiet voice, "If you saw a dog on the street, you'd take care of it, but me, you throw away like garbage." Words that are imprinted on my brain forever. She lived in that nursing home for over a year and became progressively more demented, until by the end she could do no more than babble. She was ninety-four when she died after a long, hard, and troubled life. Was I glad when she was finally gone? There's no easy answer. It's probably always difficult to lose a parent, but a mother — the very word conjures images of love, kindness, nurturance. So even though my own mother couldn't by any stretch be called nurturing, even though her rare moments of loving-kindness were overwhelmed by her rage over which she had no control, her death left me with a slightly empty feeling, a child's sense that I was now alone and unprotected in the world. Ultimately, I was both relieved and saddened when she died: relieved because I was freed from the responsibility and she from her mortifying infantile dependency; sad because I could never be the daughter she wanted and she was never the mother I needed; sad, too, because she lived a life so impoverished in human relationships, while mine is filled with riches she could never allow herself to share. I was reminded of those feelings recently when I had lunch with a sixty-year-old friend who has taken care of his mother for the last ten years. She's been in assisted living for years, moved into a nursing home two years ago, is unable to recognize her only son anymore, and her money is about to run out. We were talking about the difficulties of aging, as 1 seem to do with everyone these days, when he told me about hearing from a friend that his mother died that day. "My first response wasn't sympathy for Joe," my friend reported somewhat shamefacedly. "It was anger. All I could think at that minute was why couldn't it be my mother? Everybody else's mother is dying, but she keeps on." Taking Care of Mom and Dad 127 How often, I wonder, do even the most loving children have these thoughts? We don't admit them, often barely allow them into consciousness, yet is it surprising that after years of care, after going every week to visit a parent who hasn't recognized us for months, who is no longer the person we knew and cared about, that we'd have such feelings? It doesn't mean we didn't love them, don't love them still; it means only that the person in that bed is not the person we loved. As the parental generation grows older, their children age, too. Already it's not uncommon for seventy-year-olds to be caring for ninety-year-old parents. By the time the leading edge of the baby boomers reaches their seventies and eighties, they'll have one-hundred-year-aid parents to deal with at the same time that they're struggling with their fears and conflicts about their own advancing age. It's a disquieting thought that raises some particularly difficult and poignant issues. They come to this time expecting to gather the rewards of the years of living. This is their time: they've met their obligations, done what life demanded, only to arrive at this place and find there's yet another demand, one that tosses their dreams into the wind. Almost inevitably, giving up these years to the care of a parent is met with a storm of conflicting feelings as children, on the cusp of their own old age, see their last years slipping by without the pleasures and comforts they'd imagined and planned for. "This was supposed to be my time," says a seventy-four-year-old widower whose ninety-four-year-old mother lives with him. "Look, I know I'm doing what I have to do, but I never thought when 1 retired six years ago that I'd be spending my time helping Mom get through the day." He pauses for a moment, then sighing heavily, "It's hard not to think, What about me? I've had some heart problems, blocked arteries, you know, and when I think 128 Lillian B. Rubin about that, well..." Pained, he runs a hand over his near-bald head, then spits out, "Dammit, I could die before 1 ever have a chance to enjoy my own time now." In our need to put a gloss on these difficulties, the media have focused on tales of reconciliation, even redemption, as parents and children come together in these last years. It's true that there are moments of pleasure in being able to give our parents the care they once gave us; true also that for some people these years can be a time of reconciliation, a falling away of old grudges, a recapturing of a relationship that had been lost. "I [earned a lot about myself and about my mother in those last years of her life," says a seventy-two-year-old woman. "We hadn't been very close when 1 brought her here to live with us. I really was afraid it would be a disaster, but I felt so guilty, I had to do it. Don't get me wrong, I'm not saying it wasn't hard—very, very hard—and there were lots of times when I hated her and thought I couldn't stand it another minute. But then there were also times when she appreciated it, and it felt really sweet to be able to do for her. "Her mind was going at the end, and I don't know, maybe that's why she stopped being so bossy and hard to live with. Whatever, a lot of the stuff that used to make me so mad was gone, and she sort of became like a sweet child. I actually could feel like I loved her again, which I don't think I really felt since I was a little kid." Even under the best circumstances, however, these are hard times for both parents and children. For the children, these are their parents, the people they once counted on to care for them. How do they pay the debt they owe them and continue to meet their other responsibilities, to live their own lives, to plan for their own future? How do they manage the guilt about not doing enough, the ambivalence and conflict that are constant com- Taking Care of Mom and Dad i2g panions, the unwanted thoughts that filter into their minds when they're not looking? For parents, getting old is bad enough; becoming infirm and dependent is the realization of their worst nightmare. Even if they're grateful for their children's care and attentions, for the demonstration of their love and loyalty, their dependence is humiliating at best, dehumanizing at worst. Parents, after all, are supposed to take care of their children, no matter how old they may be; they're supposed to have prepared for their old age so as not to butden anyone, supposed to retain their independence above all else. Anything less is to have failed at the job. Ask almost any American parent what the worst-case scenario for their old age is, and the first words that generally come to them are, "Having to be dependent on the children." "It's all turned around," exclaims an eighty-nine-year-old man who lives with his sixty-eight-year-old daughter and her seventy-three-year-old husband. "It's not supposed to be this way; it goes against nature. They shouldn't have to take care of me; better I should die." When I speak with friends and colleagues about these problems of old age, they remind me that things are different in other cultures. In Norway, one friend says, there's something called grandparental leave that affords families—children, grandchildren—the opportunity to care for their elders. I listen and think; That's interesting, but how likely is this to become public policy in a nation that doesn't even take parental leave for granted? Or where corporate executives move employees around with less care than they would pieces on a chess board and with total disregard for family responsibilities, whether children or aging parents? "I did a lot of soul-searching, but I finally realized I had no choice," says a fifty-one-year-old executive who turned down a 130 Lillian B. Rubin transfer from a satellite branch to one of the top jobs in the national headquarters of a prestigious company. "Ten years ago I'd have jumped at it, but I just couldn't see moving across the country now. It was a very hard decision. Its a plum job, the one I've been aiming for my whole career, but my wife and I both have parents who are getting old and will soon need our help. We thought about moving the parents, too, but they wouldn't go for it, and the kids—two of them are still in high school—were screaming about it. We realized it was more than we could manage. "I know it was the right thing for the family, but it's not easy to live with. It's the end of my career here at the company. You can't turn down a transfer, especially a job like they offered, and expect to get the next promotion that comes up. It's not going to happen; the system doesn't work that way. So I'm stuck in limbo here. The only way I can move ahead now is to leave the company, which I'm trying to do, but that's not easy these days, either." "Yes, but it doesn't have to be that way," says a colleague after hearing this story. "Look at countries like China, where public policy is different and family stands high on the list of priorities." But that's exactly the point. There, both public policy and family culture have historically taken filial responsibility as a given. Parents, children, and the community all have shared the expectation that children will care for parents in their old age. True, that may be changing now, as China shifts from a rural to an industrial economy and people, especially the young, move to where the jobs are, leaving family and community behind.4 Still, I ask him and myself, whatever the long-term fate of Chinese family culture may be, how is this comparison relevant in our own nation, whose history is so different—a nation where government gives lip service to family stability but does nothing Taking Care of Mom and Dad 131 to secure it and where the bottom line dominates corporate policy irrespective of, and often to the detriment of, family needs; a nation where elder abuse is a problem large enough to merit a front-page article in the New York Times1 on the same day that the newspaper publishes the findings of a report deploring the fact that American communities have few resources for the old;6 a nation where the San Francisco bus system displays an advertisement about the city's Adult Protective Services featuring a photograph of a battered old woman and a line that reads, "She didn't know her golden years would be BLACK AND BLUE"; a nation where the federal government has remained silent about elder abuse, and Congress considered and failed to pass a bill to create a national database to tecord and monitor it;7 a nation where a wealthy son has no obligation, financial or otherwise, to his old parents beyond what he feels like doing. It's helpful to know there are other ways to live, other social arrangements for the aged that are kinder, more humane than our own. It broadens our horizons, puts our own culture into a larger context that allows us to see it and its problems with a fresher perspective. Ultimately, however, comparisons with other societies and ways of being have limited usefulness, since public policies and cultural norms are born in the social history of a nation. In China that history gave birth to a culture where the family, not the individual, has for centuries been the basic social unit, where individuals see themselves as part of a whole that's dependent on all its parts, tied together by social expectations and institutions. In America, individualism reigns; collective public action is akin to un-Americanism. The family itself stands alone, a collection of individuals bound only by emotional ties, which, powerful though they may be, can also be flimsy when not buttressed by social norms and institutions. Geographic mobility is so common that more than a hundred million American families, give 132 Lillian B. Rubin or take a million, live long distances from each other.8 Success, achievement, a place in the world are individual, often bought at the expense of the whole. It took the Industrial Revolution to tear apart the extended family of the past and create the nuclear family system that dominates American life so powerfully today. Changing that and the social and economic institutions that support it will take a lot more than wistful talk about how other cultures manage the problems of old age.