When the Time Comes: Families with Aging Parents Share Their Struggles and Solutions

by Paula Span

What will you do when you get the call that a loved one has had a heart attack or a stroke? Or when you realize that a family member is too frail to live alone, but too healthy for a nursing home? Journalist Paula Span shares the resonant narratives of several families who faced these questions. Each family contemplates the alternatives in elder care (from assisted living to multigenerational living to home care, nursing care, and at the end, hospice care) and chooses the right path for its needs. Span writes about the families' emotional challenges, their practical discoveries, and the good news that some of them find a situation that has worked for them and their loved ones. And many find joy in the duty of caring for an older loved one. There are 45 million Americans caring for family members currently, and as the 77 million boomers continue to age, this number will only go up. Paula Span's stories are revealing and informative. They give a sense of all the emotional and practical factors that go into the major decisions about caregiving, so that readers will be better able to figure out what to do when the time comes for them and their loved ones.

Genres: Nonfiction, Self Help

256 pages, Kindle Edition

First published May 20, 2009

Reviews

[Donna Jo Atwood · Rating 4 out of 5]

Having been in the situation of caring for an elderly parent, I can understand what this book is about. I like all the anecdotal examples, but at the same time was impatient with them, wanting to get to "the meat" of the problems. Then I relaxed--the Family Stories are the meat of the problem.
With so many people now living longer and for the most part staying healthy until later in life, elder care becomes more and more a problem thrust on people who are perhaps in their sixties or seventies themselves. The books perhaps relies too much on what is being done in Eastern Urban communities; the reality can be harsh enough there, but in smaller more rural communities the situation becomes even more critical.
Still I would not hesitate to recommend this book to people whose parents, or spouses, may soon be in need of care outside what can be provided by one family member at home. The questions at the end of the chapters are essential for making informed decisions. I intend to see that my sister and my daughter both read this book.

[Bev · Rating 5 out of 5]

I wish I had read this book a year before my mother had to move into Independent Living. The author interviews many children and aging parents (using their real names) and each chapter talks about the various scenarios from bring Mom and/or Dad home to live with you through hired help in the parents' home, Assisted Living, and all the way to Nursing Home and Hospice care. Since we had already made the decision and moved my mother, I found some of the early chapters funny when I identified with things, and also found some of the pitfalls that we fell for. I had to stop reading when I was into the Nursing Home chapter because it is by far the most depressing and the one that nobody wants to even think about, though reality tells you that sooner or later this may be the best option for your parent.

There is a lot of heroism in this book, but it focuses on the parent and not stress relief for the child. I haven't found the need for that yet, but I can feel it is coming and it has been recommended that I find a book that deals with this subject.

[Emily · Rating 3 out of 5]

The struggles of the caregivers in this book are really minimal compared to what I hear everyday at my job. Though Paula Span did a great job explaining the struggles of these caregivers and the options of home care, assisted living, nursing homes, or hospice. Perhaps I need to write the book of the caregivers where it doesn't all work out in the end, where families don't get along, where mental health creates barriers to accessing appropriate care. But excellent points were made in the book and these caregiver did have challenges to face that are by no means easy.

[Kurt · Rating 5 out of 5]

I wish I knew about this book about three years earlier. My partner and I have been caring for my mom in her home since for 3-4 years and she died while in hospice for the second time while I was reading the book. I decided to finish it. I like to finish books I started if I feel they’re well written. I also wanted to be more informed in talking to people caring for others at the end of life or considering options for themselves.

This is not a fun read but is valuable for its comparisons and analysis of various types of care. I recommend reading it sooner rather than later when caring for an elder, or deciding care for yourself, because people are often surprised how fast the final decline happens.

[Jillian · Rating 3 out of 5]

I did not expect to be reading this book in my early 30s, but after a family medical emergency in February changed things for us, my husband and I were very seriously looking at building a universal (ADA) addition onto our house for an aging, though not quite old, family member. Unfortunately, there has been a series of complications since then and it's clear home care is not really an option.

This book covered more than home care, of course, but for all of the other issues, we need to wait it out and wait for a new medical status quo.

I'm glad I read this book, however. It gave me some food for thought and a glimpse at a potential future. I still have a vision of caring for other aging family members down the road, so I may be revisiting this again.

[Marilyn · Rating 4 out of 5]

This 2009 book is a bit dated in the cost of care but probably not much else. The same issues face families and the same "solutions" are good enough in many cases. The author uses interviews with families, following them as they decide which path to take and how it works out or doesn't. It's structured by the type of care: the least amount (staying in your own home) to the most (nursing home) and finally hospice. There were some reassuring moments, some reality checks, and some reminders about what to look for as you help your elder.

[Pamela · Rating 3 out of 5]

Another one of those elder care books that is mainly a bunch of stories—but coming from someone who has only one story, that of my own parents, it's informative to see all the ways the future could play out. If you're just learning about all the options for elder care, from home care to assisted living to nursing home to cohabitation to (perhaps eventually) hospice care, this is a good emotional primer, if not a substantially detailed one.

[Wren · Rating 5 out of 5]

I loved this book because Span does a masterful job blending statistics and other research with interviews / anthropological observation. Span works with several families to observe how adult children work with their parents to support them through the aging process. The chapters are organized around degree of care: 1) living at home and adding services 2) moving in with adult chidren 3) moving to assisted living 4) moving to skilled nursing and 5) working with hospice (which usually means nurses, chaplains and social workers come to where the older adult is already residing).

Yes, the book educates readers about many programs and services available, but it's even better at illustrating how there are no clear-cut pathways to follow. Each family goes through several possible scenarios while planning and even a few trial-and-error services. No one is happy with any of the choices, and most older adults resist the suggestions of seeking higher levels of care made by their adult children. Everything is perceived as too expensive and too intrusive. Parents resent the loss of privacy and loss of choice. Some services are trying to address this by making assisted living and skilled nursing more customized. For now I oddly comforted by observing how the dynamic of adult child and parent is not easy or clear during the aging parents' late adulthood.

The book did describe many tender moments, so it's not all negative or full of conflict. But she showed me how this part of life--no matter how well researched, well planned or well financed--is not smooth and easy. It is what it is. And Span brings insight, wit, warmth, humor and clarity to those newly arrived to this landscape.

[Robin A. · Rating 4 out of 5]

"When the Time Comes" provides a very good overview of the difficulty in discussing and choosing the best care for aging family members. For anyone anticipating making this decision, this book will provide a great insight into the many emotional challenges, along with questions the family should consider while researching.

I began reading this as part of research for my next book. I noticed some of the data referenced was old by the time the book was published. In one example, the author references nursing homes with high Medicaid populations. She noted the Medicaid-supported facilities represented between 13 and 15 percent of nursing homes in the 1990's. Another reference was of 46 Florida nursing homes where 1,200 cases of verbal aggression by family members towards staff was recorded in a survey during the 1990's.

The author does not update the referenced statistics. The book was published in 2009, making that data at least 10 years old by then. 10 years is a long time to rely on a specific survey.

Overall, I liked the book. It does provide unique insights into the families, the decision making process, and the final outcomes. I do recommend this book.

[librarian4Him02 · Rating 4 out of 5]

Washington Post contributor Paula Span realized she would soon become a caregiver to her aging father. Thus, she began looking at options and has compiled stories of families in similar situations. She provides frank information about each option including moving parents into your house, assisted living, nursing homes, and hospice. Through personal stories she explains the pros and cons of each otpion. Each chapter concludes with quesitons to consider.

She also discusses Medicare and Medicaid and what each one covers. Book and websites for further information are also included. The book is logically organized from early aging to end of life. Readers will come away well-informed and with a clearer pictures of the options available to their parents. This book is recommended for those currently forcing these issues or who will be soon.

[Mike · Rating 3 out of 5]

This book is mostly anecdotal, not the handbook I was looking for. Still, for some reason it helped me be less anxious about care for my Mother, if only because I saw others with much worse problems than my own. I like the organization, based on the levels of care your parent needs: Staying Put (living in their own home), Moving In (parent living with a child), Moving On (Assisted living), What Else is There to Fear? (nursing homes), and lastly hospice care. The stories in each chapter show how different families dealt with that particular stage of elder care. And it's not all bad, since some families actually grow closer from the experience. The author's bias seems to be against nursing homes (note the chapter name), so the advice is slanted toward avoiding that option.

[Brian Keller · Rating 3 out of 5]

If you've got older parents and are thinking that maybe sometime soonish you might need to figure out how to help take care of them, you'll want to work your way through this book. It won't make you feel good, but it will give you the lay of the land regarding elder-care in the US circa 2009, which is a reasonable place to start. The three-star score is because the chapters drag on a bit, as the author shares a variety of tales. The array of stories can be useful, especially if you see your situation in one of them. But without that commonality, the chapters are just too long for my taste; the author had long since made her point.

[Lrph · Rating 4 out of 5]

Most importantly I learned that I am not alone with the struggle of parenting parents. It is full of useful and helpful information, but more importantly, it is full of love and understanding and anecdotes of real people dealing with real life issues. I believe this is must reading for any adult 40 years or older with a living parent. The time may not be now, but when it comes it's great to feel prepared.

[Jan (the Gryphon) · Rating 4 out of 5]

This is heavily oriented toward NE urban areas, but has useful information and pointers for the rest of us as well.

Ms. Span leaves one with the sense that one is not alone and bolsters one's courage to get out and find the solutions necessary wherever one lives.

[Jill · Rating 4 out of 5]

http://frugalplus.com/?p=6524

[Adam · Rating 3 out of 5]

A solidly reported guide to end-of-life options for the elderly, told through numerous touching family stories, and with very useful questions that your family can ask as it faces these choices.

[Eve Abrahams · Rating 5 out of 5]

Easy to read and informative. A good instruction and idea manual about what choices are available for our seniors...when the time comes.

[Deborah · Rating 4 out of 5]

Very helpful book for those of us beginning to enter the phase of caring for our elderly parents.