He is eighty-nine and still able to drive his car enough to take care of the few activities he chooses to participate in. He lives in his house with a middle-aged daughter who is going through a divorce but will certainly remarry in the not too distant future. He has no social life beyond a daily visit to a nursing home to sit all day with his lady friend who has Alzheimer's disease and does not recognize him anymore. The daughter either prepares the evening meal or makes sure easily prepared food is available to him.
He is perfectly content with these arrangements as is the family members with the exception of the daughter who is giving the care. No one is willing to take any kind of long look at what kind of issues might lie ahead.
The daughter feels tied down and burdened. She has a very demanding job and yet must keep one ear opened and alert to what might come up with her father. That makes her work day even more tense and tiring. She feels tied down and realizes her social life is even more limited than her father's. If she has a date there must be preparations made, and she almost feels like she has a curfew. He knows when she comes home. He does not say anything but he does not have to say anything.
She does not want to remain single. There is a chance of she and her husband reconciling their marriage, but if not she will certainly have many opportunities for marriage and wants to do so.
I have suggested and maybe even urged this family to have a meeting to face the possibilities and discuss solutions that take a longer look at their future than just how is he feeling today. So far there has been very little interest.
This is what I call the gamble of timing. When should we start thinking about long term care? When should a loved one move into some kind of care facility?
My personal feeling is we wait too long to make the first move toward care. I think the loved one needs to move while they are still able to make friends and build some kind of social life. Socialization becomes harder and harder as we age and yet it becomes more and more important as we age. Far too many people live very lonely lives at the end. If this gentleman could move to a retirement facility now, he would have a chance to build a social life. If he waits until he is bed ridden or can no longer communicate then he is shut off and unable to do so.
The gamble is that the status quo will continue until he has a stroke, breaks a hip, or experiences any of a number of things that plague us old folks. These events force the decisions and start the process of care against his will.
The daughter's gamble is that she will rock along and not bring the subject up for fear of displeasing her father and the family, until something happens to her father and she must either take her stand in a crisis which will look hardhearted or get stuck trying to run her own nursing facility in the home while continuing her job. The scenario often becomes one of hiring nurses during the day and the daughter taking over at night. This can go on for years or until the daughter is totally spent. All thoughts of her life or marriage are put on the back burner and she becomes a full-time care giver.
If you polled the family, not a single person would want that to happen. The father would probably be the most vocal about not wanting his daughter placed in that kind of situation. He does not want to be a burden. The longer I live, the more I believe that burdens are avoided by planning with openness and honesty. The failure to plan is an open invitation to someone being burdened with the care. That is too big of a gamble in my book.