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Cultural shift helped lead to huge void in family caretaking

In an idealized past, dutiful grown daughters took care of the needs of their aging parents, without complaint, without pay. They drove them to doctor’s appointments. They sorted out their medications. They moved frail parents into their homes and, as a last resort, found the best nursing homes for them. This was expected of “good daughters.”

Meanwhile, the culture was changing. Women joined the workforce in equal numbers as men, and grown children moved hundreds of miles from their aging parents.

A profession known as geriatric care management emerged to meet the emerging reality that grown daughters (and grown sons) couldn’t do everything for their older parents. The profession, still in its infancy, is expected to grow into maturity in coming decades as baby boomers age.

On this Labor Day weekend, we profile two Spokane women involved in this neophyte profession and explore the cultural attitudes working against it.

Becky Tiller started a geriatric care management business in Spokane seven years ago.

Caryl Lawton of Spokane, who gave up her career as a registered nurse for 10 years to help her aging parents and in-laws, now advocates for using geriatric care managers.

Becky Tiller, 51

Back story: First job, after getting a master’s degree in counseling psychology, was working for Spokane Mental Health’s Elder Services. She then worked as an administrator with Holy Family Adult Day Health for 12 years. She opened Tiller Care Strategies in 2004.

How the business works: Clients - usually grown children of aging/ailing parents - pay Tiller’s team to come up with a care plan.
”We have a nurse, social worker and a counselor do an assessment,” Tiller explained.

“We look at a person’s diagnosis, their level of functioning. How are they doing socially, spiritually, emotionally and cognitively?

We look at immediate needs and what is down the road. Do they need to be in a memory care unit? An adult family home? Assisted living?

“We don’t provide the services. We are the ones who say: ‘We think this agency will do well with you. We know who you can trust.’”

About 75 percent of Tiller Care Strategies clients don’t live in the Inland Northwest. Her team has worked with grown children living in London and Spain, for instance.

Tiller’s team may recommend three or four care facilities, or three of four home health care agencies. They want family members to make the final choices. (Tiller does not accept referral fees from facilities or the home care services that she recommends.)

“We want them to go out and get a gut feeling for what their parent would like and hopefully take the parent with them,” she said.

Cost: $95 an hour. Some families need just two or three hours to get a road map for their parents’ care. Others need ongoing involvement that translates to several hours a month.

“People gasp when they hear $95 an hour, but if they place their parent in the wrong place, it can be very expensive to move them,” Tiller pointed out. “And every time you move an elder, you see a decline.”

Her hope: Adult children realize that seeking professional consultation eases the burden for all family members.
”I’ve seen adult children give up their lives for their parent, and that’s not good for either of them,” Tiller said.

Most of the aging parents she works with lived through the Depression.

”Their home and their money are symbols of independence,” she said. “They will hold onto those to their dying day - or try to.

“The challenge is to get them to consider a retirement community or assistance in the home. So we start in small, incremental steps. And often we’ll see them blossom. Their mood improves - and their quality of life.”

Caryl Lawton, 63
Back story: Worked as a registered nurse for 19 years at Providence Sacred Heart Medical Center, in cardiac surgery and endoscopy.

In about 2000, the parents of her husband, Ray Lawton, got sick.

”His mother had a bit of dementia,” Lawton said. “Dad had prostate cancer and mom was eventually diagnosed with cancer of the tongue. I decided to quit my job and coordinate their care.”

Both in-laws died, five months apart, in 2002.

Then, Lawton’s own parents faced escalating health problems. Her father had strokes. Her mother, who lived with the Lawtons, survived a horrible car accident. Both lived several more years, requiring lots of care and attention.

She and her siblings shared the work but Lawton, a nurse without a paying job, did the driving to doctor’s appointments, the figuring out of medications. She researched and oversaw home health care and later researched the care facilities her father moved into.

Her dad died in 2006, her mother in 2011. After a decade of elder caregiving, Lawton was exhausted. She said: “During all this, everyone would say, ‘What do people do if they don’t have a nurse in the family?’”

Her awakening: After the family elders died, Lawton realized her nursing degree, combined with the skills learned doing unpaid elder care, would be a good fit for geriatric care management.

The Inland Northwest has about a half-dozen geriatric care management businesses. Lawton talked to several. None were hiring, because of the economic downturn.

One company, Honoring Elders, did hire Lawton four hours a week to do awareness raising about geriatric care management.

Needed cultural change: The cultural imperative, Lawton believes, still holds that “she’s a good woman so, of course, she will take care of all her family member’s needs.”

Lawton hopes that businesses will better support workers facing aging-parent demands. Companies lose productivity when workers spend hours looking for geriatric services.

Her regrets: “When you define yourself as a nurse and stop being a paid nurse, there is a loss of self,” she said. “It would have been nice to continue, but that’s not my biggest regret.

“What I regret most is all the time I spent doing tasks, rather than just being with these family elders. I regret the loss of their stories. If I’d spent more time sitting and listening and talking, they wouldn’t have taken so many of those stories with them.”

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