Quick back-of-the-envelope calculation, for Baby Boomers currently shepherding the Greatest Generation to their final reward? Hope your aged parents have at least half a million dollars apiece in the bank, because if they are anything like Mama Gross, their care until death will absorb every penny. To which an anxious (let’s say 49-year-old) daughter might respond: But what about long-term-care insurance? In fact, Gross’s own mother had purchased it, and while it paid for some things, the sum was a pittance compared with a final family outlay of several hundred thousand dollars. But how about what everyone says about “spending down” in order to qualify for Medicare, Medicaid, Medi-Cal, or, ahwhich exactly is it?
Unfortunately, those hoping for a kind of Eldercare for Dummies will get no easy answers from A Bittersweet Season. Chides Gross: “Medicaid is a confusing and potentially boring subject, depending on how you feel about numbers and abstruse government policy, but it’s essential for you to understand.” Duly noted—so I read the relevant section several times and … I still don’t understand. All I can tell you is that the Medicaid mess has to do with some leftover historical quirks of the Johnson administration, colliding with today’s much longer life expectancies, colliding with a host of federal and state regulations that intertwine with each other in such a calcified snarl that by contrast—in a notion I never thought I’d utter—public education looks hopeful. Think of the Hoyer lift that can be delivered but never repaired, or the feeder who will not push, or the pusher who will not feed.
But it gets worse. Like an unnaturally iridescent convalescent-home maraschino cherry atop this Sisyphean slag heap of woe, what actually appears to take the greatest toll on caregivers is the sheer emotional burden of this (formless, thankless, seemingly endless) project. For one thing, unresolved family dynamics will probably begin to play out: “Every study I have seen on the subject of adult children as caregivers finds the greatest source of stress, by far, to be not the ailing parent but sibling disagreements,” Gross writes. Further, experts concur, “the daughter track is, by a wide margin, harder than the mommy track, emotionally and practically, because it has no happy ending and such an erratic and unpredictable course.” Gross notes, I think quite rightly, that however put-upon working parents feel (and we do keeningly complain, don’t we—oh the baby-proofing! oh the breast-pumping! oh the day care!), we can at least plan employment breaks around such relative foreseeables as pregnancy, the school year, and holidays. By contrast, ailing seniors trigger crises at random—falls in the bathroom, trips to the emergency room, episodes of wandering and forgetting and getting lost. Wearied at times by the loneliness of the daughter track, Gross writes, in a rare moment of black humor:
I know that at the end of my mother’s life I felt isolated in my plight, especially compared to colleagues being feted with showers and welcomed back to work with oohs and aahs at new baby pictures. I was tempted, out of pure small-mindedness, to put on my desk a photo of my mother, slumped in her wheelchair.
Those seeking a more hopeful take on this bittersweet season might turn, for momentary comparison, to Passages in Caregiving, by Gail Sheehy. Reading Sheehy is always a boost—even when she’s rewriting some Passage she predicted 10 or 20 or 30 years ago, as is necessarily (and, given our ever-increasing life spans, probably will continue to be necessarily) the case. From her intro (as swingingly nostalgic—isn’t it, almost?—as Burt Bacharach):
In my books and speeches since 1995, when I published New Passages [the first update of the original Passages], I keep predicting liberation ahead—the advent of a Second Adulthood, starting in one’s midforties and fifties. At that proud age, having checked off most “shoulds,” people generally feel a new sense of mastery. Haven’t you done your best to please your parents, your mentor, your boss, and your mate, and now it’s time for you? The children are making test flights on their way to piloting solo. Your parents have become giddy globe-trotters, piling up frequent-flier miles and e-mailing playful photos of themselves riding camels … Now you can finally earn that degree, start your own business, run for office, master another language, invent something, or write that book you keep mulling.
Ominous new paragraph—to reflect tire-screeching 21st-century update:
Then you get The Call.
In Sheehy’s case, The Call was a cancer diagnosis for her husband, Clay Felker, which kicked off an almost two-decade period of medical battles before his death (which was actually not, in the end, from cancer). Although Sheehy offers her book as an umbrella guide for all caregivers, weaving her personal experience together with a demographically wide range of case studies, it strikes this caregiver as less than universal. For one thing—and in fact this is a tribute to how engagingly Sheehy tells her story—even with a tube in his stomach (for which sympathetic chefs blended gourmet food at Paris bistros, whereupon he continued to charm dinner guests as usual in his handsome navy-blue blazer), Clay Felker, on the page anyway, is still pretty great company. And then, to further vanquish the blues, Sheehy and Felker rented a houseboat, spent the summer in France … (How is it that, no matter what, Boomers always seem to be having more fun?)
And while there is some aesthetic appeal to Sheehy’s mandala-like formulation of the caregiver’s journey being not a straight path but a labyrinth (whose eight turnings are Shock and Mobilization, the New Normal, Boomerang, Playing God, “I Can’t Do This Anymore!,” Coming Back, the In-Between Stage, and the Long Good-bye), this taxonomy feels more descriptive than helpful. Also, her take on what one learns when caring for one’s failing loved one is, if not quite a Hallmark card, certainly the best possible case:
It opens up the greatest possibilities for true intimacy and reconnection at the deepest level. The sharing of strengths and vulnerabilities, without shame, fosters love. And for some caregivers, this role offers a chance in Second Adulthood to compose a more tender sequel to the troubled family drama of our First Adulthood. We can become better than our younger selves.
Jane Gross also believes spiritual growth is possible, but her take, predictably, is far less rosy, even verging on Old Testament:
Here we are, not just with a herculean job but with a front-row seat for this long, slow dying. We want to do all we realistically can to ease the suffering, smooth the passing, of our loved ones. But we also have the opportunity to watch what happens to our parents, listen to what they have to say to us, and use that information to look squarely at our own mortality and prepare as best we can for the end of our own lives.
For herself, insists Gross: “I can tell you now that it was worth every dreadful minute, a transformative experience.” And the inspiring lesson? Here it is, as expressed in a sere opening quotation by May Sarton: “I have seen in you what courage can be when there is no hope.”