NORA UNDERWOOD August 19 1991



NORA UNDERWOOD August 19 1991




Looking back on it, Dorothy Bell says that she knew in her heart that having her widowed father come to live in her Rockingham, N.S.,home two years ago would not work out. “With outsiders, Dad can appear happy-go-lucky,” said the 55-year-old Bell. “But with his family, he can be extremely difficult.” Compounding the problem facing Bell and her husband, Nelson, was her adopted son, Dwayne, 14, diagnosed as being hyperactive. As a result, says Bell, the boy requires extra attention and patience. Bell left her job as a bookkeeper and set up an apartment in her basement for her father, David Mannette, 94. But she says that he is authoritarian and that he soon began trying to make her operate her household the same way that his wife had. As well, her father and Dwayne frequently quarrelled. Nine months after he moved in, said Bell, her father began shaking the boy violently. Bell subsequently moved her father into a nursing home in the area. But she still has to take him to doctors’ appointments and help in other ways. Declared Bell: “I feel I have lost two years out of my life since Dad’s health began to worsen.”

Bell, like an estimated 200,000 Canadians, is caught in the middle and feeling the burden of looking after elderly parents as well as children. Bell and those in similar situations are the people whom some experts call “the Sandwich Generation” because its members are subjected to the demands of their children on one hand and those of elderly relatives on the other. According to an Ontario government study published last year, more than 80 per cent of

elderly Canadians are cared for to some extent by a family member. The effects on those caught in what some sociologists call a “care-giver crunch” can be emotionally and physically exhausting. Said Robert Glossop, director of programs and research at the Ottawa-based Vanier Institute of the Family: “You have a situation now in which you have adults, particularly women, caring for their children at a time when their own parents are likely to need help. As the aging of society goes on, more of the population is going to experience this.”

The problems afflicting members of the Sandwich Generation reflect the profound changes in the structure of Canadian society that have occurred during the past 25 years. Until the mid-1960s, few women worked outside the home, and families were larger, with more children to share the responsibilities of looking after elderly relatives. But as more women, who traditionally have provided care for their dependants, entered the labor force, many put off having children until their careers were well under way. Added to those factors are a high divorce rate, the growing number of single mothers and the increase in the number of two-income families—all of which mean that fewer women are able to stay at home.

Fatal: At the same time, advances in medical knowledge have reduced the fatal effects of many diseases and resulted in longer life expectancy. By the year 2000, Canadian men are expected to live an average of 75.9 years and women an average of 83, compared with 63 and 66.3 in 1941. And by the year 2036, according to Statistics Canada, almost 28.8 per cent of Canadians may be over 65, up from just 11.5 per cent in 1990. As a result, the growing number of elderly Canadians will become more pronounced ear^ ly in the next century as the largest group—the baby boomers—reaches Q retirement age (page 37).

Already, most provinces have | launched some programs aimed at z keeping older Canadians independent §

for as long as possible—and helping to deal with the coming crunch. Many such programs provide support so that elderly Canadians can remain in their own homes longer. Said Mark Novak, a professor of sociology at the University of Manitoba in Winnipeg and the author of several studies of people whose time and energy are devoted to caring for dependent relatives: “Care-giving is already one of the biggest issues for the next century.”

The problem has led to a related and alarming trend. At times, the strain of looking after an elderly parent can become so intense that some people are driven to abusive practices. They

include cheating old people financially, or mistreating them emotionally or physically (page 36). On May 19, a 44-year-old Toronto woman, Mavis McCullough, shot and killed her 83-yearold mother with a 12-gauge shotgun, telephoned an emergency number to report what she had done and then fatally shot herself. At the time, neighbors said that McCullough had been under a severe strain, living on family assistance and looking after her invalid mother full time.

While demographic changes are expected to create an even more severe crisis in caring for the elderly in the 21st century, many experts say that it is already a pressing issue—espe-


ciaUy for women. “Women tend to do the looking-after for free, whether or not they also work outside the home,” said Susan McDaniel, a University of Alberta sociologist. For the most part, individuals and families begin to search for alternatives, including retirement facilities or nursing homes, only when the burden of looking after an elderly parent becomes too heavy or when the older person needs fulltime medical attention (page 34).

Cut: Sociologists say that so-called adult children tend to start taking gradual responsibility for a parent’s life, often without immediately realizing how it is affecting their own lives. According to Sheila Smyth, a senior social worker at Baycrest Centre for Geriatric Care in Toronto, the process often starts with something relatively simple, like helping out in a parent’s garden. Later, other tasks, including shopping and housework, become necessary. Explained Smyth: “They probably have a full-time job and kids of their own. And what you see happen is they cut down on the easy stuff—the social life and the time they spend with husbands and kids.”

In some cases, helping elderly parents can take a heavy financial toll. All provinces provide assistance for some support services, including visiting nurses. But experts say that there is not yet enough public assistance available. Families caring for older relatives may have to pay for more intensive

forms of nursing or home care than government funding allows for, and almost all private health insurance plans have limits. As well, a family member may have to give up his or her job to help look after an elderly parent. And while the

Canada Pension Plan provides a seven-year dropout period for a parent who leaves work to look after a child, it offers no help to a person who must leave the workplace to look after an elderly dependant. “If the families don’t want to institutionalize, then they’ll have to start paying,” said Novak. “You may have to pay to meet your needs even though the system may feel your parents' needs are being met.”

The financial and emotional pressures can also cause rifts in families. When most of the financial responsibility falls on a single family member, said Glossop, “that can generate frustration and tension.” At the same time, the change in roles—children looking after parents and parents becoming dependent on children—is something that many families find difficult to accept. A typical case is that of Alice, in her late 50s, who like some others interviewed by Maclean’s did not want her real name used for fear of upsetting her parent. Alice said that because of her 83-year-old father’s arthritis, emphysema and blindness, he is no longer able to take care of himself. Said Alice: “It is like they are children again. Like many people in my situation, I find myself being a parent to a parent.” Alice said that it now takes her father an hour to get dressed in the morning. He can walk only short distances and has difficulty using the toilet. The old man’s health is steadily deteriorating and that, said Alice, “is hard to watch.”

Burden: Some experts say that the key to easing the family’s burden is not simply to create more long-term beds in hospitals or homes for elderly Canadians, but to provide the means for them to remain independent for £ longer periods. Some private and provincially o supported programs already exist, including 25 adult day care centres and so-called respite

0 programs under which older people are cared

1 for, enabling the family members to get relief. u Other programs that help older people to

remain independent or that relieve some of the

burden on family members include the nationwide, partly government-backed Meals on Wheels service that delivers nutritious food to elderly people, as well as providing a variety of home-repair services, transportation and home-security checkups.

In many cases, the cost of the programs is determined by what individuals are able to pay. But, said John Myles, a sociology professor at Ottawa’s Carleton University, the services are neither abundant nor readily accessible. The growing need for more support agencies, he added, “has emerged in a period of relatively slow economic growth, of spending constraint, during a decline in the belief in state intervention. So adaptations to this new reality have been slow in coming.”

Expensive: In Victoria, where 20 per cent of the city’s population is over 65, a provincially funded, $4-million-a-year project is testing ways of caring for elderly people in their own homes. Since March, 1988, the Victoria Health Project has budgeted $12 million to pay for 12 community programs involving old people. They include an adult day care centre, a family centre for people with Alzheimer’s disease and a palliative care program that enables old people to die in their own homes, rather than in hospitals. “Beds are expensive to build and staff,” said public relations co-ordinator Rod Deacon. “The whole point of the Victoria Health Project is to deliver the right care in the right place at the right time.”

Deacon said that the palliative care program grew out of pressures on Victoria’s only hospice, an institution designed to care for terminally ill patients. He added that because it did not have enough beds to handle all the cases referred to it, workers started to treat people at home, easing pain and helping patients and their families to deal with death and grief. Deacon said that the program, launched in July, 1989, reduced the waiting list for hospice beds by 50 per cent in just six months.

Many experts say that the growing trend towards less reliance on institutional care is essential to easing the burden of an older population on Canada’s health-care system. According to Statistics Canada, during a oneyear period from 1988 to 1989, elderly Canadians occupied 55.4 per cent of all hospital beds

in the country. But others express concern that if the trend away from institutional care occurs too quickly or without proper community supports in place, the burden on younger relatives will increase. Said Glossop: “Nobody has calculated the costs to the family that is going to

wind up assuming responsibility for the person.” As well, some analysts say that family members are not adequately compensated for the time, effort and money that they invest in caring for older relatives. Said McDaniel: “We have to give these people tax breaks and eldercare benefits in the workplace.”

Help: Still, experts say that some elements of a broad solution to the pressures on those who care for the elderly do exist. “There are little things that will help,” said Smyth. “Perhaps a homemaker comes twice a week and your mom goes to day care a couple of times a week. That may stabilize the situation for two to three years.” As well, informal support groups help people looking after elderly family members to share their experiences with others. Said Smyth: “To reach out and look for help outside yourself is a sign of strength.”

That is a discovery that Robin, a 49year-old mother of three who lives near Toronto, says she finally made after her 76-year-old mother had lived with her family for two years. “For women especially, there is still that old school that says we should be the caregiver, perfect mother and wife, and have a career, too,” said Robin, who asked that her last name not be used. Her mother now lives in a nearby o nursing home. “A lot of people try to z do everything themselves,” she said. ~ As Robin and others have discovered, doing everything is impossible. And in the future, with fewer children looking after more of Canada’s senior citizens, it is a responsibility that society will almost certainly have to share.