Paula Span at The New Old Age blog raises this important and timely issue about motivations for caring for a stepparent in need, especially when the remarriage happens long after the children from the first marriage are grown and on their own, and thus never raised by the new stepparent.
“Initially, many adult children whose divorced or widowed parents remarry seem delighted, Ms. Keller said when we spoke. “They’re thrilled that Mom or Dad isn’t alone,” she said. “It’s a wonderful thing — until somebody gets sick.”
Then, she has found, “it gets really blurry. Who’s going to do what?” Grown children don’t have much history with these new spouses; they often feel less responsibility to intervene or help out, and stepparents may be unwilling to ask. Perhaps it’s unclear whether children or new spouses have decision-making authority.
“Older couples in this situation fall through the cracks,” Ms. Keller said.
Research shows that the ties which lead adult children to become caregivers — depending on how much contact they have with parents, how nearby they live, how obligated they feel — are weaker in stepchildren, Dr. Silverstein said. Money sometimes enters the equation too, Ms. Keller added, if biological children resent a parent’s spending their presumed inheritance on care for an ailing stepparent.” Read more…
The comments prove to be well worth the read; full of anecdotes and questions about how to balance financially, relationally, and emotionally the caregiving needs of biological parents and countless constellations of stepparents and ex-stepparents. In the interviews that Elizabeth and I have conducted with Gen X caregivers, I think I was surprised, as someone who does not have stepparents, how basically all things boil down to simple dislike. In intact families, you can dislike people but somehow still love them. For example, I mother young children right now which means I say “NO” a LOT which means I also hear, “I hate you and you’re not my friend, Mommy!” a LOT. But my response back is basically, “Well, I still love you and I’m not your friend, I’m your Mommy.” But I’m beginning to see that in step families, where society often paints a stepparent as a “new friend,” this statement cannot be said back. Stepparents may not love their stepkids of any age, and stepkids may not love their stepparents. And thus, dislike is simply dislike. Are there outliers? Of course. But read through the comments at New Old Age, and I see that various levels of simple dislike or indifference often marks the relationship between stepparents and stepchildren of any age, which does not bode well for the already thankless and exhausting task of elder caregiving.
What will motivate us to care for the vulnerable old in the next 10-20 years? Hiring professional help is already out of reach for most Americans unless we decide to make Medicaid our de facto senior care system. Having spent some time in Medicaid Room and Board facilities though, I just can’t imagine Baby Boomers in general accepting that solution.
Categories: Aging, Disability, Death, Dying
Amy Zeitlow, could you explain this more? Why don’t you think people would accept it? Is the care poor or are you talking about something else?
“Hiring professional help is already out of reach for most Americans unless we decide to make Medicaid our de facto senior care system. Having spent some time in Medicaid Room and Board facilities though, I just can’t imagine Baby Boomers in general accepting that solution.”
This is a very difficult issue.
Caring for elders is already complicated with biological parents who raised you. Some parents do such a terrible job, that kids really can’t care for them in person. In-laws have a say, here, too – be nice to your daughter-in-law, because she may be the one who decides what happens to you.
Step-parents add another level of confusion and are often not liked by the kids.
On the other hand, I think sometimes a step-parent becomes part of the family and a loved parent. Of course, even then, there may be issues of how to divide time and money.
Step-parents can also provide a way for children to get more help caring for a parent, though.
I wonder about step-parents who entered the family when the children were grown though. What is the obligation exactly?
Great questions Diane. In terms of Medicaid Room and Board-anecdotally from ten plus years serving folks in hospice–the care is sub-par. For a combo of reasons–the reimbursement is less for those beds while the staffing model remains the same. Also, Medicaid is not easy to work with–they live with rules for AR that would astound any other businesses. They can take up to 90 days to reimburse you and if they find any problem in your bill submission or documentation in general, they freeze your payment until the issue is resolved (which can take as long they want). I share a small glimpse of the business side to show that most people in the medical or elder care field do NOT want to play with Medicaid. Hence, most care facilities only have a certain number of Medicaid beds. In terms of the care received, most states have a survey system you can look through when looking at different care facilities. Here’s the one for Louisiana http://www.healthfinderla.gov/CQNursingHomes.aspx
Across the board the level of care at facilities that offer Medicaid Room and Board beds is lower. Older buildings, outdated equipment, poorly paid and thus poorly trained staff, and disgruntled owners add up to not a pretty picture.
So for many people the choice could end up being care for your parent yourself or put them in bad care through Medicaid?
Sadly, I ‘ve seen that the only realistic choice is Medicaid spend down (thus depleting the entire nest egg of the one in need of care (and the spouse) in order to meet the poverty guidelines of Medicaid). Some folks discern that they are willing and able to stay home to care for an ailing loved one, but the systems of support for those folks are not great. As a congregation, we would try to be of help in terms of respite, meals, visiting, etc., but even then, I don’t know if it was that helpful. By the time we inherited family systems in hospice care (depending on the disease trajectory–not cancer, but definitely stroke, MS, dementia, debility) the caregivers were BURNT to a CRISP!
Thankfully, there are some models of care that are trying to show how supporting life can be both not only best practice for those in need of support but also cost effective. The PACE program is one..
I think as a policy matter, we need to get rid of the spend-down for Medicaid.
What would you think of having some kind of low-cost long-term care insurance people could buy into being provided by the government? Or maybe a coop-type thing facilitated by the government so you could drive the price down?
I am so with you and so was the government with us for 19 months as Kathleen Sibelious worked to figure out how CLASS (an affordable care option for long term care insurance) could work and they QUIT. They could not figure out how to make it financially feasible. So, they still acknowledge that this is the greatest challenge we face in the next 20 years and yet…nada. http://www.huffingtonpost.com/sec-kathleen-sebelius/the-class-program_b_1011270.html
Nothing like setting social policy by burying our heads in the sand!
Whatever family structures we have, this is going to be a huge need in the future. We don’t want to bankrupt the next generation.
Perhaps we need some kind of small tax to make it work financially – but with people buying the policy as well. Doing nothing is just going to hurt our kids and grandkids.