1. Be mentally and emotionally ready: It's hard to watch those we have been very close to and loved so dearly begin their decline. We were on the Puget Sound ferry ride to the island where Ruppenthals from all over the world were to gather in a family reunion when my mom told me, "Steve, I have been diagnosed with Parkinson's." Though these words shocked me, I could not properly process the repercussions, as I could have no idea how wrenching paralysis was going to replace all the fun we had had relating together as adults. That is why I say, be ready to change gears and turn on a dime. If you are fortunate, your mom or dad will not develop a serious disease, but be mindful that the time will come when they will switch from being an active, loving companion in your life to being needy of your time and care. Start getting ready for this change, as it's a big one. No one, however wise, can process its magnitude without deep and conflicting feelings.


2. As your parents slow down, include them but be ready for surprises: in this transitional time, your folks will no longer be able to keep up. In my case, my son and I took my mom to Hawaii one year. But we soon found that time in the sun, which she used to love, now exhausted her quickly. I would say to include your parents in activities that everyone enjoys, but when you do, be prepared for your all day surfing trip to be shortened drastically. So make sure you have other times when you spend quality time with your partner and kids that won't be interrupted; Mom and Dad can happily relax at home or at the hotel.


3. Be prepared for more trips to the doctor: If your parents no longer drive and you have siblings in the area, try to divide up tasks like meal preparation and visits to the clinic. If this burden falls solely on you, try to get help for the cooking and housekeeping, as the medical visits will probably require your presence, particularly if important decisions need to be made. And don't just take the doctor's recommendations blindly; some research will help you see that no one has a monopoly on what exactly your parents need at any particular point. I even took my mom to a Chinese herbalist and acupuncturist, when Western medicine had no answer for her except more drugs. Remember that it's really you who are in charge, using highly skilled helpers from the medical field.


4. Find a way to bring up relevant financial concerns: Unless you or your parents have built up enormous savings, hard financial decisions will have to be made. Does your mom or dad need the continual care of a rest home or a board and care facility? If so, it may mean making the hard decision to sell the house and invest the proceeds until room opens up at the right facility. Or, if they come to live with you, how will the funds be freed for you to pay housecleaners and caretakers when you need them to get absolutely essential free time to care for yourself? So far away was financial reality in my family that my dad only was willing to discuss such issues if I invited a third party, a friend of mine whose father had made a considerable fortune, over for the discussion. If your family is like mine, find a way to break the logjam, as finances will be critical to any decision you make.


5. In those last years, will your parents be more comfortable with you or in a rest home? If you are lucky, your family includes one kid-perhaps yourself-- with a deeply caring attitude towards the elderly, and they will want your mom or dad to move in with them. In that case, offer to visit your sister or brother and spell them frequently, as anyone in charge of full care will desperately need time for themselves. If the rest home is the better alternative, visit the possible facilities and see what level attention the residents really get. Study the financial arrangements you will have to make and weigh it all against having your parents age in place, with round the clock caretakers if necessary. We took the round the clock route with my mom, who elected at the end of her life to spend six weeks at a full care facility. But when the time came to decide whether to connect her to tubes to prolong her life, my mom said, "How can you speak of tubes? I want to go home," and that is where she died, amidst the warmth and love of her hired caretakers and of our family.

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