Scarcely a day goes by in the Netherlands without a news story focusing on care of the elderly. New legislation introduced at the beginning of this year has limited access to residential care and put a much greater emphasis on the role of family and friends in helping people remain living in their own homes.
Expat and social worker Ana McGinley, whose own parents live 15,000 kilometres from her home in Haarlem, has some advice about how to cope when your own close relatives are so far away.
They say that absence makes the heart grow fonder, but it is difficult to deny the poignancy of saying goodbye to aging parents. Relationships with family members are crucial in the preservation of self-identity in expat adults and children – especially when the culture of the host country is unfamiliar or confronting. Being able to ‘be yourself’ with the people who know you is a wonderful comfort often available in the company of family members.
Our relationships with family members face constant change. Most of us remember being dependent on our parents as children, yet independent of them as adults. What most of us don’t consider is that age and illness may result in aging parents becoming increasingly dependent on us, their adult children. Being an expat does not change this dynamic.
So how can you maintain relationships with and provide support for aging parents while living on other continents? Every situation will be unique but this list is a starting point which emphasises the two most important factors in caring for parents as an expat: communication and planning.
Use the Technology
Distance does not need to be the demise of relationships. Scheduling a weekly Skype call with parents and grandparents is an ideal way to keep in regular contact. Grandchildren can share the highlights of their week. Practical issues, like health care and holiday arrangements, can be discussed at length. Family members can remain actively involved in one another’s lives without being physically in the same house.
Take a step back in time
For older people who have not embraced the Internet and mobile telephones, maintaining contact will take more time, effort and planning. Weekly telephone conversations, cards on birthdays and special events, letters with photos and drawings from grandchildren, holiday postcards – all signal to parents/grandparents that you are thinking of them and making the effort to keep in touch.
Being able to spend physical time with aging parents is going to depend on distance, finances, desire and available free time. For many expats, budget cuts to employment contracts have resulted in the loss of previously funded annual family holidays to the employee’s country of origin. As a result, many families are no longer able to afford annual trips home to visit aging relatives. Alternative options worth considering include contributing to the cost of parents coming to visit; or choosing mid-way holiday destinations with both parties sharing the costs of travelling only half the distance.
Appoint a family manager
Family dynamics are complex and the basis for films, books, and mental health problems. Nevertheless, in every family there is generally one individual with a practical streak which identifies them as the person everyone turns to in times of family stress. Hopefully they live close to your parents and are willing to take on the role of family manager. Make sure they are aware you will be relying on them for factual information about your parents, should their independence and health deteriorate. Most importantly, ensure that the family manager knows that you appreciate them and the difficult role they have been allocated.
It is all in the planning
Encourage parents to be proactive in planning for their own aging. Discussion about moving from the large family home with multiple stairs, a high maintenance garden and impractical bathroom with spa should happen years before a move is necessary. Similarly, legal arrangements – appointing a family member power of attorney, writing a living will, making clear plans for the care of a surviving spouse and having a current will – are all tasks that need to be completed while your parents can express their wishes fully. Remember that dementia can sneak up slowly and render the person incapable of making their future wishes known.
The meaning of life
A significant problem for elderly people is isolation and loneliness. This is the time that their peers, friends and family members die or become incapacitated through illness. Social contact and a life purpose are important to everyone at all stages of life. Ask about who is actually visiting? Encourage parents to get involved in social clubs, voluntary work, churches, exercise programmes – things that they have expressed an interest in but need a push to join. This will hopefully propagate new connections and regular social events within their own local community.
Increase in demand
When a parent does become incapacitated and requires help, make sure health professionals have your contact details and know you want to be part of the care plan, even though you live in a different country. Your family manager should attend all medical appointments to support your parents and to provide information, and to brief you about the outcome
When you are a single child
For expats who grew up in a one-child family, a sick parent will generally require you visit promptly to assess the situation. From then on, request that you be included, via Skype calls if possible, in all interviews and case conferences with health care professionals to ensure that you have up-to-date information about the prognosis, treatment plan and short-term recommendations for your parent. This information is crucial in making your own plans about future visits.
Every expat should consider how and when they will go home should a parent become seriously unwell or die. Do your research on the fastest route you can return home, where you will access the funds to make this trip, and who will take over the roles you currently fill in both your personal and professional life while you are away. The death and funeral of a parent is an unpleasant but inevitable fact and it requires planning.
Go easy on yourself
Being a local or distant family carer is stressful. Living in a different country means you can’t visit to check your parent is receiving adequate care and that services are performing as expected. Not being able to spend quiet time together with an aging parent can cause frustration and anxiety that will distract you from your daily life and become an unconscious source of stress. Take time to also look after yourself, enjoy your life and keep things in perspective.
Ana McGinley was a social worker for 15 years, specialising in care of the elderly. She is currently writing a book about dealing with aging parents and keeps a blog about dementia.