Missionary Care

by Dr. Ronald Koteskey

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As you move toward middle age and your children become adolescents, you may find yourself as part of the "sandwich generation," sandwiched between your parents and your offspring. Although your culture holds you legally responsible for your offspring, it may not hold you legally responsible for your parents. However, you feel some responsibility for your parents. After all, they cared for you as a child, and it seems reasonable that, in return, you care for them when they need you. In addition, the Bible commands us to honor our parents.

People who do not cross cultures and travel to another continent face this same issue, but they are not as far away from parents as you are. They are also much more likely to be personally involved. Although some people have always face the question of determining their responsibility for their aging parents, only in the last century has the majority done so. Not only do more people face this issue, but it also remains an issue for a much longer period of time as life spans increase. Newly retired people commonly have responsibilities for parents who are in their 80s and 90s.\

Although there are no easy answers to the questions arising about aging parents, knowing what to expect can help you give some forethought to what you might do. Following are some of the usual phases people move through as they age in western culture. Some people pass through all these phases with years spent in each; others may skip many of them due to accident or sudden serious illness. We could list six possible phases.

Enjoying freedom

Although there is no particular age at which people in our culture are considered to be "old," retirement is often the time when people begin to be treated as older, as "aging." Retirement often begins when people are in their 50s, increases in the early to mid 60s, and a large majority of people are retired by the time they are 70 years old.

Most people find that the early years of retirement are wonderful. After an initial adjustment period in which either or both spouses may say something like, "I married you for better or worse, but not for lunch," couples find that they enjoy the freedom from set schedules and the time of being together. These people are often called the "young-old," a time defined by attitude and activity rather than by chronological age. With Social Security, pensions, and other benefits they usually have enough money to do things they want. As long as they have their health, they are involved in life.

During this phase, they have few responsibilities other than to cheer them on through the 10, 15, 20 or more years it lasts. Some people may need a little help finding a "vocation," something they feel called to do. However, most become involved in such things as volunteering, becoming involved with grandchildren, or even becoming a "finisher," involved in missions. If they have not already done so you may encourage them to do the following:

• Make a will.
• Appoint a health care surrogate.
• Make a living will.
• Appoint durable power of attorney.
• Make funeral arrangements.

Beginning reflection

Sometimes this phase comes suddenly, such as with a serious illness or financial loss. However, it more often occurs internally, with no one else even being aware of it, such as when people realize that they really aren't the men or women they used to be. It may occur when a close friend or a sibling dies so that people face their own mortality in more personal ways.
During this phase even very successful people may begin to think that their lives have been worthless, and they may become depressed. Just when they most need to talk about it with others, they may begin to withdraw.

Unfortunately, many parents and children have never engaged in serious conversation. If you have not done it before, this is a good time to begin talking about important questions and issues in life. You can be of real help to your parents in opening up these areas by

• Visiting with them.
• Bringing news about others.
• Asking tactful questions.
• Encourage life review by
• Asking for autobiography.
• Asking about old photographs.
• Having them draw pictures of places they have lived.
• Asking about their spiritual journey.

Losing a Spouse

There is nothing more devastating than losing a spouse. This loss phase requires more readjustment than any other event in a person's life. It is often more difficult for men than for women, primarily because men do not socialize as well.

Since most married couples do not die at the same time, you will probably face the loss of one parent yourself as you help the other parent work through his or her grief. Since this is the greatest loss anyone faces, it usually takes many months, even years, to be ready to "get on with life." Be patient. 

During this time you may have to help solve various problems that arise.

• Can your mother maintain home and car?
• Can your father cook and clean?
• What if the survivor sells the home?
• What about remarriage?
• What about entering a retirement community?
• What about moving in with you?
• These questions, and many more, will need answers. You, your spouse, your children, and your siblings and their families will all be impacted by the answers.

Reversing roles

If the surviving parent does not die suddenly, the day will probably come when you go to visit, and he or she will have a list of things for you to do. You switch from being the one being helped to the one giving the help—and your parent switches to the one receiving the help, often very difficult to do.

Both of you want the aging one to be as independent as possible and make as many decisions as possible. As you increasingly become the caregiver, it is good to repeatedly ask yourself several questions.

• How much should I do?
• How much can I say?
• Am I doing any good?
• What about my spouse and children?

In the three phases previously considered, there was always something you could do with the hope that things would get better. As your roles reverse, more and more you realize that things are not going to get better. They only get worse. One thing to remember is that no matter how you answer the questions above as things get worse, you are likely to feel guilty, even though you are not guilty of anything. If you are in your passport country caring for your parent, you are likely to feel guilty. If you are overseas, you are as likely to feel guilty.

Probably the most important thing you can do during this phase is to help your parent answer such questions as these:

• What good am I?
• How can my life have any meaning?
• As you do this, remember that our society has no good answer to these questions. These questions have answers only in a thoroughly Christian world-view. Our modern problem-solving approach to life comes up short, but meaning is found in God and his love for us as persons he made in his image.

Becoming dependent

When role reversal is complete, you may find that your parent is now dependent on you for help with such routine maintenance functions as getting into and out of bed, bathing, dressing, and eating. When this time comes, the goal of independent living is out of the financial reach of most families, especially missionary families.

Whatever is done next is best as a family decision with the parent and all surviving children present. This meeting should have a mechanism for everyone to be able to express his or her position. All possible options must be considered. If the family has enough money, the person may be able to stay at home, with someone hired to care for him or her at all times. However, if that is not possible, there are several options:

• Someone move in with the parent.
• The parent move in with the family of one of the children.
• A home in a retirement village where people are on call to give assistance.
• An assisted living facility where the person does some care for himself or herself in a room alone, but where meals and medications are prepared by professional staff.
• A nursing home where skilled nursing care is available 24 hours a day.

By this stage Alzheimer's and other dementias are rather common, and the parent may not even realize what is happening. During the last few years of her life my own mother was cared for by her children and grandchildren, but she referred to them as "the people who work here." Though she did not want to be put in a nursing home and was cared for by family, her Alzheimer's was at a stage where she did not even realize it. One must not let guilt feelings reign in such a situation.

Saying Goodbye

This last phase is usually a short one. People often find that facing death in a few days or weeks is quite different from facing it in the abstract "future." Most people prefer to die at home with friends and family around them. Some want to talk about their impending death.

This is the time of facing the final enemy, and no one wants to do that alone, sick, and tired. This is the time for all to be available, gather around, and say goodbye.