Coming Full Circle

Caring for an elder can be like caring for a toddler

Slide, thunk, slide, thunk--my grandmother's wheeled walker provides counterpoint to her shuffling steps. Once a tall, strapping woman, now at 92, she's frail physically. Her once-sharp mind drifts out of focus. She hears better when she wears her hearing aids, but they provide amplified, distorted sound. We just don't sound to her as we used to. Macular degeneration has stolen the consolation of reading. She often can't distinguish people by sight. Increasingly, she appears to be resident in a world less and less recognizable to her.

Although it would be easy, her daughters and granddaughters won't leave her in the foggy world she lives in. We try to draw her out, talking of the past if that sparks interest, of the present if she can. My mother watches television with her, recounting the character's actions so granny can follow the story. Her four-year old great granddaughter cuddles with her on the porch swing and dances endless performances, casting granny in sitting parts.

It's not just love and enjoying her company any more. Real fear underlies a lot of the attention lavished on her: fear that she'll fall, forgetting to use her walker; fear she'll try to cook and literally set herself on fire. Fear that she'll become so disoriented that she won't know which way to go to get to the bathroom.

A familiar face
I recognized my mother's tired face during our last visit. In many ways, it was the face I wore when parenting a toddler. She uses the same skills I tried to use with my daughter.

Patiently, she answers the same worried questions over and over. Granny must have asked ten times if she needed to prepare dinner. When making the meal, Mom tries hard to think of things granny can do. Breaking green beans can be done by touch. By pre-counting the napkins to match "company," granny can help lay the table.

I remembered wracking my brain to think of how to include Sarafina in my tasks when she was two. Could she drop napkins in the washing machine? She can carry bread to the dinner table. The same process of negotiating between her desire to help and my fears of injury to her along with my own impatience plays out daily at granny's farm.

Instead of saying "No, you can't touch that," we tried hard to make our house toddler-safe. In the same way, I notice the broad paths my aunts have carefully made between the furniture. They leave lights on, and arrange the same items in the same order beside my grandmother's chair. I notice they name themselves and others to her: "Mother, Stefani is here. She's got Sarafina with her, and they're enjoying the sunny day." Anything to help her orient herself and increase her sense of how we all fit.

Coaxing conversation
Just as we delighted in any words we got out of our quiet little one, we'll talk to Granny about anything. She tells me this isn't her home? I ask about the brother it belongs to. If she tells the same story repeatedly from her childhood, we listen. When Sarafina asked to go to her favorite "renchrant," we didn't bother telling her that's not how to pronounce "restaurant." We didn't want to correct her; we just wanted her talking to us. Right wasn't the issue then, and neither is it with my gran.

Toddlers don't always want to do what's best for them. In the same way, gentle reminders fly around granny's house. She needs to elevate her feet to control swelling. So, with different degrees of humor, variants of "Feet up, Mother," are heard. Phrasing requests as though they're inevitable seems to help. So, "Time for medicine now," rather than, "Would you take your medicine?" In order to get enough food in to a busy two-year old, I learned to make tempting morsels available when she was engaged in a fascinating activity. Sometimes she'd eat without even thinking of it.

In the same way, snack plates sometimes appear on granny's lap--cheese, crackers, fruit--things she wouldn't ask for and would reject if offered. Without engaging in verbal struggle, we all get what we want. We watch her eat, knowing that she needs the nourishment, and she can eat without having to stoop to asking for food in her own house or rejecting our suggestions.

Active listening--a sympathetic ear
It's sobering to realize that in many cases, nothing concrete can be done to help. As my friend Susan says, "Active listening, in particular, is something I find myself doing with both my children and their grandfather. As with a toddler, Grandpa gets angry when people try to correct his strong ideas, or solve his problems for him. He's happiest (and most likely to comply with requests) with a sympathetic listener, someone who can hear just the pain or anger in his voice and not worry about the reasonableness of the problem being expressed."

Sometimes I wonder where my aunts' and mother's patience to serve and care for their mother comes from. They could put her in a "home," and not make weeklong trips out to the farm to provide 24-hour help. Some of our patience with our children comes from love, and I know my family loves my grandmother.

But I think the secret lies in the parenting parallel. The conviction that those in need deserve the best care one can provide is instilled by experience. They must have received the same sort of care from her.

When we were too little to be much more than needy, we were given to. Experience like that stores up in layers too deep for memory, there when one is the strong one, when needs flow the other way. Those who received less-optimal parenting can overcome that, and give their children exquisite care. In our case, however, I think it's a case of the past giving to the present. I wonder how my daughter will manifest this as she grows.

A harder letting-go
For all the parallels, though, there is one huge difference. All the love and patience and caring in the world won't get my granny through this. Unlike a toddler, she isn't going to grow into greater independence. Her journey is in the other direction. There isn't a happier time for her often-stressed caregivers to anticipate.

For my mother, my aunts, my cousins, and myself, satisfaction doesn't come from foreseeing a future when all this adds up to a better life for my grandmother. Any gratification rises from keeping her life now as independent and comfortable as possible. Just like my granny and mother and all of us let go of our babies when it was time for them to move to the next stage, we're going to have to let go of her. It's a harder letting-go, since she'll be gone, rather than in a new stage, but we know from watching our little ones that there's really no other option.

Contributing Editor Stefani Leto writes and parents in the Bay Area. Mother of an almost-five year old and an infant, she says nothing challenges her mind like parenting. Her work also appears at and