When one of your parents dies after a long-lasting marriage, the other one does not simply become the surviving widow or widower. One of you adult children, who used to come by every other week for a brief chat over tea or a gin and tonic, is now charged with the responsibility of managing his or her health and well-being. You are expected to know everything, to be able to act as a doctor, a nurse, a pharmacist, a psychiatrist, a social worker, and a lawyer, but there were no books telling what to do to prepare, trust me, I checked. Here is a list of what I would suggest you do to take care of your parent after their spouse’s death.
First of all, you need to be prepared for health decline
Aside from any decline in health, you also need to prepare for the grieving period. Researchers have identified a real phenomenon called the widowhood effect, where the surviving spouse has a significantly higher risk of experiencing health issues and even death several months after the death of their partner. The increased risk covers heart problems, falls, and sudden worsening of existing conditions
Therefore, if your parent needs to see their regular physician more than once a year, schedule an appointment within the next few weeks, preferably before the six-month mark. Ask another family member to accompany you if you think your parent is too distraught to express concerns in front of a medical professional. Their weight gain or loss, blood pressure, heart rate, and medication tolerance levels may need a closer look in the coming months, which could not be done if you waited until their next regular appointment.
Second, make sure you have legal access to your parent’s health records.
I have heard so many horror stories about families that could not manage their parent’s health because the doctor’s office would not share any information without specific paperwork filled out by the parent. Even if you do have HIPAA authorization to be provided with personal health information, it is going to be difficult to keep track of your parent’s health if they cannot keep track of their own health. I am not saying your parent will be helpless, but their grief may prevent them from being able to recall precise details and share personal health information with you. Therefore, the first thing you want to do is ask your parent to fill out a HIPAA authorization form so that the doctor’s office can share personal health information with you directly. While you are at it, ask your parent to sign a durable power of attorney for healthcare with you. The durable power of attorney for healthcare is not the same thing as a living will; it designates you as the person who is allowed to make medical decisions in case your parent becomes mentally incompetent. The living will, on the other hand, ensures that they know what medical interventions they want or do not want if they become incapacitated. Both documents need to be signed while your parent is of sound mind, which is yet another reason why it is better to do it while they are grieving but otherwise healthy. Families tend to discuss advance directives, including living wills and durable power of attorney for healthcare, when the prospect of their parent’s impending death becomes very real, which, when it comes to a surviving spouse, happens right after the funeral. It will be much easier to have those documents in order.
Third, make sure to obtain a comprehensive list of your parent’s health needs
When a couple has been married for a long time, they often start to delegate specific duties to each other without thinking about it or writing it down. They may take turns going to the pharmacy, or the husband always calls the gynecologist while the wife can tell you precisely which orthopedic surgeon is good for knee replacements and which one is better for hip surgeries. When one half of the couple dies, the other one is suddenly expected to know everything without having to ask for help, which is not realistic. Therefore, your first task is to create a single list of your parent’s health needs that includes every medication they are currently taking, over-the-counter and prescription, any supplements they may be on, drug allergies, the contact information of every specialist they may need to see, and the most recent lab and diagnostic test results. Medication reconciliation is an absolute must, meaning a printed or electronic list of all medications the patient is currently taking, including the dosage instructions, compared to what is actually in the medicine cabinet at the moment. Polypharmacy is a common cause of medication errors among seniors who manage their own medication, especially when they are not used to doing it on their own. Seniors who are used to having another person remind them about their medications are more likely to forget to take some of them or accidentally take double doses, and either of these mistakes can cause an emergency. Get that list while everything is still fresh, and have it ready in case something happens.
Fourth, change the way you approach doctor’s appointments.
Medical professionals are very good at getting their point across, but a grieving patient may not always understand the instructions. It helps to accompany your parent to any specialist appointments and remind them to bring a printed copy of all their medications. Ask more questions if the doctor is too busy or has little time. Instead of asking to speak with their doctor privately, ask to sit in on the appointment if you are allowed to do so. Ask the doctor to write down the care plan for the patient, or at least for you, so you understand precisely what your parent’s health status is and what you need to do to monitor it. It is important to have the instructions repeated by the doctor, the patient, or the nurse to ensure comprehension. If either your parent or you cannot explain the care plan in detail, it means that it is not understood well enough, and it is better to ask more questions. This step is arguably the most crucial one in determining how successfully your parent will be able to manage their health after their lifelong partner’s death.
Fifth, treat the transition from home to hospital to home as a major medical event requiring specialized attention.
When the patient is discharged, it is important to ask to speak with the discharge planner about what kind of aftercare your parent may require at home after leaving the hospital. I strongly advise to request specialized services if those services are indicated, which means asking to route all prescriptions to the same pharmacy and making sure the patient has an upcoming follow-up appointment. In addition, ask to speak with the discharge planner about your parent’s home care needs, if any. Transitioning from one care setting to another, whether it is hospital to home or home to hospital, is consistently associated with the highest likelihood of preventable medical errors, according to studies. The good thing is that those errors are entirely preventable if a family member understands the transition and asks for the right services. You may want to speak with the discharge planner about what kind of home assistance your parent may need, such as home nursing or physical therapy. It is always a good idea to ask for more assistance rather than less, in my opinion. You may want to request that all prescriptions be routed to one pharmacy so you can keep track of them better.
Sixth, recreate the support network your parent had with their late spouse.
Asking an elderly parent to take on more responsibilities than they are used to can be emotionally taxing, especially for a surviving widow or widower. A surviving spouse is used to having another person to rely on for most daily tasks. Cooking meals, driving to the store, and asking to remind them to take their medications are only some of the daily activities that couples tend to delegate to each other without thinking about it. After one of them dies, the surviving one is suddenly expected to manage those tasks on their own for the first time in decades, which is when families may start considering help at home for an older adult. Although your parent may protest and insist that they will not need help, be prepared for your parent to slip in the following weeks and months. They may forget to cook food, take medications, or go to the doctor appointments. I believe those lapses are normal for a surviving spouse who has lost their lifelong partner and needs more help than they have admitted.
You may want to provide more help than your parent expects you to, such as having someone assist them with meal preparation, sitting with them at the doctor’s office, or reminding them to take their medications. You can provide them with more support in terms of instrumental activities of daily living, or IADLs, such as managing their medication, transportation, or finances. IADLs are an essential component of independent living among older adults. It is important to understand that IADLs play a role in ensuring physical and mental well-being, which is why their loss frequently results in a noticeable decline in functional status. Most families I know prefer to hire people to help their parents with IADLs when those parents are not able to manage on their own, and I think that is a reasonable choice. Your parent may not need someone to cook for them or clean their apartment for that matter, but they will surely appreciate someone to assist them with their medications, especially if that someone can do it on a regular basis.
Seventh, recognize the signs of complicated grief and seek professional help.
Normal grief after the loss of a life partner is distressing, but it is also something that is manageable with time. Complicated grief manifests in various ways but most often presents with unexplained weight loss and the inability to return to daily routines after months of the loss. If your parent’s grief is affecting their ability to perform basic daily functions or is dragging on for more than a few months after the loss, speak with their primary care physician about it. A social worker may be able to help if the patient is struggling with social isolation, which can happen when they withdraw from their usual routines and activities. In addition to being emotionally taxing, social isolation can have deleterious effects on your parent’s physical health. Therefore, it is important to encourage them to participate in at least some of the activities they used to enjoy before their spouse’s death. Eighth, divide responsibilities in a way that feels fair to everyone.
One of your siblings may end up doing most of the heavy lifting in the early days and weeks after their parent’s death, as they are either closer geographically or more involved in day-to-day activities. This is normal, but it cannot happen for more than a few weeks at a time, and it certainly cannot happen exclusively to one sibling, as the others may resent it and refuse to do their share later. Divide those responsibilities in a way that allows everyone to contribute to their parent’s care in a way that feels right to them. Some siblings may feel more comfortable with administrative duties, such as speaking with doctors and paying bills, whereas others may want to be more hands-on with their parent’s day-to-day activities. Discuss those responsibilities openly and allocate them to whomever can manage them best, and make sure to add them to a shared calendar so everyone knows what is due and when. Shared calendars and communication tools can help everyone stay on track.
Lastly, prioritize your own well-being.
There are approximately 53 million caregivers in the United States, and most of them are family members providing care to their loved ones (AARP). Caregivers, especially those who care for their own parents, experience burnout more frequently than other types of caregivers. Respite care is an absolute must for family caregivers who find themselves overwhelmed with responsibilities and unable to provide high-quality care for their loved ones. Name a responsible family member who will take on respite caregiving duties when needed, as this will allow you to take a much-needed break and prevent you from burning out completely. It is not helpful to the patient or anyone else if the caregiver burns out and is unable to provide quality care.
