As children, we trust implicitly that our parents will always know what to do. Then we grow up and realise that they don't have all the answers. And yet we still struggle to accept that our parents begin to rely on us more than we do them. For many people, a decline in their parents' health and independence comes as a shock and raises a host of issues they'd never even considered. Most of these are financial.
Devika Singh*, a media professional and one of five adult children, says people often fail to ask their parents if they're doing okay financially.
"Usually parents help their children [financially] out for years, and then they're left in a pickle when they hit retirement. These conversations have to be had early on, so that as a family, you can make sure that your parents will be well-positioned financially and emotionally," she says.
Singh's parents recently entered retirement and their five children have had to absorb the financial impact of this. She says the reality is that living costs in SA are high. "Groceries aren't affordable; neither is medical aid. And there is a host of other expenses that a retirement annuity or pension could never cater for. I honestly do not know how the poor majority in South Africa manage; we're privileged to be able to afford to contribute to expenses," she says.
The financial burden of caring for an older parent can be a huge stress, particularly when it comes to healthcare.
Zulaigha Ismail, a Johannesburg-based engineer, says many people fail to realise how expensive medical aid is, when it is not paid for by an employer. Her parents were not professionals and they had always relied on state healthcare.
"My father had kidney failure and he had a heart problem. The state hospitals took amazing care of him but he was told that if his kidneys deteriorated to a stage where he needed dialysis he wouldn't be a candidate. I tried to get him medical aid but because of his pre-existing conditions it was more expensive than normal — a simple hospital plan in 2008 cost about R2 500 to R3 000, depending on the medical aid scheme. I couldn't afford it," she says.
Nicolette Louw's father, a former police officer on a government medical aid scheme, was more fortunate. His medical aid scheme footed almost the entire the R1-million bill from a three-month stay in an intensive care unit after his lungs collapsed and he was diagnosed with motor neuron disease. His hospital plan later paid for hospice care and two years of in home nursing care.
Louw strongly advises that people fork out extra for medical aid while their parents are in good health. "Even if there is no illness just yet, it's always good to invest in a decent medical aid," says Louw. "People should always know exactly what they're paying for when it comes to medical aid, and what is covered and what is not covered."
At the same time, it's important to recognise that you may not always be able to care for your parents yourself, particularly as nuclear families become smaller, communities are fractured and dual-income families become the norm.
Michelle Boiley has been trying to convince her parents, aged 73 and 74, to move into a retirement village since earlier this year. Her parents, however, are resisting the idea, she says.
It's a concern for Boiley, a Pretoria-based bookkeeper. Her parents live in Port Elizabeth (PE), where her mother still works to pay the bills. Her father suffers from emphysema and his movements are restricted.
"The reality is they're getting older, they're frailer, and they can't always do the things they want to do," she says.
Boiley believes moving into a retirement village with a frail care unit would be cheaper for them than maintaining their home and would also provide her parents with the benefit of 24/7 care.
She's toyed with the idea of moving to PE but says this wouldn't resolve the issue; both she and her mother would still have to work, and her father would still be left alone all day.
"He's on oxygen 24/7, and when my mum's at work, if something happens to him..." she says, trailing off.
You have to think about what's coming. Make a plan.
"You have to think about what's coming," she says. "Make a plan."
Ultimately, maintaining a healthy relationship based on trust, respect and dignity with your aging parents is paramount. "The important thing is to ensure that they're socially integrated and socially engaged," says Karen Borochowitz, founder of Dementia SA.
There are certain practical issues that you need to stay on top of. As people age, their ability to handle their administrative affairs effectively can diminish.
Borochowitz suggests setting up a file to keep all your parents important documents in one place. "Keep a copy of their ID book and a set of their house keys and car keys," she says.
She also encourages adult children of ageing parents to find out who their parents doctors are — or, if they attended a hospital or clinic, what their medical file number is — and to find out about any medical conditions they might have or medications they might be taking.
But these steps, she says, are not meant for any other reason than to assist in case of emergency.
"Older people are very sensitive. Their lives are a lot about loss and grieving, but they can live the most unbelievably full lives," she says. "It's really about allowing them to be autonomous and independent, but to create a safety net for them."
You can call the national hotline for Dementia SA on 0860 636 679.
*Not her actual name.