As the baby boom generation approaches retirement age, millions of Americans are facing one wrenching question: What to do about Mom and Dad?
The country is approaching a "silver tsunami," as millions of families reach a new stage of life. According to AARP, there are almost 66 million family caregivers in the United States -- nearly 30 percent of the entire U.S. population. Seven out of 10 care for older adults.
This week, "ABC World News with Diane Sawyer" launches a special series, focusing on the sensitive issues surrounding eldercare. As part of the series, Sawyer hosted a roundtable on the subject with Virginia Morris, author of "How to Care for Aging Parents"; businesswoman Martha Stewart, who partnered with Mount Sinai to open an eldercare center in 2007; and noted geriatricians Neil Resnick and Marie A. Bernard.
The group discussed everything from driving to medication to the stress that's placed on caregivers.
Resnick, of the Institute on Aging at the University of Pittsburgh, said the most telling statistic about U.S. caregivers was that they bear more than $200 billion a year in caregiving costs.
Bernard, deputy director of the National Institute on Aging, said that many caregivers had health problems they ignored. She said research showed that after receiving training on their relative's disease, caregivers' pressures and depression tended to decrease.
"Much of what caregivers' stress results from is a sense of impotence, in addition to guilt and frustration," Resnick said. "A lot of that impotence is, you look at mom and dad and say, 'You're going downhill and I don't know what to do.'"
But, much of what caregivers interpret as downhill is fixable, he said. "Much of it is due to medications' side effects. ... Diseases undetected. ... Things that haven't been detected but for which steps can still be taken," Resnick said. "When those steps are taken, mom and dad are nowhere near as bad off as they looked a minute ago. They are now much better and the caregiver's stress goes down dramatically."
Watch "Families on the Brink: What to do About Mom & Dad" this week on "ABC World News with Diane Sawyer.
Morris, whose book is considered by many as the bible of elder care, said that caregivers get so focused on "I don't want her to die" that they forget to enjoy life.
"Whether it's having a pet or a garden or a grandchild to talk to -- these little tiny things sometimes can make you feel like you succeeded too," she said.
In 2011, 77 million baby boomers will begin turning 65 in a wave that's been coined "the silver tsunami."
"Who's going to take care of them?" said Stewart, a TV host, author and magazine publisher. She helped open the Martha Stewart Center for Living, which was dedicated to her mother. "We only have about 7,000 or 8,000 geriatricians in America."
She and Resnick said that number was decreasing. Resnick said that less than 3 percent of U.S. physicians received an hour of training in geriatrics. "The nursing assistants who take care of our oldest and frailest, who are in nursing homes, have about the same amount of preparation to do that as a school crossing guard," he said.
"It's not so much about aging and getting sick," Stewart said. "It's about how we are going to cope with getting older and still live, and who's going to teach us how to live a healthier life as we age."
Bernard shared some advice on bringing up end-of-life decisions with a close relative.
"Talk about someone you know who's been in a difficult situation or even a televised program. ... Use that as a springboard for talking to your loved one about what their personal preferences are," she said.
Stewart said she sent her mother to a lawyer who also had an aging mother.
Morris said that she's 51, and that her daughter, who is 12, asks her all the time what she would prefer if she fell ill or died. Stewart said she's already had these conversations with her only daughter.
"The will. Oh, my gosh. I'm not at all afraid of any of these things because I am prepared," she said. "You don't want to leave anybody miserable if you die or you get really sick. You have to write it all down."
Resnick said that in the old days, parents shielded their kids from having to discuss or think about their death or getting sick. "We decided that was wrong," he said. He said that he invited his children to participate in decisions regarding his elderly parents and asked them how they would handle a similar situation regarding him.
Resnick suggested everyone had a health-care proxy to speak for them. "My dad didn't want to be it for my mom, because he felt he would be too conflicted," Resnick said. "So they both asked me if I would do it."
Stewart remembered her mother's death two years ago. Her mother had suffered two minor heart stoppages that scared her. She was hospitalized after the third one. "She whispered in my ear that this is it, she wants to rest. I wanted her to fight. ... But I had to respect that [and] let her go. You have to do that," she said.
Morris said to start talking sooner rather than later about where an aging relative will live, whether it be an assisted-living care facility, a nursing home or at home with home care.
She said to be creative. "Get a foreign language student or somebody in your house who in exchange for rent is helping you around the house," she said.
Resnick said there were policies among established insurers that provided long-term care that didn't require a nursing home. "They realize. ... there are ways that they can provide care for less money than a nursing home, that will give you everything you need while you still live in your own home," he said.
Morris said that some elderly people were getting adjacent apartments with a shared door so they could help each other. Resnick said that some of the best nursing homes were in smaller communities. Stewart said that she took her mother to wonderful retirement villages and homes, but that her mother opted to stay at home so she could maintain her network of friends.
Morris said the mistake that many family members make getting together and telling their aging relative that they've found a great place for them to move to and that they are selling the house.
"Go in and ask questions and listen," she said. "Really hear what they have to say, because that will make them a little more open to listening."
Resnick and Morris said that no longer being able to drive was "huge" for the elderly.
"It's sort of the beginning of the end in many people's minds," Resnick said. "It's an attack to their independence, because they can't go and come as they want."
He said before loved ones even consider having a conversation about having an elderly relative give up driving, they should first talk to the person's doctor. Changes in a person's driving can be caused by overmedication, a medication's side effects or diseases like diabetes, lung disease or heart disease.
Because making a left turn can be especially troublesome for the elderly, whose reflexes have slowed down over time, Resnick said that in Pittsburgh, Carnegie Mellon University had been studying an online tool that directs drivers to their destinations using only right turns. Morris said there are driving refresher courses and car modifications available like changing the pedals and seats or adding brighter lights to a car's interior.
Stewart suggested getting a grandchild involved. "Just allocate one day a week to the grandson to the granddaughter, and you take grandma to her appointments. ... If they're liked by their grandchildren, that's kind of a pleasant time for them," Stewart said. She also suggested car-pooling.
Resnick said the average older person sees 11 doctors a year, which can be a prescription for confusion. Morris said caregivers should try to ensure that an aging relative has one primary doctor who is aware of all medical conditions and medications.
Bernard said having one pharmacy fill all of the medications can be helpful. She said she also asks her patients to do a "brown-bag autopsy" in which they bring in all of their medications during a medical visit. "Sometimes what you thought they were taking is not what they're doing or how they are taking it is not what they're doing," she said.
She said it was very important for aging patients to bring in all of the medications, over-the-counter and prescribed, routinely, so that the primary care physician and the pharmacist stay aware. "When you get to 10 drugs ... there's almost a 100 percent likelihood that there's some sort of drug-drug or drug-nutrient interaction," Bernard said.
Morris said that the baby boomers -- whose generation spans 1946-64 -- need to start thinking about these issues so that their children are not burdened and so that they receive the best care possible. By 2030, one in five Americans will be 65, according to AARP.
"Be modern in your thinking," Stewart said. "Work with a doctor or a hospital that can aid you in all these challenges."
Bernard challenged caregivers to appreciate the time spent with aging parents and relatives. "Remember what it was like when your children were infants," she said. "That seems like a terrible burden as well. [But] it's a very enriching thing. It's important to step back and appreciate some of that because you might not get it back again."
Resnick said that caregivers and families should focus on hope and help. "There's so much that can be done today, much more will be able to be done in the future. ... There's a lot to enjoy and treasure about old people," he said.
"They bring wisdom and experience and baby-sitting and participation in the arts and culture and donations and advice for how to live better lives and what the meaning of life is," Resnick said. "It's a privilege to be able to take care of older people."