A Place in Time: Care Givers for Their Elderly

Aging, Fall, 1994

A Place In Time: Care Givers for Their Elderly by Tom Koch. Praeger Publishers, 88 Post Road West, Westport, CT 06881. 1993, 236 pp., $19.95 (Hardcover).

A Place In Time: Care Givers for Their Elderly is a collectionof fairly lengthy interviews with 13 caregivers from throughout the U.S. and Canada in which they describe their daily routines and problems as well as their reactions to being so close to a declining parent, grandparent or spouse. This is Koch's second book. The first, Mirrored Lives: Aging Children and Elderly Parents (Praeger, 1990) described his five years as primary caregiver for his fragile and failing father, exploring both his and his father's emotional reactions to their changing roles.

While the interviews reveal the reality of caregiving, they are not as interesting as Koch's very perceptive and inspiring analysis of the importance of caregiving in the context of the many dehumanizing aspects of modern life. "What each care giver learned through caring is that one does not have to constantly improve, to become something stronger or better, to function as a moral arbiter or financial genius. It is enough simply to be, to exist with another," Koch observes in his final chapter, "The Chorus."

In Koch's view, for some people, caregiving can be an essential rite of reaffirming the bond developed in earlier years with the person cared for or of coming to terms, in an adult way, with a parent's failings. People mature through caregiving and increase their knowledge of themsevles and others. The "tie that binds" is also the tie that liberates.

"When I was small," Margaret Neilson says, "the big thing was to go with my dad on the weekends, and one of us was allowed to go to my grandma's house and stay with her for the weekend." To be the child chosen for an overnight visit at her grandmother's was a privileged respite. Margaret Neilson's sense of being as an adult is built on the strength of moral and emotional support she felt as a child with the older woman. As Ms. Neilson put it: "She was always good to me and I could always seek her out when I had a problem, and it (caring) was the least I could do." That mutuality -- the child's memories feeding the adult's vision -- has become a bond between the two women that Ms. Neilson does not want to sever. For the younger woman to deny her grandmother's needs, to allow her to live out her last years in institutional care, to refuse her own time and attention when asked to help, would have been to deny the moral and emotional ties, the necessary bonds that not only join them but, in some ways, define Ms. Neilson's present."

Another caregiver, Brian Leonard, returns to his family "not simply to assist his mother in her husband's care but also to come to terms with a complex of feelings and memories involving the father."

"I realized that I shouldn't feel resentful toward him any longer," says Leonard. Koch analyzes this caregiver's psychological journey along the following lines. "And so the son comes to accept the father's failings, to meet through caring the disparate parts of a parent's complex personality he has known across a lifetime. The adult's hypocrisy -- do as I say and not as I do -- which seems so intolerable to an adolescent, is accepted in maturity by the adult who knows how easy it is to fail another, how tempting it is to let demands pile up and goals be articulated that cannot be fulfilled."

For every caregiver, Koch believes facing the decline of "a once potent parent, grandparent, or spouse," means facing the inevitability of one's own decline. Koch adds that "the existential terror this reality implies, the fear it can engender, is remarkable ... Through this choice (of caretaking) comes a context in which the primarily younger care givers must face the essential, existential human anxieties of death, loss, and isolation. What is returned by the experience is a feeling of reality, a knowing that one exists not as an isolate or a function (i.e., parent, wage earner, comforter) but within the framework of ongoing, essential relations."

There are times when Koch's prose is heavy going and his explanations overly psychological -- when it's a relief to remember the answer one caregiver gave when he was asked why he continues to care for his wife who has Alzheimer's. "Because I love her."