One of the most difficult decision adults have to make is arranging for the care of elderly parents when those parents are no longer in a position to care for themselves. It’s hard enough when parents lose their physical health; it’s even harder when dementia and other cognitive losses are involved.
Different people find different solutions. A lot depends, too, on individual factors such as income, local living options, size of one’s house and space available, and so on. There are cultural factors too (more on those shortly). No solution is entirely perfect, but many families opt to have in-home carers. This offers some benefits too. For one thing, it allows elderly parents to stay in their homes, and that’s what many of them would rather do. For another, it eases the caregiving burden on the adult son or daughter.
On the other hand, even a thorough ‘vetting’ doesn’t guarantee that an in-home carer will be the dedicated individual one would hope. And there’s the issue of having someone who’s not family live in one’s home. In-home care can be very expensive, too. Still, many people take that option, and it’s interesting to see how it plays out in crime fiction.
It’s not surprising that it does. There is a rising population of adults who need such care, so it’s realistic and timely. And the context allows for lots of conflict, suspense and more.
In the years before there were well-established care homes, having an in-home carer was the only option available to those who could afford one. And in earlier centuries, those people often had no special preparation for that role. Robin Blake’s The Hidden Man, for instance, takes place in 1742. Attorney and Coroner Titus Cragg goes to visit local pawnbroker and would-be banker Philip Pimbo. When he arrives, it’s discovered that Pimbo has been shot. On the surface, it looks like a suicide, but Cragg’s friend, Dr. Luke Fidelis, isn’t sure. There is pressure to simply let the case go, but Cragg respects Fidelis, and starts to ask a few questions. One important question is: who would want to kill Pimbo? In part to get some background, Cragg visits the Pimbo home. There he discovers that Pimbo’s mother lives with her son. She is cared for by the family housekeeper, Ruth Peel, who does her best. She tries to make sure her charge is comfortable and well cared-for, but she has no medical background, and of course, in 1742, not much was known about dementia. So she certainly has her hands full, as the saying goes. It’s an interesting, if not exactly happy, look at the care customs of that time.
Agatha Christie’s Appointment With Death introduces readers to the Boynton family. They are on a sightseeing tour through the Middle East when they decide to spend a few days in Petra. On the second afternoon, family matriarch Mrs. Boynton dies of what looks at first like a heart attack. That wouldn’t be surprising, since she is elderly and not in good health. But Colonel Carbury isn’t quite satisfied, and asks Hercule Poirot, who is in the area, to investigate. Poirot agrees and begins to look into the matter. In this case, there are plenty of suspects. Mrs. Boynton was an unpleasant tyrant who delighted in keeping her cowed. And one of those people is her live-in nurse (and daughter-in-law) Nadine Boynton. Nadine met her husband when she came to live in with the family and look after Mrs. Boynton, and she’s had her share of abuse. But Nadine is the only person in the household who wasn’t really intimidated. She’s actually a very interesting character.
Fans of Elizabeth George’s Lynley/Havers series will know that Sgt. Barbara Havers faces the difficult challenge of finding the best care situation for her mother. As her mother slowly begins to suffer more dementia, Havers knows that she cannot live independently. Her mother has moved in with her, but even that’s not really enough. So Mrs. Gustafson, who lives next door, helps out, and looks after Havers’ mother while Havers is on duty. But the arrangement isn’t particularly successful. Mrs. Gustafson has no medical background, and more than once Havers worries about what might happen to her mother. In For the Sake of Elena, matters come to a head when Havers’ mother leaves the house alone without anyone knowing. This situation isn’t the main plot of the novel, but it does reflect the real difficulty many adult children have in trying to make the best arrangements possible for their parents. It’s a process filled with challenges.
The main character in Alice LaPlante’s Turn of Mind is former Chicago surgeon Jennifer White. At sixty-five, she has been diagnosed with early-onset dementia, and can no longer live on her own. But as the novel begins, she still has many more lucid days than bad days. Still, her grown children have arranged a live-in carer for her, Magdalena. Magdalena is very helpful at ‘anchoring’ White on her bad days, and all goes well enough. Then one day, Amanda O’Toole, who’s lived next door to the Whites for many years, is murdered. Detective Luton is assigned the case and begins the investigation. She makes the disturbing discovery that the body was mutilated in a way that suggests the work of a surgeon, or at least someone familiar with surgical tools. And, since the Whites and O’Tooles have a long (and not entirely happy) history together, Luton is naturally interested in White as a suspect. But White’s dementia is slowly taking hold, and Luton may not be able to get the real truth from her. Throughout this novel, it’s fascinating to see Magdalena’s role as a ‘memory bank’ when White forgets things. She has her own past, too, which makes her an interesting character.
In many cultures, it would be unthinkable to hire a carer for an elderly parent. In those cultures it’s seen as the family’s responsibility to look after elderly members. For instance, in one plot thread of Tony Hillerman’s The Ghostway, Navajo Tribal Police Sergeant Jim Chee gets a difficult case. Sixteen-year-old Margaret Billy Sosi has gone missing from the residential school she attends. Chee traces her to the outlying areas of Los Angeles, where she has a distant relative, Bentwoman. In the traditional Navajo culture, family members are responsible for taking care of elderly relatives, and that’s what happens in this case. Bentwoman is a very old woman, and doesn’t always speak coherently. She cannot live on her own. So her daughter lives with her and looks after her, doing everything that’s needed.
Sometimes that arrangement can work. But very often, when an elderly parent cannot be left alone, a live-in carer has to be found. That has its own benefits and challenges, but it is an option many people choose.
*NOTE: The title of this post is a line from Antony and the Johnson’s Hope There’s Someone.