Academic journal article Generations

Care at Home: Virture Multigenerational Households

Academic journal article Generations

Care at Home: Virture Multigenerational Households

Article excerpt

Mrs. Morse, shriveled and bent from osteoporosis, is 76 years old. She broke her hip in a fall five years ago, at which time she moved in with her daughter and son-- in-law, Carolyn and Matthew Broome. A second fall three years later left her bedridden, and now she is back in the hospital with a long list of problems. Among other things, she has developed serious pressure sores-- some bad enough that bone

tissue shows through-from being bedridden for so long. She needs regular changes of dressings on these sores, and while this is quite a painful procedure, medication has kept the pain at manageable levels. Her daughter (and to a lesser extent, her son-inlaw) is deeply involved in her care.

When the physicians ask Mrs. Morse for permission to do a procedure, she invariably responds, "I don't know. You'll have to ask my daughter" Carolyn Broome, who is an attorney, keeps explaining to her mother that she must make these decisions for herself, but Mrs. Morse just shakes her head and says, "You decide." Carolyn's decisions have been reasonable ones, but recently she has become very concerned about the amount of pain medication her mother is getting. She had a long phone conversation with her aunt Bessie, Mrs. Morse's sister about this and has been demanding ever since that the analgesics be administered much more sparingly. She says they make it hard for her mother to visit with her, and she wants her mother to be alert.

In the opinion of the treatment team, Carolyn Broome is becoming overinvolved in her mothers ill

ness, letting her own psychological needs push her into making decisions that are increasingly inappropriate. The team learned that the sister has not even visited Mrs. Mose in a number of years. The call goes out to the hospital's ethics committee in hopes that some strategy for changing Carolyn Broome's mind about reducing the pain medication can be worked out. Failing that, perhaps there is a way of get

ting her out of the decision-making loop. As one nurse puts it, "I feel as though I'm being forced to participate in the abuse of a vulnerable patient."1

This is obviously a story about ethical conflict between a patient's professional caregivers and a member of her family. Less obviously, though, it is also a story about the care that is given by one generation of a family to a member of an older generation. In what follows, we explore a moral challenge common to multigenerational family life, particularly as it involves generational differences in household roles and responsibilities. We will argue that unless professional providers of healthcare are aware of this challenge and respectful of the demands that it places on family caregivers, providers can inadvertently exacerbate the difficulties the family faces when an elderly person requires medical care. Mrs. Morse's treatment team is on the very brink of doing just that. So first we will identify the challenge, then we will offer ways to respond to it, and finally we will consider what the professionals involved in Mrs. Morse's care are doing to hurt this family.

We conceptualize the challenge in a particular way, as a version of the general social problem of dealing with diversity-in this case, differences related to gender and generation. We identify three linked factors that make it difficult to deal well with intergenerational diversity within households-change, identity, and death. In reflecting on the virtues that are needed for coming to terms with these factors, we find the resources that can keep Mrs. Morse's treatment team from standing in the way of the daughter's attempts to care admirably for her mother.

THE MULTIGENERATIONAL FAMILY AS A 'MULTICULTURAL' FAMILY

Consider two prominent features of many contemporary families, especially middle-class American ones. The first feature is their role in providing fairly comprehensive care for their members, particularly those who are very young and those who are very old. …

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