An aging, widowed parent becomes cognitively impaired, and adult children, scattered around the country or the globe, ponder their options.
Not comprehending the extent of their parent's decline until they're in town for a visit, adult children often show up in the office of geriatric social worker Paula Wolfson in emergency mode.
"Most people don't know anything about these topics until they happen to us," said Wolfson, manager of Avenidas Care Partners, the agency's social work department.
"But if you tend not to plan ahead, it becomes high drama and high stress."
Wolfson sometimes finds herself facilitating the family discussion. Should they sell the house? Bring in caregivers? Place the person in a facility? Relocate the parent to their area and try to care for them while working and caring for children?
"The ones who come in already in a state of crisis have a harder time because they're functioning with really high levels of stress and anxiety," she said.
She is partial to Louis Pasteur's observation that "chance favors the prepared mind." To that end, Avenidas holds regular education conferences on senior housing, finances and care-giving including a conference on senior housing options scheduled for Saturday, March 22.
But developments frequently catch families off guard, and Wolfson said she's never sure what kind of situation will walk through her door.
"Sometimes they just need help with how to talk to their 80-year-old father who was a general in the military or head of a corporation or a noted professor and is used to being in total control," she said.
"The conversation might be about the fact that they're not driving safely any more, or that they should not have their evening cocktail with their evening medication. These are the types of conversations that children find it very awkward to bring up with their own parents."
In other cases, initial conversations bring related issues to the surface: depression, alcoholism, financial abuse or problems with hoarding.
"We are constantly learning from our clients that one needs to take care of self first: rest, eat and sleep well, see their physicians, exercise, find community, stay connected and cultivate a positive attitude," she said.
"I keep a heating pad, tissues, cough drops and hugs available. Sometimes I physically stretch with clients as we talk."
Wolfson keeps a stockpile of information on senior housing in the area, as well as an online "caregiver directory" that can identify care facilities based on criteria such as languages spoken by staff or whether the facility welcomes Medicaid/MediCal or accepts "people who wander."
Families often are surprised to learn that their health insurance will not pay for long-term care or housing, Wolfson said. "They've worked hard and paid taxes for most of their lives and somehow they think the government is going to pay for their long-term care needs," she said.
"A lot of people are not familiar with the concept of private pay versus some sort of public funding for their aging expenses. This still surprises me, but it happens."
Other clients are not in the midst of any emergency, and just need help "reframing" their lives after a major transition such as loss of a spouse.
"What I'm discovering about some of my single older women clients is that, for the first time in their lives, they're kind of masters of their own fate not constrained by husbands or children or work schedules and rather free to create a life they love.
"Some of them come in here and just want to talk about that, what their values are and how they want to be in the world. I have an 80-year-old doing yoga and a 92-year-old writing a book, so it's not our typical world of leisure retirement any more."
Other women find themselves caring for frail family members sometimes even more than one.
"When we last met, my husband had just been diagnosed with Alzheimer's, and it was helpful talking with you," a client recently wrote to Wolfson.
"It's been about six months now, and I could sure use a bit of your time to talk through some of my newest challenges with him."
Isolation and loneliness are the greatest risk factors for seniors, said Wolfson, who finds herself linking clients with caregiver support groups, the daily La Comida lunch group and the other array of classes and programming at Avenidas.
More than 1,000 calls a year come in on Avenidas' information and assistance line, mostly related to care-giving, housing, transportation, medical crises and relationship issues, Wolfson said.
Gerontologist Anabel Pelham will headline Avenidas' March 22 housing conference, which will cover senior housing options including aging in one's own home, de-cluttering and tips for adjusting to the first month in a new housing community.
Registration is $40 for Avenidas members and $45 for nonmembers through March 14 and $50 after that date. To register go to https://www.avenidas.org/activities/conferences-events/housing-conference or call Avenidas at 650-289-5400.