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A Bittersweet Season: Caring for Our Aging Parents--and Ourselves [Deckle Edge] [Hardcover]

Jane Gross
4.6 out of 5 stars  See all reviews (94 customer reviews)


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Book Description

April 26, 2011
Just a few of the vitally important lessons in caring for your aging parent—and yourself—from Jane Gross in A Bittersweet Season

As painful as the role reversal between parent and child may be for you, assume it is worse for your mother or father, so take care not to demean or humiliate them.
Avoid hospitals and emergency rooms, as well as multiple relocations from home to assisted living facility to nursing home, since all can cause dramatic declines in physical and cognitive well-being among the aged.
Do not accept the canard that no decent child sends a parent to a nursing home. Good nursing home care, which supports the entire family, can be vastly superior to the pretty trappings but thin staffing of assisted living or the solitude of being at home, even with round-the-clock help.

Important Facts
Every state has its own laws, eligibility standards, and licensing requirements for financial, legal, residential, and other matters that affect the elderly, including qualification for Medicare. Assume anything you understand in the state where your parents once lived no longer applies if they move.
Many doctors will not accept new Medicare patients, nor are they legally required to do so, especially significant if a parent is moving a long distance to be near family in old age.
An adult child with power of attorney can use a parent’s money for legitimate expenses and thus hasten the spend-down to Medicaid eligibility. In other words, you are doing your parent no favor—assuming he or she is likely to exhaust personal financial resources—by paying rent, stocking the refrigerator, buying clothes, or taking him or her to the hairdresser or barber.


Editorial Reviews

Review

“A forthright story and trenchant advice . . . Gross’s chronicle of her mother’s decline is intimate and affecting, and her advice to readers is insightful . . . A Bittersweet Season manages to send its voice aloft, its two parts harmonizing in sorrowful, haunting song.”
            -Annie Murphy Hall, The New York Times Book Review
 
“[Gross is] an incisive reporter with a fine eye for detail . . . A Bittersweet Season is sure to become required reading for anyone with an elderly parent who depends on long-term care.”
            -Associated Press
 
“This is tough stuff, and Gross writes movingly about the toll it takes on her and other caregivers. Although her tone is often darkly humorous, she’s serious about documenting the often hidden workload borne by middle-aged daughters and sons.”
            -Kate Tuttle, Boston Globe
 
“Nothing can fully prepare you for the overwhelming experience of caring for your elderly parents, but Jane Gross’s new book, A Bittersweet Season, comes awfully close . . . Gross is an incisive critic of our systems and institutions.”
            -David Takami, The Seattle Times
 
“An invaluable guide . . . One thing is for certain: Individuals, families, medical professionals, and our society’s institutions have a pressing moral duty to reform our failing systems of care for the fragile old and dying. Jane Gross’s excellent book can help us do better on all these fronts. Middle-aged adult children can read with their parents and help prepare themselves and each other for the inevitable. Families can be encouraged to have those difficult conversations. Jane Gross has taken her own painful experiences and worked hard to give needed help to us all.”
            -Sidney Callahan, Commonweal
 
“A Bittersweet Season is sure to become required reading for anyone with an elderly parent who depends on long-term care . . . The time to read the book is before the crises begin to mount.”
            -Winston-Salem Journal
 
“Accessible and always compassionate . . . Readers may pick up this very well-written book to learn about taking care of their own ailing parents, but will soon realize that it’s also a wake-up call to become educated in order to make informed decisions about their own inevitable aging.”
            -Sandee Brawarsky, The New York Jewish Week
 
“Poignant . . . Both heartwarming and heartrending.”
            -Edith Paller, Haaretz
 
“Smart and highly detailed.”
            -Meredith Resnick, Psychology Today
 
 “In A Bittersweet Season, Jane Gross combines her unique perspectives as a health journalist, daughter and caregiver to unflinchingly explore the last phases of her mother’s life and death. Interwoven with this inspiring personal narrative are practical, hard to access, vitally useful lessons and information she learned along the way. One way or another the issues and circumstances vividly portrayed in this book will be faced by us all, so we would do well to use it to help us contemplate the inevitable and prepare as best we can.”
-Timothy Quill, M.D., author of Caring for Patients at the End of Life
 
“Jane Gross deftly weaves the story of her mother’s final days with a moving account of the toll that takes on her life and the life of her brother and the lessons learned along the way.  Hers is an indispensable handbook for anyone facing the prospect of caring for an aged parent.”
-John Darnton, author of Almost a Family
 
“Few of us were raised, much less educated, to care for our parents at the end of life. Now that need has become commonplace, opening the door to a demanding and complex duty. Jane Gross tells us the story of the struggle she had in caring for her dying mother. It is moving and at times wrenching, but as a resourceful and probing journalist she puts her story in the larger context of how we organize health care in this country, what science is coming to know about aging, and how as individuals and institutions we can meet the challenge in ways both wise and loving. It is a book equally touching and informative, a rare combination.”
            -Daniel Callahan, author of Taming the Beloved Beast
 
“A Bittersweet Season is a brave and compelling book by a masterful storyteller.”
            -Carol Levine, director, Families and Health Care Project, United Hospital Fund
 
“In A Bittersweet Season Jane Gross has produced a deeply felt and beautifully written account of a journey to the emotional center of caregiving—one backed by thousands of readers’ confirming details from her New York Times New Old Age blog and her outstanding capacity as a journalist to distill experts’ knowledge of aging and late life caring.”
-Dennis McCullough, M.D., author of My Mother, Your Mother
 
"Hugely informative, and a gripping read."
            -Betty Rollin, author of Last Wish
 
“Jane Gross’s book tells us that taking care of our aging parents will be emotionally demanding and potentially very expensive.  In a time of financial crisis, Washington is telling us not to count on it for help. This book is an invaluable and comprehensive primer on what most Americans will face soon.  Its honest and loving message is to prepare yourself now.”
            -Jeff Madrick, author of Age of Greed
 
"With great insight and empathy, Jane Gross guides us through one of the most difficult of all life transitions—the decline and death of our parents. Not only does she provide a wonderfully helpful guide for how and what to do, and when. She also enables us to understand what our parents need, and what we ourselves need, during this passage. When the old roles reverse—as we take care of them instead of them taking care of us—we're likely to face deep challenges, as well as final opportunities for love.”
-Robert B. Reich, author of Aftershock
 
“Jane Gross’s journey as child of an aging and ill parent is one that too many of us will be making. How wonderful to have her mix of sage advice, pithy insights and practical discoveries at hand when and if that time comes. A Bittersweet Season is a unique and lovely book.”
-Abraham Verghese, author of Cutting for Stone 
 
“A Bittersweet Season deals with a sobering topic. But the narrative is so lively and informative that readers will come away feeling more prepared than pessimistic . . . An intelligent guide to handling the onset of old age with sagacity and sensitivity.”
            -John Slania, BookPage
 
“Old folks—the fastest-growing demographic of all—are indeed a problem, particularly for their Boomer kids . . . Problems like [ours] need a good, big, authoritative book, and here it is: A Bittersweet Season.”
            -Ann La Farge, Hudson Valley News
 
“This remarkable book tackles difficult subjects with aplomb . . . A Bittersweet Season could be called a love story. While Ms. Gross freely admits the flaws in her family’s relationships, she also chronicles how a previously loosely woven connection becomes strengthened by time and trial. Reading this book and applying its lessons affords the reader an opportunity to better know and understand their parents and to prepare for the inevitable aging process.”
            -Phyllis Hanlon, TOS50.com
 
“I raced through A Bittersweet Season in three days . . . I couldn’t put it down. Every page held valuable, practical, unexpected information.”
            -Pamela Kelley, Alzheimer’s Reading Room
 
“Gross’s tone is straightforward, but not cold or clinical, when she shares the heartbreaking story of her aging mother, who died in a nursing home. With well-written and researched prose, Gross debunks misconceptions about assisted-living facilities and offers eye-opening anecdotes about Medicare and Medicaid, including how her own upper-middle-class mother ended up on Medicaid and virtually penniless due to health-care costs. The author also gives gentle guidance for understanding the biology and psychology of aging and ways the adult child can best help the parent . . . With a poignant, honest voice, the author recalls her mother's suffering. This book will remind readers that quality-of-life issues are important, and will hopefully prompt those types of discussions. There are no easy answers here, because there are none. A thought-provoking reso...

About the Author

Jane Gross was a reporter for Sports Illustrated and Newsday before joining The New York Times in 1978. Her twenty-nine-year tenure there included national assignments as well as coverage of aging. In 2008, she launched a blog for the Times called The New Old Age, to which she still contributes. She has taught journalism at the University of California, Berkeley, and at Columbia University, and was the recipient of a John S. Knight Fellowship. She lives in Westchester County, New York.

Product Details

  • Hardcover: 368 pages
  • Publisher: Knopf; 1 edition (April 26, 2011)
  • Language: English
  • ISBN-10: 030727182X
  • ISBN-13: 978-0307271822
  • Product Dimensions: 6.5 x 1.4 x 9.6 inches
  • Shipping Weight: 1.6 pounds
  • Average Customer Review: 4.6 out of 5 stars  See all reviews (94 customer reviews)
  • Amazon Best Sellers Rank: #160,820 in Books (See Top 100 in Books)

More About the Author

Jane Gross, founding blogger of "The New Old Age'' at the
New York Times,'' was a correspondent there for 29 years and preciously a reporter for "Newsday'' and a researcher at "Sports Illustrasted'' magazine. "A Bittersweet Season,'' (Knopf/Vintage) is her first book. You can follow her more recent work on aging and caregiving on the "Bittersweet'' fanpage on Facebook at https:www.facebook.com/JaneGrossAuthor.

Customer Reviews

Most Helpful Customer Reviews
68 of 68 people found the following review helpful
5.0 out of 5 stars Old Age is a Massacre April 2, 2011
Format:Hardcover|Amazon Vine™ Review (What's this?)
This is a memoir about the final years in the life of the author's mother - AND a guide to the Rube-Goldberg-like complexities of Medicare, Medicaid, assisted living facilities (great for those who need no assistance), and nursing homes. It's about how the system is broken - a ridiculous maze of conflicting and unrealistic rules that (unsuccessfully) try to make a for-profit health care system humane. It's also about how, as Phillip Roth put it, "Old age isn't a battle - it's a massacre."

The number one killer in the US is heart disease - number two is cancer. After a motley assortment of other diseases causing "early" death, we are left with that large group where everything is wearing out but the body refuses to die. This group is subjected to endless serial humiliations - physical and financial. Even if older couples enter their golden years with a million dollars they can die bankrupt and on Medicaid. Enlightened ones might even plan for it and give their assets away early. The wealthy and the destitute have less to worry about.

Gross definitely gets it right. My wife and I (mainly my wife - as Gross succinctly points out, the primary family rep is female at least 80% of the time), are going through this for the third and fourth times now. We have faced or are facing most of the issues she covers. Her chapter about Thanksgiving dinner in the nursing home (touching on a pecking order resembling a high school cafeteria) was perfect. She could have been describing our exact facility - with one dining room for those who could use a fork and another for those who required "feeders." In her words, "The elderly hate that you have to visit them in these surroundings on a holiday, so act like you're having a decent time even if you're not. Make it seem okay, but don't go overboard - that would insult their intelligence."

Gross emphasizes how important it is that families are heavily involved. The staff range from just OK to exemplary - but they have a lot of patients, many demands are placed on them, and the behavior of the patients (and sometimes the families) leaves a lot to be desired. The author's and her brother's constant tactful intervention (and help) resulted in consistently better care for their mother. My wife and I have used similar tactics and it makes a difference. I'll pass on a few instances where advocacy resulted in positive change:

First, when they figured out how to get re-authorization for Physical Therapy ("I'd love to be able to stand just one more time"), if just for an occasional session. She still had her mind but was completely stuck in a body that wouldn't work.

Second, when they figured out a way to get her qualified for a college-level writing class geared specifically for nursing home clientele. Problem is, a series of ministrokes had affected her speech and she couldn't manage the communication skills required for the class. Shortly after the first session started, she remarked, "I guess I can't do this either" - but it was one of the few group activities that attracted her interest. The author and her brother brainstormed and arranged this solution: a student intern who could understand their mom (through much practice) would wheel her out into the hall, take dictation, then wheel her back in and read her work to the class.

Third, when she could no longer speak at all, they came up with the "talking board." This was a recording console that had 30 big, easy to punch buttons. They programmed it with 28 recordings she could choose from to interact with nurses and staff. The last 2 buttons, they saved for their mom to have fun with. For 29, she decided on this response, appropriate for the occasional surly aide: "You'll be old too, someday, you know." The 30th button was outrageous: "Get the f___ out of my room." When she used that one on the persistent rabbi, the ice was finally broken and they became friends - communicating only on her non-religious terms.

In this kind and gentle memoir, you'll learn a lot about our health care system, how in old age less care can be better care, and that you need a primary care physician who gets the big picture (a geriatrician). After her mother's death, the author started a blogsite about "end of life" issues. It appears that the experience with her mother and that blogsite led to this book. "Bittersweet Season" was surely a labor of love for this author. It was a pleasure to read and offers a wealth of resource material for anyone who has yet to face this very difficult part of life & death - and I recommend it highly.
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36 of 36 people found the following review helpful
5.0 out of 5 stars Ripped From The Headlines Of My Life May 6, 2011
Format:Hardcover|Amazon Vine™ Review (What's this?)
The worst nightmare of most adult children is that their parents will die a lingering death, suffering a drawn-out and humiliating series of losses and depleting all financial reserves. Yet somehow, we think, "It won't happen to OUR family."

Wrong! In Jane Gross's important new book, she reveals that approximately 40 percent of Americans, generally past the age of 85 will follow this course - and that number will only grow with improvements and prevention and treatment of cancer, heart disease, and pulmonary disease.

Those of us who are baby boomers - used to being in control - must stand by and (as one of Jane's bloggers stated), "watch our mothers un-live." Yet we are stuck in a medical world where old age is considered a disease with a cure...when in reality, precisely the opposite is true. There ARE no heroics and there IS no cure for aging. Jane quotes Dr. Sherwin Nuland in saying, "The very old do not succumb to disease, they implode their way into eternity."

This one is PERSONAL for me. Like the author, I was thrust into an unanticipated role of moving my vibrant mother halfway across the country to a senior facility nearby. It upended my life, causing never-ending cycles of guilt, resentment, frustration, overriding terror and exhaustion - along with the days of feeling unaccountably blessed to have the chance to be a part of my mother's world again. I trusted my intelligence and management skills and believed I was making all the right choices. I wish I had read this book two years ago! Among the insights that Jane Gross reveals:

*The Medicare fee-for-service system is broken. To get paid, doctors must recommend a billable procedure; recommendations on lifestyle changes, for example, translate to no payment. Small wonder that few doctors are opting for gerontology or even internal medicine. Small wonder, too, that one-third of Medicare-age patients have difficulty in finding a new physician!

*Researching the best specialist in the field isn't always (or even usually) the answer. Sometimes, an operation can be performed and the elderly patient dies of the recovery. The question to really ask is, "Is the procedure worth it, given the waning number of years?"

*Public policy has yet to keep up with the needs of a populace, inevitably adult daughters, who put their own jobs and marriages at risk. In a study, most respondents wanted caregiver tax credits and respite services - an unlikely scenario, given today's economy.

*There comes a time when the person you viewed as parent and protector begins receding into the past. "She never stopped caring about us, per se," writes Jane Gross of her own mother, "only in our babble about a world she no longer lived in."

I could go on and on about this amazing book. I read parts of it with tears streaming down my eyes because I've been there, done that - the late night trips to the emergency room, the confrontations with a mother who initially held me responsible for her diminishing independence, the vacation guilt, the being labeled an "hysterical daughter" when I demanded certain care levels, the scramble to find quality care and a caregiver we can trust.

I was luckier than most: my mother did save up for old age and we rather quickly found a senior facility that concentrated on living, not dying, in The Hallmark (Chicago). And I have a wonderful sister who is on the same page. But the fact that I'm interjecting myself into this review is the whole point: this is shared problem that demands shared answers. Bravo to Jane Gross for a well-researched, highly personal, crucially valuable and very intelligent book.
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34 of 35 people found the following review helpful
Format:Hardcover|Amazon Vine™ Review (What's this?)
This book is particularly pertinent to me. My Mom is 84 and has just moved to be near me and lives in an independent living facility. However the author points out, if you are in your 40s and your parents are in their 70's it may be time to have that difficult conversation on how they want to finish out their days. The story starts out, with the author Jane Gross moving her Mom from Florida to NY state to be near her after some medical issues. This book tells of her ensuing struggles and mental angst that we will all face someday.

If you are in your 30's-60's and have living parents, this book will provide you one example of what you may well face as your parents age. There are many questions and choices that have to be made. This is a combination memoir and cautionary tale of the end of life struggles in our and our parent's futures. The author writes of what she went through with her Mom very specifically, but also provides information and discussions on aging in the US.
Some things unique to the author and her Mom, that she acknowledges:
* The author's Mom knew it was time to move nearer to family, there was no resistance. This is not the most common situation.
* The author's Mom was of sound mind and quite practical.
* The author's Mom purchased long term care insurance and had assets of her own
* The author had a brother who worked with her at this time
* The author and her brother have upper middle class jobs
* The author and her brother are childless
* The author and her brother live near New York City, so prices as well as availability of services were high.

To many of us, this situation is much better than we will face. However in a broad sense the author speaks of making the choices at this stage in life over quality of life versus quantity. She also speaks of the need of a primary care physician (Geriatrician) that coordinates care between specialists to understand the broader implications of choices that a specialist may not consider. This is very helpful. However this speciality is quite unique and may be in short supply. I myself noted when my Mom was ill, that her primary care physician did not coordinate and was content to leave decisions to specialists, that might not have the full picture. Often I ended up providing this coordination and quite frankly I'm not qualified. Are you?

As I read through this book, I became more and more frustrated. As the author points out, Medicare does not provide for any level of custodial care. Medicaid does but only after the recipient has "costed down". Essentially this means, once the individual has become penniless they will qualify for this care. How ironic. The same group of people that this country has been on the backs of for their entire life, must be sucked dry before they qualify for the benefits they deserve (and in many ways paid for). The penniless that may have never worked, get this as a gimme. This truly burns...

The author recognizes that she and her brother are lucky in the sense their Mother was practical and cognizant and financially was able to handle most of the cost. She also knew she was not sandwiched between children and an elderly parent. Financially she and her brother could bear some of the burden a bit better than most.

However similarly, they were not prepared for the bureaucracy and poor structure that is out there to handle caring for an elderly parent, be it hospitals or nursing homes. They also had the balance between work and caring that we all face, as their parent must be represented during doctor's appointments by one more able to handle the transportation and paperwork. Worse yet, they also felt sandwiched between specialists that don't consider the impact their recommendations would have on an elderly person, hence the recommendation for a geriatrics coordinator or specialized doctor (Geriatrician) mentioned above.

In reading this, I was also quite floored about how many holes in quality care there was. As a matter of fact hospitals, as a model of organization, seem clearly a major hazard in an older person's health. The author talked of issues with lack of clarity on discharge orders or issues reviewing them with a patient. The author also spoke of a not too uncommon occurrence is discharging an elderly person without their eyeglasses or dentures. Often they get left behind if a family member is not helping during the discharge. This may sound like a slight oversight, but as most of you would know replacement would run in the $1000s. On a fixed income this could be devastating. I was hoping my poor experiences with hospitals and the elderly were an unusual occurrence. Now I'm disheartened.

Another point the author made was on statistics provided by Dr. Joanne Lynn which I am only partially quoting below on deaths of older Americans. There are mostly 3 main ways to die:
* Cancer deaths peak at 65 after years of good health and cause 20% of older American deaths.
* Deaths due to organ failure peak at 75 kill 25% of older Americans.
* Or a long drawn out death over 85 that bankrupts the individual and taxes the families. 40% of those over 85 will die this way.
As we approach the largest population in the US of old age, these statistics are frightening.

The end of the book has 9 pages of resources. I intend to avail myself of all that information.
The author also has a blog called the New Old Age blog. Hopefully here she will continue to provide useful information for the rest of us. This book is a must read for those of us entering this stages of care for our parents.
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Most Recent Customer Reviews
5.0 out of 5 stars Outstanding
A must read for anyone with aging parents. Sobering look at health care and financial burdens adult children may face.
Published 4 days ago by Karen
4.0 out of 5 stars Good overview of elder care issues
I love the Old Age blog on the New York Times, but this book gets a bit whiney at times. There is good basic information about caring for an elderly parent, but it's not always... Read more
Published 24 days ago by Leah G. Forster
4.0 out of 5 stars Really gave me perspective
Some of the details are out of date, but it provides good guidance on what not to do and gives emotional perspective.
Published 1 month ago by JEB
5.0 out of 5 stars When children become the caretakers...
Just as the author, Jane Gross, found herself becoming more and more the "adult" in her relationship with her mother, my husband is experiencing the same change in family dynamics. Read more
Published 1 month ago by QueenKatieMae
4.0 out of 5 stars Very good retelling of author's experience
Very in depth retelling of author's experience, ups and downs. I recommend reading it in advance of parent caring season of life because there's so much to learn especially if... Read more
Published 1 month ago by Gardener
5.0 out of 5 stars 70 plus and counting
My children think I am still in my 50's. So it is hard to talk to them about my aging. I read this book and gained a lot of information. Read more
Published 1 month ago by Jimbob
5.0 out of 5 stars a very informative heads-up!
Both easy to read and informative. I'm approaching this issue in my family, so it helps to be aware of the many issues I may have to deal with before too long. Read more
Published 1 month ago by Karen L Thompson
5.0 out of 5 stars Essential reading.
This book is essential reading for any adult child who is caring for aging parents. There are plenty of us. Read more
Published 2 months ago by A. E. Davidson
4.0 out of 5 stars Though provoking, and very detailed. Too US oriented, and even within...
Interesting and useful read. Changed my attitude towards parents and in-laws.
I'm not from the US, so several chapters are not applicable.
Published 2 months ago by Alexandru Jalba
5.0 out of 5 stars Highly recommend.
Insightful & very informative. Our book club will be reading it as we are all experiencing caring for our aging parents now.
Published 2 months ago by K
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