By Paula Span
(Reviewed by Dr. Jane Duhl)

I kept seeing myself in Paula Span’s book. First, I was 59-year-old Jane, living in Virginia, daughter of 80-year-old Sophie, living in Florida. Jane was talking with Sophie each day and flying to Florida every few months to balance her checkbook—and to check her balance. And her balance was off . . . a meticulous housekeeper whose bathroom was now dingy; a great cook whose taste buds were failing; a driver whose friends refused to get into her car anymore; a doting grandma who didn’t remember her granddaughter was pregnant; my sister Ilene (living in New York) and I going nuts about what to do. How can we get Sophie to consider leaving the home and community that she loves so much and has embraced her for the last 20 years, and what satisfying, dignified alternatives are there for her?

Paula Span’s informative and well-crafted book about families responding to the needs of frail and aging parents was just what we needed. Too bad for us it wasn’t published until 2009. The beauty of When the Time Comes is that it is told through family stories—real scenarios illustrating how children and their aging parents approached difficult questions about what to do next, because change is essential for the health and safety of a loved one. The aim of the book is to help seniors and their families assess which strategies are best suited to their own situation. While the book is filled with well organized and researched information, the stories are its heart.

In the introduction, we meet Paula Span and her 83-year-old father. Dad is fairly healthy and living in his own home. Outgoing and cheerful, he is driving, playing cards, cooking, helping less able friends, and attending religious services. But like my mom, his home and personal grooming has become sloppy. Dad and daughter are visiting an assisted living center to see if it might be a place for him when/if his health and abilities deteriorate. How smart and sensitive to do this before it is needed! Now, three years later, Dad is still doing well on his own. It was this experience, and many conversations with friends of aging parents, that sent Paula Span on the three-year odyssey it took to explore the way families “step up” and what services are available to assist them. Each chapter explores different options and is filled with information about services, questions to consider, and stories of families dealing with difficult decisions.

“Staying Put” is what most seniors want; they want to stay in their own home and community. The next option discussed is “Moving In”—sharing a household with a family member. Next is “Moving On,” i.e., considering an independent or assisted living facility. The next chapter delves into what everyone fears: nursing home care. Discussed last is “Hospice Care,” the wonderfully compassionate end-of-life service. This book is a gift basket of great information.

Adult children are the intended audience of When the Time Comes, but how do elderly parents feel as they read this book? Jane, now a 73-year-old, and husband Dan, 83 years old, are luckily in pretty good shape and living in their own home. But reading about the failing health that elders are bound to experience unless they die quickly was often depressing. The vision I have for myself is to live fully, and then die quietly and sweetly in my sleep, not dealing with illness, nursing homes, caregivers, the smallest task, or my children needing to care for me. But, as always, I want to be prepared for my future, whatever it is, and Paula Span has helped me think through how to do it.

Thank you, Paula. I’m going to give a copy of your book to all my children.