For Melinda Cavanaugh, the decision to bring her mom to Juneau was emotional.
Cavanaugh's father died in 1998 and her mother, Lotus Pasternak, was bedridden.
"At the beginning it was just an emotional reaction," Cavanaugh said. "We didn't really think of anything else."
Cavanaugh didn't realize then that Pasternak had Alzheimer's disease, an irreversible neurological disorder often associated with aging. She didn't wonder how they'd all fit in the Cavanaugh's single-family home or check what sort of senior services Juneau offered. And her husband, Archie Cavanaugh, didn't question the sacrifice he was being asked to make.
"I accepted it immediately just simply because if she was my grandmother or my grandfather or my dad I'd do the same thing," he said. "I just have this immense obligation that if family that close needed my help, for all the things they've done in my life, that would be a small token of repayment of appreciation."
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Many other adult children make the same decision. A 1998 survey for the Juneau Committee on Aging found that 8 percent of Juneau seniors live with their children and 27 percent have physical disabilities. The survey showed that about 3 percent had Alzheimer's.
The number of middle-aged children caring for their parents is expected to increase nationally as the number of the oldest seniors grows, potentially tripling in the next 60 years. More than half the seniors 85 and older have disabilities.
For Melinda Cavanaugh, the first year was difficult. She found herself grieving for both her dead father and the mother she'd once known. Though Pasternak improved physically as the Cavanaughs got her out of bed and walking around, her mental abilities slowly deteriorated. Now 89, Pasternak repeats the same stories and phrases, not realizing she said them before. An hour after dinner she'll forget she ate.
"My mom is not the person she used to be," Cavanaugh said. "Most kids that are in my position, it's hard to have the roles reversed, where I'm the mom actually."
There are wonderful things about having her mom in the house, too. Pasternak sometimes helps in the kitchen, stirring the gravy or putting away plates. She plays with her 4-year-old granddaughter.
"They're both like little children," said Archie Cavanaugh. "It's funny to see those two sometimes arguing or playing with their dolls. It's kind of comical."
Though Pasternak can be childlike, and often forgetful and confused, her sense of humor remains.
"She's a joy to have in our lives because as elderly as she is, she has a sense of humor and she's the same in that way," said Archie Cavanaugh. "We always laugh at the same parts."
The Bridge Adult Day Center, which provides a safe place for seniors needing assistance during the day, has made it possible for the Cavanaughs to care for Pasternak. Melinda Cavanaugh drops off her mom in the morning on the way to work, then the Care-A-Van, a small bus for seniors and the disabled, brings Pasternak home at the end of the day.
"Bridge and Care-A-Van have been really my lifesavers," Cavanaugh said. "Without them I would have to quit my job or we'd have to have somebody at $18 to $20 an hour sit with her, or put her in a nursing home."
The Bridge gives adult children and their aging parents a break, said Pat Costa, whose father, Gene Specht, spends five hours a day socializing at the program at the Juneau Senior Center.
Costa originally signed up her father to go just a few days a week, but then overheard a nurse asking him how he liked it.
"It'd be great, but she only lets me go three days a week," he answered, so Costa signed him up for more. She thinks many other seniors could benefit from the program.
"There's a lot of lonely elderly people that need socialization and they don't go for one reason or another," Costa said.
Though Costa's father is in the assisted-living home Shattuck Manor, she still spends most of her time away from work taking him to appointments, doing his shopping and looking after his other needs. Costa used to run, swim and refinish furniture. She's given all that up, plus most vacations.
"I have no time for that," Costa said. "I work and I care for Father."
Saturday, the one day she and her husband have off together, is spent with her father. It takes half the day to get him ready and take him to dinner.
"It affects every minute of your life," Costa said. "It's with you. Even when you're not thinking about it, you're thinking about it."
Despite the time and sacrifice, Costa said she wouldn't have it any other way.
"I love this man to death and I'm surprised so many people don't do that," Costa said.
Taking care of her mother has made Cavanaugh think more seriously about her own old age. She used to think she'd retire somewhere warmer, "but now that down south has gotten so crazy, whether it will be in Juneau I don't know, but we probably will stay in Alaska," Cavanaugh said.
She wants to move into a condo or some other housing without much maintenance.
"Like everybody, we'd all like to live as independently as we can," Cavanaugh said. "Even my mom, in her diminished mental state, I can remember her telling me she'd never thought she'd end up living with any of her kids."
Cavanaugh doesn't tell her children they must care for her someday, but she hopes they'd be willing.
"I wouldn't want them to ever feel like they had to, but I do know this - my mom was a very independent, bright woman. If it could happen to her it could happen to anybody."