Kathy Kroening

The relationship between mothers and daughters is complex.  As a psychiatric nurse practitioner, I have studied it extensively.  The last 20+ years of my career I have worked with teens and parents, witnessing numerous mother-daughter dyads in various stages of relationship.  As a daughter I have lived it. Mothers have a significant impact on their children’s lives but for daughters they embody what it means to be a woman.  They influence daughters’ self-esteem, confidence, social culture, body image, and expression of femininity. These relationships run the gamut from best friends to total estrangement with most being somewhere in the middle.  Intense love and extreme frustration can co-exist. Since family relationships are created through biological and genetic ties rather than personal choice, some parents and children are not always a good fit for each other. Every individual navigates their own journey within the family structure as they grow, age, and mature, making choices about identification, time, commitment, and support along the way.

“I am not your mother”, something no child ever wants to hear regardless of their age but something my mother has said to me several times within the past year. My mother is 91 years old and has advanced dementia. As her cognitive and emotional capabilities continue to decline I find myself frequently reflecting on our relationship and trying to make sense of what is happening to her. Since I started this blog in July my mother’s story has been filling my head and begging for release but I have resisted. Why?  A lot of what ifs.  What if I am unable to do her justice? What if it causes embarrassment for her or other members of my family? What if it is not good enough? What if I am not emotionally strong enough to write it? I can come up with many legitimate excuses but quite honestly the real reason is fear. There is a lot of water behind that dam and if I write, the dam will break, and I will drown. As much as I disdain my own tears, I cannot contain them. My intention is not to cause embarrassment or shame, which is really what keeps dementia a secret within families. My goal is to shine light on the debilitating consequences of dementia and bring awareness to a disease that devastates individuals and their families and will become a medical crisis in the next twenty years.

From the beginning it was pretty clear that my mother and I had very different personalities. I am much more like my father, fiercely independent, driven, hardheaded, stubborn and needing to be in motion.  My approach to life is very logical and analytical.  While I excel in providing emotional support to others in my work and my personal life, I am not adept at receiving. The strongest bond between my mother and I has always been our love of music.  She began playing the piano at the age of five and was both an accomplished pianist and vocalist as a young woman.  She would have loved a career in musical theatre but it was discouraged by her parents as an inappropriate career choice for a young woman at that time.  She enrolled me in piano lessons beginning at age five for which I am eternally grateful.  Music is one of my passions and something I enjoy on a daily basis.  I can’t imagine my life without it. Whether I am listening or playing music feeds my soul like nothing else.

Undated photo from Kroening family collection.

My parents met in college. My mother taught elementary school for a year while my dad finished his degree. My father trained as a pilot in the Air Force after he graduated and spent ten years in the military from 1956-1966. He flew tankers on refueling missions including B52 bombers. My brother was born in Texas and two years later I was born in Delaware.  My dad was away on missions for three weeks a month leaving my mom to single-parent two small children living far away from home. There were a number of crises in the United States and the world during that time including the Suez Canal crisis, the Bay of Pigs invasion, the Cuban Missile crisis, the assassination of John F. Kennedy, and the Vietnam War.  It was a scary time for everyone, but it created an immense fear for military wives and families who did not know when a crisis would become personal.

Given my father’s absences and a world that was very unpredictable, my mother’s resources were definitely limited.  While not intentional, I think I probably overwhelmed her patience and parenting resources as a young child.  During the time my parents were in the military, my mother wrote to her parents regularly and my grandmother saved a number of these letters which I inherited when she passed away. They are very enlightening.  In some ways it was reassuring to discover that the traits I like most in myself were present from a young age. But in other ways it was difficult to see how much my mom struggled during that time.

A few gems from those letters help illustrate the early battles my mother and I had. From 1963 when I was a year and 8 months: “What an independent cuss that Kathy is.  She wants you to do absolutely nothing for her!! I can’t even feed her – what she can’t get in her mouth by herself just doesn’t go in.  And she persists in doing things she isn’t supposed to do…last night she somehow got up high enough by the TV to work all the knobs and we couldn’t even get a picture.  Thought it had blown a tube already and we were cussing the TV – instead of Kathy, for a change. She can be the most loveable child and I try to cuddle her – which she does not like – as much as possible. But she can nearly drive me out of my mind as well.” From later that year when I was two years and five months: “Gosh she’s mature in her speaking – it doesn’t seem possible it’s all coming from a two-year-old. Jerry said she’ll be the terror of the neighborhood and will take on all comers.  She already fights for what is hers!!”

Perhaps my personal favorite was written several weeks after that: “…and when we were at Carsons Sandy took out a cigarette and Kathy was really taking it all in.  So Sandy said “Would you like to take out a cigarette for me?” and Kathy nodded.  So Sandy put back the one she had and allowed Kathy to get a cigarette for her. But Kathy wouldn’t give it up then so Jerry, over my protests said, “OK, light it and let her take a puff. We’ll teach her a lesson!” Kathy took a big breath, inhaled a small amount of smoke and as professional like as you please, blew the smoke out her nose.  No cough, no nothing! So Jerry tried again – the very same results! I don’t know who learned a lesson – but it wasn’t Kathy!! She didn’t even cough or even clear her throat!!”

While it may seem like my mother was being unfair in her assessment of me, I think she was confused and struggling to figure me out. In another letter written some time in the summer of 1964 when I was three, she wrote: “Kathy, the little pill, is cute as she can be at times.  I get so tickled at her.  She’s a talker and when I sit down and really talk to her, we can carry on quite a conversation.  But she’s so different in many ways from me that I struggle to understand.”  And that has really been the crux of our relationship.  We are very different and while we do share some interests and beliefs our timing was never great and we were often just out of sync. Have I loved my mother and has she loved me, absolutely, but love is complicated. I did not need her the way she needed and she could not parent me the way I needed.

Photo by Jerry Kroening. Dover, DE. 1963

When my father left the military in 1966, he purchased a Western Auto Store in a small town in Eastern Washington State. My parents had both grown up in small towns in Washington and wanted to raise their family in a similar environment.  My mother helped my dad with the store and was at home with my brother and I after school until I was in third grade.  At that time, in order to keep her teaching certificate active, she had to return to teaching and return to college for a “fifth year”.  She taught third grade in a classroom next to mine that year and attended night and weekend classes at the nearest college, about a 60-minute drive away. I remember seeing her doing homework in the evening and thinking how cool it was that my mom was in school now too!  It would take years before I realized the determination and stamina it took for her to do that.  She was helping her husband run a business, parenting an 8- and 10-year-old, teaching full-time, going to college nights and weekends, AND doing all the shopping, cooking, cleaning, laundry, and other household chores! As an adult it gave me a new perspective and a tremendous amount of respect for her persistence. She stopped teaching when I was in sixth grade and returned at the end of my senior year of high school, teaching elementary school until she retired.

Photo by Jerry Kroening. O’ahu, HI. 1969 

My mother was a stunningly beautiful, petite, fashionable, ultrafeminine, and elegant woman. I knew early on I was never going to be any of those things. As a kid I was a tomboy and puberty was especially brutal for me.  As a young teen, I was a tall, skinny, geeky girl with bad cystic acne and crooked teeth. Beginning in junior high, I channeled my energy into school and sports which kept me busy.  I appreciated my parents’ support at all of my sporting events. Once I went to college, I was pretty independent, working summers away from home so I did not spend much time there after high school. After college I spent the first five years of my career as an Air Force nurse and was far away from home for that time.  After leaving the military I settled in western Washington State, about 330 miles away from my parents. I think the time and distance helped me start to escape the shadow of my mother but I have to admit I was a very late bloomer when it came to embracing and expressing my own femininity.

Photo by Jerry Kroening. Lavenham, England. 1988

My parents enjoyed splitting time between a home in Arizona and their home in eastern WA in retirement. My mother started to display some memory problems in her late 70’s.  The first thing I noticed was her retelling a story in the same conversation without remembering she had done so.  It did not happen that often and my family attributed it to normal age-related changes.  In the fall of 2015, my father experienced complications from shoulder surgery and was hospitalized with an infection in the surgical site, pneumonia, and a separate infection in one knee. I cancelled a week of work and drove five hours to get to the hospital.  Although it was late I was allowed to see him, and he was not in good shape.  I honestly did not think he would survive the night (nor did he) and pretty much said my goodbyes.  I then drove an additional hour and half to my parent’s home to stay with mom who was not used to being alone. As expected, she was also not doing well.  My dad was in the hospital for a week and on IV antibiotics for another six weeks after discharge but recovered although he had limited use of the shoulder after that.

Undated Photo from Kroening Family Collection

During the five days I was there, my mom’s cognitive functioning declined.  She put a pot of water on the stove to boil one evening and forgot about it but fortunately I found it before anything disastrous happened.  She was very anxious about remembering where we parked at the hospital and being able to find the car when we finished visiting my dad every day.  I tried to help her with memory and orientation tricks like using the letter of the parking level as the first letter of a word that had some meaning for her and verbally repeating the walking path from the car to the elevator several times but she had a lot of difficulty remembering these things.  Since my dad was not sure he was going to make it out of the hospital that first night he had asked me to teach my mom how to fill up the car with gas and how to use their debit card.  I tried, but she seemed overwhelmed and confused and lacked confidence in her ability to do these things independently.  My brother shared his concerns about her decline in cognitive function and I told him I thought it was most likely due to the stress of dad being in the hospital and her fear of losing him and being alone.  I fully expected her to return to her baseline once he recovered. Sadly, her cognitive decline continued at an accelerated pace.

As I reflect on our relationship, I am grateful for many things my mother taught and modeled for me. She demonstrated a strong work ethic and taking pride in what you do no matter what others think. She taught me to embrace a love of fashion although our styles are very different. She was bright and flowy, and I am much more muted and tailored. This love of fashion sparked my boot, jacket, and jewelry obsession. It also included learning how to iron.  I realize I am probably the last person on the planet who still irons, but I dislike wrinkles, and I love crisp creases. She taught me how to entertain, set a nice table, and host an enjoyable dinner party. She passed on her love of sports and as a family we enjoyed watching college and professional baseball, basketball, and football including attending many games in person. And of course, our shared love of music. I am so appreciative of these gifts my mother gave me.

Video Screen Shot by Kathy Kroening. July 2021. Newport, WA

The number of individuals living with dementia is increasing.  It is estimated that in Americans over the age of 65 there are currently 7.2 million living with dementia, with almost two-thirds of these being women. (Alzheimer’s Association, 2025) My generation, the Boomers, includes those born between 1946 and 1964.  The oldest members of this group are now approaching 80 and the youngest are in their early 60’s. (United States Census Bureau, 2025). The Boomers are entering the age when symptoms of dementia begin to show and we are a fairly large segment of the population. Estimates of the number of Americans who will be living with dementia in 2060 reach 13.8 million. Barring development of a miraculous cure this means caregiving burden and strain on the health care system will be enormous, not to mention the cost of this care that many will not be able to afford. Two-thirds of those providing care for individuals with dementia are women. (Alzheimer’s Association, 2025)

This illness takes a tremendous toll on caregivers and close family members and the estimated lifetime cost of care for an individual with dementia is a little over $400,000. (Alzheimer’s Association, 2025) The median cost for independent living facilities is $3,100 a month, for assisted living $4,995 a month, for memory care $6,200 a month, and for in-home help approximately $30 an hour. (A Place for Mom, 2024) These rates vary dramatically depending on state and city with The District of Columbia and New Jersey at the high end and Alabama and Wyoming at the low end with a gap of over $3,000 in between.  If an individual with dementia requires five years of assisted living followed by five years of memory care the median cost for that ten-year period is $671,700.00. For those without long-term care insurance, modest savings, and on a fixed income the costs will far exceed available funds.  If significant changes are made to social security and Medicare benefits, this will create additional shortfalls in funding.  If we project this cost out to the estimated number of individuals living with dementia by 2060, we are looking at a total cost of 9.27 trillion dollars. For comparison purposes, the current US national debt stands at 37.9 trillion dollars.

While lack of funding is a significant part of the challenge of receiving care for dementia, it is not the only issue. There are eight known common causes of dementia including Alzheimer’s disease, cerebrovascular disease, frontotemporal degeneration, hippocampal sclerosis, Lewy Body disease, limbic-predominant age-related TDP-43 encephalopathy, mixed pathologies, and Parkinson’s disease. (Alzheimer’s Association, 2025) Diagnosing and managing care for individuals with dementia requires specialized training. It is estimated that 18,142 geriatricians will be required in the United States to meet the needs of all individuals living with dementia in 2050.  The current number of geriatricians is approximately 7,000 and that number has not increased in the last decade. (Alzheimer’s Association, 2025) Medical providers are not entering this specialty, creating a dearth of expertise. This will most likely result in missed diagnoses, inadequate medical care, and additional strain on family members and other caregivers as they try to fill the gaps. Age, genetics, and family history contribute to the development of dementia and are not within our control. The good news is there are other risk factors that can be mitigated such as preventing traumatic brain injury, eating a healthy diet, getting regular exercise, maintaining a moderate level of cognitive and social engagement, good sleep hygiene, and decreasing your risk of hypertension and diabetes. The bad news is the disease process leading to dementia can begin up to 20 years before symptoms present. (Alzheimer’s Association, 2025)

Dementia is a significant burden for women. Of the 7.2 million American’s living with dementia, 4.8 million of those are estimated to be women.  If we add in another two-thirds of that 7.2 million as potential women caretakers that is a total 9.6 million women affected directly by dementia. That number will skyrocket in the next twenty years. Many of the women who are caretaking are working and also caring for children, grandchildren, and other family members. In order to ease this burden these women need significant support in the form of financial assistance, medical care, and respite care.  They need time for themselves to manage their own health and mental health but often do not ask for or receive it. Where will this support come from? It is a question without good answers but one that needs to be addressed and soon.  

My mother’s condition has declined significantly in the last several years.  My father, who is 92, has been providing care for her at home but she needs constant attention.  She requires prompts for everything including dressing, self-care, eating, activities, and going to sleep.  She is fearful, paranoid, and angry at times and cannot tolerate being alone. Even with in-home help my father was struggling to care for her at home, so they recently made the decision to move to an assisted living facility this year. She often does not know where she is, what is happening, who my dad is, or even who she is.  With the usual social inhibitions stripped away by the disease she often lashes out in fear and frustration, yelling, screaming, accusing, throwing things, and occasionally hitting. She becomes jealous and aggressive if my dad’s attention is diverted by anyone which means I have become a threat and a trigger.

Since my parents’ return to Washington State full-time in 2021, I have tried to visit every six weeks barring crises in my own life. I take a Friday off work, drive 5-6 hours, visit for a few hours then check in to my accommodations. I visit most of the morning and afternoon on Saturday and for a few hours on Sunday before driving home. Several months ago, my father asked me to give a sixty-minute piano recital of 50’s and 60’s music during my visits, telling me how much my mother and the other residents would enjoy it. I told him I had not performed in a recital since I was 12 and he told me not to worry about it. Easy for him to say! Now when I visit, in addition to worrying whether the very sight of me will set my mother off, I also have to deal with fairly wicked performance anxiety. What a fabulous twofer! It is a draining weekend but seeing my parents in person is helpful for me and my dad really appreciates my visits. And as far as the recital goes, the residents really do enjoy it but the best part is, even if my mom has no idea who I am, she smiles and sings along, and for that short period of time we can be joyful together.

Photo by Kathy Kroening. September 2025. Spirit Lake, ID

I just returned from a visit this weekend. As soon as I walked into the facility, my dad whisked me into a meeting with the head nurse and the director to discuss medications and behavior management strategies.  My mother had a very difficult day on Saturday.  She did not know who she was or others around her.  She was extremely confused and did not remember much of anything which made her fearful and angry.  She lashed out with her language and tried to hit others. She made repeated statements that nobody wanted her around, everyone thought she was stupid, and we must hate her. My family and I regularly consult with the facility staff to modify her medication regime and daily routine to keep her and everyone around her safe. But the truth is, there are no magic medications or interventions and this is a lot of trial and error. As the disease progresses, so too will her current symptoms.  It is painful and heartbreaking to watch someone you care about lose their dignity and sense of self. What is it that makes each of us unique and binds us to our loved ones? Is it still there, inside her somewhere, or is it completely gone? Why does the body persist when the essence of a person ceases to exist? I can’t find her anymore, but I keep looking.

Until next time sisters stay safe, be well, be kind to yourself, support each other, and spread the love.

Photo by Kathy Kroening. Seattle, WA. May 2025

References:

Alzheimer’s Association. (2025). Alzheimer’s Disease Facts and Figures: Alzheimer’s Dementia, 21(5). https://www.alz.org/getmedia/ef8f48f9-ad36-48ea-87f9-b74034635c1e/alzheimers-facts-and-figures.pdf

United States Census Bureau. (2025). Older Adults Outnumber Children in 11 States and Nearly Half of U.S. Counties. https://www.census.gov/newsroom/press-releases/2025/older-adults-outnumber-children.html

A Place for Mom. (2024). Cost of Long-Term Care and Senior Living. https://www.aplaceformom.com/senior-living-data/long-term-care-costs