Editor's Note: The post below recently ran in our column Living and Loving: Elder Care in the 21st Century, in the Concord Journal.

iStock 000005242444XSmallReaders and others often ask us how to start conversations with parents about planning for the parents’ potential care needs and other aspects related to their declining capabilities. As we approach the holiday season, this is an especially good time to have these conversations – key family members who may be available only during holidays are often present, and it may be easier, even given holiday activity, to find some time for a quiet conversation. In hopes of facilitating a successful discussion this holiday season, we offer a few thoughts about what needs to be discussed, and how to conduct a conversation with an elder family member to plan for a time when he or she may not be able to manage independently.

First, as you approach the conversation, you will typically find best success if you think of it as

a normal planning conversation. At all costs, avoid connotations that suggest this is a “now that the end is near” discussion. Not many people, especially those for whom the end may be approaching more quickly than they wish, want to reflect on their demise. Rather than present it in a way that makes Mom think that you are measuring her for the coffin, make it a normal planning activity that all responsible adults should conduct.

All of us should a medical proxy designated and power of attorney named to handle matters if we become incapacitated; everyone should have a current will and a record of where all the bank accounts are and the account numbers and relevant data. You might even mention that you recently reviewed your documents with your attorney to be sure they were up to date (if it’s a white lie but it makes the conversation easier, my advice is lower your standards and say it). Make up a “life event” excuse – we did it because the kids are older, someone left for college or graduated, you changed jobs, got divorced or remarried, moved to a new town, whatever. And having recently reviewed it yourself, it prompted you to ask about your elder – what would he or she want if there were a car accident or a sudden surgery and they needed help? Who should handle the money and who should make care decisions? What kind of care would they want?

Depending upon the personality of the elder, you may still get resistance. This is especially true if the person tends to use denial as a coping mechanism. But if you approach it as a hypothetical exercise (what if there were a car accident or a sudden surgery?), you may find more success. If the person is concerned that you are really maneuvering to take away the car keys, you will be met with suspicion and mistrust.

The trickiest part is often not the actual end of life – most people will concede it will come eventually, just not now – but the period prior to that, when they are healthy enough to live at home but not quite able to manage alone. In these cases, the elder typically is concerned, legitimately, about a loss of privacy, but also often needlessly concerned about a loss of autonomy. They may well fear that you want (or hope to) send someone who will tell them what they can and can’t do, and who will report on – “tattle” is how they are likely to see it – their activities.

The best way to avoid that kind of resistance is to present the care you think is needed, or may soon be needed, as an assistant. No one wants a baby-sitter, but most folks would like to have someone to handle daily tasks we don’t want to do ourselves. If it is clear to the elder that he or she remains in charge, and is giving the orders rather than being ordered around, resistance often declines. Let the assistant take care of the grocery shopping or the laundry, and Mom can relax. That has much more appeal than someone who is going to tell you that you are too old to drive any more.

As always, we strongly recommend that these conversations be started before they are needed. Once the person begins to decline, his or her resistance is likely to grow and any cognitive impairment can make the conversation difficult, or even or impossible. It may take several attempts so start early. And do not be afraid to ask for help from a counselor, clergy member, family friend, or a professional. These efforts will always pay dividends if the time comes that care is needed.


Last updated: Sun 02 December 2012 09:27
Created: Fri 30 November 2012 08:08
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