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Difficult Conversations: Helping a Parent Face Age-Related Declines
Posted in: Caregiver Support
Figuring out how to sensitively handle your concerns when a parent is encountering age-related declines is, hands down, one of the greatest challenges you will face as a child. Doing so reverses a long-standing power structure – and it can be uncomfortable. This is especially the case if your parent is having trouble accepting the fact that they need assistance.
My career has included assessing the need for transitions between levels of care at a continuing care retirement community, and I now work as a director for Asbury Home Services. I know there is no one-size-fits-all checklist for this issue. But these guidelines should be helpful. The important thing to remember: Don’t wait! Difficult conversations don’t get easier by delaying them.
Preparing for the conversation …
Before you begin a conversation, it is important to understand the areas in which your loved one may need assistance. The broad categories include:
- medical safety
- activities of daily living
- home safety
- driving safety, and
- financial safety.
Gain an accurate idea of their monthly income and investments. Determine if they have advance directives such as a Living Will. Educate yourself on the resources that exist nearby, so that when you begin the conversation you have concrete options to offer.
Be clear about what you can offer in terms of caregiving should your parent continue to decline or even sustain an injury. Your parents may assume you will take them into your home if the need truly arises. If you are unable to do that, and you know they have the financial resources for an alternative, 1. Don’t feel guilty, and 2. Tell them now that it’s not an option. Most parents don’t want to “be a burden” to their children. Remind them that you are being proactive to ensure a good quality of life, one that doesn’t require you caring for them.
Start with the facts …
How you approach this subject is important. Give your parents as much control and as many options as possible. Make sure they know that you are doing this because you care and explain the benefits of assistance. Rather than saying: “Mom, I need your keys,” try this instead: “Let’s make this convenient for you. How about I make arrangements for transportation for you to your appointments; it’s time for you to enjoy some pampering.” Another example of what not to do: “We’re going to arrange some home care services for you. Isn’t that wonderful?” Instead, try: “We know this must be difficult for you, and we wouldn’t suggest help if we didn’t think it was the best way for you to remain independent in your home as long as possible.”
To start the conversation, start with evidence. Maybe you’ve noticed the house is getting cluttered or unclean. Try, “You have been cleaning this house for 25 years. Let’s try bringing someone in to do it, so you can …” If you are noticing declines in personal care, it can be helpful to bring them in front of a mirror and ask them if they notice anything different about their clothing or hair. If safety is a concern, try “It’s becoming more difficult for you to get up and down the steps. Have you noticed that?” If dad says, “Yes,” you can talk about moving the bedroom downstairs and making modifications. Sometimes this conversation helps make it clear that making the necessary modifications isn’t feasible, and a move will be necessary for true security.
When it comes to bringing in assistance, suggest your loved one “give it a try.” This alleviates the pressure of making a final decision. Usually, people keep the assistance because they have now made a connection with the helper. Remind them that having services in place can help prevent injuries and problems that will essentially force them to leave their house. If you do encounter resistance, especially the dismissal that “I can’t afford that,” don’t hesitate to bring money into the discussion. Try, “Mom, it will cost you $600 a month to have this partial help compared to $14,000 a month if you injure yourself and need 24-hour care.”
LISTEN to your loved one with an open mind and receptive ears; this will allow you to discover their real feelings and understand their wishes. Discuss the fact that the loss of independence is not a sign of weakness or personal failing but a force outside their control. Be empathetic. Talk about how you hope assistance will allow them to maintain relationships and a fulfilling life. It is very likely that you will need to have the same conversation many times. If your first attempts are dismissed or dissolve into a yelling match, disengage and try again a few days later.
Bringing in a third party might be helpful …
You don’t have to approach this alone. Gather a care team together that can include your parents’ physician and lawyer, a pastor, friend or close neighbor. It can be helpful to bring in an outside person who doesn’t have the emotional pitfalls that often come with parent-child relationships. Your parent may feel more comfortable opening up to someone other than you.
In some situations, physicians can be very helpful. If you are noticing memory care or depression issues, it is time to get a physician involved immediately. However, even if that is not the case, taking your parent in for a check-up can lead to some undeniable evidence that assistance is needed. Most individuals trust their doctor. Just be sure to inform the physician prior to the appointment of the issues at hand.
If your parent does not have advance directives, this is a good time to discuss those issues with the physician. Once those wishes are known, you or your parent can contact the family lawyer.
If efforts fail …
Sometimes, the more “pressed” an individual feels, the more resistance occurs. Understand that you are not at fault and try not to feel too guilty if your loved one sustains an injury because of care refusal. You can’t always “save” your parents, but if you are aware of their needs, have educated yourself on resources in the community and continue to have conversations that empower them to make decisions, things should start to fall into place. If they don’t, educate yourself on the process that occurs when a health crisis arises. Ask around regarding local rehabilitation and home care services. Trying to choose a care provider in the midst of a crisis makes a difficult situation much worse. And remember this list:
- Remain positive, have patience and continue the conversations in a non-confrontational way.
- Keep in mind this is a process, a journey. The first step is to have those tough conversations with your loved ones.
- Reach out for help.
- Self-care is a must.
The Driving Safety Issue
Driving safety is a major issue as people age, and the area where you will almost certainly encounter resistance. Have transportation options and cost on hand when you begin this conversation. If you are concerned about a parent’s driving, contact a local driving safety classes for older adults. They can assess your parent’s driving and place restrictions on the license, if necessary.
This may not seem so bad if the possible alternative is a total loss of driving privileges. And remind your parent that if they have an accident while driving, and an officer is called to the scene, they could have their license revoked on the spot.
If driving safety is at a critical level, you can make an anonymous call to the state Department of Motor Vehicles and they will send someone to the home to assess your parent’s driving.