How do you have a heartfelt, respectful, and constructive talk with your parents about the type of care they may need in the future?
How do you approach subjects that either you or they may consider sensitive?
You want to do what's in their best interest, but it can be very frustrating to put things in place if they're reluctant or even unwilling to discuss these matters with you.
There can be a number of reasons for this, so having an understanding of what could be holding your parents back discussing matters will actually help you in creating an effective way to begin a conversation where they feel heard and respected.
What could be behind their resistance?
One reason may be that your parents don't really have a plan to speak of. They have been capable, independently functioning adults for decades, and like us, younger adults, have simply taken that for granted. It's uncomfortable to contemplate a time when they won't be as independent and as in control of their own lives as they may be now, so tend not to dwell on it. That means, sometimes, they're not clear as to how they'll manage the changes that will occur as they age.
In other words, it's a sort of denial of how their way of life is going to shift as they transition through their later years. Perhaps it's a bit of parental pride - not wanting to let their offspring see them less than capable and prepared.
A common reason behind your parent's reluctance to talk to you is their fear of losing control and independence if they start allowing you to be more involved with their eldercare needs. Their concerns centre around quality of life issues - and how theirs might be impacted if you become active in making decisions about their care, and their needing to trust that you will respect their values and wishes.
Generational and cultural influences can play a part as well in their reluctance. While this ties into the notion they may not want you to see them as less than capable adults, they might also believe that if they are having any issues, they don't want to be seen as "a burden" to their children. Your parents might be very private people and/or concerned with security. They may not want others to know of their personal issues, and so maybe reluctant to have service providers such as care aides, companions, or cleaning staff in their homes.
There are those of you with parents who are, ahem, "fiercely independent". This could be beyond simply being a personality trait, but also somewhat of a "mask" - possibly done unconsciously - to cover up their concerns or feelings of unpreparedness in order to present to you, their child, a strong and competent front.
Tips to Approaching the Sensitive Subject of Eldercare
Topping the list is lots of patience! This is a process that will need to evolve over time. Obviously, the earlier you can start the conversation, the more options both you and your parents will have in putting their eldercare plan in place, and avoiding being unprepared should a crisis event occur.
Ask. Lots. Of. Questions. This shows you are interested and show respect for their values and wishes. It's also a great way to tie in "interviewing" your parents to record their memories and stories for the genealogist in your family.
A great way to start the conversation is by using “My Voice: Expressing My Wishes for Future Health Care Treatment”, a multi-page booklet that guides families through some of the things they need to consider when putting their Advanced Care Plan together. You can usually get one at your GP’s office, at clinics or hospitals, or you can Google it to download a copy to your computer.
Part of the booklet helps your loved ones get clear on what their values are, so that they know how they wish to be cared for in the event they no longer can themselves and are unable to communicate their wishes. There is also Power of Attorney and Representative Agreement forms and discussions as to how they should be set up.
My Voice will help you ask them how they want to be cared for in the future. Done in a loving and respectful way, you can let them know that even if they don't think you can do anything for them right now, you've left the door open for them to ask for your help later on.
If your parents are open to receiving some help, get clear on what that looks like. Who is available to help, in what capacity, and how often? Create a simple schedule for your parents so they know who will be coming into their home, when and for what purpose. Would they feel more comfortable with a family member present when a service such as a cleaning lady or a tradesperson is coming to their home? They will then feel more in control as the schedule can only be created if they are in agreement with the particulars.
Keep in mind that a capable adult, regardless of their age, has the legal right to "live at risk". While you may be concerned about some aspect of their safety or independence, you have to step back if your parents have told you they aren't currently in need of your help. You don't have to like it, but you have to respect it.
To ease your mind if you think that your parent has begun showing signs of decline but still insist they don't need any help, you could contact their GP to express your concerns and ask if they would observe them the next time they have an appointment. Unless you have a Representative Agreement, Temporary Decision Maker, or other recognized authorization over your parents' healthcare decisions, you will not be able to give any specific directions other than to ask for their doctor's help.
Again, linked to concerns over loss of control and independence is the huge issue of what alternate living arrangements might need to look like if, for whatever reason, your parents can no longer remain in their own home.
A genuine fear is that they may be separated if they need to go to different accommodations - depending on their specific healthcare issues. This is not unrealistic as one parent may do well to be in assisted living, while the other needs complex care.
Having that conversation early on is ideal. Nonetheless, your approach in this instance can be to show your parents they can still have control if they establish - and clearly communicate - the milestones or "red flags" that tell them it's time to consider moving.
If they're open to it, arrange for tours of local facilities to get a feel for what's out there. Often, your parents' fears are dispelled when they see the activities and social interaction offered. It's been more than once when an elderly parent was resistant to going into assisted living, but once there and settled in, was thrilled. Some facilities have both assisted living and complex care units, and couples that need different levels of care can still be together even if not living in the same room.
For that "fiercely independent" parent - who obviously values control above all, you may want to hold in reserve the conversation of what may happen to them after their second or third fall. Seniors who have been living independently - even with sometimes deep concern from their family - and have suffered yet another fall and are back again in the hospital, are assessed and may be deemed to be too high a risk to go back home, and are, instead, placed into care.
This clearly constitutes a crisis, as there is usually no emotional or psychological preparation for either the senior or their family, and all are left scrambling in the wake of this sudden change. Your parent then confronts the exact opposite of what they wanted; the loss of control over where they want to live.
Overarching all these reasons why your parents may be reluctant to discuss issues with you is their perception of you as their "child", regardless of your age. They may feel better discussing things with someone other than yourself - initially. This is where you'd need to place your ego aside. Your parents may prefer to talk with someone in their age group - someone else who's gone through the same life experiences as them and so "speaks the same language". They might feel more comfortable talking with their GP or spiritual advisor.
Be the one to make these suggestions. Your parents will appreciate that you are acknowledging you don't have all the answers, haven't had the same amount of life experience they've had, and are simply encouraging them to at least get the conversation started.
You can make suggestions as to minor and inexpensive adjustments your parents can make in their homes to address your concerns over their safety. Suggest that the installation of a medical alert communication system or grip bars for the tub and toilet or better lighting will go a long way to making you feel better about them living independently. These and other measures are non-intrusive but will help your parents more safely navigate their home and give you more peace of mind.
As with all things, courtesy and respect must lead these conversations. By doing your homework to know what suggestions to make in the first place, you can be confident you are providing your parents with viable options from which they can make their own decisions.
Your parents are... your parents, but they're adults first. Simplistic though it may be, when your parents are finally willing to talk, make sure you address them in the same way you'd want someone to talk to you.
And remember, patience is the key!
© Nancy Glover | Aging With Grace www.AgingwithGrace.ca
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Nancy Glover, a healthy aging advocate, mentors extraordinary women and men who have stepped into the challenging role of caring for their elderly spouse or parent by managing their well-being in the later stages of life. Blending first-hand expertise with practical step by step systems to support the needs, goals, and desires of the elderly spouse or parent, Nancy helps caregivers maneuver the complex and often challenging role with supportive advocacy and resources that equally focus on everyone’s well-being. Learn more about her at www.agingwithgrace.ca and sign up to receive timely information and strategies to empower caregivers and families in transition.