Difficult Conversations with Parents: Helping a Parent Face Age-Related Declines

The Hard Part Is The Conversation.  After That, It Usually Gets Easier

I’m the youngest of seven kids. Irish/Catholic? How ever did you guess? Our parents lived in their home for about twenty-five years and were seventy-nine and seventy-six. They both survived cancer and at this point, neither of them had a significant diagnosis of any sort. We began to notice though that their days were filled with obligations only, such as doctor’s appointments, grocery shopping, car and home maintenance. There was absolutely no fun, no relaxation, and it certainly didn’t look like the “Golden Years”.My dad started to get softly addicted to trying to figure out his computer and the Internet, which fascinated him. Mom was starting to feel that he was occupied only by screen time and expressed to us kids that it was monopolizing his days. As my dad’s gait became worse, we worried about the stairs in the home. The outside home maintenance he insisted on doing himself, even though between the seven of us, we were willing to make a schedule to help.Three out of four of the daughters in the family work for seniors in some capacity. I help seniors in finding senior living and home care options in the Chicagoland area. My sister Eileen is an Elder Law Attorney and Rita is the Sales and Marketing Director for a Continuing Care Retirement Community.  The four daughters sort of take the lead on any issues or concerns we have with mom and dad. We collaborate on what to do moving forward and we fill our three brothers in from there. It works well! We’re lucky to have a functioning dynamic in our family where all of us want to work collectively toward the best scenario for our parents.After the seven of us communicating and agreeing that mom and dad needed a change in their living arrangement, we decided to ask them to meet one Saturday afternoon. We started the conversation with some of our concerns such as dad going outside shoveling after a fresh snowfall, or mom taking care of the household duties, but never having any kind of outlet of her own. We talked about the need for socialization that would be at their fingertips, instead of the effort in making plans, which didn’t seem to happen anymore.  We talked about the negative effects of too much screen time to dad, and suggested that if given more easily accessible active opportunities, he may take advantage of those more readily.And as the tears started flowing on both sides, we talked about wanting more for them in their later years. Keeping up with day- to- day obligations………..don’t we all hope for more than that in our later years? It was so hard. We all felt sadness, guilt, and as if we just started some sort of grieving process. We did. We felt the loss of what mom and dad used to be capable of and the great memories made in their house. We grieved the fact that we were the children being raised by mom and dad. Now, who is calling the shots? That’s a hard pill to swallow on both sides, I believe. We knew this was the worse, before it could get better.It’s not an easy process and I don’t take for granted that my siblings provide an invaluable support system. But as hard as the conversation was, it needed to be done. Our parents were failing before our eyes.  Here are some tips and observances I have noticed over the last twenty years of working for seniors:

1. Most seniors are aware of the fact that they’re lives are not as abundant as they once were.

Some may even say they are “declining”. A lot of seniors are fearful of falling and being alone, especially at night. However, it’s not often you will hear the senior say, “I think I’m ready to change my living arrangement, can we go look at some senior living communities?” If you hear this, you have been blessed! More often, it’s the adult child bringing up the possibility of changing living arrangements, and you know what? Often times your senior loved one experiences a sense of relief when you say those words.

Oh they won’t act happy, no! They will tell you all of the reasons why they should stay in their home, or all the reasons why they don’t need a caregiver to help them out in their home, but deep down inside, they agree. Here is yet another time when it will get worse before it gets better. The senior may give you the cold shoulder or lay some guilt on you at this point. It’s okay. You have made it this far, so test your armor and keep pushing forward. Most seniors are ready, but they will never tell you that. ! It will get better. I promise.

2. If your senior loved one has a diagnosis whether it is Dementia, Parkinson’s, or Arthritis it is a smart idea to move them into senior living prior to any major decline in their health status.

This way, the staff is familiar with the senior and can detect any changes that the physician should become aware of.  Also, it’s important that as the senior’s health status changes, they have become connected to their new home, environment, routine, and staff. Versus waiting until a major health status change to make the move out of their home, now they senior is not only grieving the process of leaving their home, but they’re also grieving their prior better health.

It’s too much all at once. My family’s proactive stance with our parents served us well when eighteen months after their move, my dad was diagnosed with Congestive Heart Failure and Vascular Dementia. Our mom was diagnosed with Dementia as well. So to have gotten these diagnoses was a major blow. But we were so thankful that we took action when we did so that we were dealing with the “new normal” of learning about these diagnoses and how to treat them, versus the diagnoses plus the enormity of moving our parents at the same time.

Take action when your senior loved one is healthy. Do not wait for a crisis. Decisions will be made hastily and that will result in a more traumatic transition for your loved one. Get ahead of any future diagnosis so when/if that time comes, your senior loved one is declining in the comfort of what has now become their home.

3. Recognizing that you may be enabling your senior loved one to remain in their home when they are declining can be part of the barrier in moving toward a new living arrangement.

Whether we promised our family we would never place them in senior living, or feeling that nobody can take care of them the way family can, or preserving assets for as long as possible are all ways that we may be getting in the way of your loved one realizing their full potential as an aging adult.

If there are no assets owned by the senior, it is true that family may need to collaborate on caring for their loved one in order to keep them at home. When their care becomes too advanced, Medicaid skilled nursing would be the option at this point. The family would want to either apply for Medicaid for their loved one or see an Elder Law Attorney to do it. They may also want to consider pre-planning a funeral with any assets that may be left. As hard as it is to discuss these things, it’s reality. However, if there are assets, sometimes making the decision to transition to senior living while still healthy can protect your financial future.

As I mentioned, my parents were diagnosis free when they first made the transition to their Continuing Care Retirement Community. Because of this, they were able to get what is called a “Life Care Contract”. This means that even as their level of care goes from independent living, to assisted living, to skilled nursing, they will never pay market rate for a higher level of care. They will continue to pay the rate they are currently paying in independent living (barring any yearly increases which 3-6% is normal for senior living). This is a protection of their assets and had they waited until one of them had a diagnosis to make a move, they would not have qualified for this Life Care Contract.

The truth is, the staff who choose to work in senior living communities are a different breed. They genuinely enjoy the seniors they work for everyday and consider them to be like family. There is real ownership taken of the happiness and dignity that the residents are made to feel on a daily basis. So when family visits, they are seeing the best in their loved one. Most often when I call my parents, they aren’t home. This is a good thing! They are busy doing activities from after breakfast until 3:30pm when “Jeopardy” comes on! Even sometimes in the evening, they are downstairs watching entertainment of some sort.

This has become their home. A home that just so happens to have any kind of activity at your fingertips available all day everyday. A home that serves them great meals so this is no longer a chore of moms. A home where they have met new friends and meet up with them for dinner, card games, and swimming dates. Make sure you are not in the way of your senior loved one experiencing their Golden Years to the fullest. They will love their new lifestyle. It may take some transition time, but they will love it. Oh, and remember the cold shoulder you may have gotten? That will eventually fade as well.

4. If you don’t have a large support system when having this conversation with your senior loved one, you don’t have to do it alone.

I often suggest to my clients to get your senior’s doctor involved. Calling up the doctor and asking for assistance in bringing up the subject at the next appointment or if you choose to bring it up, having the doctor site reasons why he/she is encouraging a lifestyle change. A lot of seniors view their physicians’ opinions as extremely valuable and rely on their guidance. So, having the doctor help support you can be a great tool to take at least some of the weight off of your shoulders.

Another option is to work with a Geriatric Care Manager, Nurse Practitioner, or Senior Counselor to help your loved one hear concerns of yours, but through an unrelated third party. We know that we often get the brunt of any anger our loved one may have once they know your proposed plans for them. However, when the information is coming from a third party, it may come across as more objective and your senior may take it and truly contemplate a change.

5. If you are the caregiver for your senior loved one, you are under a tremendous amount of stress.

AARP in a December 2011 article listed the “6 Signs of Caregiver Burnout” as feeling furious one minute and sad the next, catching illnesses easily, snapping at everyone, not exercising, no social life, and being the one and only go-to caregiver. According to an article written by S. Zarit in 2006 titled, “Assessment of Family Caregivers: A Research Perspective”, estimates show that about 40%-70% of caregivers have significant symptoms of depression and one quarter to one half of these caregivers meet diagnostic criteria for Major Depression.

Caregivers have the hardest job in the world, in my opinion. They can’t do it forever and they can’t do it alone. At some point, assistance needs to be brought into the home via caregiver service or the seniors’ living situation needs to change. A lot of guilt surrounds the concept of “giving up” and changing the seniors living arrangement instead of charging forward with the hardest job in the world. But who is this really helping?  The senior is not being socialized, not enjoying their lives. They feel safe at home, yes, but if they are still on this earth, than there is life to be lived! So go live it! Even if it’s different and more limited than in the past, there are still friendships to be made, new hobbies to try, new freedoms to experience that home cannot give the senior.

Take “giving up” out of the equation and replace it with “giving more”.

At home, there comes a point where you’ve done all you can do.  The access to personalized care, activities, three meals a day, housekeeping services, and transportation is ready and waiting to be taken advantage of to the fullest extent by the senior. At some point, the caregiver needs to hand the baton to the senior living community that is well equipped in its’ physical plant to safely allow residents to navigate their apartments, and has the loving staff who make sure residents are happy and well cared for on a daily basis. There is strength in numbers and more support that a community provides.  Give more doesn’t mean the caregiver gave up.

6. This requires you to have "tough love" for your elder loved one.

When we raise teenagers, we hear the term “tough love” a lot. It means that what we’re about to do or say to the child won’t be well received, but we are confident that one day, the child will realize it was all out of love. It came from the heart. It was not easy, but it was for the best.

At some point, the roles reverse in life. It’s a strange feeling. Giving tough love to your parent or senior loved one is no different. It comes from a place in your heart that wants to protect the life of a person that you love so much. A little tough love certainly never hurt anyone. The outcome is usually a very good one. Getting there may be bumpy, but the end result which is happiness, safety, and dignity for our elderly loved one is worth every uncomfortable, strange feeling during the process.

My good friend, Jill Herrmann, called me about two years ago thinking it was time for her mom, Adele, to consider a move. Adele was in a large home about a half hour from Jill, so it was a bit of a trek to get to her. Adele’s passion is to dance! She travels to Indiana from the Chicago area every Wednesday to go to a dance they have there! Even though Adele is definitely a mover and a shaker, Jill could see the signs of dementia in her mom and knew they needed to get ahead of a further decline.Reluctantly, Adele toured several communities with Jill and I to find the right fit. They found a Continuing Care Retirement Community for Adele that allowed her to choose all of the finishes in her apartment and she was also able to keep her beloved dog. When Adele first moved in, she felt like an outcast. She felt that friendships had already been made and wasn’t sure where she fit in. Jill and I knew in just a short time, with Adele’s larger than life personality, she would soon be running the ship!I’m proud to share this latest text with you that I got from Jill over this past weekend. It reads: “Hello Sunshine, I had to tell you this! Last night, Adele told me that she hated to admit it, but I was right about her new community. She loves it and the people are so wonderful. She has made so many friends. She told me that she loves the interaction everyday! I can’t tell you what a relief it was to me. I cried of joy! Thank you my friend. “Anything worth anything in this world is not always easy to get, but happiness, no matter the age, is worth fighting for every time. The conversation is not an easy one to have, and it may sting for a while causing sadness and grief. But as you can see from Adele’s story, and the fact that my parents are always out and about doing something new everyday, the transitions seniors make turn out to be very worth the challenges. Our seniors deserve the best that the world has to offer. Age is a number. Life is to be lived to the fullest. The answers are out there. Have the courage to seek them and hold your senior loved ones hand all along the way. They’ll see the light eventually, and when they’re ready, they’ll turn to you and say, “Thank you for loving me the way you do.”