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From Freedom to Dependency for the Elderly, the Difficult Family Talk

Throughout November, National Family Caregiver Month, we are revisiting posts such as this one from December 2015 that focus on the issue.

Many who spend time with elderly loved ones will notice that they are starting to decline and may need help around the house.  Some folks will be lucky and their loved ones will ask for help and a difficult conversation will be avoided.  But the vast majority will not have it this easy.  They will have to struggle with the issue of how to approach Mom or Dad and have the “care is needed” conversation.

If you have elderly loved ones, you have had this conversation or eventually will.  Right now, almost one in three U.S. adults is a caregiver and 47 percent of adults surveyed expect to provide care to an elderly loved one at some point during their lives.  A lot of us will face this issue.  As caregivers, we are concerned about our parents’ health and well-being while they are concerned about maintaining their independence and dignity.  It quickly becomes complicated because emotions are involved as well as traditional familial roles and history.  Too frequently, conversations are avoided for these same reasons—until a crisis occurs and people are forced to deal with the situation.

Having the initial conversation about whether help is necessary is usually one of the most difficult and anxiety provoking aspects of caring for an elderly loved one.  People who have had both the “sex” talk with their kids and the “care is needed” talk with their parents routinely say the latter is more difficult.  Getting a person who was once young, active and independent to accept that those days are in the rearview mirror is difficult.

Here’s a typical example: Something triggers a concern about Mom’s well-being—laundry or mail piling up, her losing weight, difficulty with bathing, walking or standing, etc.—then comes the task of getting her to recognize it and accept help.   You bring up the topic, and she shuts you down.  At some point, she reminds you that she “raised you” or, in many cases, accusations start to fly, such as, “You just want to control me.”   No matter how it unfolds, the goal of the conversation is to reach agreement and get her the assistance she needs.   FYI, this is normally not a “one and done” conversation.  The conversations will likely happen in bits and pieces and take an extended period of time. Expect that most older adults will not easily accept that they now need help to safely make it through the day.  It’s normal for the initial conversations to be difficult and uncomfortable. Subsequent conversations may also be tense—but they are necessary.

The discussions will go better if they happen before a crisis forces everyone to make decisions on the fly. Without that pressure, family members can work to ensure  everyone’s fears and anxieties are addressed and that no one feels demeaned, diminished or excluded.  Here are a few suggestions that may help you get started:

  • Take advantage of opportunities to initiate a conversation. If Mom starts to mention that walking is getting more difficult and she’s having trouble standing for long periods of time, this may be your opportunity to start “the talk.” You may not get a perfect opportunity, so be open to “good-enough” opportunities.
  • Misdirection is sometimes a way to start the conversation. Perhaps start talking about the father of someone you work with. Mention how a crisis situation occurred and the difficulties it caused for that elderly person and his family (but be sure not to imply he was a burden to his family). See where the conversation goes. It may open the door for you and your dad to have a productive discussion.
  • Be sensitive to your elderly parent’s position and remember when communicating there is a generational divide to consider.  Approach your parent and the conversation with an open mind. Listen to him or her so you get a sense of where he or she is in the process, mentally and emotionally. You may also get lucky and find out your parent has already begun to make preparations for himself or herself.
  • Try to keep it casual and focused. If Mom or Dad is resistant, the conversation can quickly and easily refocus and shift to you, your relationship with her or him or your role within the family.  The more intense the conversation, the more likely this will happen. Try not to let it become confrontational.
  • Remind your parent and yourself that the ultimate goal is to help. This will become especially important if the conversation becomes heated or confrontational.
  • Tell them you love them and care about their well-being and safety, then ask them how they are doing. Starting this way will likely open the door for conversation. If you see them becoming defensive, back off a little, but remember that they just gave you a clue as to how future conversations on this topic will likely go.

Regardless of the family’s culture or the difficulties, make it a point to have discussions with your elderly loved ones.  Also, be sure to have conversations with siblings to make sure there are no assumptions that will cause discord or hurt feelings. However you initiate the topic, try your best to keep the focus on your elders and their needs. Remember, it is not a surprise to them that they are getting older and will likely require assistance. No matter what they say, they appreciate your help. The more they are able to maintain their dignity, the easier it will be for them and for you.

Derrick Y. McDaniel is the author of Eldercare: The Esssential Guide to Caring for Your Loved One and Yourself and the founder of Caring Hearts Homecare of New Jersey. Follow him on Twitter @MrElderCare101.

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