Plan to Talk about Future Living Arrangements
Deciding when and how to discuss a family’s concerns about the safety of your aging loved one is difficult at best. Family and friends recognize signs that tell them their aging parent should no longer be living alone, but how does the family address their concerns with the parent? How do you talk to your father about his ability to continue to drive safely? Avoiding these difficult topics does not make the situation go away and family dynamics become tense.
Tara Koestner, Administrator, of The Continental at St. Joseph’s (CSJ) Assisted Living Center advises families to start these discussions early while aging family members are still doing well. By having sensitive discussions while the aging adult is still doing well, the family improves their chances of a smooth transition from independence to increasing dependence. Ideally, the family can develop a plan that respects the wishes of their senior family member as to where they will live when they become frail. The most important step is getting the discussion started. Tara recommends having a plan to start the conversation. She has developed the follow list of tips to assist family members feel more comfortable discussing their concerns about their loved ones future health and living arrangements:
Tips for Initiating a Conversation
Extended family decision makers need to agree in principal.
Although extended family members may not agree as to when their loved one should have assistance with daily living, hopefully, they can agree on the type of help (home health, assisted living, skilled care, or long term care) would be appropriate when assistance is required. The Continental at St. Joseph’s administration recommends that the family elect one person to be the healthcare “manager” and other family members agree to support the manager’s efforts. Tara Koestner states, “If extended family members can agree in principal first, the decision making process regarding when changes are needed to keep senior adults safe goes smoother.
Approach the subject of alternative living arrangements indirectly.
Use an example of someone else their age and a problem that they are dealing with. Ask your loved one, “What would you do in that situation?” Or try to offer some small tips, like using a pill organizer, to manage medications.
Watch for openings to the conversation.
Senior adult comments about difficulties or sarcastic remarks about “being put away” may be subtle statements indicating that more help is needed. Listen for hints of frustrations or worries your family member may have.
Share your feelings about their changing life. Assure them that they can always ask you for help when they need it.
Be direct, but non-confrontational.
You want to get your point across without making your loved one feel like they’re being interrogated. Use a matter of fact approach with as little emotion as possible.
Make a list.
The Continental at St. Joseph’s management suggests that families consider giving the aging adult a list of questions and concerns and schedule a time to discuss it them. This gives the senior adult time to prepare for the discussion and a chance to think about the types of help that they would be open to considering. Focus your list on key points. Let your loved one know that you do not want to guess about the type of assistance they may want in future. Guessing can lead to serious mistakes and hard feelings. Discuss with them their concerns about their current condition and their feelings about the future. Tell them the list includes subjects are you worry about and you need to know their thoughts on the subjects. Try to cover these topics:
- Current housing: Is their housing accommodations still ok? Would some simple modifications help?
- Daily activities: Do they need help with house work, laundry, meal preparation, or bathing? Can they hear the door bell and telephone ring? Are they still able to socialize with friends?
- Mobility: Are they experiencing any difficulty with balance, walking, or getting out of the chair? Have they considered using a cane or walker? Can they still see well enough to drive? Are they able to park the car with ease? Are they able to react safely to varying road situations? Are they getting where they need to go?
- Health: When did they see the doctor last and what did the doctor say? Are prescriptions current? Do they remember to take their medications on time? Would installing a Life Alert system make them feel safe?
- Finances: Does their insurance coverage provide for home health care? Would they consider letting a home health aide come to their home to assist them? Do they have long term care insurance? Are they or their deceased spouse a Veteran and eligible for VA financial assistance to help pay for assisted living expenses? Do they need to consider making an application for Elderly Waiver Assistance through the State Human Resources Department? Would it be a good time for a family member to be added to the bank account to pay bill should an emergency arise? Who is the financial power of attorney?
Tara Koestner warns families to expect some resistance to discussing these issues. This is normal. Senior adults may try to reassure family members telling them that everything is fine or telling you to mind your own business. But remind them that the family will be dealing with these issues sooner or later, it is best to plan ahead by learning what the senior adult may see as appropriate for their future so you can respect their wishes:
- Respect their feelings. If they are clearly avoiding the subject, try again later.
- Push the issues of health and safety, while keeping in mind that they are in charge of their own lives.
- Act firmly, but with compassion. If you decide that it can’t wait any longer, tell them that the situation has to be dealt with immediately.
- Involve other people that they turn to and trust such as a minister, doctor, lawyer or family friend.
- Get information from community resources such as home health care, meals on wheels or a transit bus to get where they need to go. Share these options with them.
Most importantly, keep the conversation positive. Try not to ‘parent’ your parents. Continue to treat them as important decision makers. As long as their judgment is not impaired, they should be able to make their own decisions. Discuss all of the alternatives, home health care and assisted living centers are viable options for helping senior adults bridge the gap from independence to accepting help.