How to have tough conversations with a senior: 6 strategies for every family
Clara always had a contentious relationship with her fiercely-independent mother, and things didn’t get easier with time. Then, Clara's mother fell and injured herself. Afterwards, she became increasingly frail yet refused to accept help. Clara wanted to broach the topic of long-term care with her mom but was afraid it would backfire.
Talking about the needs of our aging parents can be uncomfortable. Topics such as money, health, end-of-life care and even driving are often emotional land mines for both parent and adult child. No one wants to contemplate needing care one day, but it’s better to understand your parents’ preference before a crisis occurs. For older adults, these topics stir up fears of losing independence and control, which may in turn increase their resistance.
What's the result? Adult children may try strong-arming their parent into accepting help — only to feel angry and dismayed when their efforts fail. "Mom, I'm concerned that you're not safe at home. So I've researched assisted living and I think it's best for you." Does this work? Usually not. But if your mother refuses help altogether and her safety is at stake, you may need to respectfully push a little harder. Sometimes, as Clara discovered, recruiting the perspective of a professional or trusted friend can make a difference.
"When I initially broached the subject of my mother needing help she flat out refused,” Clara explained. “I told her she was being stubborn, as usual. But after consulting an elder care expert, I approached the subject differently. This time, I spoke to my mother from a place of empathy rather than frustration and the conversation went differently. My mother confided that she was afraid of becoming dependent on me. She worried how that would affect our relationship. She also didn’t want to hire a caregiver because she didn’t want a stranger in her home. After acknowledging my mother’s concerns, it was easier for us to talk about next steps. Eventually, we worked out a plan to hire a caregiver on a trial basis to help with meals, laundry and transportation.”
Keep in mind: Whatever arrangement you come up with will likely change as your parents’ needs intensify. Caregiving is more of a marathon than a sprint and it helps to be prepared. In my book, "My Parent's Keeper: The Guilt, Grief, Guesswork, and Unexpected Gifts of Caregiving", I recommend the following strategies to approach sensitive caregiving conversations with parents and loved ones.
1. Have conversations early
It’s best to bring up the topic of long-term care before a crisis erupts so you can discuss the topic calmly, without a sense of urgency. That way, you’ll have a framework for putting a plan in place if and when the time comes. Does your father want to stay in his home as he ages? What if he needs help down the road? Would he want to stay put or make a move? Has he planned ahead?
2. Research options ahead of time
Learn about community resources – such as area agencies on aging, in-home care and adult day programs. If your parent is not safe at home, research senior living options such as independent and assisted living, multi-level communities and skilled nursing facilities.
3. Address financial issues
Does your mother have savings, long-term care insurance or is she eligible for Medicaid or veterans benefits? It’s hard to determine the best options for care if you don’t know how you’re going to pay for it. An elder law attorney or financial planner can help you and your loved one sort out finances and fund long-term care.
4. Get on the same page with your siblings—if possible
If you have siblings, discuss your concerns together before broaching the topic with your parents. Have you or your siblings noticed changes in your parent’s behavior, functioning and mood? If so, decide how best to approach your parents. Try to focus on what’s best for your parents rather than stirring up unresolved conflicts, which will only derail your efforts.
5. Take it slowly
If possible, gradually integrate a paid caregiver into your parent’s routine. If your mother and the caregiver click, it will be easier to increase the amount of care over time. But be patient: During the initial adjustment period, accepting help may feel more like a loss than a gain for your parent. Over time, that will likely change as your mother experiences the relief and support of having the help she needs.
6. Talk about end-of-life issues
Talking about end-of-life is a topic that most families avoid, to their detriment. It’s important to explore and understand your loved one’s wishes before being faced with the urgency of a life-or-death decision. Has a health-care proxy been appointed for someone to make health-related decisions should your father become incapacitated? Are legal documents in place, such as a power of attorney to enable someone to manage financial matters if your dad is unable to do so? A website called the Conversation Project can kick-start the conversation and guide you through the planning process.
When broaching sensitive caregiving conversations, it’s best to position yourself as a supportive helper rather than an enforcer, phrasing concerns in a way that won’t take control away from your parent. Clara learned that after she acknowledged her mother’s fears and put aside her own. Ultimately, it is our parents’ choice to decide what type of care they need and will accept. As family caregivers, we can only do our best. We strive to help our parents with whatever challenges they face, so they can remain as independent as possible and live their best lives.