Daughter: “Dad, don’t you need some help managing the house and cooking for yourself? You’ve lost some weight. Your checking account isn’t up to date. You don’t hear the phone. And you tripped on the throw rug in the hall and bruised your arm. What if you fall and you can’t get up?”
Dad: “No, I don’t want strangers in the house. Why are you looking at my checking account? My shoe caught on the rug and I picked myself up. I’m fine. Stop treating me like an old helpless person!”
One of the most difficult conversations a son or daughter will ever have with a parent is the one that sounds like this. You suddenly realize your parent isn’t coping as well with living at home as before. You perceive a deterioration in your parent’s well-being. All your ‘fear buttons’ are punched at once. When you discuss your concerns, you run up against a wall of resistance or avoidance.
You are not alone. Everyone who has aging parents, including caregiving and healthcare professionals, has faced or is facing this situation. An IBM/Consumer Technology Association Foundation study found that the most difficult discussions were about moving from home into assisted/long-term care, followed by dying and legal preparations, financial planning/stability, using technology, diet and exercise, and transportation/loss of the car.
All too often, these conversations are about almost everything at once and often around the holidays, a ‘Christmas Tree’ that overwhelms the family and puts everyone on the defensive.
It’s uncomfortable and emotional. Seeing your parent decline can make you feel scared, sad, vulnerable, and can bring up past issues with family. The timing may be terrible in coinciding with challenges in your own life. You may also be making decisions for both parents at once.
“The Conversation” should be a series of discussions and discovery steps, the earlier taken the better. Here are some helpful strategies to create a better setting for you and for your parent.
- Approach conversations with empathy, concern, and love. Your parent has fears too, and they are many: loneliness, physical change; loss of control, dignity, friends, privacy; no longer feeling needed; illness, and death. Do not deny those fears. You may have to approach some topics indirectly.
- Bring in the family, including extended family, and share responsibility wherever possible. Have a meeting with your siblings, cousins, and older children. Consider including trusted friends and neighbors. Discuss your concerns openly and non-judgmentally. Resolve to find solutions and act as a united front. If this is problematic, you may want to seek out a caregiving support group and advisory services through your local hospital or Area Agency on Aging. There are also multiple online resources, references, and caregiving groups.
- Recruit outside help early. Arrange for a medical checkup and before the visit, speak to the physician or nurse about your concerns. Speak with your family attorney, financial managers, clergy, neighbors, family friends, and community resources such as senior centers and the local Area Agency on Aging. In addition to updating financial information and legal instruments like wills, powers of attorney, and living wills (advance directives), this will also help you and your family gain an objective outside view or in some cases, to be a mediator. In this process, you may also want to source and meet with professional geriatric care managers.
- Do your research first, and then include your parent. Seek options in living arrangements, such as catered (independent) or assisted living, including options such as the Green House homes that combine care with a small community that looks and feels like home. Be honest with yourself about the level of care needed and what a community can provide. Check in person first, and then arrange a lunch meeting and tour with your parent. If remaining at home (aging in place) is best, research home adaptation and updating, downsizing in the same community, non-medical home assistance, and traditional medical home care. Your parent and family should be part of these discussions.
- Assistive technology can create a safety net. Mobile phones, smartphones, and smart watches with easy connections to assistive call centers have largely replaced the traditional personal emergency response pendant (PERS) medical alarm button. If your parents use a smartphone or tablet, there’s a health app for almost anything: medication reminders, diabetes coaching, exercise, diet, and checking in with friends and family—with the benefit of added socialization. Insurers and health systems are increasingly offering telemedicine for 24/7 doctor visits. Your parent is not a ‘digital native’ but devices have become simplified and accessible. Other options are sensor-based smart home and security systems that can be remotely monitored by friends and family, and police-sponsored telephone check-in programs available in some rural and suburban communities.
Prioritize. Keep a list of the problems by importance and what you’ve done to address them. This can relieve stress by marking your progress on what you have done.
Finally, accept your limits, and learn to back off. You have your own family, job, and health to consider. Recognize that your parent is an adult and, as much as can be, your partner in this. You cannot force your father or mother to do what you think is best on your timetable. Stay engaged even if rejection stings. Respect and honor your parent, and remember their care for you when you were far more helpless. By working as far as possible in advance, you can help them have a better future and perhaps avoid a family crisis.
Additional reading: Helping Aging Parents Who Don't Want Help (Forbes), 9 Strategies to Help a Parent Who Refuses Care (Care.com), 35 Questions to Ask Your Aging Parents (AARP), Building Better Nursing Homes (The Atlantic), HomesRenewed