Have 'The Conversation' with Aging Parents Before a Crisis
by: Gail Sheehy, for USA TODAY
"Dad, you shouldn't be driving anymore."
" I haven't hit anyone yet!"
"You ran over Mrs. Peabody's cherry tree."
"That tree was half dead anyway," Dad growls. "And so is Mrs. Peabody!"
Are you dreading a conversation like this over the holidays? It's that time of year when we are confronted with signs of aging in our parents that are not evident in long-distance phone conversations. One friend of mine was shocked to find her father on a ladder stringing Christmas lights despite his heart condition. When she learned he was having chest pains and told him she'd drive him to the hospital, he exploded in rebellion, jumped in his own car and peeled away.
Not long after that Christmas, she got The Call. Her father ran a red light and hit another car. And didn't remember how it happened.
Was it his heart? Or maybe his mind? You don't want to wait until a crisis like this to have The Conversation. Two-thirds of Americans admit they haven't talked with a family member about providing them with care in the future, yet most Americans believe that a family member will "be there" to care for them. The best strategy is to start the conversation with your siblings before the crisis.
Pick up the phone before a holiday or send around an e-mail and suggest everyone think about this: When the time comes, what is each of us best at? Many people have told me they made notes in the margins of my book Passages in Caregiving and sent it around to other family members to do the same. Mom and Dad may be eager to participate in The Family Meeting. More likely, they will resist, fear that if they acknowledge needing any help, they will lose their independence.
Don't wait until a life-threatening illness adds more tension, or your loved one isn't well enough to take part. By the time you get The Call, and find yourself expected to assume the role of primary caregiver, your siblings may become conveniently absent. Months or years later, when you have to make the crucial decision about where to place a parent, you can bet that the sibling who lives farthest away and has been least involved will call up and say, "You don't know what you're doing."
Ask your parents to sign a written request to release their medical records to you. Fax the documents to their doctors. Now you are able to boil down the main points into a cheat sheet to send to family members so everyone is on the same page. Once the medical history and contact information on Mom and Dad's doctors is in their hands, they will be more inclined to help (or feel guilty enough to do so).
Sometimes it's a creeping crisis. My friend Anne confided, "Mom's not making a lot of sense. She's been falling a lot. Maybe, it could be, who knows, signs of dementia?" These are the first hints of a chronic caregiving crisis. Call the closest chapter of the Alzheimer's Association to be referred to your local diagnostic center for a full work-up. The organization will help you even without a diagnosis of cognitive illness.
If you and your family members work and live in different states, you may need to hire a geriatric-care manager. These are usually social workers or nurses who have the skills to assess the needs of your parents and the rest of the family. They can recommend and negotiate for services. Private-care managers can be expensive, but in the first weeks after a health care crisis, even a few hours of their guidance can save you from bureaucratic brush-offs and blind alleys.
Suppose Mom or Dad refuses to meet with a care manager? "I don't want a stranger telling me what to do" is the usual response. Break the ice by arranging a low-key meeting with a "friend" of yours. Let your parent and the care manager discover mutual interests and maybe set up another visit or an outing. The key is to establish trust.
The best chance of success in a family meeting is to have it led by a neutral facilitator. That will take you out of the line of fire. Have a list of your own questions and ask your siblings to bring theirs.
How long will the family meeting last? Oh, not more than the remainder of your parents' lives.
Sound Options is passionate about empowering and guiding families through their eldercare needs. As a professional Geriatric Care Management company, we have been that neutral facilitator for families throughout the Puget Sound since 1989. As RN's & MSW's, Care Managers are experts in eldercare and lend their professional know-how and creative problem solving skills to each family’s unique needs and dynamics. A great starting point to planning is to begin with a one-hour Eldercare Coaching session with a Geriatric Care Manager. This initial conversation can provide the orientation, resources, and professional help to the family of an aging loved one.
Published on February 18, 2013.