The How, When and What-If's of Talking to your Parents About Aging Issues
If you're reading this you've probably reached a point where your parents have gotten old. You see them struggling to do day-to-day things like cooking or cleaning. You start to wonder about talking with them because you worry about their health and wellbeing. Yet you also wonder what to say to them and whether they'll listen.
In the following pages, I've provided some tips and tools for talking with your aging parents about concerns you have for them. There's also information to help you determine if your parent's safety is at issue. In the event your mother or father doesn't want to talk about the safety issues you see, there are several ideas for ways to handle the situation. Finally, there is a list of the many care options available to your parents along with a brief description and the pros and cons of each option in my opinion.
HOW TO TALK WITH YOUR AGING PARENTS ABOUT CONCERNS YOU HAVE FOR THEM
Give some thought to the emotional response your concerns may bring up. Often, when
adult children with aging parents are scared or worried they begin to make demands. They tell their parents what to do.
I encourage you to step back from your emotions and identify your concerns. This increases the chance of a having a successful conversation with your parent(s). I suggest you write down what's going through your head when you think about the situation and what you think needs to be done. Then write these reasons down, starting with the word, "because."
My concern Because...
You can't live alone anymore.
I'm afraid you're going to start a fire because you can't see as well as you used once did.
I'd never forgive myself if you got hurt.
I worry that you'll fall and won't be found for days.
You can't drive anymore. I'm afraid you'll get in a wreck and be seriously hurt or die.
I'm worried you'll hurt yourself or someone else.
The "because" column is how you want to start the conversation with your parent(s). Notice the language in the first column compared to the second column. You vs. I. Generally the reaction to the word "you" is defensiveness. When that happens conversations turn into a battle of wills. So speaking from your own perspective, using "I," reduces defensiveness. It also comes from a place of caring and concern. Your parent is more likely to respond when they know you're concerned and care about them. Parents usually don't want their kids to suffer. Ask for their input. Do they worry about falling? Have they thought about getting into a car accident? Older adults are painfully aware of how aging is affecting their bodies though they may not talk about it. So chances are that they've given some thought to what might need to change.
Ask them how they'd solve the problem. Include your parents in the solution. Too often, as people age, they are ignored or overlooked. It's a societal problem. It's also extremely frustrating and if your parent(s) think they don't have a choice, or their opinions don't matter, they're more likely to dig in their heels. But, more importantly, it is their life you're talking about. They should have the power to choose their destiny and will be more likely to be happier with the decisions.
Be aware that your parent is afraid of losing their independence. Chances are, you're both on the same page where their independence is concerned. Discussing your concerns sooner rather than later decreases the chances they'll harm themselves or come to any harm. By recognizing that they may be afraid of losing their rights, their ability to choose and control over their own lives, you'll better understand why they may say or react they way they do. You'll be better able to talk with them and relate to what they're going through and more likely to be successful in talking with them.
WHAT IF I THINK MY PARENT IS UNSAFE AT HOME?
If you feel your parents may be putting themselves or someone else at risk it's important to address it as soon as possible. Most older adults have one primary fear: that their independence will be taken away. Contrary to how they often see it, reducing their chances of getting hurt is the best way to maintain their independence. An obvious safety concern is driving. If you suspect, or know, your parents are unsafe behind the wheel then it's probably necessary to intervene. You may have noticed how often there's news coverage of an older motorist hitting someone or something. Some of these accidents have injured, or even killed, the older adult or other people. Admittedly, this is a tricky area to discuss with your parents, which I'll explain later, so it's a common issue that children with aging parents avoid. Doing so, however, keeps your parent and others at risk. Another concern is safety in the home. Poor balance, strokes that affect your parents ability to get around, overmedication, and the need to go up and down stairs daily are some common things that increase a person's risk for falls. Poor eyesight or an inability to think clearly or react quickly [due to a stroke, reduced oxygen to the brain, overmedication, or the beginning stages of dementia] can create a situation where your mother or father aren't able to prevent a fire from starting if a hot pad falls onto a burner or a candle tips over, for example.
H*#@ NO, I WON'T GO
Even though you feel you feel your parents are unsafe, they may not agree. I suggest to clients that they give their parents several choices and a deadline for deciding. A script for this:
"I know you don't want to discuss leaving your home; however, the reality is you can't stay here unless you accept in-home help or, you have the option of moving to assisted living. You'll have to decide by [give them a specific deadline]. I know this isn't easy for you and I'm sorry about that."
Your parent may continue to object and you may need to continue repeating some version of what I've outlined above. Showing compassion yet being firm can move many parents who dig their heels in, but not all. Despite all your efforts your parent may continue to live in an unsafe environment until something serious happens that makes it impossible for them to return home. Depending on the issue that prevents them from moving home, they may have few options.
It's not unusual for assisted living facilities to have waiting lists. Depending on your parent's health situation he/she may have to skip assisted living entirely and go to a skilled nursing facility. The best you may be able to do is talk with facilities near you, or near your parent's home, and ask to be put on a waiting list. This gives you some control over circumstances if you have to make quick decisions about your parent's living situation later on. Facilities will check with you if your name is getting near the top of their move-in list as apartments become available. If circumstances haven't changed for you, most facilities will move your name to the
end of the list.
CARE OPTIONS
There are many types of care options and each has its pros and cons.
Living with Adult Children
This option is not for everyone. I ask clients who are considering this if they've sat down and discussed it with their parents. It's not uncommon for adult children to feel it's their duty to move their parents into their home and care for them. However, when they talk with their mother or father about this they're often surprised their parent doesn't want this. Likewise, some elderly parents expect their kids to make a place for them in their home when they can no longer care for themselves. This often isn't realistic. Adult children may literally not have space for their mother or father to move in; money to pay for things their parent needs as
they age [or to move to a bigger home]; be able to afford to work less hours or take time off to provide the help their parent needs or, may not have the fortitude to be with their parents that much. Unless adult children and their mother or father have established a relationship as adults that allows for each other's differences, throwing parents and children together after years of being apart can create a lot of stress for both parties. Even if the parent/child relationship is strong and both sides are respectful of each other's time, space and lifestyle, adding a parent to your household can be hard on significant others and grandchildren. This decision takes careful consideration for everyone involved, you, your parent, your kids, your significant other, your siblings, because it impacts all of them in some way.
Pros...
In-Home Care
There are companies that provide caregivers that will come to your parent's home. Services vary but generally they provide light housekeeping, prepare meals, write letters, provide socialization (visit with your family member), transport to appointments, help bathing and dressing and medication reminders. These companies may, or may not, provide nursing services (described below).
Pros...
In-Home Skilled Nursing
Companies that offer this service may provide many of the same services in-home care providers do but they also provide nursing services such as: giving medications, reporting conditions and changes to your parent's doctor, taking vitals, drawing blood, giving injections, setting up medications and physical and occupational therapy.
Pros & Cons are similar to those of in home care above.
Retirement Communities
Generally these are independent living communities of people 55 and older. The living quarters can be homes or apartments, depending on the community, and residents may have the option to buy or to rent. Retirement communities are much like independent living but some services may be provided and residents are usually 55 years of age and above.
Pros:
These facilities have apartments with kitchenettes. Generally they provide three meals a day that are part of the monthly rent. Most only serve meals in the facility's dining room. There is a nurse on staff and nursing aides who administer medications (some facilities will let residents who are cognitively able manage their own medications). Most facilities offer outings throughout the month for residents. Housekeeping is provided.
Pros:
Skilled nursing facility (a.k.a. nursing homes)
This is the type of facility that was available for your parents' parents. Most confuse assisted living with this type of facility. Nursing homes have become skilled nursing facilities (SNF pronounced like sniff) because medical insurers can save costs by moving patients here who need rehabilitation or a longer recovery period after their hospital procedure. It is not true, as your parents may believe, that you never get out of a SNF. It depends on why someone is there. Usually people stay long term if their needs are more than an assisted living facility can provide. (This would be similar to in-home skilled nursing services; the needs are greater than "basic" service: wheelchair bound; need helping getting in and out of bed, chairs, etc. can't walk without assistance, etc.) Some people on Medicaid may be in a SNF because they can't find an assisted living facility that will take Medicaid. Some people may not have enough money for assisted living but have too much for Medicaid. There may be a unique reason a person would stay in a nursing home long term besides those I've mentioned.
Pros:
Some senior housing options have a retirement community, assisted living and skilled nursing (or only the last two) all in the same place.
Pros:
Lynne Coon, MS
Counseling and Resources for Adults with Aging Parents
www.lynnecooncounseling.com
In the following pages, I've provided some tips and tools for talking with your aging parents about concerns you have for them. There's also information to help you determine if your parent's safety is at issue. In the event your mother or father doesn't want to talk about the safety issues you see, there are several ideas for ways to handle the situation. Finally, there is a list of the many care options available to your parents along with a brief description and the pros and cons of each option in my opinion.
HOW TO TALK WITH YOUR AGING PARENTS ABOUT CONCERNS YOU HAVE FOR THEM
Give some thought to the emotional response your concerns may bring up. Often, when
adult children with aging parents are scared or worried they begin to make demands. They tell their parents what to do.
I encourage you to step back from your emotions and identify your concerns. This increases the chance of a having a successful conversation with your parent(s). I suggest you write down what's going through your head when you think about the situation and what you think needs to be done. Then write these reasons down, starting with the word, "because."
My concern Because...
You can't live alone anymore.
I'm afraid you're going to start a fire because you can't see as well as you used once did.
I'd never forgive myself if you got hurt.
I worry that you'll fall and won't be found for days.
You can't drive anymore. I'm afraid you'll get in a wreck and be seriously hurt or die.
I'm worried you'll hurt yourself or someone else.
The "because" column is how you want to start the conversation with your parent(s). Notice the language in the first column compared to the second column. You vs. I. Generally the reaction to the word "you" is defensiveness. When that happens conversations turn into a battle of wills. So speaking from your own perspective, using "I," reduces defensiveness. It also comes from a place of caring and concern. Your parent is more likely to respond when they know you're concerned and care about them. Parents usually don't want their kids to suffer. Ask for their input. Do they worry about falling? Have they thought about getting into a car accident? Older adults are painfully aware of how aging is affecting their bodies though they may not talk about it. So chances are that they've given some thought to what might need to change.
Ask them how they'd solve the problem. Include your parents in the solution. Too often, as people age, they are ignored or overlooked. It's a societal problem. It's also extremely frustrating and if your parent(s) think they don't have a choice, or their opinions don't matter, they're more likely to dig in their heels. But, more importantly, it is their life you're talking about. They should have the power to choose their destiny and will be more likely to be happier with the decisions.
Be aware that your parent is afraid of losing their independence. Chances are, you're both on the same page where their independence is concerned. Discussing your concerns sooner rather than later decreases the chances they'll harm themselves or come to any harm. By recognizing that they may be afraid of losing their rights, their ability to choose and control over their own lives, you'll better understand why they may say or react they way they do. You'll be better able to talk with them and relate to what they're going through and more likely to be successful in talking with them.
WHAT IF I THINK MY PARENT IS UNSAFE AT HOME?
If you feel your parents may be putting themselves or someone else at risk it's important to address it as soon as possible. Most older adults have one primary fear: that their independence will be taken away. Contrary to how they often see it, reducing their chances of getting hurt is the best way to maintain their independence. An obvious safety concern is driving. If you suspect, or know, your parents are unsafe behind the wheel then it's probably necessary to intervene. You may have noticed how often there's news coverage of an older motorist hitting someone or something. Some of these accidents have injured, or even killed, the older adult or other people. Admittedly, this is a tricky area to discuss with your parents, which I'll explain later, so it's a common issue that children with aging parents avoid. Doing so, however, keeps your parent and others at risk. Another concern is safety in the home. Poor balance, strokes that affect your parents ability to get around, overmedication, and the need to go up and down stairs daily are some common things that increase a person's risk for falls. Poor eyesight or an inability to think clearly or react quickly [due to a stroke, reduced oxygen to the brain, overmedication, or the beginning stages of dementia] can create a situation where your mother or father aren't able to prevent a fire from starting if a hot pad falls onto a burner or a candle tips over, for example.
H*#@ NO, I WON'T GO
Even though you feel you feel your parents are unsafe, they may not agree. I suggest to clients that they give their parents several choices and a deadline for deciding. A script for this:
"I know you don't want to discuss leaving your home; however, the reality is you can't stay here unless you accept in-home help or, you have the option of moving to assisted living. You'll have to decide by [give them a specific deadline]. I know this isn't easy for you and I'm sorry about that."
Your parent may continue to object and you may need to continue repeating some version of what I've outlined above. Showing compassion yet being firm can move many parents who dig their heels in, but not all. Despite all your efforts your parent may continue to live in an unsafe environment until something serious happens that makes it impossible for them to return home. Depending on the issue that prevents them from moving home, they may have few options.
It's not unusual for assisted living facilities to have waiting lists. Depending on your parent's health situation he/she may have to skip assisted living entirely and go to a skilled nursing facility. The best you may be able to do is talk with facilities near you, or near your parent's home, and ask to be put on a waiting list. This gives you some control over circumstances if you have to make quick decisions about your parent's living situation later on. Facilities will check with you if your name is getting near the top of their move-in list as apartments become available. If circumstances haven't changed for you, most facilities will move your name to the
end of the list.
CARE OPTIONS
There are many types of care options and each has its pros and cons.
Living with Adult Children
This option is not for everyone. I ask clients who are considering this if they've sat down and discussed it with their parents. It's not uncommon for adult children to feel it's their duty to move their parents into their home and care for them. However, when they talk with their mother or father about this they're often surprised their parent doesn't want this. Likewise, some elderly parents expect their kids to make a place for them in their home when they can no longer care for themselves. This often isn't realistic. Adult children may literally not have space for their mother or father to move in; money to pay for things their parent needs as
they age [or to move to a bigger home]; be able to afford to work less hours or take time off to provide the help their parent needs or, may not have the fortitude to be with their parents that much. Unless adult children and their mother or father have established a relationship as adults that allows for each other's differences, throwing parents and children together after years of being apart can create a lot of stress for both parties. Even if the parent/child relationship is strong and both sides are respectful of each other's time, space and lifestyle, adding a parent to your household can be hard on significant others and grandchildren. This decision takes careful consideration for everyone involved, you, your parent, your kids, your significant other, your siblings, because it impacts all of them in some way.
Pros...
- an opportunity to give back to your mother or father for all they've done for you
- if the above benefit sounds rosey it's because it usually is. Rarely does the dream match reality.
- high stress simply because your parent's needs will increase the older they get.
In-Home Care
There are companies that provide caregivers that will come to your parent's home. Services vary but generally they provide light housekeeping, prepare meals, write letters, provide socialization (visit with your family member), transport to appointments, help bathing and dressing and medication reminders. These companies may, or may not, provide nursing services (described below).
Pros...
- your parent can continue to live in their home
- may be less expensive than assisted living
- covered by long-term care insurance
- Depending on the cost your parent may still be home alone much of the time. Having a device like Lifeline is one solution. You might remember the ads on television, "Help, I've fallen and I can't get up." Your parent wears a device around his/her neck and if something happens and they need help they push this button. When your mom or dad activates the device, several things may happen: some devices allow your parent to talk to a person who assesses what's needed and/or talks to your parent until help arrives; other types of devices alert a dispatcher at the company who works from a list of contacts provided by the family, if they are unable to reach anyone or, after a certain period of time, 911 is called. The main challenge with these types of devices is getting your parent to wear it ALL the time.
- Your mom or dad may be limited in where they can go, or when they can schedule appointments if they have to be within the hours the caregiver is present. This is one of the biggest obstacles older adults face if they stay in their home. It's one of the main reasons they continue to drive when they shouldn't. Imagine what it would be like to always have to rely on someone else to take you where you want to go. Most U.S. lack a good public transportation system so there are many places, besides rural areas, where public transportation is not available.
- Parents can be uncomfortable having caregivers do things for them so they may use the time for visiting or encourage them to leave before they've completed their chores. Asking the staff of the home care company how they address these issues before you hire them is one way to deal with this problem. Continuing to ask the company for caregiver feedback is another. Asking your parent what things the caregiver is doing for them may also give you a feel for what's being done, or not being done.
In-Home Skilled Nursing
Companies that offer this service may provide many of the same services in-home care providers do but they also provide nursing services such as: giving medications, reporting conditions and changes to your parent's doctor, taking vitals, drawing blood, giving injections, setting up medications and physical and occupational therapy.
Pros & Cons are similar to those of in home care above.
Retirement Communities
Generally these are independent living communities of people 55 and older. The living quarters can be homes or apartments, depending on the community, and residents may have the option to buy or to rent. Retirement communities are much like independent living but some services may be provided and residents are usually 55 years of age and above.
Pros:
- Less upkeep than a home- Generally the dues or rent include services for grounds keeping; house cleaning services may be offered; a dining room or other type of meal service may be available and other amenities may be offered.
- Less likelihood your parents will be isolated. There are often activities, excursions, etc. offered in these communities and residents tend to reach out to one another.
- Potential for narrowed thinking- While your parent may not be isolated from others, residents are primarily spending time with their own age group. Their experiences outside of the community may also be limited. These factors create the potential for them to view the world more narrowly.
These facilities have apartments with kitchenettes. Generally they provide three meals a day that are part of the monthly rent. Most only serve meals in the facility's dining room. There is a nurse on staff and nursing aides who administer medications (some facilities will let residents who are cognitively able manage their own medications). Most facilities offer outings throughout the month for residents. Housekeeping is provided.
Pros:
- Your parent will be less isolated
- They can get their care needs met less expensively than with in-home care
- Facilities can be fairly regimented- It's less expensive and more convenient for the facility to provide meals and some services to residents on a schedule. This can be fairly frustrating since this is another area older adults lose control over basic things: when to eat; bathe, etc.
- Your parents daily needs may not be met quickly- A focus on turning a profit and a lack of employee commitment to the work (usually due to low wages) often means facilities are understaffed
Skilled nursing facility (a.k.a. nursing homes)
This is the type of facility that was available for your parents' parents. Most confuse assisted living with this type of facility. Nursing homes have become skilled nursing facilities (SNF pronounced like sniff) because medical insurers can save costs by moving patients here who need rehabilitation or a longer recovery period after their hospital procedure. It is not true, as your parents may believe, that you never get out of a SNF. It depends on why someone is there. Usually people stay long term if their needs are more than an assisted living facility can provide. (This would be similar to in-home skilled nursing services; the needs are greater than "basic" service: wheelchair bound; need helping getting in and out of bed, chairs, etc. can't walk without assistance, etc.) Some people on Medicaid may be in a SNF because they can't find an assisted living facility that will take Medicaid. Some people may not have enough money for assisted living but have too much for Medicaid. There may be a unique reason a person would stay in a nursing home long term besides those I've mentioned.
Pros:
- Staff have the training to take care of extensive medical needs
- It is less expensive than in-home care
- Facilities are often understaffed and employees are usually overworked
- Privacy is often at a minimum
- Your parent has little control over their environment
Some senior housing options have a retirement community, assisted living and skilled nursing (or only the last two) all in the same place.
Pros:
- Your parent can get the level of care they need without having to leave familiar surroundings and friends
- Any of the cons I've mentioned above
Lynne Coon, MS
Counseling and Resources for Adults with Aging Parents
www.lynnecooncounseling.com
Labels: aging drivers, aging parents, housing options, moving
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