If everything were perfect, we would all plan our retirement and our twilight years while we were lucid, healthy and open-minded.
Your scowling parents are sitting across from you with tightly folded arms as you try to explain, once more, why they should think about moving to a care community.
They’re not buying it.
Don’t they understand how worried you are for them?
Welcome to the conversation countless families across the continent are having - or trying to have - with aging parents who don't agree they need help with their day-to-day living.
How can you make this whole thing more comfortable?
Is there a way to help the people you love so much make a decision that will greatly benefit their safety and wellbeing?
After all, this is one of the most difficult conversations you can have. Giving up their family home and its memories and mementos is a devastating thought for your parents. The fear of losing their privacy, independence, and autonomy is equally overwhelming.
And if they are ill, or infirm, or unable to care for themselves as well as they used to, they probably realize help is needed - but that doesn’t mean they are ready to accept it.
If everything were perfect, we would all plan our retirement and our twilight years while we were lucid, healthy and open-minded. And while some people do plan for changes as they age, most stay with what they know until they can no longer cope.
Whatever the reasons your parents need support you are reading this because you want to help them be safe while ensuring they are also happy.
Knowing how to start the process of considering a major move may make their transition easier for all of you.
1. The sooner you have “the talk,” the better, but keep it light.
The sooner you and your parents can talk about planning for their future the easier it will be to have the conversation remain open and productive. Their wishes are paramount, and they may already have some ideas and plans to share with you.
If however you have reason to be gravely concerned for them resist the urge to launch right in with a barrage of worried questions. During your regular visits or phone calls, just ask general, “How are things?” questions. Keep it light, wait for responses that might indicate you can go deeper, or conversely, a signal that you should back off a bit.
2. What are those bruises?
If you see your parents on a regular basis, it’s likely you know how they are managing, but they could surprise you. Your parents may assure you that all is well, they are “getting on just fine, thank you,” and that they can take care of themselves without help, but what you notice around the house might indicate otherwise.
If you live too far to visit frequently, look around a bit when you do visit:
- Do they have enough fresh, nutritious food? Seniors with poor eyesight or forgetfulness run out of things or don’t always notice that food has spoiled or has been left out too long.
- Are the bills paid on time? Check to see if they have opened the necessary mail.
- Has the garbage been taken out?
- Is their home relatively clean and the laundry done?
- Do Mom and Dad look (and smell) clean? Bathing can become very awkward as people age and odors might also signal incontinence or even infections.
- Do your parents walk steadily, especially up and down stairs?
- Do they have any unexplained marks or bruises that could mean they’ve hurt themselves somehow, such as from a fall?
- Do they seem unusually confused or forgetful?
- Are they getting out to medical and dental appointments? If you aren’t taking them, who is?
- Are they still driving? Have there been any accidents or tickets? Is the car in good shape? Are there unexplained dents or scratches?
Take stock of how things appear. Deal with emergencies as you see them, but start thinking about next steps and how you will approach the situation. Even though you are worried, resist the urge to fire questions at your parents during your visits; you’ll only put them on the defensive.
If you have siblings, let them know what you’ve found. Get them onside from the beginning. Talk to your siblings about how all of you should take the same approach. It’s important that you all be in accord, unified but not overwhelming.
3. Did you know that people aged 80 – 84 use an average of 18 prescription medicines a year! Ask your parents for a list of what they take.
The American Society of Consultant Pharmacists warns that: “Medication-related problems are estimated to be one of the top five causes of death in that (65 years and older) age group, and one of the leading causes of confusion, depression, falls, disability, and loss of independence.”
Ask your parents how they manage their daily medication dosages. People aged 80 – 84 take an average of 18 prescription medicines a year. That’s a lot for anyone to track.
4. Keep your approach light but get that vital information!
If you ask your parents to let you have a list of their medicines, their banking accounts, and other personal information, they may feel their privacy is threatened. Remember, they have always been the caretakers, the parents; it’s not easy for them to acknowledge that their roles have changed somewhat.
On the other hand, they might be glad to let you take over the banking and bill paying chores, but ask first.
One way to get personal information from your folks is to tell them that in an emergency like a fire, accident, sudden illness, or a major natural disaster, you would need their records so you could help them and that they should have yours for the same reason.
Learn whom your parents have appointed as their Executors. If they don’t have anyone yet, add that to your “to do” list.
5. Don’t be bossy and abrupt. Resist the urge to take over.
Finding your way into a delicate conversation with an elderly loved one takes patience and skill. You’ll want to keep communication open, and the best way to do that is to ask their opinion. “What do you think we should do,” will meet with less pushback than, “ You can’t stay on your own anymore, we’ll have to find you a home with special care.”
Asking, “What does your doctor think,” is going to go over much better than announcing, “That’s it, something is wrong; I’m calling your doctor.”
Resist making decisions and issuing ultimatums. Instead, “I messages” like, “How can I help,” or “When I see you with those bruises I get anxious,” are the best.
6. Ask your loved ones what they want to experience in their future years. What are they least willing to give up? What do they least like doing now?
Preparing a list of questions with your parents can help them organize their thoughts about what they want and need. Maybe your Dad has always wanted to take art classes, or your Mom wants to write a memoir. Perhaps they’d like to have a small garden to tend, nearby woods to walk in or even a kitchen and dining room to have family in for dinner.
Some older adults start to find housework and outdoor garden chores tedious, exhausting, and time-consuming - and easy to give up! Especially if not having to do them means there’s more time for the fun things in life.
7. Ask your parents what they want most in their new home.
Moving from the family home requires downsizing. Parting with personal belongings and a lifetime of memories is heart wrenching for everyone, but especially for your parents. Knowing they can look forward to keeping some of their most precious mementos, to having a small garden, a kitchen to cook in, and maybe even their beloved cat can make a huge difference.
Some older adults are happy to know their children and grandchildren will appreciate their treasures and that those mementos don't disappear.
For many people, independence and privacy are as precious as any tangible items. If a new home includes what is most important to them, it will be easier to make the change.
8. Find out about the different kinds of senior care communities in an area where your parents would like to live. Which ones offer items on your parents’ wish list?
Research what kinds of senior communities are available. Options will depend on your loved ones’ personal preferences and health needs as well as finances, and include the following:
- Home care workers assist with a variety of daily tasks including personal grooming, meal preparation, feeding, and light housework.
- Skilled nursing care can be given at home and is a term that refers to a patient's need of care or treatment that can only be done by licensed nurses.
- Independent living communities: The independent living category encompasses a range of housing arrangements, from apartment-style communities to housing co-ops. Generally though, residents live in separate dwelling spaces and have a common area where they can gather with other members of the community. Independent living can also be referred to as an active adult community, senior apartments, a retirement community, a 55+ community, a retirement home or a CCRC.
- CCRCs: residential care options that include independent living communities, assisted living facilities and skilled nursing. CCRCs provide a ''continuum of care'' for residents, so that residents can move from one level of care to another if the time comes. These are also known as “aging in place” communities.
- Assisted living communities: Assisted living is geared more towards helping aging adults who need some assistance with activities such as bathing, doing laundry and keeping track of their prescription medications. Staff members—including some kind of medical professional (typically a certified nurse practitioner)—are on-call 24 hours a day in most assisted living residences.
- Memory-care residences contain special memory care units designed for individuals with mild or moderate dementia.
Both independent living and assisted living communities have recreation schedules that are unique to each facility. Common activities include: game nights, field trips, support and discussion groups, holiday celebrations, exercise classes and continuing education courses. They also provide transportation services to shuttle residents to and from doctor's appointments, the grocery store and other errands.
Visit a few communities and residences on your own (and with your siblings if possible) and ask questions, gather brochures and investigate costs. Look into independent reviews of places that you like but don’t be tempted to decide for your loved ones. It should be their decision.
When you have some good options, tour the communities with your parents and take photographs. Later you can look at the photos for reference, and discuss the pros and cons of each site together.
9. What will you do if your parents refuse to move and get angry with you for bringing it up?
To get past outright resistance, you will need to understand that your parents' anger comes from fear. The fear of losing their home, privacy, autonomy, and independence can be paralyzing. Even the fear of upsetting and worrying their children can shut down communication.
It’s important that your parents and you know that disagreement about things does not mean the loss of love. Stay positive about the benefits of a transition but also acknowledge their sense of pain, fear and loss.
Empathy and respect are vital components of supporting your parents during this change.
10. Could an objective third party like a counselor or doctor help?
A doctor, the clergy, or a trained Geriatric Care Manager can often bring objectivity and authority as well as trained counseling skills to an awkward conversation requiring an even more challenging decision.
If you’ve reached a stalemate, and your parents’ situation is such that they really do need daily supports, consider calling in a professional to speak with them. Sometimes taking the family out of the discussion can help defuse the emotions.
11. Are they still not ready? Can they stay in their home?
If your parents refuse to move, it can be frustrating, but it is understandable. Fear and denial are powerful forces. There are still a few options if your loved one refuses to move.
If your parents are not in immediate danger because of significant memory loss symptoms, injury or severe illness, it may be possible to wait and start the discussion process again after a few months.
In the meantime you could do the following:
- Check into home care that could visit daily to prepare meals, shop for groceries and do light housekeeping. Some home care workers will assist with bathing and other personal routines.
- Arrange for skilled nursing services that could visit several times a day if needed to administer medication or perform other medical procedures.
- Look at making the family home accessible and safe throughout with ramps, stair chair systems, non-slip rugs, higher toilets, shower bars, etc.
- Install call systems and monitoring devices.
Unfortunately, it sometimes takes a catastrophic event such as a fall, fire, or sudden illness for some elderly parents to fully realize they are fragile and vulnerable and require assistance day and night.
12. Can your loved ones live with you? How to determine if that will work.
You and your family members may have been struggling with this idea for a long time. There may even be a sibling who carries the responsibility for your parents’ care already, visiting daily, living with them, or staying with them overnight.
Often elder care falls to the family member who does not have children of their own or who lives closest to the parents. It’s not unusual for these siblings to become resentful and suffer from caregiver fatigue, feeling physically, emotionally and mentally exhausted.
Ask yourself the following questions before you invite your parents to live with you:
- Do you get along well?
- Do you have room for them?
- Do you and your spouse work full-time?
- Do you care for young children?
- Is there something for your parents to do at your house if they can’t get out daily?
- Will they still be alone all day if you are at work and the children are at school?
- Are you robust and healthy enough to care for them?
13. Start making plans for your own aging experience now.
Once you settle your parents in their new home, you may feel relief. You may also feel guilt, remorse, and grief. After all, you’ve just gone through the dismantling of your childhood home and all its memories. Not to mention the roller coaster of emotions that come with accepting that your aging parents need care and seeing them moved in!
These feelings are normal, and with time, as you see your loved ones adjusting and even thriving in their new community, you will come to feel at peace.
You can learn from this experience too. It may be a good time for you to plan for your future as you age and to voluntarily start that awkward conversation with your kids, so they don’t have to struggle with it down the road.
Photo Credit: Italo Vardaro