Family Education

Starting the Conversation

Conversations about the effects of aging and plans for the future of an aging loved one can be tricky. Here are some suggestions for tackling such issues as long term senior care, finances, driving, household safety, and end-of-life choices.

Some things to consider before you begin:

Don’t think of your changing relationship with your parent as “role reversal”, think of it more as becoming a peer or friend. Chances are, if you become the “parent” by ceasing control, they’ll become the “child” and rebel.

Don’t think of it as “The Big Talk”, but rather as a series of conversations. It’ll be easier to get started if there’s not a huge list of things to accomplish. And it’ll be easier for your parent not to feel overwhelmed. Be sensitive to their level of comfort and stamina.

Sooner is better – talk before a crisis occurs and when your parent’s health allows them to fully participate.

Remember that while most kids assume their parents will resist having this conversation, the fact is that many parents want to share their thoughts but think their kids don’t want to hear it!

Try to ask questions and then listen carefully. You’re trying to find out what your parent wants. DO NOT give ideas, suggestions or input unless asked. If you jump in with a bunch of plans and solutions before asking what they want, you’ll likely meet with resistance. Ask what, where, who, how and when… but avoid asking “why”. If you do you’ll likely meet an emotional and defensive response.

Pick a time for the conversation that’s not rushed. And don’t do it during family occasions such as holidays or birthday celebrations.

Educate yourself before you start. It’s important to know what needs to be discussed, ie, living arrangements, outside help, power of attorney, when to stop driving, etc. Understand the options available. The more you know the better you’ll be able to ask the right questions.

It’s possible you’ll get some resistance. Remember that resistance is usually the response to fear. You can reassure them that the reason you’d like to discuss things is so you can help them live the life they want, even if in the future they can’t do certain things for themselves.

Remember that decisions made today can be changed tomorrow. Especially after having had the time to think about them more and from various perspectives.

Try to keep it light, involve only immediate family, don’t make it an intervention, and limit your initial expectations.

Some conversation starters

Hopefully one of the following examples will give you an idea:

Use an experience you’ve had or that of a friend. For example, “My friend’s mom broke a hip and is in the hospital. My friend has to make decisions for her and is unsure what to do. It got me thinking that I should know what you’d want me to do if that happened to you. Can we talk about it?”

“I read an article about how seniors often lose control as they age because others’ have to make decisions for them. I want to make sure you never feel that way. Can we talk so I’m clear about how to help if you need it?”

You can share an experience such as your own retirement or estate planning as a way to gracefully transition into a conversation about your parents’ thoughts regarding the future.

If you are unsure what sort of documents you might need, see the Legal Considerations section of our Family Education area.

Ask about records and documents. Explain that you want to be prepared to help them when needed. Ask where they keep important documents such as insurance policies, wills, trust documents, investment and banking records, tax returns, living wills and durable powers of attorney. This approach could also serve as a way of finding out what plans he or she have already made and what needs to be done.

Some signs of a looming problem might be if you notice damage to an older driver’s car, or if you notice that they’re reducing driving at night due to vision problems. “Let’s figure out a plan for how you can get around town if you no longer feel safe driving.”

If the house is a mess… “Mom, I have some extra cash. What do you say we find someone to help you with the heavy stuff?”

Even if the house isn’t a mess, you can help open the discussion by inquiring whether there are any responsibilities – such as home maintenance, yard work or bill paying – that they’d like some help with to make life easier.

If you see medication bottles everywhere… “How the heck do you keep all these pills straight, Dad?” There might be good reasons such as, some are in the kitchen because he takes them with food. Some are on the nightstand because he takes them before bed. On the other hand, if the response is something like, “I don’t know. I do my best. I’m not even sure what some of them are”, then the situation probably needs more attention. A pill organizer might help, or perhaps a trip to the doctor or pharmacist together to get it sorted out.

Household clutter is a little-known cause of senior stress. Perhaps offering to help a parent sort through a cluttered home will give you the time together to broach a tougher subject and busy hands to make it seem less onerous.

If you notice bruising… Pay special attention. It could simply be a result of certain medication (though if extreme the doctor should be consulted), but it could also be due to falls, malnutrition, or elder abuse. “Mom, that’s a nasty bruise, where did you get it?” If she tries to pawn you off with a generic response such as “I’m just clumsy”, dig further. “Sure Mom, our whole family is clumsy but we aren’t all walking around with big bruises on our arms. So how did it happen?” If you notice empty cupboards or spoiling food in the fridge… “Boy, there’s not much food around the place – what are you guys eating?”

Involve third parties. If your parent resists your efforts to begin the discussion, he or she may be more open to the guidance of a respected non-family member. Doctors, clergymen, geriatric care managers or trusted friends who have already helped a loved one in a similar situation might be possible resources.

Approaching a parent about giving up the car keys

We typically consider driving a significant part of independent living, but the fact is that the ability to drive safely decreases with age. Response times slow, manual dexterity decreases, peripheral vision and depth perception decline, concentration ability declines, hearing loss, and decreased flexibility to look around for problems are just a few. Many people are able to drive safely into their 70s and even their 80s, but people age differently. Knowing the risk factors and warning signs of an older loved one who has become unable to safely operate a vehicle will help you gauge when it’s time to hang up the keys.

According to the National Institute on Aging, there are several critical indications that a senior may be losing the judgment or ability to drive:

• Incompetent driving at night, even if competent during the day.
• Drastically reduced peripheral vision, even if 20/20 with corrective lenses.
• Struggling to drive at high speed even if he or she drives well locally at slow speeds.
• Erratic driving, such as abrupt lane changes, braking or acceleration, hitting curbs, missing turns or scaring pedestrians.
• Getting lost frequently, even while driving on familiar roads.
• Trouble reading street signs or navigating directions.
• Frequently startled, claiming that cars or pedestrians seem to appear out of nowhere.
• At-fault accidents or more frequent near-crashes or scrapes on the car or mailboxes, garage doors, and curbs.
• Failing to use turn signals or keeping them on without changing lanes.
• Drifting into other lanes or driving on the wrong side of the road.
• Range-of-motion issues, such as failing to look over the shoulder, trouble shifting gears or confusing pedals.
• Increased traffic tickets or “warnings” by traffic or law enforcement officers.

Talking to a relative about his or her need to stop driving is one of the most difficult discussions you may ever face. However, it’s better if it comes in the form of advice from you or someone he or she knows rather than by an order from a judge or the DMV. One of the main reasons seniors are reluctant to give up driving is that it is one of the few ways they can continue to feel self-sufficient. The discussion becomes even more difficult when the person still maintains most of his or her faculties, just not those that enable safe driving.

Be empathetic. Imagine how you would feel if you were in your parent’s place. Ask others to join in the meeting. It helps to involve other family members in the discussion to help, but not to confront.

Keep the conversation non-accusatory, honest and between “adults,” not “child and parent.” Say things like, “We’re concerned,” “We care” or “We don’t want you to get hurt or to hurt others.” Once you’ve both come to an agreement, you can continue to support your loved one in ways beyond just offering rides.

Help the senior make a schedule. He or she can plan activities and combine trips on days when a caregiver can drive.

If all else fails, they might have to hear the news from a doctor.