Time to Talk

By Ronit Rose

Ronit Rose is a freelance writer, based in Chicago. She has a special interest in health, healthcare and preventive medicine.

The tough conversation about stepping up care

It’s one of the most difficult conversations to have: letting a loved one know they may no longer be able to care for themselves. Chicagoan Abby Clancy knows this all too well. “We had been having the conversation about moving with my mother on and off for years,” she says. “These conversations always ended badly, so for a long time we ignored the issue.”

Indeed, when an adult child notices that their parent needs additional support — whether that means part-time help at home, a full-time companion or a move to a residential care community — it may be past time to talk about it.

It’s optimal to have the discussion before the family member needs help, says Joyce Mahoney, regional director of memory care and programming for Belmont Village Senior Living, an assisted living company with five locations in the Chicago area.

“In our experience, we find it best to have conversations early on,”
she says, “and to have the conversations while [loved ones] are healthy, so if something does occur, the family will know [their] wishes. It will help alleviate some questions or even guilt on the family member’s part.”

Opening the conversation

Once you decide to approach your family member, plan the conversation carefully, says Randi Israel, life care manager with LivHOME, a senior care company that helps clients in Illinois and other states navigate care and stay in their homes.

Find the right time — ideally not during their favorite TV program or activity — and take care not to sound critical, even if you’ve noticed that their housekeeping or hygiene has slipped.

“It is important to go into this situation from a place of kindness, even if you are frustrated,” Israel says. “Engage [your family member] in the conversation. It is okay to let them know you are losing sleep at night, you are worried.” 

Before you open the conversation, educate yourself about the different care options available, such as in-home care and assisted living. Many older adults are familiar with (and wary of) nursing homes but
are not aware of other options.

Depending on their prior experience with long-term care, they may have some preconceived notions that are no longer accurate, Mahoney says. The industry has expanded and changed over the past few decades, as retirement and assisted living communities have entered the picture.

These days, communities offer many more options, amenities and levels of care. “We did not have the options years ago like we do now,” Mahoney says.

Framing the conversation

Family members often feel guilty about curtailing a loved one’s independence or imposing changes on them, especially when that person is resistant to change. It’s important to acknowledge the loss of independence and also to remember that you are making changes to improve their situation, Israel says.

“Whatever the reason [for these changes], you did not cause it or create it, and it is not your fault that your family member has this going on,” she says. “Sometimes things are not fair, but, given the situation, you are going to present the best options possible.”

Another tactic is to position this change as one more of life’s challenges. “People generally do not live to 80-plus years without experiencing sadness, challenges, hardship and just difficult situations,” Israel says. “The same internal resources they used then, they’re going to use now. Let them know, ‘I’m going to be there all the way, I will support you and help you through this process.’”

If you are thinking of transitioning a loved one to a residential community, explain to your family member that the residential setting may enhance their independence. Because independent living communities provide meals, amenities and activities, individuals can continue to enjoy social activities and age successfully, Israel says.

Certainly, there are some potential pitfalls of these difficult conversations. Family dynamics play a role, and the better you see eye-to-eye with your siblings and other family members, the more likely you are to have a successful outcome.

In the absence of family consensus, if someone holds healthcare power of attorney, that person may need to make the final call. Healthcare power of attorney is a legal status that designates an agent to make medical decisions if the person needing care can’t make decisions for themselves.

Fortunately for Clancy’s family, things worked out well. Her mother moved to Chicago and is delighted with her assisted living community.

Nothing about this transition process is easy or comfortable. But there are ways to prepare for it: Know your options, keep an open mind and approach your parent or loved one with a supportive and positive attitude. The conversation is not easy, but by approaching it thoughtfully, you’ll be honoring your loved one with the best options for all.

Resources

Administration for Community Living, acl.gov

This government website has information on support options for older adults and those with disabilities. Its Eldercare Locator, eldercare.acl.gov, discusses housing options and rights, insurance issues and even tips on how to talk to your parent about driving.

Aging Life Care Association, aginglifecare.org

The site’s consumer resources link provides a comprehensive list of websites with information on elder care that might help family members make informed decisions for their loved ones.