I recently had an extensive conversation with the family member of an elderly person about approaching the subject of moving to a senior community. This adult child was experiencing the type of anxiety shared by so many of the families I have met with over the years including fear that their elderly loved one could fall at home and not be found for hours or days; guilt about not being able to care for their mom or dad at home; stress trying to balance caring for their loved one and caring for their family; sadness knowing that their parent is experiencing the situations commonly associated with aging; confusion over learning about senior housing, assisted living, long term care, VA benefits and other topics so foreign to most people until they face the life transitions associated with getting older.
This article addresses the “when” and “how” to broach the subject of making a move to senior living. Our experience tells us that doing nothing or delaying the conversation may put a loved one’s health, safety or well-being at risk, while possibly escalating their health issues and your own stress level as a caregiver.
The solution is to do some advance planning – before problems arise or get worse – to make these conversations easier for everyone.
PLANNING THE CONVERSATION
Start early. An AARP survey shows that older adults feel better about having these discussions when things are going well, as part of planning their future. Too often, families wait to have such discussions until after a parent has had an unexpected health issue or crisis, such as a fall, accident or medical emergency, and is no longer able to take care of themselves. The urgency at this time causes increased stress, confusion and uncertainty when the clock is ticking, care options are limited, and significant decisions have to be made quickly.
Being proactive instead of reactive will help provide calm, thoughtful discussions, and ensure families have a plan in place should a loved one’s health situation change unexpectedly. Planning ahead also enables mom or dad to get on a senior living community’s waiting list, if necessary. Selecting a “continuum of care” community allows adult children choose the best care option for mom or dad for the time being, while planning for additional assistance should the need arise.
Prepare for the discussion. You might consider scheduling a time for the talk and giving your loved one a list of questions, issues or concerns beforehand. This helps them prepare for the conversation by letting them think about the specific kinds of help they may need or what’s important to them in a new living environment. At the same time, you’re facilitating their important need for some degree of control in their lives. By knowing their wishes, you’ll be better able to help your parent live life the way they want.
Schedule a “preview tour”. This will educate you about your options and prepare you for those challenging conversations with your loved one. At Nazareth Living Center, we welcome you to tour our Continuum of Care Community and will show you everything on the campus.
Decide the best people to be involved. Usually this includes adult children who live nearby and may already be involved in caring for mom or dad. It may also include a spouse of the aging parent if the couple has different care needs. Limit the number of participants to avoid overwhelming the parent or loved one. You can always update additional family members after the conversation. Often it can be helpful to have someone in addition to adult children be involved in the discussion; mom or dad may be more likely to listen to an independent, unbiased perspective from an outside party, such as a trusted friend, relative, doctor or pastor.
ASKING QUESTIONS THE RIGHT WAY
Once you come together, there are particular communication procedures you might use and signals to watch for – both within yourself and your loved one. Seniors seem to have a radar that is highly tuned in to the signals we send when we’re about to tamper with their control without their permission. We need to signal back that we’re friendly and “on their side.” Keep in mind that you’re “partnering” with your loved one to solve a particular need or issue in their lives, as opposed to “parenting” or taking a one-sided approach that tells them what to do or what is best.
Consider this approach in speech and delivery of your side of the conversation:
- Give your loved one time to settle in and get comfortable.
- Listen with your full attention and let the conversation flow. Make it a dialogue instead of getting preoccupied with your own “agenda.”
- Don’t rush. Wait for them to gather their thoughts. Pause is good, and silence can serve a great purpose. Indicate with your own body language that you’re “all ears” and eager to hear more.
- Speak in terms of questions, not answers, so you can gather as much information as possible.
- Be thoughtful in choosing the right words so your meaning is clear and supportive.
Here are some suggestions for dealing with delicate topics:
Approach the subject indirectly:
“Mom, I know you’re taking a lot of pills. How do you keep track of them? Would it help if you had someone to remind you when to take your medication?”
“John says his dad has given up driving. Have you thought about how you would get around if you could no longer drive?”
Be direct, but non-confrontational:
“Mom, I’m worried that you seem to be unsteady on your feet. I’m wondering what we can do to help protect you from falls?”
“Dad, if you ever decided it’s not a good idea to live alone, have you thought about where you might want to live?”
Watch for openings:
“Uncle Joe, you said you were having problems with your eyesight. Now that you no longer drive, do you have anyone who can take you to your regular doctors’ appointments?”
“Gramps, after you said last week that you had trouble turning the handles on the water faucets, I wondered how you were managing with the shower?”
Share your own feelings about your loved one’s changing life:
“You’ve always been so independent, Dad. I imagine it’s hard for you to ask for help now. But if it were readily available, what kinds of things would you like help with?”
“Aunt Jane, I know you must be bored alone in the house all day with me at work. Wouldn’t it be nice to be someplace where you can be around interesting people and have stimulating things to do?”
DEALING WITH RESISTANCE
Be prepared for your loved one to resist any conversation about their diminishing independence and health. They may be offended, telling you to mind your own business, or they may dismiss your concern with reassuring statements, preferring to pretend that life is as normal as it has always been for them.
In such situations, experts advise:
- Respect their feelings if they make it clear they want to avoid the subject, then make a mental note to return to the conversation at a more suitable time.
- Push the issue if their health or safety is at risk, yet recognize their right to be in charge of their own life.
- If you decide you simply must intervene, act firmly, but with compassion: “Dad, we can’t ignore this any longer, we must deal with the situation. I’m here to help.”
- Involve other people your parents respect, such as a family friend, attorney or minister.
- Hold a family meeting so everyone can discuss concerns and jointly develop a mutually agreeable plan. Once your loved one has agreed to at least consider the idea of seeking additional help, possibly in a continuing care senior community, research your options carefully and learn everything you can about what life will be like for your loved one if a move is the answer.
Moving to an independent or assisted living or skilled nursing community can be one of the best decisions a family can make for an aging parent, particularly when activities of daily living become more than they can handle, social isolation is an issue, or their care needs are more than family members can provide. Starting the conversation early will make your loved one’s transition into their next phase of life easier and more enjoyable for everyone involved.
(The following references were used in preparing this information: Loverde, Joy. The Complete Eldercare Planner. New York: Three Rivers Press, 2000.Solie, David, M.S., P.A. How to Say It: Closing the Communication Gap with Our Elders. New York: Prentice Hall Press, 2004.)
Susan Cablish, Marketing Director at Nazareth Living Center