Eldercare in Durham and Chapel Hill: Starting "The Conversation"

By Helen Antipov

Aging happens. There is no getting around it.

Unfortunately, conversations about preparing for our senior years often do not happen. At least not as soon as they should.

In this article, Comfort Keepers of Durham and Chapel Hill offers suggestions for overcoming the discomfort that many times prevents adult children and parents from beginning these important discussions—whether about long-term elder care and finances, health care, end-of-life decisions, driving or safety around the house.

The best advice is to plan carefully and think through such conversations so that they are as positive and productive as possible. Write down what you think needs to be discussed so you don’t forget anything. Remember, Comfort Keepers of Durham and Chapel Hill is here to help.

Also, do not approach this important opportunity as “The Conversation,” but as an ongoing series of conversations. Address one issue at a time rather than trying to resolve everything at once. It is less intimidating that way. If you start small, you are more likely to start.

Following are additional tips for starting the discussions:

• Begin early when your parents health allows them to fully participate and share their wants, needs and preferences. Otherwise, your elder care decisions may be dictated by a life-changing event and may not necessarily reflect your parent's wishes.
• Choose a time and place that makes everyone comfortable. Avoid special family gatherings, like a birthday or holiday celebration. Choose a time that is not hemmed in by other obligations so you can have a relaxed, unhurried conversation, giving your parent plenty of time to share his or her wishes.
• Include other family members, but meet before approaching your parent to make sure everyone’s on the same page to avoid an unproductive, confrontational situation. 
• Make the experience non-threatening by letting your parent know you’re concerned for his or her well-being and want to know how you can help them. Explain that you would like to help them write down their plans to help assure that they are followed. You also can help open the discussion about long-term planning by inquiring whether there are any responsibilities—such as home maintenance, yard work or bill paying—they would like you or someone else to help with to make life easier.
• Use good communication skills. Maintain good eye contact and get close enough to your parent, without invading personal space. Closeness builds trust and allows you to speak—and be heard—in an even, controlled voice.
• 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. A friend or relative’s medical emergency could also serve as an opening for dialogue.
• Ask about records and documents. Ask your parent 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. Explain that you want to be prepared to help them when needed. This could also serve as a way of finding out what plans he or she have already made and what needs to be done.
• Ask open-ended questions that encourage your parent to share feelings. Then sit back and carefully listen to learn what is important to him or her.
• Offer options, not advice. Pose questions and offer more than one acceptable solution. Ask your parent which choice they prefer. This involves them in the elder care decision process and enables them to exercise control and independence.
• Speak with respect. Approach the discussion as a partner with your parent. In other words, make sure your parent is an active participant in the conversation. Stop to listen and respect their desire and need to maintain control over their lives. Avoid reversing roles in the discussion, that is, you acting as the parent and your parent as the child. This could cause your parent to resist your attempts to open discussion.
• Keep it simple. As stated earlier, do not try to resolve everything at once. The goal is to open an ongoing, honest dialogue about your parent's future, to share information and to understand your parent's wishes and needs so that decisions can be made.
•  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, such as a doctor, a member of the clergy, a home care provider, a geriatric care manager (www.caremanager.org), representative of an area agency on aging (www.n4a.org) or trusted friends and neighbors who may have already helped a loved one in a similar elder care situation.

Seniors Can Initiate the Conversation, Too

If you are a senior who is looking ahead and wanting to plan for the future, you do not have to wait for your children to bring up the subject. Often adult children don’t like thinking about their parents getting older and are reluctant to initiate the discussion.

• Take the initiative. If you begin having difficulty with activities of daily living, such as bathing, driving, or managing finances, speak with your physician or other healthcare professional. Also bring up the subject with family and ask for their suggestions and assistance.
•  Share your preferences with family and friends. Do you want to continue living at home but with the help of a caregiver who can assist with certain tasks around the house? Or if you are finding it more difficult to prepare nutritious meals for yourself, would you prefer having meals delivered or having someone prepare meals for you in your home?
• Learn about available services to help you as you age. Physicians, social workers, elder care providers, geriatric care managers and other healthcare professionals can guide you in this, and your local Area Agency or Council on Aging can provide a listing of home care services available in your area.

How to Approach a Parent About Giving Up the Keys

We typically consider driving a significant part of independent living. But the ability to drive safely decreases with age. According to a 2007 report from the U.S. Government Accountability Office, older drivers, based on miles driven, “are more likely to be involved in a fatal crash than all but the youngest drivers.”

So, there comes a time when families are faced with having to talk with an older loved one about giving up driving, for their own safety and that of others. How do you do this and minimize a senior’s feelings of resentment over lost independence?

Comfort Keepers offers these tips:

• Build a case. If you feel safe doing so and have not done so in a long while, ride in the car with your parent at the wheel. Get a sense for whether your intuition is right or not. It may turn out that your parent is a safer driver than you suspected. However, if your hunch bears out, you will have at least one reference point to go to when you talk with your parent.
• Refer to recent headlines—local or national—about accidents caused by elderly drivers. This can help you transition into a discussion about your parents driving.
• Approach the conversation with compassion, making it clear that you are motivated purely by concern for your parents well-being.
• Rely on others’ help when you feel you cannot convince your parent on your own. Many motor vehicle bureaus offer assessment services for elderly drivers. The senior’s physician may also provide an evaluation and a prescription to cease driving due to safety concerns. A friend who has already given up driving can offer the reassuring voice of experience.
• Offer your parent alternatives to driving. For instance, volunteer to take your parent to church or to the grocery—and have other family members and friends help out. Or suggest a professional caregiving service, such as Comfort Keepers, which provides clients incidental transportation to appointments and other needs.

At Comfort Keepers of Durham and Chapel Hill, we understand the stress that caregivers go through and how hard "the conversation" can be. We are here to help you and give you the support you need when dealing with a loved one and Alzheimer's and eldercare issues. Call us at 919-338-2044 or visit us online.