When Virginia Morris, author of the well-regarded guide How To Care for Aging Parents, was working on the first edition of her book, her father died, giving her special insight into the chapters on death and grief. As she revised the book for its second edition, she fretted over the fact that her mother insisted on looking at retirement apartments rather than consider moving in with her.
It all goes to show, she says, that no one is immune from the cares and potential pitfalls that come with caring for your parents. But it helps if you've prepared yourself by addressing the future forthrightly with the very people who are most closely involved: your mom and dad.
"Nobody wants to plan ahead for this," says Morris, a journalist who has written widely on the topic of aging. But, she promises, "You will be so grateful you did it because if you don't do it, you'll end up responding to one crisis after the next, and you are exhausted, and your parents will get mediocre care."
So, the moral? It's never too early to talk to your parents about their future.
In fact, "the sooner, the better," says Donna Schempp, a licensed clinical social worker and program director at the Family Caregiver Alliance, a nonprofit group that champions the interests of what is by far the largest segment of the population caring for the elderly in America: family and friends. If you bring up the subject before your parents need any extra support, "then it's not crisis driven," she explains. "It's not a way of saying, 'Mom, Dad, there's something wrong with you.'"
Even if your parents don't need your help now, sooner or later in all likelihood they’ll join the growing group of Americans who need some kind of long-term assistance. In 2000, about 10 million people needed help with tasks that range from dressing and eating to doing the household chores and managing money to needing care 24/7. By 2050, the U.S. Department of Health and Human Services estimates this segment of the population will more than double in size to 27 million.
How to Start the Conversation
How you bring the subject up depends somewhat on your relationship with your parents, says Sandy Markwood, chief executive officer of the National Association of Area Agencies on Aging, an umbrella organization for more than 650 agencies that deal with elder care. It often helps to bring up changes in the health or living arrangements of a friend, a neighbor or someone in the news and ask your parents what they'd like to do in a similar situation.
"It gets your mom and dad to start thinking about the fact that this might happen, but it does so safely," says Markwood. "It begins the conversation. You can say, 'I'm not telling you what to do, Mom, but how can we work together so we can make sure your wishes are met?’"
Another way to broach the subject is to make the conversation about you. Family Caregiver Alliance’s Schempp suggests sayings something like, "Hey, Mom and Dad, I realize I don't have a durable power of attorney for health care or a will or trust, and I'm thinking about getting them. I'm wondering where you are with that?"
The most important part of the conversation, says writer Morris, may not be talking at all. It's listening. "The first thing to do is to really listen to your parents," she says. "'What do you think about, Mom? What do you worry about? What do your hope for when you look at the future? What do you want out of it?'" Adult children who charge in with a full plan of action before asking these basic questions make a big mistake, she says.
"Let them know this is about them," Morris says. "It isn't, 'OK, now I'm in charge.'"
After the initial ice is broken, Schempp says, some families benefit from setting up a more formal family meeting. (For more on how to organize a meeting, see the Family Caregiver Alliance's, "Holding a Family Meeting." But keep in mind, she cautions, you won't cover everything in one conversation.)
"These are very complex issues," she says. "Talking about how to make decisions, what your values are, how you should think about what your parents' needs are going to be—those are all ongoing conversations."
What to Cover
The questions that face you and your parents seem endless, but for starters consider:
- Do your parents need any help right now?
- Have they written a will?
- What would your parents like to do if they can't live on their own?
- Should they still be driving?
- How much medical intervention do they want if they have a catastrophic health problem?
For more questions, see the National Association of Area Agencies on Aging's fact sheet, "Topics to Discuss Now With Your Aging Parents."
It can seem overwhelming. So, both Schempp and Markwood say it helps to begin the conversations by focusing on the big issues:
What will we do in an emergency? For Markwood, the devastation brought by Hurricane Katrina drove home the importance of developing a plan for a crisis, be it a flood, earthquake, heat wave or severe storm. "There needs to be a plan of action," she says. "There needs to be someone to check on an older person in an emergency, especially if family does not live in the area." Put the plan in writing, she says, including phone numbers of nearby friends or neighbors you can call on for help, and any evacuation information developed by local municipalities.
What about health care? "How much intervention do you or don't you want if something catastrophic should happen?" asks Schempp. "If you are in a coma, do you want life support? If you have dementia, would you want a feeding tube? These are the kinds of things that, if they happen, tear families apart." It's also important to have a handle on the details. Does everyone in the family have a living will, and are there copies in medical files? What kind of health insurance do your parents carry? Who are their doctors, and how can you reach them? Have your parents given their doctors permission to speak with you about their condition and care?
What's the financial situation? Talking about money isn't easy for most people. "What we've found is adult children are reluctant to ask and parents are reluctant to give out the information," says Markwood. "But we've also heard horror stories." For example, she remembers a family that spent a long and painful period dealing with the estate of a parent who had died without a will, only to discover later that a will did exist. You may not need to know what the will says, Markwood stresses, but you do need to know where it's kept. The same is true for financial information ranging from savings accounts to investments to property deeds.
What services are available in your parents' community, and which ones do they prefer? Your mom and dad may not need care now, but you'll be in a better position to help them if you know what kind of services are available should the time come. Start by checking the Eldercare Locator, which provides information on services for seniors.
Finally, don't lose your courage. "The main thing is bringing the subject up," says Schempp. And, as usual, that first step is always the hardest.
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