Creating a Plan

The holidays can be an opportunity to discuss emergency plans for aging family members.

It’s human nature to plan for the “fun” events – weddings, birthdays, anniversaries, and reunions. But when it comes to the not-so-fun things, many people tend to put off creating important plans; ones that let others know what to do if an unpleasant situation – a health crisis, an accident, or an unexpected death – should arise.

With the holidays approaching, many of us will visit family and friends; some of whom we haven’t seen for a while. We generally expect Thanksgiving, Christmas and Hanukkah to be times of celebration and warm exchanges, but sometimes it is the time we become aware of decline in older relatives or neighbors. Adult children especially find themselves needing to step in and assist in some way.

Research indicates that more than two-thirds of families wait too long to begin discussions and proactive planning for end-of-life issues. Once a crisis occurs – a fall, hospitalization, or car crash – plans become much more difficult and rushed. According to legal professionals, the majority of family disputes over aging issues that end up in court could have been avoided if the family had clearly discussed and documented wishes in advance.

I love the advice that Joan Lunden, former TV host and founder of A Place for Mom, gives on tough conversations with older adults. She provides the following tips:

• Pick the right time to have the conversation, when there are no distractions or other obligations. Try to include other key family members. Notes or even an outline may help you stay on track.
• Calmly and without judgment, share your observations. Maybe the house is unusually unkempt, Dad has lost significant weight, or unpaid bills are stacked on the kitchen table. Open-ended questions (as opposed to yes-or-no questions) work to elicit more information, such as “How’s your health? What’s the doctor saying these days?”
• Emphasize your role as an advocate. Never tell your relative what to do, but state that you need to know their wishes and that you will be “on their side.”
• Listen to their concerns. Knowing what is most important to them allows both sides to focus on agreeable solutions. Consider their wishes as it pertains to safety, freedom, social connection, and feeling in control. Reflexive listening – rephrasing what the other person says, as a way of confirming you understand – can be effective when you believe he or she is in denial of their situation, or not addressing the greatest problems. For example, “I hear you saying X….but it’s also worth thinking about Y….”
• End the conversation with a plan to clarify shared expectations.

Generational differences may also impact these conversations; your relationship with your parent(s), grandparent(s), or other relatives while you were younger all play a role. Remember if your loved one has any cognitive impairment that may cause some problems as well. If you have experienced mainly contentious conversations with this particular older adult, expect that to continue, and even escalate, when discussing difficult issues. Adult children often want to “solve” the problem and move on; older adults primarily want to maintain a sense of control and dignity in the time of their lives marked by many losses. Traverse slowly and carefully through these difficult topics. If you are not sure how to proceed when dealing with a family member with memory loss, I will be writing a future article that may provide assistance.

If your relative refuses to address the issues or give you feedback, there are others who may help move decisions forward. For example you may be able to enlist some assistance – a doctor, family friend, or clergy may be better suited to bring up such topics as driving, living arrangements, or health matters.

Remember life transitions involve an ongoing dialogue. Although the first conversation about a sensitive topic may be uncomfortable, it’s likely the first of many you need to conduct in order to discover solutions everyone will be content with.

Aging Together is a collaborative partnership of people concerned about senior citizens and caregivers in the Piedmont region. For more information, call 540-829-6405 or visit www.agingtogether.org.