One of the toughest, most emotionally charged conversations you may have with an older loved one is that of their future care and the role you'll play in the caregiving process.
From the older person potentially having difficulty admitting — and accepting — they need more care to the younger person fearing the decline of their loved one, it's a shift in your relationship dynamic that can be unsettling to talk about.
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Because this discussion can be a difficult one, many people put it off for as long as they can. But the sooner you initiate it, the better.
"Having these conversations with your loved one before or early in the caregiving journey can have a profound impact on their quality of life and boost your feelings about the experience of helping, too," Andrea Pezel, LCSW, California-based medical social worker and support lead for the caregiving platform Grayce, tells LIVESTRONG.com.
If you wait until you have to have these talks, time won't be on your side to work out the details in a way that's best for your loved one, or for you as their caregiver.
"You'll not only be dealing with pre-existing concerns (living arrangements, assistive devices, delegating tasks, ongoing costs), you'll have limited time to work through thoughtful resolutions because your loved one's caregiving needs are imminent," says Christina Steinorth-Powell, LMFT, Nashville-based licensed psychotherapist and author of Cue Cards for Life.
Starting these talks with your loved one can be scary, but there are several strategies you can use to make the process easier.
1. Expect to Have More Than One Conversation
One of the biggest mistakes people make when initiating this particular discussion is expecting to have one chat and it all be wrapped up with a pretty bow.
"Very rarely does all of this get done in one conversation," says Jennifer L. FitzPatrick, LCSW-C, author of Cruising Through Caregiving. "Be prepared that the initial time these topics are introduced, your loved one is unlikely to commit to any plans. It often takes patience and persistence to get any of the decisions you feel need to be made, made."
It's also important to go into the talk without any preconceived notions or assumptions about how it's going to go. Sometimes the conversation's unexpected and they might feel blindsided by it. "Other times, your loved one may actually be eager to discuss this, as it's been on their mind, too," FitzPatrick says.
2. Keep the Nature of Your Relationship in Mind
"The best place to start is to use the communication dynamics already built into your relationship," Steinorth-Powell says.
If you have a great relationship with the person who'll need care, you can say something like, "Mom, I know you may not want to have this conversation, but we should probably start talking about what we'll do if you need more care in the future."
Using a collaborative approach is always preferable, as it gives the person who needs care a sense of independence. "This will also minimize them viewing you as taking over their life," Steinorth-Powell says.
On the flip side, if your relationship isn't so great with the person you'll be taking care of, consider being less direct in your approach as you start these discussions.
"Saying something like, 'Dad, have you given any thought to what type of care you might need when you get older?' takes you out of the caretaking role and makes the subject more conversational, which may be viewed as less intrusive to the person you're talking to," Steinorth-Powell says.
3. Set the Stage
Start by explaining your intentions for the exchange you'd like to have. "Be honest about your concerns and worries," Pezel says. "Let them know you want to act as their support system moving forward and would like to talk about what that might look like."
Invite them to think of topics they'd like to discuss and decide on a time to have a chat that works best for both of you.
This gesture doesn't just give you both time to prepare what you'd like to talk about, it also prevents your loved one from feeling caught off guard and makes the process of taking care of them a team effort from the start.
If they seem hesitant, "explain that being prepared helps you feel more certain and confident about helping them in the future," Pezel says. That way, you'll know exactly what to expect from each other.
4. Start on Common Ground
Once you both have your talking points prepared, sit down and go through them with each other one by one.
"During the initial conversation, it's important to start with the ultimate goals and items you both agree on," Nicholas Hardy, LCSW, a licensed therapist based in Houston, tells LIVESTRONG.com. "When this is established, it can be used as the lens through which you filter future conversations."
Sample goals you agree upon might include wanting to help them maintain a sense of normalcy as their health declines, gain access to a community of support and define ongoing support options so they're cared for 24/7 in case of an emergency.
"Each person having the chance to contribute their topics allows them to have an equal voice in the conversation and know their feelings and opinions are valued," Pezel says.
5. Emphasize They're in the Driver's Seat
"Whenever I work with adult children of aging parents, I always tell them to assure their loved ones they're in the driver's seat of their future care," Steinorth-Powell says.
To remind them they have control over their caregiving needs, try comments like: "It's important to me you don't feel like I'm trying to control you or your life when we're making these decisions."
6. Use 'I' Statements
It's hard to keep emotions out of these discussions (and you don't want to entirely, or you might come off cold), but do make an effort to keep your emotions in check.
"Focus on giving specific, concrete examples of why you're concerned about your loved one," FitzPatrick says. (Think: four fender benders in the last three months.)
Using "I" statements ("I'm worried you might get hurt on the road") instead of "you" statements ("You've become a dangerous driver") allows you to voice your concerns in a non-blaming way so your loved one won't feel the need to go on the defensive.
7. Ask Open-Ended Questions
This allows space for unexpected answers and authentic responses. "With open-ended questions, you have more opportunities to gather honest answers, which will lead to stronger collaboration and better outcomes," Pezel says.
Example: "Are there any health concerns you'd like me to know about or help with?"
8. Lead With Empathy
Empathy allows you to understand how your loved one might be feeling — to acknowledge their emotions, respect their feelings and build continued trust in the relationship.
"We're often consumed by the facts of a situation and overlook the subtleties of how someone's feeling," Hardy says. "Positioning yourself as someone who cares versus someone who's the expert is invaluable."
You can show empathy by asking how they feel about what you're discussing, listening intently as they share their feelings and perspectives, acknowledging verbally how difficult it may be for them to do so and sharing relatable vulnerabilities of your own.
9. Address Their Concerns
It doesn't matter how good your intentions — even if you go at the conversation from a place of proactive enthusiasm instead of fear and worry, coming on too strong will likely trigger resistance.
One way to hit the brakes on being unintentionally pushy is to remember that one of the main concerns your loved one may have is losing control of their life.
"Not only is it difficult to admit you may need more care, but in some cases, there's concern their freedom may be limited (or perceived freedom, in that the person who needs care thinks they're more socially active or independent than they are in reality) or they might be taken advantage of financially," Steinorth-Powell says.
There also might be concerns about what happens if they're unhappy with how they're being cared for. Will they be trapped? How seriously will their feelings be taken, now and in the future?
10. Expect Pushback
If the exchange goes awry, know it's most likely not about you.
There's a lot of fear about the unexpected when someone realizes they'll need more care than they've had in the past — fear of losing their independence, their life being taken over by someone else, losing the home and possessions they've spent a lifetime piecing together.
Be sensitive to the sense of loss and fears they might be experiencing as a result. "This won't always be easy, and at times, their resistance to your attempts to help them may be exceptionally frustrating," Steinorth-Powell says.
If they become resistant, defensive or angry, walk away and try again when things calm down. "But if they repeatedly lash out at you for trying to help, know it's OK to remove yourself from the caregiver role," Steinorth-Powell says. "No one deserves to be abused."
11. Define Your Terms
Consider drawing up a contract both of you will sign that clearly acknowledges the boundaries and expectations you have for each other.
"This might sound outlandish to some people, but it's a very important step in the early caregiving process — especially where there hasn't been a great relationship between the person who needs care and the caregiver in the past," Steinorth-Powell says.
Your portion of the agreement might include stipulations like only receiving calls between 7 a.m. and 6 p.m. (unless it's an emergency), while your loved one's portion might outline how they'll maintain their own bank account until they're unable to, at which point they'll appoint so-and-so to step in and manage it for them.
Pezel also recommends incorporating dual-planning into the process: "Dual-planning means coming up with a preferred plan (Plan A) and an acceptable plan (Plan B)," she says. "This allows for a more thorough discussion of choices and better prepares you to make difficult decisions down the road."
Having a clear and detailed contract will help both parties experience a smoother ride through the caregiving process because you'll know where each other stands on just about everything — and when miscommunications come up, you'll already have the necessary clarifications in writing to refer back to.
12. Respect Their Decisions
"While we may have the best of intentions for our loved ones, it's important to recognize their self-determination," Pezel says. "This term is mostly used in therapeutic settings but is fundamentally important because it refers to each person's ability to make choices and manage their own life."
At some point in your life, you may find yourself in a similar situation and would want to be involved in those decisions when the time comes.
Even if you ultimately have the final say, approaching each decision in a collaborative way allows your loved one to feel empowered.
Not only does this minimize feelings of both helplessness and hopelessness, but "when people trust your intentions and believe you care, they'll be more open to certain decisions you feel are best, even if they don't fully agree with them," Hardy says.
13. Recap Your Talks
At the end of your talks, it can be helpful to recap the conversation you've just had and confirm you're on the same page.
"Listening to the other person and then repeating what they've said back in your own words shows understanding, active listening and respect for the person you're taking care of," Pezel says.
For example, "It sounds like you want help with grocery shopping but not meal prep — did I understand correctly?"
14. Don't Force a Resolution
As unfortunate as it may be, your caregiving-related offers and suggestions may ultimately be refused. "When this is the case, if the person you're wanting to take care of is of sound mind and body, there's really nothing you can do," Steinorth-Powell says.
It's their decision to make (even if it's a bad one), and you owe it to yourself to know when to table the discussion.
"However, if the person who needs care has some sort of cognitive decline going on, you may have legal options available to you that will help you do what you need to," Steinorth-Powell says. "When it comes to something like this, it's always good to seek the advice of an attorney who specializes in elder issues."
15. Keep Talking
Because planning and decision-making for your loved one can be complex and ever-evolving, it's important to keep talking.
This might involve thanking them for sharing what they have with you so far, then asking if they'd be open to making the discussion a continuous one so you can make sure they always have what they need throughout the aging process.
"Ensuring the person feels heard and is comfortable expressing themselves will allow for future conversations organically," Hardy says. The goal is never to have all the answers, but to build a bridge for open and continued communication.
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