Can we please talk about this?

If it’s sex or giving up driving, Mom doesn’t want the conversation.

Death, on the other hand, is okay to talk about, according to a recent Canadian study, The 40-70 Rule, by Home Instead Senior Care.

The title refers to the report’s suggestion that by the time you are 40 or your parents are 70 (whichever comes first), it’s time to start talking—and keep talking--about the hard subjects.

The 40-70 study found that the easiest topics to discuss were end-of-life wishes, living will, health concerns, and legacy. The hardest topics for Boomer children and their parents were independence (when Mom needs to move out of her home), personal hygiene, money, and when it’s time to quit – working, driving, and so forth.

Aside from parents refusing to talk, the main block to the conversation seems to be unprepared and fearful children.

Just how hard those conversations can be, and how little skilled most of us are in having them, is a message we keep hearing.

• At our January Member Meeting, Dialog with Discharge Planners, it became clear that no matter how good a job we do at discussing options at the end of life for advance directives, we haven’t really begun to talk about the shifts before the end. “Don’t resuscitate me” might be a much easier decision than what to do when Mom needs more help. We’ll pursue this topic further at our July 10 Consortium member meeting on Advance Directives. Check the calendar at our website.
  

• Yesterday (January 22), at WALA’s Aging In Place. . . Prepare for Evolution conference with Jim Moore, it was clear that senior housing operators also need to have clearer conversations with residents and family about changes in functioning that call for changes in housing or service.

David Solie’s blog entry, No Easy Way Out, has a wonderful discussion of the conversation problem. Solie is author of How To Say It to Seniors: Closing the Communication Gap with Our Elders.

As my mother approached 90 and despite increasing frailty and her super human responsibilities for my special needs brother, she simply refused any assistance. Every approach was rejected. The best we could do was build support scaffolding around both of them for when “the bottom fell out.”

This went on for years. Airline flights, phone conversations, involvement of other family members, protracted conversations with our family lawyer, meetings with my brother’s case worker, and endless strategy sessions with my wife all ended with the same outcome. It was my mother’s way or the highway.

So we shored up the situation the best we could. Despite my mother’s derogatory objections, we purchased long term care insurance when she was in her late seventies. We petitioned the court so she and I could have co-guardianship of my brother. We got her to sign a Medical Power of Attorney. Then we waited.

His recommendations?

1. Advance as far as you can go based on the personality and the nature of your relationship with the parent.

2. Retest the boundaries of that advance periodically even if they appear initally absolute. You never know when there is some give in the system.

3. Build the best scaffolding you can with what you have.

4. Keep asking yourself this question: What am I responsible for?

5. Draft a “When The Bottom Falls Out” list of the items that will require your management. Print it out and then start making weekly annotations. Your brain works better with a “starter” document. I think just “pre-thinking” about the house, the Medicare forms, the Power of Attorney steps, and so on will give you greater stability in the midst of the actual chaos.

6. Rethink what you know about the final mission of life. Most of what we are seeing in our aging parents is a need to maintain control in a world where all control is being taken away. Nothing is going to change that. It is not a rational need; it is simply a developmental task. We have all lived them in our own lives. The problem with the last one is how deeply it is connected to our family systems. However, knowing its true magnitude reduces the guilt over trying to craft a perfect ending or trying to control things that beyond our capabilities.

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We'd love to hear your comments, as always.

When the reality of aging loved ones hits home

Labyrinth of Hope from Johns Hopkins University Interfaith Council

Almost daily for the past month or so, I’ve gotten an “aging alert” article about using the holidays to check on one’s aging parents. It’s the perfect time, the authors say, to evaluate how well older adults are doing in their current living situations.

This year, the message became more than academic for me. My sister called the day before Christmas Eve to say that Mom, who lives in independent senior apartments, wasn’t doing well. Pain from arthritis in her spine was making it hard for her to walk, and her anxiety was soaring. With those triggers, she was becoming confused.

I drove up a day earlier than planned and stayed a day longer, feeling grateful that my kids were old enough to have their Christmas usurped without feeling resentment.

Trying to get information and make arrangements over the holidays is a nightmare. But because Mom lives in a retirement community with multiple levels of care, we were able to get an assessment for assisted living today. If all goes well, she will move to a place that’s familiar to her and where she’ll feel safer and get the help she needs on Monday.

We are all feeling a little stunned, apprehensive, and relieved right now. The pieces seem to be sliding into place as well as possible.

Some random thoughts:

• We who live in Milwaukee are so fortunate to have sources of information and assistance that aren’t available in smaller communities.
• I’m so grateful to the social workers and home care managers who return calls even on Christmas day. Your service in allaying anxiety and helping people think through next steps is incredibly valuable.
• While many of us hope to see more “catered” home care delivered in people’s homes and independent apartments, the model of senior apartments-assisted living-skilled nursing on one campus still has a tremendous amount to offer.

To all of you who take care of our older adults, creating safe home for them wherever they are, deepest thanks. It truly takes a community to support us throughout our lives.