Resources for the Comprehensive Geriatric Assessment based
Proactive and Personalised Primary Care of the Elderly
Discussing Tough Issues
Wondering how to start the conversation with an aging parent about a sensitive topic?
Whether you need to talk about moving, giving up driving, or bringing in help, knowing which words to use and to avoid can improve the odds of moving toward solutions.
How to have "The Talk" With Your Parents
Insights and guidance for individuals who need to discuss a thorny issue with a loved one.
Start by realizing that there are fundamentally two different types of parents : those with whom you have a relationship in which you can be straightforward and they welcome your ideas and feedback, and those who tend to be more self-conscious or private and don't welcome this kind of discussion -- and may even find it somewhat insulting.
Even if, in the past, your parent was sharing and receptive, this can change due to aging-related issues such as depression, creeping dementia, lowered self-esteem, or other frustrations.
On the other hand, a close-lipped parent may be relieved to talk because he or she is worried, too.
What to say about sensitive subjects can also be tricky because you have different goals.
Most adult children want to solve the problem and move on.
Their parents, however, want foremost to maintain a sense of control and dignity in a season marked by many losses.
Your goal in how to have "the talk": Balance both sides' needs by moving forward slowly and with care.
Do some homework.
Before you say a word, take time to collect some information and research possible solutions. Ultimately, the goal is to problem-solve together through a dialogue with your parent (not to dictate the solution or to convince through arguments).
But if you gather facts first, you'll be able to help in a way that's better informed and less stressful for everyone.
Watch your parent drive, looking for signs of an unsafe driver.
Research the alternate transportation services in your parent's area or explore other ways he or she might get around if there's no personal car.
Observe what specific kinds of limitations you're seeing: Trouble climbing stairs? Cooking? Managing finances? Grooming?
Thinking in terms of specifics helps you figure out the best solutions, as well as be able to describe the problem accurately to your doctor (and your parent).
Closely observe what activities your parent is having trouble with.
Look around the house for concrete signs he or she may not be faring well independently.
Start to research sources of in-home care help and costs.
Moving or relocating
Check out a few places on your own so you have concrete examples to talk about.
In general, most people have more difficulty with abstract conversations about assisted living,.
If you live in a different city, you can read reviews about options and make appointments to check them out when you're there, or consult a local geriatric care manager to get recommendations.
Don't think of it as being "sneaky" -- it can be less anxiety-provoking for your parent if you present winnowed options. You can always go through the whole list of choices together if he or she prefers.
Test the waters.
Also before you start the conversation, take time to get a sense of whether your parent is open to it. You can do this by first introducing an unthreatening related topic -- by phone before a visit or, if you see your parent often, in a separate visit.
This isn't yet the time for hot-button topics, criticism, or anything contentious.
Stick to the positive and general. Does he or she respond openly? Defensively? Evasively? This will give you important insight into how to proceed.
Say something like:
"How's the house? It must be hard to keep this place in good shape."
"How's your health? What's the doctor saying these days?"
"How's the car? Still driving to the city every weekend?"
If your parent sounds interested, say something like:
"Is there some way I can be helpful?"
"Yes, I can see why that would bother you. Let's talk about it more when I see you."
Even if, in a test-the-waters chat, your parent sounds receptive to discussing a tough issue, it's usually best not to plunge in yet.
In this first talk, you just want to float the issue, not problem-solve.
You want to show in a respectful way that you can be a helpful, nonjudgmental resource.
If he or she asks you, "What should I do?" say something like:
"I'll be there soon; let's work on it together then."
"What are you thinking? Give me some time to think about that, too."
What not to say:
"Yup, that's a problem. I'm going to do X and Y to take care of that for you."
"Sounds like it's finally time to move to an assisted living place."
"You sound mixed up; I'm going to call your doctor."
Choose the best messenger.
What if your parent resists any talk about his or her future?
Pause to consider whether this conversation is best had by another party.
A neutral third party -- a doctor, a family friend, a cleric -- is often better suited to bring up tricky topics like driving or whether to live independently.
These people can lay the same groundwork, explaining what seems to be wrong and suggesting options for fixing it, without risking a strained relationship in the way an adult child does when a parent is especially resistant or feels manipulated.
Start a Conversation
Set the right tone.
So you've done some homework and gotten a sense of how ready (or indifferent) your parent is. How do you take the plunge?
Plan to start the conversation on a different day from your test-the-waters chat, in person if possible. This feels less threatening and overbearing, and more natural.
Don't get critical the minute you walk in the door. Focus on connecting and having fun, while also using this time to observe.
You may be on a mission to resolve the problem, but you'll have a more ready audience if you first take the time to enjoy one another's company before diving in.
Try opening with compliments -- say something like:
"I like how you've . . . "
"Wow, looks like . . . "
Look for an opening.
The best time to enter into a serious conversation is when your parent brings it up first and asks for your help.
Failing that, look for an opportunity when everyone is relaxed. Then take the plunge. Describe what you're seeing.
If a direct approach feels welcome, say something like:
"I see the steps are a problem for you and you almost fell this morning. Is that happening a lot?"
"It looks like you're having trouble getting off the couch, and you seem a little lonely and mixed up when you're tired. You know they say that people do a lot better where there's a lot of activity going on, and things to enjoy."
"Mom said you got another ticket, and I noticed the rear fender of the car is bent again. What do you think is going on?"
If an indirect approach feels better, say something like:
"I read about this man in the paper who lost control of his car and killed some kids on the sidewalk. He was about your age. It made me think we should consider what's in your best interests with the car now."
"Lauren's parents just sold their house on Elm Street and moved to a retirement community -- you should have heard her mom rave about not having to do any more yard work."
"Remember Jack, my friend who became a doctor? He told me that his whole family has living wills and I'm thinking we should all do that, too."
What not to say:
"The house was a mess last time I was there. You need a housekeeper."
"Mom, Dad looks awful! We need to go to the doctor when I get there, because you obviously are having trouble looking after him."
"When are you going to give up driving? I heard you had another accident."
Listen and Follow Your Parent's Cues
Use reflexive listening, an effective communication technique for difficult conversations. Rephrase what your parent says, as a way of playing back that you understand -- making your parent feel supported -- and then move the conversation forward.
Say something like:
"I hear you saying . . . but it's also worth thinking about this. . . ."
"Yes, I agree that . . . on the other hand. . . ."
"I know you're really worried about. . . . Me, too -- but if X doesn't happen. . . ."
"That sounds upsetting for you. . . . Have you thought about. . . ?"
Realize that some older adults can't articulate the real issue.
They may shy from change, perhaps because they fear what it would be like or they lack the energy to deal with it.
Often they avoid making a change not because of their own preferences but because they worry about upsetting someone else.
If she's anxious, say something like:
"You're right that moving is a huge hassle. But we'll help you sort and pack and you won't have to do much. We'll set up your new bedroom to look just like this one."
"I know we've always spent the holidays in this house, but we'd love to have Thanksgiving at our house this year. You can still make your special pies there without having to worry about all the getting ready or cleaning up."
"You may call them ugly old grab bars, and that's what they used to be. But I was reading how universal design is really trendy, attractive home design right now."
Find ways to be reassuring, talk up the positives, or stress how the solution is good for everyone.
If she's resistant, say something like:
"Bob says he'll pick you up for Breakfast Club every morning so you won't have to miss it, and I'll get your groceries."
"Let's make a list of pros and cons."
To help with resistance, focus on the solution, or, look for the underlying cause.
Some people push back for a specific unmentioned reason, which may be emotional, physical, or cognitive.
Maybe Dad doesn't want to talk about moving because he thinks he can't afford it.
Maybe Mom lacks the cognitive ability to realize she can't live alone.
If the person is very resistant, the most successful person to have the conversation is not usually the adult child.
A family friend or doctor may have better luck.
If she's interested or agreeable, say something like:
"What would it mean to you if you stopped driving/had someone to cook meals/moved?"
"What would be the most difficult thing about. . . ?"
"Let's make a list of what you can do about this."
"Let's think through the pros and cons of each situation."
"Why don't you try doing X for a couple of months and see how it works for you?"
The goal is to encourage more input and to keep the discussion positive and collaborative.
If you want a parent to consider an assisted living option, one option is to casually drive by the best place you've identified through prior research, and suggest dropping in together to have a look.
Better yet if you have a logical pretext -- visiting a friend's parent, stopping to see a "friend" who works there, participating in an activity or meal you've prearranged.
Make sure it's a place you've prescreened so that you're pretty sure your parent will find things to like.
Even if there's not much choice, lay out the options and their pros and cons, strategize solutions to the biggest problems, and let your parent draw his or her own conclusion (assuming dementia is not an issue).
Let it percolate awhile.
Whatever you do, don't launch an aggressive "sell" on your favorite option the minute you get back home or the next time you talk.
Don't push for making a decision right away. Try not even to hint or nag at first.
What not to say:
"I hope you've been thinking about our idea of bringing in some help."
"So, selling your car -- have you done anything about it yet?"
"Wasn't that place we saw nice? We need to get you out of here!"
Be ready to continue the conversation at any time.
If your parent mentions the conversation at all, use this as a wedge to revisit the matter in a supportive way.
If he or she offers something positive, say something like:
"Yes, I could see you being happy there. What do you think it would be like to live there? Let's think about what we'd have to do to make that happen -- I can help."
If he or she expresses a concern:
Take it as a positive sign that he or she is at least aware of the issue and thinking about it. Go over the facts as well as the solutions again in a nonthreatening way.
If he or she says something negative:
Don't fall into an argument. Be patient and try to get at the underlying concern.
Is it fear of running out of money?
Is it a feeling that admitting help is necessary is also admitting failure of some kind?
Look for ways to address and support the concern.
Maybe you give a weekly cleaning service as a Mother's Day gift "because I don't know what else to get you and you deserve to be treated like a queen," for example.
Test the waters (again).
After some time passes, if your loved one doesn't give you an opening, you can try bringing up the issue again in a test-the-waters way.
Say something like:
"How's the car?"
"What did the doctor say?"
Know when to bring in help.
Total resistance means it's time for a third party (not the adult child) to try.
This conversation may need to be more direct. It may have to include a discussion of the risks and the possibility that if they don't voluntarily yield, say, their driver's license or residence -- there is a risk that others will take over because of the dangers involved, and then they may have less say in what comes next.
They can be told it's better to work on it voluntarily with someone who loves them and only wants to help them get what they need.
If the issue is critical and the person still won't make a safe choice, it may be time to get a family doctor and lawyer involved to evaluate competency and, if appropriate, activate a power of attorney or appoint a guardian who can make safe choices on the person's behalf.
Make it clear that you're comfortable with any decision.
If your parent is of sound mind but just making decisions that you disagree with (not endangering ones), all you can do is continue the conversation in a positive way. Any choices are ultimately his or hers.
You may not like the choice, or you may end up needing to revisit the matter later, but you can't make the decisions for him or her in that case.
What you can do is to remain upbeat and supportive, even if you're frustrated or worried.
This keeps you a welcome sounding board as your parent moves, however slowly, toward resolution.
Remember that transitions involve an ongoing dialogue.
Difficult as that first conversation about a sensitive topic is, it's only the first of many you're likely to have as you strategize your way toward a solution that everyone can feel better about.
This article was written by Paula Spencer Scott, (Spencer Scott P, 2014).
Downloaded and edited by Dr Angelo Grazioli, Jan 2014.
This is one of several topics presented in the Thorny Issues sector of this toolkit
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