How to Beat the Bad-Guy Rap in Discussions with Aging Parents
As two gray-haired gentlemen set their trays on the table next to me at Panera Bread, one of them asked the other, “Have you seen Ted lately?”
“Nah,” the other replied. “His kids made him sell the house and move to one of those places.”
The instant lump in my throat made it hard to swallow the bite of Greek salad I’d just taken. Years before, I had all but forced my mother to sell her home of thirty-five years and relocate to a senior apartment near my sister. I flashed back to the morning, about a week before the move, when Mom told me she wished she had died in her sleep so she wouldn’t have to leave.
It had been clear to my sister and me that our mother could no longer live well and safely in her condominium. It was equally clear that Mom saw the situation differently. We worried about her increasing trouble with balance, her weight loss, and her isolation as she dropped out of bridge games and book club. We thought the adult congregate living facility near my sister would offer Mom the freedom of her own apartment, with the added benefits of minimal supervision, social activities, van transportation, and a daily hot meal in the company of other residents. Mom acknowledged she was slowing down, but insisted she didn’t need help.
It was neither the first nor the last time that we found ourselves on opposite ends of a tug-of-war—Mom on one side, clinging to every last shred of her independence, and my sister and me on the other, trying to keep her safe. We battled about giving up her car, about her need for a personal care assistant (home health aide) and about getting a walker. The discussions were difficult and after several rounds, during which we rehashed the same tired arguments, a win for either side felt like a loss for all.
My friend Kate suggested getting a professional involved in these discussions. “Your mother is more likely to listen to someone with credentials. It’s too easy for her to argue with you because she’s your parent and still feels like she is the boss,” Kate said.
My first chance to try out her advice came when I accompanied my mother on a visit to her doctor. After Dr. G checked my mother’s vital signs, we discussed her medications, including the tranquilizer he had prescribed to help her deal with anxiety about her upcoming move. “Remember not to drive if you’ve taken any Xanax,” he said. I felt a jolt. I’d been worried about Mom’s driving and had been trying to convince her not to take her car to her new home. I asked the doctor if he had any advice about when to stop driving. He directed his answer at my mother, telling her how important it was to listen if family members are concerned about your driving. He mentioned slower reflexes and recounted stories about older people who had caused accidents where others were hurt or killed. By the end of the visit, Mom had decided we should sell her car. I had to restrain myself from giving that doctor a big kiss.
Now I understood what Kate had been telling me. Mom’s physician served as the “bad guy,” who told the unpleasant truth and urged the unwelcome change necessary to ensure my mother’s safety and well-being, so that I could be the one to sympathize and offer loving support.
After that, I tried to enlist a professional whenever my mother’s view of her situation and mine were at odds, or when I felt that she was being resistant to accommodations aimed at keeping her safe. An unbiased professional changes the dynamic of the discussion. He or she brings a trained eye to objectively evaluate the situation, and knowledge about what options might work best given each family’s unique circumstances. He or she can ask the difficult and sometimes painful questions, and then make sure everyone is heard.
The best option is a professional who is known and trusted—perhaps a lawyer, a clergy member with counseling skills, or, as with my mother, a doctor. Healthcare providers are particularly helpful when the issues relate to physical or mental decline. If there are worries about balance, reflexes, or senses (eyesight, hearing), or about memory or reasoning, arrange a joint visit with the physician, physician’s assistant, or nurse practitioner and ask specifically about each concern.
Sometimes, families get their first opportunity to speak with a healthcare provider when an aging loved one lands in the hospital. Initially, physicians and nurses will be focused on the illness or injury. It will be up to the family to ask about what might have caused the crisis, how another crisis might be prevented, and concerns about returning home. Providers who focus on curative care may not have the skills or training to help, but the hospital should have one or more palliative care professionals (physician, nurse, and/or social worker) on staff. Palliative care providers are trained to facilitate conversations among family members that focus on the patient’s goals and on the best options for his or her overall care. These professionals are invaluable when a family faces a difficult decision about aggressive treatment (e.g., surgery, chemotherapy, intubation) or about the optimal place for the patient to live.
When a family’s concerns focus on activities of daily living, including whether to adapt the family home to be more senior-friendly or to move, the local Area Agency on Aging is a good place to find trained staff who can provide information and access to a range of community-based services and living arrangements. (Find your local Area Agency at n4a.org.) Area Agencies assist families at all income levels, and are funded, in part, by the Federal Department of Heath and Human Services.
Another option is an Aging Life Care Expert (ACLE). ACLEs, formerly known as Geriatric Care Managers, are adept at planning, problem solving, and supporting both aging parents and their adult children. Some ACLEs conduct health assessments, and all of them help families identify needs, and then connect with resources to fill those needs. The website of the Aging Life Care Association (aginglifecare.org) provides a geographic search tool to locate nearby professionals. Medicare does not cover payment for an ACLE, but these professionals often provide a free initial assessment. In addition, employee assistance programs (EAP) may offer coverage for a limited ACLE engagement.
When my mother wanted to back out of her decision to move close to where my sister lived, I reached out to an Aging Life Care Expert. The three of us sat at the rattan table in my mother’s sun room and Karen, the ACLE, deftly determined my mother’s capabilities through pleasant conversation about what my time Mom got up in the morning, what she usually ate for lunch, and what she liked to do outside of the house. When the topic of moving came up, Karen simply said that living near family, when possible, is always the best option.
“Do you really think I should go?” Mom asked Karen.
“Yes, I do.” Karen looked directly at my mother, ignoring me.
When my mother closed her eyes and said she would follow Karen’s advice, I was there to wrap her in the consoling hug we both needed.