Archive for June, 2010

Parenting your parent(s) can be one of the hardest things to do.  Planning ahead is very important and necessary as a proactive approach to caring for aging parents.  Most children do not want to think about what happens when your parents age but when you look at the fact that 80 to 90% of all chronically ill older adults will need care at one time or another, you can’t ignore the statistics.  To make your job, or as we call it labor of love, easier you should ask your parents questions about their financial and medical status before a crisis occurs.

You never know when they may suddenly become ill and you are the one that has to provide information to a doctor or other health care professional.  While these questions are not easy to ask now, it won’t be any easier months or years from now.  I had to learn this piece of advice the hard way when I had to suddenly care for my ailing father.  It is far easier to talk to parents when they are healthy than when they’re incapacitated or hospitalized.  The object of these conversations is to get the information you need so that you can determine what kind of help your parents may need or wish.  Since their needs will change, you may have to have this conversation more than once or twice.

In addition to finding out about what they can do and what they need help with, you’ll want to understand what they want out of life, what their biggest concerns are, and what they cherish most.

Some general tips to use when talking with a parent are:

• Talk when you won’t be interrupted and when you are both relaxed.

• Don’t tackle everything in one conversation.

• Ask open ended questions such as “When you think about your future, what are you most concerned about” instead of “What about going to a nursing home”, something nobody wants to do.

• Do not be judgmental.  Your parents are competent adults.

• Don’t pepper them with questions.  Finding ways to have a conversation about the future rather than answering a quiz will cause less anger and stress.

• Involve others if it will help.  There are people out there who help manage later life decisions and issues for families.  In some cases, it’s easier to talk about these matters with an outsider than with a family member.  Call your local Area Agency on Aging, attorney, or doctor for assistance.

• Be open and clear about the facts.  Don’t whitewash problems.  Be straightforward about factual medical prognoses, for example.

• Actively listen to their concerns, don’t just convey your own.

26 QUESTIONS TO CONSIDER

1. Do you know the names and phone numbers of their doctors?
2. Do you know these physicians personally?
3. Are your parents enrolled in an HMO?  What do you know about their coverage and the quality of their HMO?
4. Are they covered by Medicare? Do they have supplemental insurance?
5. Do your parents’ have a lawyer? An Accountant? A financial planner? Do you know any of these people personally?
6. Do your parents have a will? (70% of Americans don’t) Do you know where it is kept?
7. Do you have health care power of attorney?  Do you have power of attorney?
8. How familiar are you with the “continuum of care”.  Do you know the difference between a retirement community (Sun City), an assisted living, a nursing home, skilled nursing facility, rehab, Alzheimer’s units, hospice care and home care services such as homemaker, personal attendant care, and skilled home health agencies.
9. Do you know how your parents feel about the possibility of leaving their home?
10. How much do you know about your parent’s finances?
11. Do you know what level of care they can afford?
12. Do you have other family members who might help serve as caregivers?
13. How honestly – and how recently – have you talked with your siblings and other family members about how you plan to care for your parents?
14. Is the family in agreement on what should be done?
15. Do you know who will be the primary caregiver or if it will be a shared responsibility?
16. If you will be the primary caregiver, how do you feel about that?  Are you willing to take on the responsibility?
17. How do your spouse and children feel about your commitment to your parents?
18. What is your current relationship with your parents?  Is it open and honest or are there a number of unresolved issues?
19. What can you do to resolve or ameliorate those issues?
20. Do your parents live nearby or will caring for them require a move?
21. Will they be moving near you or will you be moving near them?
22. How does your immediate family feel about either of those choices?
23. How candidly have you talked to your parents about their future?
24. Is there an “elephant” in your living room?  Are there on-going issues that have not been discussed such as alcoholism, prescription drug abuse, dangerous driving, memory loss, inadequate diet or self-imposed isolation?  Do you have the courage to discuss these issues?
25. Do your parents want extraordinary measures taken in case of medical emergency?  Do they have a living will?  Do they want to be organ donors?
26. Do you know what kind of funeral service they want, if any?  Do they want their service in a funeral home or a church?  Would they prefer an open casket or closed?  Do they want to be cremated?  Do you know a reputable funeral home?

I just finished reading Dr. Barry Jacobs’ book “The Emotional Survival Guide for Caregivers; looking after yourself and your family while helping an aging parent” and found it to be very insightful. It was easy to read which means I could put it down and come back to it without getting lost or having to backtrack. I loved the way the book followed a caregiver and the family through the whole caregiving process and pointed out issues that could occur, or did occur in this case, and then gave suggestions for everyone on both sides of the issue. The suggestions where very pragmatic and I believe helpful to any caregiving situation.

Here’s are a few excerpt I especially liked:
page 62 “Or, as I’ve heard many primary caregivers put it over the years, “No one else knows how to take care of our sick family member as well as I do since I’m the one with her all the time.” But as a long-term plan, concentrating the caregiving in few hands courts disaster. If you do the vast majority of the work, you’ll likely suffer the brunt of the cumulative physical and emotional toll that caregiving usually causes over months and years. If you give up the pursuits of your own life, you probably will grow gradually more resentful of the family members who still have the luxury of pursuing theirs. The danger is, without consistent logistical support, you’ll burn out and then not be able to take care of your ill relative well at all”

page 63 “Information, empathy, and hands-on help are the kinds of support that could bolster you to handle any caregiving situation. But there’s one proviso: You have to be willing to use the available supports. That brings us to the third common problem of many family members caring for loved ones. They don’t take full advantage of the help they’re offered. They say things like “God only give you as much to carry a you can bear” and then tell other family members they don’t need assistance.

Page 70 has several ideas for family members to use to encourage the primary caregiver to accept help. They include gently persuasion, recruiting the doctor, giving permission, asking instead of telling, and enlisting the help of the person receiving care.

The book is a great read for families who are working through the caregiving process. It’s not easy and it’s always helpful to have your thoughts validated. Whether you get validation through a book or in a support group it’s always helpful.  I get frustrated with my mother often but reading through the book let me know that other folks feel the same way and it’s OK.  My mother and I have actually gotten along better since reading the book.

I highly recommend Dr. Jacobs book.  The caregiving process can be a wonderful experience but not at the expense of your own health.  I personally try really hard to keep up with my kids and care for my mother.  She deserves to be well cared for but I need to keep up my relationships with my kids and other family members so that when I get old and need help they will be there for me.  Plus I don’t want the stress to kill me before my grand kids arrive.