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Families need to communicate in order to plan for aging loved one's care

by Carol Bradley Bursack, Editor-in-Chief

Many fortunate adult children watched their parents care for their aging grandparents. Making decisions about elder care was a natural part of family life, with the elders leading the way if they could. Some people didn't witness this generational concern. Whether families were separated by geographical distance, dysfunctional behaviors or early death, they've missed seeing generational communication about caring for aging family members. In either case, aging elders will face challenges, so family communication is the best way forward, when possible.

For me, caregiving was never a conscious decision. I grew up with regular family visits to my grandparents. Eventually, my paternal grandmother, who was severely crippled by rheumatoid arthritis, came to live with us in our home. My parents built a house specifically to accommodate her needs. My maternal grandparents were in good health until their mid-eighties. At that time, my mother, the geographically closest of the adult children, assumed the caregiving role for her parents, as well. As I've said, I never gave elder care a second thought. That was what people did.

Two of my grandparents' lives ended with nursing home care, but they were in a home in our community, so my mother spent many hours with them, daily. Some of us in the younger generation spent time with them as well. We never felt Mom was "giving up" on caregiving when our grandparents needed extra care. We knew she'd handled all she could, and that she and Dad would continue being caregivers to their parents. They simply hired extra help.

As the next generation - my own parents - aged, I was the only one of my siblings left in the same community, so without any deliberation, I became the primary caregiver. Most decisions about my parents care weren't too difficult, as my siblings and I had seen the previous caregiving generation in action. Knowing our parents did their best for their parents gave us a blueprint for our own parents' care. My family also talked openly, throughout the years, about preferred care options. I was fortunate.

Talking early and often

Most of us would like to make our own choices about how we want our futures to look as we age. Naturally, we'd like to avoid the whole process, but realistically, we all age. So, ditching denial and beginning to communicate with our adult children at a fairly early stage is normally a good idea. If your kids saw you caring for your aging parents, they will likely feel that what you did for their grandparents is the kind of care you'd like for yourself.

However, options for elder care have exploded in the last decade or so. It behooves all of us to talk with our aging parents, or with our adult children if we are the older generation, about our care preferences under different aging scenarios.

If communication about our aging process is part of an ongoing and natural conversation with our families, transitions in life are fairly natural.

Get the paperwork in order early

Often, I find, it's the adult children who avoid the topics of a Power Of Attorney, a will and burial vs. cremation. They can be the ones in denial. My own adult children are very uncomfortable when I talk about the fact that I "won't be around forever." They found my presenting them with my legal papers difficult to handle. I simply told them that now that I've covered the legal aspects of my death, I intend to get on with the business of living as I always have. We all got through it.

I am not yet at an age or place in my life that I want to say where I want to live once I can't live in a house anymore. However, that time will come. I expect my children will use my caregiving history as a guideline, but I do intend to throw out clues from time to time.

There's nothing like an example

If your parents are avoiding the topic of getting a Power Of Attorney for financial business, a health directive, also known as a Power Of Attorney for health care, and a will completed, adult children can often bring up the topic by stating that they are going to get their own legal planning done. After all, anyone can have an accident or a health episode that can put him or her at risk.

If, for example, a son conversationally tells his dad that he's just read in the newspaper about a horrible example of a family making decisions about a young fathers life and death situation, with no guidance from a health directive. The son says he is going to have his legal work completed so his family isn't left with a problem like this, the father may just possibly ask to go along with him and get his own legal papers drawn up, as well. If nothing else, the father may ask the attorney's name. At the very least, this conversation plants a seed for the elders to start thinking about legal paperwork.

Let the elders lead when possible

A vital reason for talking early on with our aging parents about their preferences for providing health care as they age is that there is no hurry. We can openly discuss these issues without pressure, or without implying that the elder is half in the grave, so something must be done. You don't want to ambush the elders with your own plans. You are there to listen. The older generation can lead the way, with a few hints, when necessary. Eldercarelink.com has a brochure that can be very helpful for both generations as they think through the type of care the older generation would like as they age.

Every family is different, so this brochure is only a guide. Still it helps get the conversation going. Download the Senior Living Guide by clicking on the pink icon on the www.eldercarelink.com main site labeled, "Need to talk to a senior about elder care?" This guide can be a jumping off place for discussion. The ideas should lead to more open conversation. Just leaving the brochure around the house can be helpful, without seeming pushy.

When elders won't or can't make decisions

If your elders are, well, really elderly, and aren't mentally or physically able to make decisions for their own health care, or if they are just too much in denial to talk about aging, you and your siblings may have to meet without them.

Have a family meeting, if your family is inclined, and discuss the different ways your elders' situation could unfold. If you and your siblings don't get along well, try to make it clear to them that this is about your parents, and that adult children need to lay aside other issues.

Yes, I know. Not every family can do this. Many can't. Family mediators can often help splintered families come together enough to make plans for the best interest of the elders. So can family counseling, if your siblings are willing.

When one sibling does it all

I must address the reality of family dysfunction that is so serious there's no hope of any agreement among the siblings as to parental care. If the elders aren't in good enough health to decide matters for themselves, and siblings can't or won't share the decision process or the work, often one of the adult children takes on all of the responsibilities.

Try, even then, to see if far away - geographically or otherwise - siblings can do something, even if it's just monitoring bills or doing research. Understand, however, that one sibling may end up "doing it all." If you are that sibling, you'll eventually need to look for care assistance through in-home care, assisted living or a nursing home, even if those steps weren't agreed upon in advance. One person can only do so much.

If the family can't provide all of the care, then paid care or, if there are no assets, care through volunteer services, social services and/or Medicaid, are often the only alternatives to one lone sibling trying to balance the elder care responsibilities and their own life with no outside help. Too much long-term responsibility for elders can lead to caregiver depression, as well as other stress related illness due to burnout.

Most of us have heard the old adage "plan for the best but prepare for the worst." In many families, the adult children will come together to form some kind of a care unit. However, in some families, one adult child will provide most of the care, but the siblings will offer some help. In some families, the worst case situation of no help, or even interference from siblings when one sibling steps up to the plate, can be the case. When that happens, outside help may be your only choice.

So - talk early. It's nearly always the easiest route

Do try to start the care conversation with your siblings and your parents early on. It's better for your parents and better for the family as a whole. This is not always easy, but it's generally worth the effort. Talking about aging issues early can, sometimes, keep ugly family fights over elders care from tearing your family apart.