A conversation most adult children do not look forward to having with their aging parent is about the parent’s future lifestyle options, especially when it involves possible changes in lifestyle and the potential need for institutional or home care. As health issues arise, or simply with the effects of the normal process of aging on mind and body, most adult children come to terms with the fact that they will need to have a conversation with their parents about the difficult topic of the need for a change of lifestyle and long-term senior care. Yet opening up conversation about what may seem to be an uncomfortable topic may actually allow an opportunity for the parent and child to grow even closer together, and can lead to better decisions and quality of life for everyone down the road.

Starting the conversation early

There are many reasons to avoid putting off this conversation. An earlier conversation will give parents an opportunity to clearly articulate their priorities, wishes and needs. As a parent ages, they will undergo changes in their mental, emotional and physical conditions. Having a conversation when parents have not yet been severely impacted in one of these areas may help the conversation progress to clear conclusions, and it may seem less scary and imminent to all involved

Additionally, beginning the conversation early can open up a dialogue. The type of relationship a child has had with their parents will impact the type of conversations they have. If a relationship has been particularly difficult or strained, taking the time to have a conversation about the future – especially if it seems like a distant future – can let the parent know that the child cares and is interested. It could also give the parent and child an opportunity to repair strains in the relationship. Finally, particularly in cases where early dementia has been diagnosed, is suspected or is anticipated, early conversation can allow the parent to express their love and appreciation for their child before their dementia progresses. This can be particularly meaningful for the children who may later struggle with the deterioration of their parent’s mental capacity.

Another reason to have the conversation earlier rather than later is to begin to gain access to information that may affect future decisions. A parent is likely to have given their future some serious consideration and may even have put in place significant plans. Learning what a parent has already done may end up easing a child’s mind, especially if solid financial plans have been put into place. Knowing in advance who may have helped them prepare legal, financial and medical documents can help a child know who to call in the event that there is a sudden change in the parent’s ability to communicate, such as in the event of a severe stroke or other significant impairment. It is also important to understand a parent’s long term wishes for medical care and the type of medical interventions that they would prefer in the event of serious illness. Finally, if no plans have been put into motion or little thought has been given to preferences, the sooner the topic is initiated the better for all involved.

Opening up a dialogue

Depending on the relationship a child has with his or her parents, it may be easier to begin the dialogue by having it come up as part of a regular conversation. For others, a more formal environment might be preferred. Regardless of the environment for beginning the conversation, the child should be gentle and honest with their parents about their wishes for them and about options now and down the road. Perhaps more importantly, the child should make sure the parent has an opportunity to express their wishes and desires and listen attentively to what they share.

A dialogue should:

• Provide the child/children the opportunity to share their own feelings and reassure their parent that they will support him or her and help them solve any problems.
• Permit the parent to express their hopes, fears, and desires for the future, and the child/children to listen attentively, even if they are concerned that their parent’s expectations and desires may be unrealistic. Acknowledging their parent’s desires is important even if they cannot be fulfilled.
• Give the parent as much control as possible as long as possible in making his or her own decisions. Once the parent is no longer able to make their decisions on their own, the child should try to honor their wishes as closely as possible.
• Take small steps toward change. It is best to have initiated dialogue long before a major change like moving to an institution is necessary. Small incremental steps allow the parent – and the child – to adjust.
• Allow all relevant parties to be included. Preliminary conversation may include just the child and parent affected, but all parties that will help provide the senior care should be involved in more in depth conversations. This includes not only other siblings that may help provide home care, but also the parent’s spouse or partner as well as any others that may help provide such care.
• Respect the child’s own limitations and needs. Adult children should be honest with their parents about their time, energy and financial limitations.

It may be wise to take notes, record the conversation or write-up the most important conclusions of each dialogue session so that years later this information will be available in the event that the child’s memories fade, or there is a disagreement among family members about the person’s wishes.

After the initial conversation

After finding out where everyone stands, many follow-up conversations are likely to be necessary. Research may be necessary to find out specifics related to long-term care insurance, at home care, community resources and programs, what expenses are covered by Medicare and other insurance, as well as other legal, financial, and medical matters. Outside experts may need to be consulted. Friends or family who have gone through similar experiences may serve as resources.

If attempts to initiate dialogue fail or end in frustration, anger or are overwhelming, it may be useful to seek professional help. A professional counselor may be able to help identify stumbling blocks to communication and be useful in providing support through the transition.

Although decisions about senior care can be difficult, if conversations begin early and constantly return to a place of love and openness to dialogue, they can be some of the best decisions ever made with positive results for all involved.