Having That Important Conversation: Useful Tips

By Liz Loewy, EverSafe General Counsel

People are living longer. Advances in medicine and health care have contributed to the growing aging demographic. And the impact that increasing life expectancy will have on family dynamics and family decision-making is undeniable. According to the National Center for Health Statistics, an American man living until the age of 65 has an average life expectancy of 83, and for women, it’s 85. But this news is bittersweet. What’s the bitter part? According to the CDC, over five million Americans are now living with Alzheimer’s disease, with symptoms usually appearing after age 60 and increasing with age.

Adult children are often the first to know when issues related to their parents’ advanced age begin to surface. The problems may be primarily physical. Mom may be unsteady on her feet while living in a residence that has steep stairs or other unsafe conditions. Dad may still be driving, despite his failing eyesight and occasional fender benders. And of course problems with memory, both with respect to everyday family events or business and financial transactions, can be a real concern.

Family members may feel conflicted about what to do when older loved ones begin to exhibit signs that they’re having trouble. These are the folks who raised us, and attempting to initiate a conversation about advanced planning about issues like caregiving and incapacity can feel counter-intuitive and downright awkward. Well-meaning adult children worry that voicing their concerns will be misinterpreted, or viewed as disrespectful or condescending. Others who have already attempted to discuss important issues with their parents may have had their efforts culminate in heated disagreement, or even estrangement. There are good reasons to try again.

Having a conversation about important issues while your parents are physically and mentally healthy, can avoid misunderstandings and heartache later. The benefits of developing a proactive plan far outweigh the possible discomfort of sitting down around the kitchen table to discuss potential problems related to aging. In fact, with a thoughtful and sensitive approach (plus a dash of humor, if it suits your family), you can support your older loved ones’ ability to maintain and extend their independence.

Starting the Conversation

Before initiating ‘the conversation,’ it’s a good idea to reflect upon who should participate as well as the topics that might be addressed. Consider involving all siblings to avoid problems later. Naturally, the dynamics of the conversation will differ from family to family. The discussion can occur in stages, and, at some point, it may be advantageous to involve your parents’ attorney or power of attorney, their doctor(s), or other professionals (e.g., accountant, financial advisor, broker) - with their permission, of course. Some families may decide to use a mediator. Whatever your strategy, be mindful that your parents may already have a plan in place. It’s their decision whether or not to share the details with you.

Potential Discussion Topics

• Contact List: Asking for your parents' list of important contacts, in case of an emergency, is a good way to begin the conversation. You should learn the names of their current attorney, power of attorney, doctor(s) (primary physician and specialists), local pharmacy, financial advisor, broker, accountant, landlord, place of worship as well as their preferred hospital.  Make sure that you periodically review and update your parents’ list so that you have the most current information. Sharing your own contacts with them is also a smart idea in case there is an urgent situation on your end.
• Safety First:  Address any safety issues in your older loved ones' living environment without delay. Examples might include a dangerous structural issue in the senior’s residence (e.g., stairwell), lack of food or heat in the residence, an individual who is physically, emotionally or financially abusing them, or a problem involving substance or alcohol abuse. The danger could also involve memory problems that result in untended burners or cigarettes. If, after discussing the situation, it's clear that the matter is beyond your family's control, Adult Protective Services or law enforcement should be notified. Similarly, when a senior who shouldn't be driving gets behind the wheel of a car, the results can be fatal. A family intervention on this issue may be difficult, but necessary. If the older driver resists, consider bringing in their primary physician to participate in the discussion, contacting the DMV about your loved one’s disability or taking away the keys to the vehicle.
• Advanced Medical Planning: It’s important for all adult family members to discuss what their wishes would be in the event of sickness, disability or a life-threatening situation. The conversation with older parents need not be centered on the potential development of dementia - adults of any age may encounter a medical emergency that renders them unable to make decisions. According to the National Institute on Aging, more than one out of four older Americans face questions about medical treatment near the end of life but are not capable of making those decisions. A conversation that includes the topic of advanced medical planning will prevent family members from having to guess how Mom, Dad or their adult children would respond to critical healthcare questions. The appointment of a health care proxy or medical power of attorney should be considered, if it hasn’t already been addressed. Learning whether your loved one has long term care insurance, a living will, and their wishes regarding emergency measures (e.g., CPR, ventilator use, surgery, or a Do Not Resuscitate order) can save families a good deal of anguish in a crisis situation.
• Protecting Finances:  Your parents may not be inclined to share details regarding their financial situation with family members. Many seniors prefer to keep this information private. If they are willing to provide you with general financial information, such as the nature and location of their bank and investment accounts, safe deposit boxes, trusts, credit cards as well as any insurance coverage. This may prove to be helpful in the case of incapacity or suspected fraud. Raising awareness of the risks associated with financial abuse can be critical. Scam artists know that older adults save their money. Learning about current scams and sharing this information in your conversation with loved ones can prevent the loss of a lifetime of savings. For more information, see the Retirement Scams section of this portal. Experts agree that monitoring can play a fundamental role in keeping assets secure. Your parents may welcome your offer to help review their bank and credit card statements as well as their credit report. The use of online banking and technology solutions to detect any irregular activity can simplify the process. Younger and older adults can use tech monitoring to receive alerts on each other’s accounts via email, text or voice alerts.

Having that important conversation with loved ones on issues related to aging may be the most important step you can take to ease older family members through challenging times in later life. Taking steps to plan that discussion so that the conversation is thorough but respectful of the participants’ feelings can strengthen family relationships in unforeseen and wonderful ways.

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