Independent Living: Starting a Dialogue
Cynthia Dykes invited her parents to her California home on Easter Sunday, for a celebration of the holiday and for a discussion she says they "couldn't put off any longer." Her parents—William, 79, and Reita, 75—are in relatively good health, but their daughter is facing a challenge.
The 56-year-old artist and middle-school media center director is fighting ovarian cancer and is adamant about addressing her parents' long-term needs in the event she isn't able to care for them herself.
"I knew it was time to talk seriously together," says Cynthia. They had virtually no problems getting the conversation going. "It's always been easy to talk to Cynthia," says Reita, "and to listen to her. We had touched on these things before, although the subject would often get changed. So a potential caregiver needs to step forward, because it's important to think these things through."
Adapted from Caring for Your Parents
In Good Times, Good Communication For your parents' welfare and your piece of mind, it's important to have family conversations about staying at home before problems arise. An AARP survey found that most parents feel better about having this discussion when life is going well. Consider these tips for beginning the conversation, dealing with resistance, focusing on the most important points, and keeping the dialogue positive.
Take the Initiative Bringing up the subject of independent living can be a major stumbling block. Aging and communication experts offer ways to break the ice:
Let your parents know what you need.
Example: "What kind of help would you want if you were not able to do everything yourself but wanted to continue to live safely in your home?"
Share your own emotions about your parents' changing situation, and urge them to do the same.
Example: "Dad, I know you've always cherished your independence. I imagine it's difficult for you to ask for help. Is that right?"
Raise the issues indirectly, related to someone else's experience or something you have read or seen in the news.
Example: "I know you're taking pills for arthritis, your heart, and cholesterol. I saw a commercial for a pill organizer that keeps track of which pills to take when. Would it help if you had a medication organizer with a slot for each day of the week?"
Watch for opportunities your parents provide.
Example: "You mentioned problems with your eyesight. Have you seen the doctor lately? How does it affect what you normally do, like reading or driving?"
- Give your parents a list of questions you have about their current and future health and living situations, and schedule a later time to sit down and talk about them. (Do what feels comfortable and consider your own relationship with your folks when attempting this.)
Expect Resistance Your parents may not want to talk about these issues. Some resistance is common. They may delay with reassuring statements or tell you to mind your own business. Should you stick with it? Professionals offer this advice:
- Respect your parents' feelings when they make it clear they want to avoid a subject. Plan a different approach later.
- If your parents' health or safety is at risk you will need to pursue the issue. Crises such as health care expenses depleting a bank account or parents avoiding the need for important legal documents may demand your immediate action.
- Act firmly, but with compassion, if you decide you need to intervene.
Example: "Dad, we can't ignore this any longer. We have to deal with it."
- Involve others, such as close family members or others your parents respect. You may want to gather these loved ones to discuss concerns and to develop a specific, proactive plan.
- Find out about community resources such as transportation or home health care that preserve independence. Then, if it's clear that your parents need assistance, you'll be ready to share these options.
Focus on These Key Points First, discuss with your parents not just their future needs and worries but their hopes and goals. Guesswork from you can be destructive. Here are some common issues that affect an older parent's independence:
Where they live.
Questions to ask: Is your home still appropriate for your needs? Can you manage the stairs, or could you do better on one level? Does your home come with safety hazards? Could simple modifications make it more convenient? Should you think about living somewhere else?
Questions to ask: Do you need help with household chores, such as cleaning, fixing meals, or taking care of the yard? Does poor eyesight interfere with your daily activities? Can you always hear the telephone or a knock at the door?
Questions to ask: Can you get out to your doctor appointments? Is driving the car getting difficult? Do you have reliable transportation for shopping, medical visits, religious services, and visiting with family and friends?
Questions to ask: What health problems do you have? Are your prescriptions current? Have you been to your doctor lately? What did he or she say about your health? Did the doctor review all your medications for possible bad reactions? Are you having any problems taking your medications? Could you use help remembering what pills to take and when? Can you pay for your medicines?
This can be a sensitive area for adult children and their parents. You may want to be less direct than the following questions, depending on your and your parents' comfort levels.
Questions to ask: What are your current and likely future bills? Can you pay for what you need? Do you need help getting government or pension benefits? What about financial planning to make your money last? Are your Social Security and pension checks deposited directly in the bank? Is all your financial information in one place? What about getting extra income from the equity in your house? Have you considered that you might need money down the road to help pay for assistance with everyday activities? Do you have any bills you can't pay?
Paying for health care.
Questions to ask: What kind of health insurance do you have? Medicare? Medicaid? Other insurance, such as a Medigap supplement policy? Has your health plan paid your health care bills so far? Do you have long-term care insurance or life insurance? Have you paid your insurance premiums? Would you like some help in filling out forms like insurance claims? Have you been told that insurance won't cover some medical tests or procedures that the doctor has ordered? Do you have any questions about Medicare or Medicaid?
While you probably won't want to discuss all these matters in one conversation, they are issues to raise as your parents' situation changes. You may want to ask them what issues concern them the most.
Keep It Positive In even the closest families, communicating with parents about their needs often requires focus and determination. Several strategies can keep the conversations positive and productive.
State your concern in the "I" form. "I feel," "I need," or "I'm concerned" are less threatening than "you" statements.
Example: "I'm concerned that you may fall on the stairs. I could put a 100-watt bulb at the bottom of the stairs and install a handrail. That would make it safer for everyone." Don't use: "Going upstairs in your condition is ridiculous. You're sure to fall."
- Don't "parent" them. The most productive ways to help your parents meet their needs arise when your parents and their adult children feel equal in the relationship.
- Be prepared to let your parents make their own life choices even if you don't agree. Your parents have a right to make decisions (as long as they are not cognitively impaired with Alzheimer's disease or other dementia). Growing older does not diminish that right. Even when they make what you consider an unwise choice, it doesn't necessarily mean that they are no longer capable of independence. You should set limits on your involvement so that their decisions don't run your life.
Some of this material appears in slightly different form in Caring For Your Parents: The Complete AARP Guide.
© 2003, 2004, 2007 AARP. Reprinting by permission only.