I get asked all the time when should someone start having the discussion with their aging parents and how long will it take?
The question is a bit ambitious and misses part of the point of my message. First off it should be stated that “Starting the Dialogue” means just that. It’s a start and there may never be an end until death knocks at the door. I don’t mean to be flip about this, but honestly the “dialogue” is one that is ongoing and should occur many times over the course of a lifetime.
My second point is that there is no right time to initiate the conversations around health care, living arrangements, finances, safety, healthy lifestyle, and end-of-life preferences. Hopefully, you have a close relationship with your parents and these discussions have been ongoing since you were still living in their home and learning about life. Unfortunately, for many, that isn’t the case.
Regardless of what the current state of your relationship is with your parents now is the time to start building (or in many cases, rebuilding) the relationship to a point where these discussions occur easily and without stress for either party. Waiting until illness, a crisis, a death, or other major life-altering event occurs is not the time to start the conversation.
Some of the topics are easier to discuss than others and I suggest starting with those. It’s easier to ask at a family dinner where your parents envision themselves living when they retire than it is to ask who they would like to be their executors of the estate when they pass away.
In other words, if you have a good relationship with your parents you may be able to jump right in and ask about their finances and how they want them handled after their death, or who they want to be their Durable Power of Attorney for Health Care if they become unable to make health care decisions for themselves. On the other hand, if your relationship isn’t especially close I would start out by letting your parents know how much you love and care about them and their well-being. Move the conversation forward slowly over time (and multiple conversations) until there is a comfort level on both sides.
If your parents haven’t retired yet, are in good health, or are relatively young (say in their 50s or 60s) you might just start with general conversations about their retirement goals and where they would like to live. As they move toward retirement or eligibility for Medicare and Social Security benefits you might want to bone up on those topics and have general discussions with them to show that you are aware of the issues they face, but not necessarily feeling a need to be involved other than conversation.
If however, you are the one approaching retirement age and your parents are already in their later years (late 70’s on up) the discussions take on a bit more urgency and need to be more in-depth. Sometimes having a doctor, religious advisor, or financial advisor present eases the tension especially if your relationship isn’t particularly close. Each family, each topic, and each situation require different approaches and some advance planning on your part.
Regardless of when you “Start the Dialogue” or what age your parents are here are a few things to keep in mind:
- Do some research on the topic you’d like to discuss.
- If your parents are very independent or the relationship isn’t close be prepared that your parents may not be ready to have this discussion with you. This doesn’t mean you give up, you will simply have to approach it from a different manner at another time.
- If you think you are going to come up against resistance then have some articles printed and ready to show your parents backing up whatever you are discussing. This way they will feel less resistance and recognize that you are not just trying to take over their lives
- If things start getting heated then back off, find a neutral topic, and try again another time. Sometimes getting the advice of a professional, or better yet, having them present during the discussion eases the conversation.
- This is about love and caring for your parents so leave your ego out of it.
There is no magic potion that makes it easy to deal with your parents and their affairs as they age. Keeping love and calm as your focus points will always get you much further than if you become demanding and bossy. Remember how it feels to have someone telling you what to do and don’t go there.
If you have something to add please leave a comment. I read all comments and reply to them and very much appreciate your input. HAPPY ST. PATRICK’S DAY
I’m a foodie (foody sp?). I fully admit it. I love food. I love reading about it, growing it, preparing it, eating it, and most of all sharing it.
I’ve owned restaurants, taught classes in food preparation, taught classes on proper foods for various chronic illnesses and diseases, and I’ve worked my way across the country and back many times based on where my food preferences were leading me.
Here’s what I’ve learned about food:
- There’s always more to learn about food.
- Food is often expressed as love.
- Food is the easiest way to remain healthy.
- Eating natural foods is an experience many people don’t realize is as nurturing as taking a walk in the forest.
Let me expound a bit on these concepts.
Food knowledge: I have read hundreds of books, magazines, and articles on food. Some were about growing it while others were about preparing and serving it, and even more were about the effects on the body of different foods. As much as I’ve learned I come across something new and interesting about food every day.
Currently, I have the good fortune to be teaching diabetics and pre-diabetics about food choices they can make that will prevent the development of Type II diabetes and it’s attendant complications within the body. It’s a joy to hear the excitement in the voices of my participants as they share new discoveries on their journey to healthier lifestyle decisions about food. The joy they experience as they lose weight without cutting out food and the new energy they have discovered because of healthier eating is a testament to how important food is in our relationship with our bodies.
Food as love: Think about food as love. Did you have a favorite food that your mom prepared on your birthday or grandma made when you went to visit her? How do you celebrate major holidays? Many people do it with special dishes prepared lovingly to share only on those special days.
When my children were little we would make a monthly trip to visit an elderly extended family member. She would spend days preparing treats for our visit. She didn’t speak much English, but even with her broken Italian we all knew she loved us because of the care and devotion she put into preparing those foods. When we would leave to make the three-hour drive back home the trunk of the car would be laden with boxes full of veal cutlets, bacon wrapped chicken legs, meatballs in homemade sauce, cheesecakes, and special cookies. Every one of the boys knew that the love she expressed was through the food she prepared for us. To this day the kids still talk about the food she made for us even though she’s been deceased for over 13 years. How many kids can say that about a present they received from an elderly family member?
Food for health: As a nurse I have had many conversations with patients about food. Those who eat healthier foods tend to have healthier bodies. They also have more stamina, less chronic disease, and often a greater appreciation for life than those who just eat because they have to. Of course there are exceptions, but overall the more thought and effort one puts into the food they put into their mouth the healthier that individual ends up being in the long run.
As part of my reading on food I often come across articles that state that eating certain foods, or avoiding other foods, leads to better health. Newspapers and the media flood us with information about cutting out salt, increasing our consumption of fruits and vegetables, the benefits of lean protein, and the rewards of increasing whole grains. Of course there is alot of competing advertising for prepackaged and sugar laden foods, but follow the more scientific studies and you will find research that will point you in the right direction. Basically eat plenty of fruits and vegetables (fresh or frozen is best), whole grains rather than super processed cereals and flour, lean meat in smaller portions than what our “super sized” society is now consuming, nuts and seeds, healthy oils, and watch portion size.
Drinking plenty of water plays a huge role in the process as well. We need both food and water in order to survive and keep our bodies functioning at their optimal performance levels. We also need these things to keep our immune systems fighting off infection and disease.
Food is nurturing: Have you ever seen someone who is incorporating healthy eating into their lifestyle? Usually their skin is pink and moist as opposed to pale and dry, their eyes sparkle rather than being framed by dark circles, and their zest for life is infectious. Wouldn’t you like to feel that way? Wouldn’t you like your aging parents to feel that way and maybe help them regain some of their excitement and joy for living rather than watching them sitting around waiting to die?
The concept of eating for better health and a happier life is one that can be started at any stage of life. Past gastronomic experiences may have led to disease and decline, but with something as simple as dietary changes some of the debilitating effects of chronic disease can be decreased, and in some cases, reversed. It’s worth a try don’t you think?
Feel free to leave a comment, ask a question, or share your own story about dietary changes and how they impacted your life or the lives of others. I appreciate your comments and will respond to any inquiries or comments. Thanks for reading my blog.
As health care consumers many patients are unaware of the changing trends in healthcare. I’m not talking about the Affordable Care Act and all of its requirements. I’m not talking about new treatments for chronic diseases or the discovery of new pathogens. My post today will address one of the intricacies of reimbursement and how it is changing the landscape in the management of acute illness and, most especially, in chronic disease management.
You may be asking how this has anything to do with you starting a dialogue with your aging parents?
Hang with me for a few minutes and I’ll try to explain because you can play a very important role in helping your parents navigate through these particular changes as they start to unfold rather than later.
First let’s review some economics that have to do with health care.
- Many private practice physicians, clinics of all sizes, and hospitals of all sizes depend on Medicare and Medicaid reimbursement in order to stay afloat. Medicare is a federal program and Medicaid is overseen by the states. I’m going to make a broad generalization here but usually if Medicare sets out a ruling Medicaid attempts to fall in line. Physicians, clinics, and hospitals have t o “opt in” to accept Medicare and Medicaid assignment of the benefits allowable and they cannot charge the patient for charges above what the Medi/Medi (Medicare and Medicaid) plans will pay.
- Private insurance usually reimburses at a higher rate than Medi/Medi. Once again, if the physician, clinic, or hospital is a participating provider with a private insurance plan, HMO, PPO, or MCO they agree to accept what the plan allows as reimbursement for services rendered. Patients may be responsible for part of the allowable charges.
- Since Medi/Medi and private insurance plans are the primary sources of reimbursement for most health care entities they lay out some very strict guidelines and highly regulate the health care business. In addition, they also have very large and “loud” lobbying abilities when it comes to legislation related to health care.
- Please keep in mind this important factor related to the economics of health care: people are getting older and with aging they are getting sicker. That means treating those who are getting sicker is becoming more expensive because the cohort of aging seniors is growing as the baby boomers move into their later years. This means there is the possibility of health care costs outspending the funds available.
I hope you’re still with me on this because now we move into what may develop as a way to cut costs.
There is a new trend to focus on “Patient Centered Medical Homes” as a way to shift some of the burden away from the medical providers and onto the patients. The concept is a good one and actually very empowering for the patient, but it is often misunderstood and resisted by both health care providers and patients.
Bear with me as I attempt to explain.
- For years patients have turned over total control of their health to their health care providers. If the doctor says take this medication for your high blood pressure or your cholesterol then most patients will do it without worrying or even thinking twice. If a physician recommends a colonoscopy every ten years after the age of 50 many patients will simply comply and get it done when they are reminded to do so.
- Many patients I see every day have decided that they don’t need to worry about what they eat or how much physical activity they engage in because if their symptoms get worse they can always get another pill, have a surgery, or get a treatment to take care of it. The same goes for smoking or substance abuse (alcohol and drugs).
- An idea that we are entitled to excellent health care without responsibility for our own individual health has become rampant and is especially prominent in the elderly at this point. I’ve had more than a few patients say something along the lines of “I worked hard all my life, paid my taxes, and now Medicare will take care of me when I’m sick.” Some go even further to say… ” if Medicare doesn’t cover it then Medicaid will take over and I’ll be fine.”
All three of the bullet points directly above are a very dangerous way to think in this age of changing health care trends and exorbitant costs. I hope I’ve grabbed your attention and that you are starting to think on these points. Don’t take my word for it, read the newspapers and journal articles. Listen to the debates about health care. One thing crops up over and over again–we need to cut the costs of health care.
Ok, now back to the “Patient Centered Medical Home” concept. This idea (for which many doctors, clinics, and hospitals are seeking recognition) means exactly what it states: the patient is at the center of their own health care. For years we’ve had patient rights about privacy and choice. Now the idea is to get the patient actively engaged in their health care as truly equal partners.
For instance, someone comes in with a new diagnosis of diabetes. Instead of the doctor laying out the entire treatment plan and telling the patient what medications to take and what needs to change the doctor will discuss evidence based guidelines for treatment and emphasize that the patient’s own involvement will dictate the course of treatment.
From there, the Medi/Medi and private insurance plans will be looking to see where the greatest outcomes are and they will reimburse for services based on the measurable outcomes such as lab work, hospitalizations, length of stay in the hospital, use of the emergency rooms, weight loss, and other measurable aspects of healthier lifestyles. Where they see the greatest impact and care provided to increase the populations health will be where the greater reimbursement goes. In offices, clinics, or hospitals where the chronic disease rates don’t change and people aren’t taking better control of their individual health the reimbursements will be less.
What does this mean?
- Eventually fewer doctors will think favorably of practicing in an area where there are lower reimbursements. This means that patients may not have access to convenient or local health care.
- Maybe doctors won’t accept patients who are not willing to work diligently to improve their health care.
- The sickest individuals may find themselves not receiving the same level of care that they expect.
Please note that the above three bullet points are not set in stone or even policy, but could become so in the future.
What can you do now to avoid any negative effects for your aging parents, yourself, and your children?
- Start the dialogue about healthy lifestyle adjustments. This can be about the food that is eaten, physical activity, decreasing and then stopping unhealthy behaviors, and speaking up about what care is desired and actively stating wishes about treatment.
- Encourage a healthy diet that is based on lean protein, whole grains, at least the minimum servings of fruit and vegetables, and low-fat dairy. Avoid processed food and calories with no nutritional value.
- Make sure you, your parents, and your children are adequately hydrated with water. The amount varies with each individual but paying attention to whether skin is dry or supple is a good simple indication of hydration status. If skin is dry then drink more fluids. If it is smooth and supple then hydration is probably adequate. There are other ways to test hydration status and you can ask me a question in the comments section if you want further clarification.
- Physical activity is a great way to improve mood, avoid putting on the pounds, and keep circulation flowing. Look through the archives of older posts for more on this subject.
- We all know smoking is unhealthy and excessive alcohol can lead to horrible disease problems. If your parents engage in either of these activities raise the subject gently, but let them know you are concerned for their health.
- Encourage the development of health care proxies, living wills, durable power of attorney for health care documents, and end of life planning.
- Help your aging parents understand that the medical providers they see want them to be involved and knowledgeable about their health and the care they desire. Assist your parents in researching any new diagnosis they may be given by a medical provider. Work with your parents to develop their concept of how they would like to see their care unfold and what actions they are willing, or not willing, to engage in to increase their health status. Most importantly, help them to understand that asking questions or stating their needs is expected by their health care providers and the best way for them to assist in getting the care they need and desire.
There is much more that could be said on this subject. Please feel free to leave comments or ask questions if you want greater elaboration. Thanks for reading my blog.
One more month to go and then the calendar will tell us it is officially spring. Here in west-central Idaho we had a warm and sunny January that had us all thinking that we were getting an early spring. Not so. By the end of January we were back to snow, sleet, hail, rain, wind, and the dreaded gray skies. As we’ve moved through February those bleak late winter days have hung over us like clouds of darkness on a dreary landscape. ( A landscape that is vibrant and beautiful the rest of the year and on warm, sunny winter days.)
I don’t know about you, but I’m ready for the soft tendrils of a spring sun peaking through and lighting up the world. It will come, as it does every year, but I’m hoping to hurry it along. Your aging parents may be feeling the same way especially if they live in an area where there aren’t many activities to engage in during the winter months. Those who live in urban areas can get out and walk in the malls or take a water aerobics class at an indoor pool. Many rural areas don’t have those options so people tend to stick indoors and hibernate through the winter.
The question is: What can be done to engage interest and activity during the bleak days of winter?
Here are a few suggestions:
- Encourage your parents or elderly friends to have small social gatherings such as card parties, progressive dinners (or luncheons), board game challenges, or old fashioned quilting bees.
- Take the time to sit with your parents (if you live close or visit over the phone) while perusing seed catalogs. Seeing the bright colors and planning even a small flower garden can brighten any day.
- If you live close by plan a day spent in the kitchen baking family favorites and then offer to drive your parents around to their friends or other family members to deliver the items. If you don’t live close by try taking an afternoon to bake your parents’ favorite treats and mail them to them with a nice newsy letter.
- Projects of any kind can make the days pass more quickly and give everyone a sense of accomplishment. Maybe that box of old photos can be organized into albums or scanned onto a disc to share with other family members as a gift. Dad can get started on some woodworking projects that can result in gifts for the grandkids next Christmas or for upcoming birthdays. The possibilities here are endless.
- Quilting bees or knitting circles can be a good time filler with productive results. Don’t forget to involve the men. They often enjoy using their hands and socializing just as much as the women do. If you live in close proximity to your parents maybe you can organize this activity or open your home. If you don’t live close then plant the seed with your parents and assist them in setting one up by giving ideas and offering suggestions.
- Book clubs are another good time passer for the winter months. These can be held in someones home, but can also be about a group of people reading the same book in different locations then having an online chat in the form of a book club. With all the technology available today we don’t have to meet face to face in order to carry on a social event.
Bottom line: Encourage your aging parents to remain active and engaged during these late winter months. Keeping their minds active and their bodies moving improves health and gives a reason to look forward to the coming seasons.
What have you done to keep the boredom at bay for your aging parents during the cold winter months? I’d love to hear from you with any suggestions you’d like to share.
The title to this post contains a very interesting question. As children of aging parents there are all kinds of articles telling us how we should feel. From there the articles often go on to tell us how we should act. In essence thee is an expectation and many struggle to live up to it. Today I’d like you to put all of that aside and just answer the question.
How do you feel about your aging parents and their current situation?
- Are you comfortable with their abilities to care for themselves for the time being?
- Do you feel they have prepared well for their lives as seniors?
- Are you worried for them financially?
- Do you experience bouts of anger regarding their situation?
- Are you feeling overwhelmed by the things they are asking you to do for them?
- Is the relationship between you and your aging parents strained or comfortable?
- Have you spoken to your aging parents about their situation?
- Do you feel responsible for keeping them safe and well cared for?
Most of us don’t take the time to deal with feelings around these issues. Adult children of aging parents have spoken to me a number of times about the guilt they feel for not doing enough, or for not meeting the expectations they’ve grown to feel others are placing on them. What frequently amazes me though is that when I ask them how they FEEL they start rattling off what the other siblings think they should be doing or what the neighbor does for her aging parents.
I didn’t ask them about what they are doing; I always ask how they FEEL.
Why is it important to know how you feel about an situation?
Personally, I don’t believe that anyone can come up with a solid plan unless they have explored how they feel about the options. Not the options that society presents, or the options our siblings would like to see us develop, but rather how the individual FEELS in their gut, in their soul, and in their intellectual evaluation of the various options.
- There is no handbook out there that says as an adult child of aging parents we must forsake our own lives to care for our parents.
- Financially our parents made their decisions and we are not obligated to pick up the pieces of either good or bad judgments on their part.
- On the other hand, our parents are not obligated to leave us an inheritance that will make life simpler for us when they are gone.
- Watching a parent age can be an avenue of discovery for ourselves and the depth of our affection for them or it can be an experience of shame and despair.
Until you step up and actually recognize how you feel about the changes that are taking place and those that are going to come in the future you will be on an unmarked path and prone to irrational decisions that may at times appear to be contradictory.
My challenge to you for the next few weeks is to reflect on your feelings about the situation with your aging parents. Journal your feelings. Let it pour out of you without restraint. You don’t have to share this with anyone since this is an exercise in your own self recognition. Once you have recognized how you feel then start thinking of how you act.
If you have questions or comments about this exercise in self recognition please leave me a comment. There are multiple ways to work through even the worst feelings. At best your commitment to love and cherish your parents will be strengthened. At worst you will learn something about yourself without judgment from anyone else.
February is often tagged as the “Heart Health” month. Make this your heart healthy month by reading through this previously written blog post on how to love, and sometimes not love, your job as a caregiver. Be kind to those you care for, but also be kind to yourself.
As all caregivers know the tasks involved in caregiving–especially for an elderly person–require physical strength. But how many stop to think of the mental fortitude required in caregiving situations? In caregiving for the elderly there is the conundrum of being an adult (who may have been the child in this household at one time) dealing with another adult (who may now be acting like a child). How does one maintain order, safety, and respect in such a situation?
One of the first things to recognize and integrate, despite the possibility of close family ties, is that nothing should be taken personally. This is often difficult to comprehend. If you are a family caregiver for your aging parent your entire relationship has been based on interpersonal interactions. The rules have now changed: nothing is to be taken personally. Get out of your head and deal with this from your heart in order to build mental strength. How? That one word is probably hovering at the tip of your tongue and aching to escape with a strong voice.
You will find your own way to the “How.” Each individual will do what is comfortable for them in their situation, but here’s the way some handle it. When you were young, sick with a fever, not wanting to follow doctor’s orders or your mother’s advice you probably threw a temper tantrum, had some tears, or rebelled in your own fashion to something you were being told was for your own good. Your mother, or father, didn’t stop loving you because of your tears, angry words, or harsh tone. They made excuses for you because you were sick, or stressed, or in pain.
Now it’s time for you to return the favor. This is where you start to understand the concept of “Take nothing personally.”
The next step is to realize that even though you are thinking with your heart, and may feel an obligation to sacrifice yourself, you are not the sacrificial lamb. You must set boundaries and make self-care a priority. Here are some suggestions:
Do you like to read? Get out of the house and go to the library or bookstore once a week and find new things to engage in your reading habit.
Do you have questions about caregiving? Spend time each day on the internet researching and find a support group or a local organization where you can ask questions and get answers.
Are you tired of cooking a bland diet for the person you care for so they can chew it, easily digest it, process it, and not suffer any stomach upset as a result? Get out once or twice a week to a restaurant, or friend’s house, where you can indulge in the food that you enjoy.
These few suggestions should give you some idea of areas where you may find yourself chafing at the bit for a return to a life you had before taking on the role of caregiver. Look at all the areas in your life. Are there situations where you feel like a martyr? Are you focusing too much time and attention on the person you are caring for and not on yourself? What good does it do anyone if you are not functioning at your very best?
Ask yourself these questions and take time to really think about the answers. Answer from a place of neutrality. If necessary ask your friends or a trusted advisor to help you assess these questions and come up with truly honest answers.
As you go through this process make yourself a priority, keep yourself mentally strong, seek friends and others who will assist you in staying on track with your own needs while you meet the needs of the family member or client you care for. The final step is to realize that guilt has no place in this picture. If you are doing your best for yourself and giving your client the best possible care while maintaining your own boundaries there is no room for guilt. It doesn’t exist.
This topic often brings up strong feelings in readers. Feel free to share, ask questions, or tell your story in the comment section.
I’d also like to know if there are specific topics you would like to see addressed. Feel free to let me know. This blog is for your information. Feel free to share it.