On The Home Front

30th January 2015

How to help your parent(s) make that most difficult of decisions… what to do as independent living becomes more challenging.

Peter Neighbour of Home Instead Senior Care recommends a softly softly approach to the necessary conversations, and speaks from personal experience.

A few months ago I received a call from a lady who was trying to navigate one of the most complicated periods of her life. Her 87 year old mother, a bright independent woman who had been living alone for several years, was now growing more and more frail. My contact knew she needed to talk to her mother about help and assistance, but was finding it difficult to broach the subject. When she finally shared her concerns with her and raised the idea of having some help or the possibility of moving into an assisted living facility, she met with a very firm denial: “I don’t need any help and I’m not moving”.

These can be the most difficult words that a child can hear from their elderly parent. So how does a concerned family member convince a reluctant parent that moving to a long term care facility is in their best interest?

As people get older they often have an unrealistic expectation that they will be able to take care of themselves for the rest of their lives, and this is where their children or other family members can help to identify the problem and help instigate change.

No matter what the age of your parent, experts say now is the time to begin talking about the future. If you open the lines of communication early, words like, home care, assisted living and residential care lose their sting later on. Most people leave it until the situation is in crisis, which results in a confused elderly parent, disorganised, yet well-meaning children and a family in emotional turmoil.

You can avoid this unnecessary pain by having regular open and honest conversations with your parent about what the future might hold. Put the focus on your worries rather than your concerns about them. If you place demands on them and tell them what they have to do, they are much more likely to resist. Instead say “Mum, I’m really concerned about you; it makes me worried thinking about how you are coping.”

Most parents naturally do not want to burden or frighten their children with their own concerns, so they will often respond to this sort of honest conversation.

But what do you do if your mum or dad flatly refuses to even consider moving home? You could ask them to indulge you and just go to visit the new accommodation, but remember all of us when placed under duress to change will typically resist, even if the suggestion we’re fighting against makes perfect sense. In these circumstances it may be best to back off and look for opportunities when you can raise the issue again.

Unfortunately sometimes things have to get worse to get better. It may take a fall or a scare for the realisation to dawn on them that they need help. If your parent shows signs of warming to the topic, emphasise that it is their decision, but also stress the need for action. Tell your mum or dad, “I can’t make decisions about how you run your life, but it would make me feel better if we could go through the options together; to look at some facilities, so that you are better informed about what choices are available. What do you think?”

It is important that your parent feels in control of the situation; all of us are more likely to change our position or lifestyle if it is of our own choosing.

I had a similar situation with my own father, Harry. He was a fiercely independent man, who had looked after himself very well, but as he entered his 90s he was not as capable as he once was and, in particular, found walking any distance difficult. I broached the subject of him having some help at home, just to do some of the heavier tasks and those things I felt he didn’t particularly enjoy, but he characteristically refused point blank. I let the situation lie and within a couple of weeks he said “Well, have you sorted some help out for me?” The key thing was that he had made the decision, not me.

If there is a willingness to accept some help or entertain the idea of a residential home, then don’t waste any time in setting up some appointments or visits. Point out that most places will allow a potential resident to try living there for a week or even a month before they have to decide whether to stay permanently. That bit of extra reassurance can make all the difference if they are still hesitant.

When it comes to approaching a parent about making a move it is crucial that the whole family are on board and that everyone is giving their parent the same message. It’s advisable to get the family together – without the parent – to discuss the situation and agree a joint way forward. It only takes one disgruntled offspring urging their parent to stay at home to make any change nearly impossible.

When families come together, there can sometimes be personal “baggage” brought along. It’s best if this can be put aside for the good of the parent. These can be very emotional issues, but remember it’s not about you it’s about what’s best for your mum or dad.

With an aging population, dementia is becoming ever more of an issue for everyone to consider. It is important that you prepare for the day that mum or dad may have to live with dementia of some form. In these circumstances, it is vital that early consideration has been given to your parents financial and care needs. Professional advice should be sought at an early stage about arranging a Lasting Power of Attorney, which involves appointing a capable family member to act on your parent’s behalf; to make financial decisions and look after their health care. It is important that this is done while your mum or dad can make their wishes known about how they would like to be cared for in the future.

No matter how smoothly the process goes, children often retain guilt about moving their parent in to long term care. Remember that regardless about the promises you may have made about never putting your parent into a residential home, the decision must be based on what is best for them at the time. Often it may be the most loving thing to do, because it improves their care and improves their quality of life from both a medical and social perspective. Homes may vary in quality but people often thrive in them.

Finally, bear in mind that residential or nursing homes are not the only solution. There are many options to help support a loved one to stay in their own home safely. They range from home care which may be from a couple of hours a week, helping out with shopping or just some companionship, through to more regular hands on personal care. In addition there is the possibility of live-in care if space at home allows. Assisted living facilities where a scheme manager is on site can also offer a good compromise in certain circumstances. Compromise… that’s the key.

Peter Neighbour is the director of Home Instead Senior Care, Watford

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