Oct 23

The Big Move: Discuss It Ahead of Time

by Alice Miller

When people begin talking about seeking long-term care outside their homes, they broach one of the most emotional topics for families with aging adults.

“Mom took care of me for 40 years, and now I’m going to expect someone else to take care of her. Is that fair?” is a common way to feel, said Derik Sapp, local long-term care ombudsman at Cascade and Chouteau County Aging Services Agency. The conversation brings up death and the last chapter of life, which is especially difficult for both parties, said Sapp, who works with seniors and their families to find the best option for care.

The idea of losing independence and moving from their home can be daunting and unappealing to seniors, said Laura Booth, caregiver support coordinator at Adult Resource Alliance of Yellowstone County. Socialization and availability of services, such as the prepared meals and medicine reminders assisted living facilities provide, can mean better quality of life – and more independence, longer, she added.

“I think that’s the biggest fear with most seniors, (that) if they say that they’re vulnerable or if they admit to it that a family member’s just going to put them away in a nursing home,” Booth said.

Include seniors in every aspect of the process so they feel like they are controlling the next part of their lives and where they will spend it, Sapp said. Empower them to be the decision-maker.

“She needs to live there. We have to look at the fact that what I see in the facility could be the exact opposite of what mom sees,” he said.

Accept that you might not be the best person to have the conversation. Maybe your loved ones listen more to another family member, or trust a doctor or family friend. So find that person and let them start the conversation, suggested Booth.

 Take the opportunity to visit friends who are in nursing homes or assisted living facilities, Sapp said.

“In their minds, it doesn’t matter where they’re going. It’s not going to be home,” Sapp said.

“So if there’s a success story, use it for heaven’s sake; use the success story, and that can be your segue,” he said.

The best way to undertake the conversation, regardless of who’s doing it, is to use subtle approaches.

“Maybe ask that parent, ’What would you like? How about if we find some resources and then we can look at them together?’” Booth said.

Don’t assume that aging adults haven’t considered the options for additional help or assisted living.

“I think older adults are very much aware of their decline and their situation,” said Mary Dalton, resource specialist program manager at Missoula Aging Services.

Even if you’ve done research and have information to share, listen to what they say about long-term care, she said. Don’t patronize, and make sure to validate how they’re feeling.

“It’s possible that they already know everything you’re going to talk about,” she added.

One way to bring up the topic is to ask, “How do you see yourself remaining as independent as possible?” Then build off what they say, Dalton said.

Remember, what you want might be different from what they want. Do what’s best for them, instead of what you think is best for them, Dalton said.

If the conversation becomes too emotional, back off and revisit the topic later, she added.

A medical event, such as a stroke, can make communication more difficult or impossible, said Sapp. 

If traditional communication fails, have your loved ones keep a journal of thoughts and what they would like. It can be easier for some people than verbal communication and provides a clear outline of wishes for care, Sapp said.

“That way you can have the comfort and the knowledge that, yes, I’m doing exactly what mom would want,” he added.

Ignoring the issues, though, isn’t the thing to do. Accidents or rapidly declining health factors can take the decision about where and how people want to spend the last years of their lives out of their control.  Because of the risk of health issues, such as strokes or injuries caused by falls, no time is too early to start the conversation.

Regardless of what communication method you choose, create an ongoing conversation about how your loved ones are feeling and what they need.  Don’t rush the process, Sapp said, adding that you can’t expect people to change their situation in a day or a weekend. When people delay talking about assisted living, an emergency situation, such as a fall that places a person in assisted living, can happen.  Then people tend to react with emotions instead of what’s ideal, Sapp said.

“That’s why starting the process earlier is better off than waiting for an emergency to occur,” he said.


10 Signs Adults May Need Additional Help:

• Eating habits: weight loss, lack of appetite or skips meals?
• Personal hygiene: dirty clothes, body odor, bad breath, neglected nails and teeth, skin sores?
• Home: change in cleanliness and sanitation?
• Behavior: unusually loud, quiet, paranoid or agitated, or making phone calls at all hours?
• Relationships: changes causing friends and neighbors to express concerns?
• Physical: burns or injury marks, which may result from general weakness, forgetfulness, or misuse of alcohol or prescribed medications?
• Activities: decreased attendance to events that were once important to them, such as bridge or a book club, dining with friends, or attending religious services?
• Forgetfulness: unopened mail, piled newspapers, unfilled prescriptions or missed appointments?
• Finances: unpaid bills, lost money, multiple payments of the same bill or hidden money?
• Purchases: multiple subscriptions to the same magazine, entering an unusually large number of contests, or increasing purchases from television advertisements?

Information from: www.eldercare.gov.


Aging Services information
Call 1-800-551-3191 to be directed to your nearest Aging Services office to learn more about area facilities and assistance options both in and out of home. Or visit www.eldercare.gov or www.mt.gov.\

Alice Miller is a freelance writer living in the Mission Valley.

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