Talking About the Future

Talking with your aging loved one about difficult issues like finances, housing, or the impending future is never easy. Generally, both parties are in denial--your elder and yourself. Even when you can foresee what is going to happen, it's often human nature to look the other way with the hope "it" will resolve "itself." Unfortunately, a crisis situation can be created which possibly could have been avoided.

I like to compare denial to a den of comfort. In our den, we are not scared. We do not risk rejection. We do not risk being hurt. When we step out of our den and into the open, we are no longer protected. It's frightening and uncomfortable. But to be able to live a life relatively free of self-made crises, one must step out and take the risk. In the end, it's less frightening when you are prepared, rather than caught off guard.

Getting started
So, how do you start a conversation with your elder on topics which will be uncomfortable? Depending on the topic, an indirect approach may work. For example, if it's always been an unspoken understanding that insurance and finances would be handled by your father, you could use a recent ad or article on Long-Term Care Insurance to break the ice. You could say something like: "Dad, I know you handle the insurance needs for you and Mom. I ran across this article and found it interesting. May I share it with you?" This approach works well with men and women; it's not a direct advance on their "territory."

Often, an elder will not initiate a conversation out of fear of upsetting you. This is especially true when dealing with a parent. They may feel that they don't want to burden you with their finances or talk about an impending death. If you break the dam, and allow an open and safe environment to speak in, you may find that your loved one has the same fears that you do, but has also been afraid to discuss them.

Dealing with the delusional
When dealing with an elder who suffers from Alzheimer's Disease, you are not only dealing with forgetful dementia, but also delusional dementia. Being proactive in this situation is imperative to keeping your sanity and the safety of your loved one intact.

A good friend of mine, Sandy, recently had a stroke at the age of 52. Her mother suffers from Alzheimer's Disease and is becoming increasingly more paranoid. Because of this, her mother has been fighting her every step of the way in trying to move into a safer environment than her home. When Sandy had her stroke in December, because she had documented everything and had been proactive, her mother was safe during Sandy's 6 weeks in the hospital. As an only child, Sandy had made sure to show her close friends where all the paperwork was just in case anything happened during her surgery. Since Sandy had taken the time to discuss any necessary plans with her mother before she became too ill and irrational, Sandy had a plan in place if she was ever in need--and it served her well.

Ask yourself these questions
If you are uncertain what to discuss with your elder, here are a few basic questions to help guide you.

--What are your elder's greatest fears and concerns? Is it for their spouse? A dear pet? Their home?

--What aspect of their life is most important to them? Remaining independent as long as possible? Having a garden to tend to or sit in?

--How important is it for your loved one to remain in their home? Where would they like to live if that becomes dangerous for their well being?

--What are your loved one's current financial needs and potential future needs? Do they have any insurance policies in place which will help pay for long term care?

--Do they have adequate insurance coverage? (Health, life, disability, etc.)

--Do they have a doctor they can trust?

--Does he/she dread the prospect of a possible disability? If so, what is their fear?

--What frightens them the most about dying? Being alone? Leaving a dependent spouse? Being in pain?

Get these papers in order
There are three crucial documents which your loved one must have or at least have considered.

1. An updated and valid will. A current will reduces the likelihood of family conflict and tends to make all feel more at ease.
2. A durable power of attorney which allows a designated person to make legally binding decisions for your loved one. Be very careful who is chosen.
3. Advance directives which specify your elder's wishes concerning medical care and name someone to make medical decisions if need be. (A living will and durable power of attorney can also do the same).

Gathering this information may be difficult, but not impossible. Being organized is the key to being proactive. I have found that a small spiral notebook works wonders. I keep it in my purse for jotting down ideas, errands, and thoughts which I need to keep track of. It's amazing how much you can accomplish at a red light!

Use a calendar/planner and schedule!
I also recommend keeping a large desk calendar, the At-A-Glance kind which has large boxes with lines for notes on it. With so many tasks to remember--doctor appointments, dental appointments, social worker appointments--it's easy to forget what day the recycling comes at your home or your elder's home. Write tasks which occur once a week or once a month on the calendar to remind yourself. In times of stress, it is easy to forget who we are, never mind when the garbage has to be out by the curb.

I also find that keeping notes on the above calendar in reference to who I spoke to on what date is very important to tracking medical advice, etc. By keeping a record of who you spoke to, on what date, concerning what topic, you will be better prepared to answer any questions your family or doctor has concerning the care of your loved one.

In addition to using the calendar to track appointments, it is important to photo copy all receipts and medical information you receive concerning your elder. Not only will this create a paper trail which you can fall back upon if needed, but it also creates documentation which you can use for tax deductions.

And finally, create a daily schedule. As a mother of two children, and owner of two cats, two cars, two businesses and one home, I actually have to schedule in time for myself everyday! If I forget to schedule it in, I do not take the time I need to recharge my batteries. By taking time for myself, I am better able to give more back to my family. As caregivers, it is so easy to forget we need to take care of ourselves so that we can better take care of those we love.

Remember that when speaking to your elder about sensitive topics you need to be gentle. Make sure you are speaking at a time which is good for them and their state of mind. Be sure not to allow interruptions such as the phone to intrude upon your time together. Let your loved one take the lead, but guide them with your questions. Don't pressure them for answers the first time around, unless it is a life and death situation. By being proactive and having these discussions early in the diagnosis, or even as it is progressing, you are helping yourself and your elder be better prepared for the future.