Home for the Holidays

The tree is gone, the decorations packed away and you have a moment to consider what just happened.  Your siblings and their children came home to spend Christmas with Mom and you were disturbed by what they noticed.  You’ve been visiting her almost daily, taking her shopping for food, getting her prescriptions, helping her around her house, empty now that Dad has passed away.

Of course you noticed Mom’s occasional forgetfulness but she’s always been that way, hasn’t she?  Now your siblings expressed their concern, especially since it has been several months since they last saw her.  They noticed she refuses to use her walker even though she moves from place to place clutching chairs, tables and even the walls so she won’t fall.  She stares at them for several moments before her eyes reflect that she now recognizes them.  Her prescriptions have increased in number and they have no idea why she takes them.

The Holiday Season often elicits reactions like this when family returns to visit a parent.  No one wants to believe their mother, father, aunt or uncle is not the same vibrant person they always knew and never worried about.  But now it’s different.  Now it’s time to have “the conversation”.  No, I’m not talking about the birds and the bees.  Your parents gave YOU that talk (though you probably didn’t need it anyway).  I’m talking about the conversation you need to have with your elderly relative regarding plans they have made for their future care.  Are they healthy enough to live safely in their present home environment?  Do they need help with the everyday activities of daily living?  Are they financially capable of handling medical emergencies, living arrangements, and transition to assisted living or, in the worst case, to a nursing home?

Do they have an advance health care directive or living Will?  What about a durable financial power of attorney?  Do they have long term care insurance?

Ideally, your parents will already have initiated the “talk”.  However, all too often they procrastinate until they are overtaken by events, such as a sudden illness or death.  Then you are called upon to take matters into your own hands with no assistance from them.  You are now called upon to nurture and give back some of what your parents gave you.

So how to do this?  How to have the talk with your parents about health and financial issues?  Here are some keys to having a successful discussion:

AN ATTITUDE OF RESPECT.  You may feel that Mom’s present circumstances allow you to treat her like a child.  After all, today’s culture all too often treats elders as obsolete, in the way, or simply as problems to be resolved so we can move on with our own lives.  If that is your mindset as you enter this conversation, you are doomed to failure and frustration.  Whether you are talking to Mom about health or financial issues, keep in mind that she and your Dad have a long history of caring for themselves.  For many decades they have handled their health and financial issues.  They knew when to seek assistance and, essentially, “ran the family business”.  They worked, took home a salary, spent and saved money, paid the bills, hopefully accumulated some retirement savings and raised you and your siblings.  They may resent you if you appear to be taking over their decision making.

You need to enter the conversation with respect for your parents’ history and the legacy they hope to leave behind.  This should not be a conversation where you are the parent and Mom is the child.  This should be a conversation where you treat each other as equals.  It should be a conversation that begins positively with a comment such as “I want to be sure I do the right thing for you” and not negatively with a comment such as “You’re disorganized and you need to do better”.

You, as part of the sandwich generation, are not only dealing with Mom, but also continue to have the pressures of your job, dealing with your own household issues and concerns for your children.  Mom is basically still grieving the loss of her partner and is beginning to let go of many of her prior responsibilities.  Mom knows she is unable to do many of the things that assured her prior independence and she may be distraught that you are unable to see how disruptive change is to her.  From your perspective Mom’s inability to move around her house, keep it clean and cook her own meals is sufficient evidence that she should move to assisted living.  From Mom’s perspective the idea of leaving the home where so many of her memories and life events occurred is frightening.  Keep this in mind when you approach delicate subjects like changing residence, giving up driving, or seeking help to control her finances.  Perhaps the best way to do this is to:

LISTEN AS WELL AS SUGGEST SOLUTIONS.  Before having the “talk” you should have researched possible solutions to the problems Mom faces.  Determine what alternatives actually exist to help Mom.  Discover the resources available in the community for assistance.   Make a list of things you actually know about Mom’s health issues (what medical problems she has, the prescriptions she takes, the name of her doctors) and her financial issues (does she have a mortgage, bank accounts, an IRA or other retirement account) and then make a separate list of things you really need to know to fill in the gaps.

Knowing in advance what these resources might be is extremely important if you are going to be in a position to suggest logical solutions for Mom.  But equally important to being ready to make suggestions is your responsibility to LISTEN to Mom.  Encourage her to talk about her health issues, how she feels, how her illnesses affect her ability to perform the activities of daily living, whether she is overwhelmed by the bills or has trouble keeping up the checkbook.  Ask her what she thinks she needs in the way of help.  Take notes to convince her you are taking her seriously.

TRUST, TRANSPARENCY AND SUPPORT.  Elderly parents can occasionally become nervous and even suspicious if you want to talk to them about money.  If you have siblings, make sure they are aware that you are going to have this conversation with Mom.  You should decide whether it is better to have the talk with or without the siblings present.  Mom might be more receptive to a one-on-one (where she is treated as an equal) rather than feeling she is being ganged up on if all the children attend.  Tell your siblings that whatever information you learn or whatever decisions Mom makes will be shared with them.  Tell Mom that you have told your siblings that you are having this conversation with her and that they support your efforts.

Elders can be secretive about their finances (simply telling you “not to worry, I’m okay”).  They fear losing control and that is understandable.  You should be empathetic and tell Mom you would be at a loss as to how to help if you don’t have some idea how she is fixed financially.  You should be firm but compassionate.  Mom should know that you worry – perhaps unnecessarily – how Mom’s possible financial difficulties might affect your own family obligations if you have to help her financially.  Tell Mom she could alleviate that stress if she was forthcoming about her finances.  After all, you would suggest, maybe she is fine but perhaps with some financial review could be in even better condition and wouldn’t she prefer to know – as would you – that she is financially able to meet her future obligations?

In some cases, especially where Mom is showing signs of dementia or is diagnosed with Alzheimer’s, you should consider whether to utilize the services of a geriatric care manager (“GCM”).  A GCM is licensed as a nurse and or social worker, specializing in working with geriatric patients.  They work closely with elder law attorneys and families to help determine the capabilities of elders with reference to activities of daily living, can suggest the best ways for the elder to adapt to independent living with assistance and can also make informed suggestions as to alternative living arrangements if continuation in the home is unsafe.

MAKE SURE PROPER DOCUMENTS EXIST.  Your parents should have up-to-date health care directives and/or Living Wills as well as properly executed financial powers of attorney.  In the context of what we have discussed above – Respect, Listening and Transparency – you might suggest that you are also working toward such documents for yourself and you want to be sure Mom has taken similar steps.  If she has documents that are more than five years old, suggest she have them reviewed by an elder law attorney.  If she has no documents at all, suggest she make an appointment to establish her planning as soon as possible.  The absence of such documentation can be catastrophic to an elder, especially if he or she has become legally incapable of signing new documents as a result of cognitive disabilities.

Finally, keep in mind that Mom and Dad have the right to make their own life choices and you need to be prepared to accept them, even if you might disagree with the choices they make.  Don’t become confrontational as that will only make continuation of the discussion (and it usually takes more than one occasion) very difficult if not impossible.  If you believe your parent is making a bad choice because of dementia or Alzheimer’s then you may have a more difficult choice to make.

If an elder displays unsound judgment regarding health, residence or financial issues, intervention of a court to establish a guardianship may be necessary and is a step you will have to consider.  This is where a geriatric care manager and your parent’s primary care physician will be helpful.  Intervention by guardianship requires the physician to complete a Decision Making Assessment Tool which the Court will rely on in deciding whether guardianship is appropriate.  That discussion, however, will be the subject of another blog post coming soon.