Six Keys to Successful Family Communication

Being a part of a family can become more and more complicated as our parents age.  As adult children of the elderly, we mature and begin to have our own families, concerns, challenges and problems.

As time goes by, we sometimes ponder, “If Mom or Dad becomes ill, what are we going to do?” If you have considered this question, then you are in the same boat with thousands of other families around the country. Every day, families find themselves in crisis because a beloved elder has become either permanently or temporarily unable to care for him or herself.

The crisis that involves a beloved older adult is often the most difficult and stressful of times for families. Frequently, the adult children do not live in the same community (or even state) as their elder. Time is of the essence. Other siblings have to be considered. The initial crisis can even become a series of other complications – like the domino effect. Is there anything a family can do to prepare for a crisis with an older adult?

The resounding answer to that question is “yes!” Over the years, I have observed many families in crisis and have seen a variety of ways of handling those complex family issues and dynamics. The guidelines below are ones that I have learned directly from families in crisis. Every family is different and every crisis with an older adult is different; but the six keys below are ones that I have seen employed by successful families as they begin the journey of aging with an elderly parent.

Key One: The best time to get along with your siblings and other family members is BEFORE a crisis.

Families that seem to do the best in a crisis are usually families who have good, healthy, relationships before the crisis. Most of us have someone in our family with whom we have a difficult (at best) relationship. When a family crisis looms, those difficult people can become impossible. Think of it this way: you have a variety of protective resources in your life – such as car insurance, house insurance, retirement plans, etc. I am suggesting you invest in some “family communication” insurance: Give some serious thought to mending fences with your siblings and parents or other significant family members.

Make the first steps. Write that letter. Send that card. Make that phone call. It will be far easier to wish them “Happy Holidays” and try to open a friendly dialogue during a good season than it will be to try to negotiate with them in the middle of a crisis. If you already have solid relationships with family, you can always go to the next level: In preparation for a potential crisis, begin to discuss with each family member the “what ifs” (more about this in Key Two). Try to do this in a low-key, low stress environment where there is plenty of time to talk and listen to each other. Building relationships during the good times helps immensely in making it through the bad times.

Key Two: Prepare. Gather as much information as possible in advance.

It is a sad reality that many of us really do not know the likes and dislikes of our closest relatives. Simple preferences in music, art, television, radio, hobbies, etc. are not known, let alone the difficult questions of whether they would ever want a feeding tube or a respirator if they needed them. Getting to know your loved one who might need caregiving is an art that can take years. You will want to build on this information a little at a time so that you can have as clear and comprehensive picture of this person as you possibly can. This information will be very helpful if they ever are unable to communicate their wishes. You may need to enlist the help of other family members – like the siblings of the parent – or even your own siblings. This can be done in a low-key conversational way.

When my father was facing serious surgery a couple of years ago, I had no idea if he had any kind of “living will.” My father was a very private man; so I chose not to ask directly as he would have taken that as confrontational. Rather, when I visited my older sister, I simply “wondered out loud” if Dad had any kind of advance directive for health care. Sure enough, she knew Dad had one because he had asked her to be the “agent” of his wishes. So, I learned two valuable things in one conversation.

Use family get-togethers to talk about stuff as casually as you can. Many of us still think that talking about death is morbid and should not be discussed during family events. However, I have seen families successfully use these family times in positive ways to obtain helpful information. One woman of my acquaintance decided she wanted to introduce the concept of “advance directives” (more about them later) to her dad. Rather than ask him pointblank if he had ever heard of this method of describing your likes and dislikes (with regard to medical interventions should you become unable to declare them), she chose to tell her dad that she had decided at age 50 that she needed to have one. She opened the conversation by describing what she had done and why and that she wanted her dad to know her wishes in case anything should happen to her. That opened the conversation with her father in a very non-threatening way and they had a good talk about those matters. She learned some new things about what her dad would or would not prefer in the event he was facing a serious health crisis. And, no doubt, he learned some valuable things about his daughter!

Key Three: Don’t be afraid to ask for help from professionals; but try to get to know them and the services they offer BEFORE the crisis.

After all, you may only have one mom who has had one terrible stroke. Social workers, counselors, nurses and other health professionals have seen hundreds of moms and dads with hundreds of problems. Use their expertise and experience to your advantage. In my work as a program director for a social service agency, I came into contact with many adult children who were trying to figure out what to do with their parents now that there had been a dramatic change in their ability to care for themselves. Sadly, the majority of the calls were during the crisis. They would go something like this:  “My name is Sally Smith and my mom is June Smith. She is 79 and is just getting over a stroke. I live in California. Since she is getting out of the hospital tomorrow, I need to arrange services for her. I have to go back home tomorrow; so can you come today?”

Many adult children have little or no contact with social services agencies that serve older adults and they often have some misconceptions about how much can be done; how quickly it can be done and how much it is going to cost. The most successful families I have dealt with made their calls before their loved one was in crisis. For example, I got a call from a son of an 86 year old. His mom had suffered a stroke; but was in the rehabilitation wing of a local nursing home. He called to simply chat with me about what his and his mom’s options might be should she be well enough to leave the nursing home. That was one savvy son. He made contact with several agencies and got a very realistic idea of what services might or might not be available to provide his mom. She lived in a rural area, and finding someone to come in for 24-hour care was going to be nearly impossible. Also, he was shocked to discover the cost of such services. Adult children of elders rarely know all of the details of what Medicare pays for (and doesn’t) or what going rates are for nursing homes or home care aides – until they are in the middle of a crisis and the grim reality of what they are facing sinks in.

Key Four: If you are not alone in making decisions on behalf of your beloved elder, keep these simple insights in mind:

• Include the elder if at all possible as you discuss what his or her wants are. You may wish to have a conversation with them privately before you have a larger family meeting. It may be impossible to get everyone together where the elder is; so you may need to use conference calls to be sure that all are included who need to be included.

• Select a quiet spot to talk. Try to be sure you have plenty of time blocked out. Include every family member whom you know has an interest in this elder. Remember who has the most to lose and who is the most vulnerable. I once wrote a paper in which I suggested that prisoners, dorm students and old folks are the only people in our society who are expected to get along with a room mate who is not of their choice! We need to seriously think about the consequences of changes in residence for our beloved elders. The decision may still have to be made; but if we can all respect the sacrifice that is being made by the elder, it will go a long way to helping with adjustment and acceptance. I worked in a nursing home for seven years and I saw many elders crying privately because their families didn’t seem to understand how hard it was to give up a home, a familiar bed, a beloved pet, or … as one elder put it: “my squirrels and cardinals that I fed every day.”
• Try your best to keep an open ear to all ideas and suggestions. You may be the eldest child of five, and as such, you have taken control and handled difficult family situations in the past. Being a gracious listener to all siblings at this time can go a long way to keeping the bonds of the family in love and respect. Fighting among siblings breaks a parent’s heart. Conversely, you may be the youngest child, and you may feel that your concerns about your parents have never been fully appreciated. Ask for a family meeting. Set the agenda in advance and be sure that the other siblings know what topics you wish to discuss.  Do your homework. Come to the meeting prepared to support your ideas with facts. For example: if you would like to have your mom come live with you after she gets discharged from the hospital, come prepared with the factual data on how that could be a reasonable and rational choice. (i.e.: “I have a spare room.”  “I don’t work outside the home; so I can be with her during the day.” “I can take her to the hospital and doctors that she is familiar with.” “My husband and family support this idea.” “I am willing to try it, and if you don’t think it’s working, I am willing to reconsider other options.”)

Key Five: The legalities

It will help both you and your beloved elder to know a little about the various legal matters surrounding the issues of supported living, medical decision-making and financial arrangements. Many adult children of elders do not know that there are now a variety of choices for supported living. A few years ago, nursing homes and apartments were about the only thing available to older adults who were going to be leaving a family home. Now there are retirement communities (each with their own rules, entrance fees, special accommodations, etc.), assisted living facilities where you can obtain services to meet a variety of levels of need, community based residential facilities (some call them “group homes” – a step up from the old “boarding house” concept), nursing homes, and in-home support services (the services come to where you are, rather you having to move).

With regard to medical decision making: you need to know that the generic term for documents that address these issues is: “Advance Directives.” Many folks use the term “living will;” but that is a more technical and specific term that describes a certain kind of medical decision-making tool. You need to know what is considered legal in the state that your loved one lives. There is no “national living will.” Not every state has them. If you or your parents live in a state that doesn’t have advance directives, you can create your own.  That does not mean that every hospital will accept it; but you can at the very least write down what your wishes would be in the event that you are no longer able to communicate with others about your health care needs. In Wisconsin, where I live, there are actually two different tools: one is called a “living will” and one is called a “Durable Power of Attorney for Health Care.”  They each have very specific requirements.

When it comes to financial decision-making, the “financial powers of attorney” (POA) must be drawn up by an attorney on behalf of an elder. This can be a very simple or extremely complicated documents that explains who the elder wishes to have perform financial functions on their behalf and what those functions are to be. The document can also provide specific guidance on what the agent can and cannot do with the elder’s resources. A commonly misunderstood issue about POAs is that it puts the person “in complete charge” of mom or dad’s financial resources. Some adult children think that they now have the right to tell their parent what they can and can not do simply because the elder wanted them to help write out their checks each month. Most POAs are designed to leave the elder in control. The person who is the agent for the POA is simply supposed to be doing the things that the elder wishes for him or her to do – not taking over completely!

There is one legal remedy that actually gives a person the power to control the decisions of another – guardianship. Guardianship is a legal condition that has to be obtained through a court. Guardianship is only awarded by a judge. And… a judge is the only person in the U.S. who can legally declare a person is “incompetent.” Guardianship actually removes a variety of rights from a person. They cannot vote, cannot decide to marry, cannot decide where they wish to live, and cannot make simple decisions without the permission of another person.

We hear that word bandied about by nurses, social workers, doctors and family members; but it is only a judge who can actually declare a person is “incompetent and need of protective services” (like guardianship or protective placement in a safe facility). Keep this in mind: years ago, guardianships were handed down a little more easily and with little investigation. Many older adults (and some disabled folks) were placed under guardianships that they did not need. Over the past few years, there appears to be a deeper respect for the rights of older adults and the disabled, making it a little more difficult to obtain a guardianship on someone. The judge should hear from a variety of experts and seriously consider whether the person actually needs a guardian before awarding a guardianship.

Unfortunately, there are many older adults who need some help; but don’t need full guardianship. These elders who are “partially competent” are sometimes the most challenging and difficult for families to help. A qualified social worker or aging services specialist should be able to provide a number of suggestions or ideas on how to help an elder in this kind of situation.

Key Six: Boundaries

What is my responsibility as an adult child of an elder in need? This question merits some serious consideration. I have witnessed many disasters for both an adult child and an elder when a decision is made out of “duty” or “obligation” that creates great stress for all concerned. What are your responsibilities toward an aging parent? I truly believe that each adult child has to answer that question in light of their own set of standards and morals. I do not think there is an “absolute” definitive moral standard on this. Family dynamics can get very complicated. I may greatly desire to have my elderly mom live with me; but that would mean moving my teenage son into a room with his two sisters. The consequences of decisions need to be thought out as much as possible. A spouse, or young children in a family sometimes are expected to make great sacrifices so that a grand parent can move in. This can cause resentment and even hatred toward that older adult – not a healthy dynamic for any of them! I have also seen an adult parent use guilt and unreasonable demands to get their way with a loving adult child.

It is sad but true that some aged parents are not willing to compromise. That is why I feel that the boundary issue can work both ways. Not only does an adult child need to clearly explore and define their obligations toward their parent; but an aging parent (if they are still able) needs to seriously consider their expectations toward their children.

There are professional social workers, care managers and counselors who are trained to help families work their way through some of these difficult issues.  As you face these things in the life of your parents – or even in your own life – may you be able to use some of the helps in this article to be a positive force in your own family.

Communication Checklist

1. Everyone who has an interest should be included in the discussions.
2. Everyone should be encouraged to participate so that no one can later say, “I didn’t get to talk”.
3. Listen “generously”.  Remember that there is usually more than one way to solve a crisis.
4. Take notes so that things can be sorted out later; and ideas can be written down if more thought is needed.
5. Obtain the help of an objective outside party if needed. Many social workers are trained mediators and able to help families negotiate sensitive issues with a goal to having the best possible outcome.
6. If anger crops up, suggest a break so folks can “cool off” and hopefully come back to the table a little more willing to work through the challenges.
7. Be willing to compromise. Rarely does anyone get to have his or her way all the time and on every point.
8. Agree to disagree without being “disagreeable” if at all possible!  Common courtesy and civility does matter in keeping things positive in family discussions.
9. Have more than one meeting if needed and if appropriate so that ideas can be explored, phone calls made and new facts presented before a final decision is made.
10. End the meeting by affirming the following:
1. what was decided
2. what is left to be decided
3. who is going to do what before the next meeting
4. setting up a time for the next meeting if needed

Related Articles:

 - Choosing In-Home Care Assistance
 - Using Family Meetings to Resolve Eldercare Issues
 - Promises, Promises
 - Transition Issue for the Elderly and Their Families
 - Moving Your Elder In With You: Practical Tips and Suggestions
 - The Do’s and Don’ts of Communicating With Aging Parents
 - Safety vs. Independence: A Case Study
 - The 11^th Commandment: Thou Shalt Not Parent Thy Parent
 - Elder Law Basics
 - Personal Affairs Checklist
 - Estate Planning: The Basics

Recommended Reading:

- Coping With Your Difficult Older Parent by Grace LeBow, et. al.
- Caring for Yourself While Caring for Your Aging Parents by Claire Berman
 - Respecting Your Limits When Caring for Aging Parents by Vivian Greenberg
 - Are Your Parents Driving You Crazy? How to Resolve the Most Common Dilemmas with Aging Parents by Joseph Ilardo and Carole Rothman
 - As Parents Age: A Psychological and Practical Guide by Joseph Ilardo

 - Additional books, excerpts, reviews, and interviews with authors are available in the ElderCare Bookstore.

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