For many of us who are in the thick of working and caring for our family, it’s enough just to get through the week. Looking ahead and making future plans can be daunting. We just don’t know what the picture will look like a month from now, let alone a year from now, or three years from now.
A post in the New York Times’ New Old Age blog tackled the difficult subject of how hard it is for older folks and their families to look forward to the decline and frailty that almost inevitably come with aging - unless sudden death intervenes.
Writer Paula Span pointed out that while many older people can talk about their wills or their funerals, they jump over the intervening years and the difficult subject of how the family should deal with their needs as their health and strength decline. Yet this is an important reality for us to try to face; most people are not, in fact, going to die suddenly of cancer or heart disease but will spend a number of years in an increasingly frail state of health as they move toward the end of their lives.
Following up on the NYT post, UCSF geriatrician Ken Covinsky writes in his blog Geripal that the danger of failing to study and talk about this life stage is that we overlook ways in which we can help frail dependent elders maintain a good quality of life.
I thought a positive way for us at Gilbert Guide to join this dialogue would be to think of some ways families can talk about planning for these last years of increasing frailty, so it doesn’t come as such an unexpected and unprepared-for event when things take a turn for the worse.
It can be hard to face head-on the issue of dependence and the fact that many seniors in their later years will be unable to manage without help, but talk about it we must.
Here, then, are a few “talking tips” from experts who help families plan for the various transitions of aging.
1. Recognize that the fear of losing independence can be overwhelming and may lead you to make poor decisions.
Talk about the fact that the loss of strength, mobility, mental faculties, and independence is just another type of loss. How have your family member faced and dealt with losses in the past? What kinds of resources have helped?
2. Talk about the fact that, as one social worker put it, “Independence is knowing when to ask for help.”
Redefining asking for help as a sign of strength can help overcome stubborn attachment to going it alone.
3. Tell your family member what makes you feel safe and cared for.
Then ask yourself how you want to make sure you receive good care when your caregiving needs become too much for a working family to shoulder. It’s important to get this topic on the table for practical discussion so you don’t get stuck at the “Promise me you’ll never put me in a home” level of discussion.
4. Offer yourself as many choices as possible in your old age.
Having choices, experts say, is the essence of feeling in control. And loss of control is the scary fear that underlies the fear of losing independence. Discussing the range of choices available, from assisted living to in-home care to moving in with family members, allows the reality to sink in for everybody, and will hopefully prevent you from having to make decisions under the pressure of an emergency.
5. Discuss limitations along with options.
Talking about the possibilities ahead of time also allows you to raise the issue of your limitations while you’re still in the decision-making process. So, for example, your adult children might say “I’d be happy to have you live with me, mom, but we’d need a day nurse while I’m at work in order for you to be safe, and we’d need money to pay for that.” Family caregivers often say they wish they’d discussed these issues ahead of time while their loved ones had more faculties intact to prevent misunderstandings and disagreements later on.