FHCA - Having the difficult "needing help" conversation

Takeaways:

• As loved ones age - they may not be able to continue caring for themselves safely

• However, even as loved ones' physical / mental abilities decline with age, the expectation that they can continue to be completely self-reliant and even care for others oftentimes remains

• Having a conversation with your loved one about how to support them before any crisis develops (such as a fall / new diagnosis) is difficult - but important to protect your loved one

• As caregivers, we are the support that families / seniors ask for during this time. Sometimes, as family caregivers, we have the dual mandate of helping our loved one identify the types of care needed - as well as providing the care ourselves

The 35-65 rule:

You should start the conversation with loved ones about senior care as early as possible, ideally long before any immediate need or health crisis arises. Beginning these discussions early (when your loved ones are still healthy, independent, and can actively participate in the decision-making process) allows families to understand concerns and form strategies before emotions are heightened due to an immediate crisis. Here at MedTec, we often get calls from families where the children would like their parents to receive care - but the parents refuse. Sometimes it is because the parents don't like the idea of the family spending money on something the family can do themselves - but oftentimes, it can involve many complicated factors (pride of independence, feeling like decline is unavoidable, not wanting an outsider to help, etc). Establishing a general action plan of "we will start looking for help if these situations arise" may help families to overcome the first hurdle of "do we need help" - and instead focus on the more important "what's the best way to help".

A common guideline is to begin discussions when the adult child is around 35 years old and the parent is around 65 years old. This timeframe allows for thorough, unpressured planning.

How to have the conversation:

What your loved one may be feeling...

Many seniors view needing help as a loss of identity and control. They fear it's a step towards total dependence and that they will lose the ability to manage their own lives. As one senior put it, "I felt two emotions — overwhelming relief & disappointment. I was relieved that I asked for help but disappointed that I couldn't fix myself"

• One senior expressed the struggle of accepting help with tasks they had done for decades: "Having to accept assistance is admitting capability is diminishing. Getting others to help means we are no longer in charge of this life we have lived for so very long. It is giving others control of our lives... tasks we used to do as and when we wanted we now have to wait until someone does it for us".

• Meanwhile, other seniors wish to either simply maintain dignity. They have always been self-sufficient and the parent in the relationship. Feeling like they are being treated like a child can cause resistance to surface as anger or defensiveness towards family members.

• Some loved ones who insist they don't need help, are coping with their fear of sickness, weakness and their own mortality.

How should I approach the conversation?

While we have tried to distill the many resources on having conversations with seniors into the general guidance below, we believe that the main things that will lead to success are: starting the conversation early, accepting solutions that may not be ideal - but may be the best given the personalities and fears in the room and being loving and caring for your parents during what can be a scary time

Before the Conversation

• Start Early: Do not wait for a crisis or an emergency. Begin conversations when your loved one is healthy and can be an active participant in planning their future.

• Do Your Homework: Research available options (in-home care, assisted living, etc.) and potential costs beforehand. This allows you to provide concrete information and address financial concerns with facts.

• Work Through Your Own Feelings: Acknowledge your own emotions (fear, guilt, resentment) before the talk so you can remain calm, grounded, and focused on your parent's well-being during the discussion.

• Involve Siblings/Family: Get on the same page with other family members first to present a united front. Consider a family meeting or involving a neutral third party, like a social worker or geriatric care manager, if family dynamics are complex.

   

During the Conversation

• Choose the Right Time and Place: Find a quiet, private, and comfortable setting without distractions. Avoid stressful times, like holidays or immediately after a doctor's appointment.

• Lead with Empathy and Respect: Start from a place of love and concern, not urgency or accusation. Use "I" statements to express your feelings (e.g., "I've been feeling worried since your last fall, and I want to make sure you're safe") instead of "you" statements (e.g., "You can't live alone anymore").

• Listen Actively: Give your loved one your full attention and listen for their underlying fears (e.g., loss of independence, fear of strangers). Acknowledge their feelings and validate their concerns without interrupting.

• Frame it as a Partnership: Emphasize that the goal is to enhance their quality of life and independence, not take control. Use "we" and "us" language (e.g., "How can we make life easier for you at home?").

• Offer Options, Not Ultimatums: Present different choices, such as a few hours of in-home care per week or touring different communities, rather than forcing one solution. People prefer to feel they have a say in their future.

• Use Concrete Examples: Gently bring up specific, non-judgmental observations, such as unpaid bills, expired food in the fridge, or difficulty managing medications, to illustrate your concerns.

• Start Small: If they are resistant to major changes, suggest minor adjustments first, like hiring someone for yard work or grocery delivery. This helps them get used to the idea of receiving help. 

After the Conversation

• Be Patient and Plan Multiple Conversations: A single "big talk" is rarely effective. These discussions are a process and may take place over weeks or months. Be prepared to revisit the topic often.

• Document Wishes: Write down key points, preferences, and decisions made during the conversation. This documentation helps prevent confusion and ensures everyone is on the same page.

• Seek Professional Help: If discussions become too tense or challenging, consider involving a neutral professional, such as a geriatric care manager, social worker, or elder law attorney, who can provide impartial guidance.

• Involve Them in Next Steps: Encourage your loved one to tour potential senior living communities or meet with a home care provider for an introductory visit to make the options feel more real and less intimidating 

What options are there for long-term senior support? How are they paid for?

Types of Long-Term Care and Costs

Care can be provided in various settings, with costs varying significantly by location, facility, and level of care. 

Financial Impacts for Most Seniors

The financial implications of long-term care are significant, as most seniors are likely to need some form of LTC in their lifetime (about 70% of people turning 65 will need care at some point in their lives). Without preparation, these costs can quickly overwhelm family resources. 

• Primary Payment Method: Out-of-Pocket Funds: For most seniors, the initial costs of long-term care are paid for using personal savings, pensions, retirement funds, or proceeds from selling a home.

• Medicare Coverage Limitations: Medicare does not pay for most long-term care (such as assistance with daily living). It generally only covers short-term, skilled nursing facility stays after a hospitalization or limited home health care if prescribed by a physician.

• Medicaid as a Last Resort: Medicaid is the primary public payer for long-term care, but individuals typically must "spend down" their assets to near-poverty levels to qualify for coverage. This can lead to the depletion of life savings for middle-class seniors.

• Insurance as an Option: Long-term care insurance is a way to mitigate financial risk, but many seniors do not have it, or policies may have limits on coverage. Premiums can also be expensive, especially if purchased later in life.

• Family Burden: Without adequate planning, the financial burden often shifts to family members, who may cut back on their own basic expenses or incur debt to help pay for care. 

Need more help? Please call us at 847-470-4701 and even if we don't know the answer, we'll do what we can to help you with any challenges you may be facing!