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Updated: September 18, 2023

Tips for having the tough conversation: It’s important to connect on sensitive issues before it’s too late

Discussing long-term care options for an aging loved one is not a conversation people happily anticipate. In fact, it can be challenging and uncomfortable. 

It’s also a conversation that shouldn’t be put off.

Experts agree that discussing preferred options with a loved one early improves their chances of maintaining their quality of life. Whether the desire is to receive care at home, live in a senior community or long-term facility or move in with a family member, a discussion about options should not wait until the last minute.

Advanced planning matters because it’s hard to predict when the moment of decision will come, says Megan Walton, CEO of the Southern Maine Agency on Aging.

Courtesy photo
Megan Walton, CEO of the Southern Maine Agency on Aging

“Unfortunately, you may reach a point where you are no longer able to have a sound discussion with your loved one if they’re suffering from memory impairments,” Walton says. “It’s important to have these conversations early on so that if you’re left in charge of implementing your loved one’s wishes you have a clear idea of what they are. Also, there can be extensive wait times to get into the facility or location of choice. It is helpful to have these conversations up front so you can take your loved one’s wishes into account when planning for (long-term care).”

Long-term care experts shared the following tips for knowing when it is time to talk and how to have a productive conversation:

1. Start today

The key to productive long-term care conversations is to have them before they are needed. Working in advance allows your loved one time to process options and clearly state their goals and desires. Waiting until a health issue forces the conversation can lead to high stress, poor decisions and hurt feelings.

“Having these tough conversations helps you understand what might be scaring them or creating anxiety,” says Robin Sherman, a home health social worker with Northern Light Health. “By avoiding the conversation, this sometimes causes a false narrative in the aging loved one’s mind: ‘Are they just going to stick me in a home?’”

2. Look for ‘red flag’ issues

Frequent falls, minor health issues that turn into larger, lingering problems and a decline in the skills needed for daily living are signals that a change might be imminent. Other concerns to be on the lookout for include noticeable weight loss, neglected pets or plants and changes in hygiene or social interactions. Keep in mind that simply pointing out your concerns might not be enough, and that you may have to get a medical professional involved.

“As much as you might try to cajole, persuade or encourage (your loved one), some people are very stubborn,” says Diane Kibbin, director of operations at senior living communities OceanView at Falmouth and Cumberland Crossing. “And if there’s an element of cognitive malfunction, they don’t realize that there’s anything going on.”

3. Be prepared

Familiarize yourself with options that are in your area. Before you begin a discussion with loved ones concerning care options, know what options are available. Each choice has pros and cons, and it is best to have a full understanding of the good and the bad before you begin talking to your loved one.

“There are so many variables out there,” says Randy Corkum, director of assisted living at OceanView. “There are private pay, Medicare and Medicaid environments. And financially, it’s a big number. Trying to find that right place for mom and dad is not only about finding the right place, but can you afford it?”

4. Listen

Your idea of the best long-term care option might not be the same as that of your loved one. Genuinely work to understand their point of view and why they might prefer staying at home or why they view a community as their best option.

5. Enlist help

Involve other family members in the conversation. It might be beneficial to include trusted medical providers and friends in the discussion. Sometimes your loved one might be quicker to trust the judgment of others outside the family. Ask for their help.

“It can be helpful to have the person’s physician be a part of this conversation,” Walton says. “Sometimes it is easier for the care recipient to accept if they hear it from a trusted health professional. The (primary care physician) may also be able to write an order for home health care, which can get other professionals into the home to offer additional safety recommendations or measures.”

Sources: Southern Maine Agency on Aging; Alzheimer’s Association; AARP; the Conversation Project

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