No matter how old they get, your parents never stop being your parents. As mom and dad age, adult children may have a hard time asking important questions. It could get a little personal, maybe a little embarrassing. Experts say these conversations can be tough to start, but they’re vital to have. And the best time to start talking? Right now.
“If you’re dying, what should we do?”
You may not want to even think about this, but when it’s time to make decisions about your parents’ end-of-life care, you want to be sure you’re fulfilling their wishes. And the sooner you have this discussion, the better.
“By the time people get to hospice care, the conversation has been pushed ahead by timing and imminent care needs,” says Kim Rumaker, manager of social work at Samaritan Healthcare & Hospice. “We have a bird’s-eye view of what would have been helpful to talk about before it became necessary. We always think, ‘It can wait,’ and then it gets to us before we get to it.”
Rumaker says failure to plan ahead and have these tough conversations can result in crisis when an illness progresses.
“There are a lot of logistical issues,” she says. “Where are my assets? How will my children or loved ones access them? Who’s going to manage my healthcare insurance? Basic things become significant issues when someone becomes unable to speak or write. Sometimes if you wait too long, there’s a point where you can no longer appoint a power of attorney. If you’re confused or unable to communicate, that’s a point beyond all return, and the business of living can become very complicated.”
Rumaker says it’s important for children to help their parents make informed decisions about the kind of care they want at the end of their lives.
“The presentation of medical intervention on TV is really influential, and it’s not accurate,” she says. “End-of-life intervention looks like this miraculous thing, but in real life everything has a consequence. So if, for instance, someone wants to be placed on a respirator, we need to make sure they understand they’ll likely be unconscious and unable to communicate. When people get that education, they start to make the choices that are right for them and not just choices based on fear.”
If these questions are settled ahead of time, Rumaker says, hospice patients and their families can focus on the things that are truly important to them.
“When you’re caring for anyone, it’s important to remember what’s important to them,” she says. “So maybe it’s important to me that I can always read my newspaper or that people from my church continue to visit. Those things can get lost in the midst of caregiving, but they add dramatically to somebody’s quality of life.”
“Is it time to move?”
One of the most difficult conversations you can have with a parent is asking them to consider moving out of the home they love, especially if they lived in that home with a deceased spouse or raised children there. But there are many reasons to have the conversation, even if you’d rather not.
“People tell me they saw signs but didn’t do anything. When it’s your parent and you see something may be off, you think, ‘Oh, she’s fine. She’s just having a bad day,’” says Melissa Repkoe, executive director of Brandywine Living Voorhees. “When they talk to me, they’re feeling a lot of guilt.”
“But when you’re not sure if it’s the right time, you can look for one tried-and-true sign: check the pill box. Are yesterday’s medications still there?” adds Repkoe. “That’s a sign a new community is a good option.”
Repkoe suggest the person who is closest to the parent initiate the conversation, because it most likely will be met with some resistance. “Roll up your sleeves and use your people skills,” she says. “What to say is different for each person. Just remember what’s important to your parent.”
Once your family is ready to explore living options, take a tour.
“When you come in,” says CareOne’s Lisa Kelly, “don’t be afraid to ask the residents questions.”
“Ask why they like it. Make sure there are activities and programs, and that they’re running all the time – including evenings and weekends,” says Kelly. “Ask how long the staff has been there, and if they’ve had training. Longevity of staff shows how dedicated people are to the building.”
“Go in with your eyes wide open, and be honest,” adds Repkoe. “If your mother needs to go to Wegmans every day at noon, ask if that can be accommodated.”
Kelly also suggests letting a hesitant parent give it a try.
“Try it for 30 days,” she says. “It’s called a respite stay, and most places offer it. Ninety-five percent of the people who come for 30 days end up staying. They feel like they got to try it out on their terms, and now they want to stay.”
“The other big piece of advice for adult children is to tour a place before they bring their parents,” Kelly adds. “The last thing you want to do is tour and it’s a total nightmare. They’ll never go see the second one.”
“Ever heard of scams and trolls?”
Adult children – and even grandchildren – can help with this one. Older people are a common target of internet scams, says Jim Brown, director of the Digital Studies Center at Rutgers-Camden.
“Online scam artists are savvy, and they target certain demographics,” he says.
Older internet users are definitely getting better at recognizing scams, Brown says, but as they evolve, so do the people who would like to take advantage of them.
“What worked a few years ago is less likely to work today, given that word spreads about particular kinds of scams,” Brown says.
“For instance, phishing scams – scams designed to make people think they are getting an official email from their bank or other institution – are better known now. This means that scammers are always adjusting and looking for new approaches.”
To keep mom and dad safe in a digital space, the best thing to do is help them build their internet skills.
“People might share examples of scams they see,” Brown says. “If someone sees an email scam in their inbox or gets a scam phone call, they should stop and think about what tipped them off. What clues did they read? Then share that experience with an older parent. Tell them how you spotted the scam so they can start to develop a set of tools for noticing scams on their own.”
“You have a lot of doctor appointments, but are you getting regular check-ups?”
Your parent may spend a lot of time at a specialist’s office for a specific condition, but they shouldn’t forget to see their family doctor for a regular check-up.
An annual preventive care visit can be the most important appointment for an older patient to keep, says Michael Taylor, MD, attending physician of internal medicine at Cooper University Health Care.
“It’s a long, annual visit that’s covered by Medicare,” Taylor says. “It’s an opportunity to talk with a physician about topics beyond any current physical ailments. The big focus at these visits is testing and screening. We do cancer screenings, vaccines, blood work and depression screenings.”
The annual visit is a prime opportunity to discuss and diagnose symptoms of depression, which, Taylor says, is more prevalent in older people than you might think.
“It’s very common to see depression develop as people age,” he says.
“All of a sudden they’re sleeping more, they’re not eating as much, maybe they’ve stopped doing things they previously enjoyed. A lot of times people think it’s dementia setting in, but it’s not. It’s depression, and it’s absolutely reversible and treatable; it just needs to be diagnosed properly.”
In terms of mental health, Taylor says, adult children can eventually expect to notice a decline, but it’s also important to check for other reasons a parent isn’t acting normal.
“Part of promoting a healthy brain is exercise, staying active and socializing, and it’s also important to make sure hearing isn’t an issue,” Taylor says.
“If you can’t hear, you won’t socialize, and your mental health will decline much more rapidly. A lot of times when folks are disengaging, it’s because they can’t really hear you. People don’t want to admit they have a hearing problem. It’s like acknowledging a disability. Some encouragement from family and friends can go a long way.”
“Where’s all your money? How much is there?”
Yikes! Talk about getting personal.
But discussing your parents’ financial status – and all the details surrounding that issue – is important.
“The time to start talking about this is as soon as possible,” says Stan Molotsky, president of SHM Financial Group. “You don’t want to wait until something happens to one or both parents.”
Molotsky says the most important part of discussing money matters with your parents is just making sure you have all the facts. His firm offers clients a “generational vault” – a secure online server that keeps a family’s financial information in one place.
“A lot of people throw things in a shoebox or a filing cabinet, and if something happens it can be a mess for the people who are left behind,” he says. “They can put any information they want in the online vault, from asset lists and copies of wills to tax returns, last instructions and power of attorney. These are all things they should be talking about with their kids, to make sure nothing is a surprise.”
Ed Garruto, certified financial planner with M Financial, says family financial meetings can come with a lot of pressure, so you might want to consider bringing in an advisor to help things run a little smoother.
“Parents can be worried they’re going to lose control of their resources, and kids can have a hard time questioning parents who’ve been doing things for 60 or 70 years,” Garruto says. “We can help facilitate a family meeting so you can begin to talk about investments, bank accounts, tax returns, passwords; just get a handle on everything.”
Molotsky advises his clients to plan carefully to ensure their assets will keep them comfortable, potentially for decades after retirement.
“When I started in practice, nobody lived past 75,” he says. “Now we want those assets to last until 110. Fortunately, we can make plans and use products that make sure the money is there if you need assisted care or home healthcare. You can be prepared for the possibility of things that might happen down the line.”
