A Simple Way to Think About Caregiving Conversations

Guest blogger Sherri Snelling, corporate gerontologist, discusses how to have family conversations about long-term care and end-of-life decisions.

How do we begin these sensitive conversations? Some experts find that having the discussion early on is the key. When the adult child is age 40 or the older parent is age 70 may be a good time to review wishes as well as legal and financial plans for LTC. Waiting until a crisis happens can mean there’s little time to adapt plans to help avoid medical or health care bankruptcies. Also, crisis creates chaos and can result in family conflicts that could have been avoided. What’s important is to have the older adult available to participate in the conversation and to ensure all impacted family members are aware of the plans ahead of any crisis event such as a medical diagnosis or emergency.

One method that can help kick-start these conversations is what I call the C-A-R-E Conversation Method. In my book A Cast of Caregivers, I devote an entire chapter on how to approach these family conversations. Here is a summarized excerpt:

C – Create the care conversation. I recommend starting the conversation by using a news headline to avoid interrogating a parent and easing both sides into a dialogue. For instance, the recent passing of actor Sean Connery (aka James Bond), who had dementia, can lead an adult child to say, “The news of Sean Connery was sad—I wonder if his wife cared for him at home or if he had to be in a dementia care facility? It must have been a hard decision either way.” This prompts a parent to discuss Connery’s situation rather than feel they are under pressure to deliver immediate answers. The purpose is to have parents share their wishes without having to focus on their own aging vulnerabilities.

A – Ask questions and acknowledge wishes. As the conversations continue, it helps a future family caregiver to become a journalist and ask a lot of open-ended questions so parents can share what they wish. (Avoid questions that can be answered with “yes” or “no.”) Once those wishes are shared, it becomes the adult child’s role to help advocate and support their parent and to find empathy in their loved one’s plans. Arguing about what you think is best may cause tension and stress for both parties. As a caregiver, you can have an opinion, but this is about your parent’s needs and desires. Instead, state important alternatives and why they make sense, using facts, not emotions. If your parent’s decision will have a negative outcome for you, then share those concerns. However, in the end, allow your parent to have control over their life and make the decision.

R – Review the plans. It is not enough to know a parent has a long-term-care (LTC) insurance plan or does not want heroic measures in the hospital. As a caregiving advocate for a parent, know the details. What is the term and the coverage limitations of the LTC plan? Where is the legal documentation for a parent’s health care directive, or do they have a do not resuscitate (DNR)/do not intubate (DNI) form (also known as a MOLST or POLST)? Former Good Morning America TV host Joan Lunden told me that she knew her mother had a LTC insurance plan but she did not know the specifics. She thought it would cover her mother’s costs in assisted living for as long as her mother lived. When the covered benefits were depleted after six years, it left Joan to pay for the additional 10 years her mother lived beyond the plan’s benefits term.

E – Engage the whole family. Depending on family dynamics, some siblings or stepparents can engage in a Hatfields vs. McCoys battle over care decisions concerning parents who can’t speak for themselves. In 2014, it was revealed that radio DJ Casey Kasem had Lewy Body dementia, which sparked an ongoing feud between his second wife and his adult children from his first marriage about his end-of-life wishes. It reminds us how important it is for the person receiving the care to share his/her wishes with everyone so family conflicts and frustration can be avoided. Sometimes bringing in an objective third party, such as a spiritual counselor, an elder law attorney or a caregiving expert from Brookdale, can help moderate the conversation and keep the focus on the plan and not the emotions involved.

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