Having Tough Talks With Aging Parents

Jan. 23--"The only way you're going to know ... is by asking."

At some point, in normal parent-child relationships, the power dynamic flips. Child is caring for parent. This can be uncomfortable, uneasy, difficult to manage. One or both parties may have trouble accepting that arrangement.

Regardless of how it comes together, you and your parents need to talk about death and dying. It's inevitable. You can't avoid it. You may even do a disservice to your loved ones by avoiding it.

"It's not looking at how you die, but it's how you live to the end of your life," said said Phyllis Greenberg, associate professor in the gerontology department at St. Cloud State University.

Here are possible topics of discussion:

* Will.

* Financial plans.

* Advanced care directive.

* Power of attorney for health care.

* Needs for a parent's well being. Is home health care an option? Assisted living? Is it time for a nursing home? What about driving?

* Long-term care insurance.

* A do-not-resuscitate order.

* Organ and tissue donation.

* Plans for after death, including financing, burial choices and a plan for the funeral

Yes, you need to have the talk out of necessity. But it's also a positive. It's the best gift an older person can give his or her family, Greenberg said, because of the difference it can make at the time of death.

"You need to be dealing with your emotions. You don't need to be dealing with last-minute decisions," she said. "It makes that time of difficult transition a little smoother."

Just start the conversation. "I think dying is a more taboo subject than death," Greenberg said. "I think people have more fears about dying than they do about death."

Your parent may be just as afraid to bring up the topic, for fear of worrying you. Having a plan may put your parent, and your family, more at ease.

It's also about having a good death, like your loved one had a good life. Consider what music they want playing, who they want to be there, where they want to be.

"You get to be a little selfish at that point," Greenberg said. "The whole idea is to make that person comfortable."

If you as the child are unable to start the conversation, consider who might be able, like a faith leader or someone in the health care community.

Get your own house in order first. Before you ask your parents to start this process, go through it yourself. Greenberg says that way you'll be acquainted with how it works and what questions will be asked. She said you shouldn't ask someone to do something you haven't done yourself. Take your time. It's something that deserves some thought.

Do it, together. Whoever is selected as the health care agent should help fill out, or at least go over the health directive form. You don't want any misunderstandings. Discuss it with family members if appropriate.

It's almost always the right time to start the conversation. Greenberg says it's recommended that everyone age 18 and over have an advanced care directive because, simply, you never know. So it's just as important to have this discussion with your children, your spouse, your sibling, your friends -- anyone that you could end up making decisions for, or vice versa.

Don't wait until someone has a terminal diagnosis or they're sick. You make better decisions when you have time to think and process, and death isn't looming.

Make information accessible. Greenberg had a student whose parents had an advanced care directive, but it was in a safe deposit box and her student had no idea it existed. Have paper copies of the advanced care directive available. There are some devices, like jump drives, that can hold the information. You can have the plan filed with your parent's clinic or the hospital they're likely to go to, so it's included with electronic medical records.

But not all the information. Financial information, insurance information, user names and passwords and other sensitive information should stay in a safe place, accessible only to the person who needs it in case of emergency, or who has power of attorney.

Pick the right person. Make sure that the person identified as the executor or the health care agent is able to do the job and able to do it as you wish. For instance, some people may choose a spouse as a health care agent, who may not be capable of saying no to certain measures because of their own emotions. Consider distance, too. Greenberg was her mother's health care agent, even though she lives in Minnesota while her mom lived in California. Think through who would be available in an emergency.

Consider emotions. By thinking through this now, your parent is giving their family a road map to follow when something happens. The family members know what to do and what mom or dad would want them to do. At times of high emotion, we are more indecisive, Greenberg said.

Ask for help. Don't be afraid to seek help from a professional. Of course, a lawyer can advise on wills and finances. And there are people who go through training that can help fill out advanced care directives. Find resources at the end of this story. CentraCare Health offers help, the Whitney Senior Center sometimes hosts events on these topics. On April 16, National Health Care Decision Day, there will be events.

Remember it's a living document. As you change, as technology changes, your preferences may change. So be sure to update every five to 10 years or so, and whenever you may have a life change event, like a marriage, a divorce or a major surgery.

Remind your parent, for the most part, the choice is theirs. You are in charge of your own life. You decide what level of care you want. Medical staff will do their best to accommodate wishes and follow plans.

Follow Stephanie Dickrell on Twitter @SctimesSteph, call her at 255-8749 or find more stories at www.sctimes.com/sdickrell.

Resources

The National Institute on Aging

For more information on advance care planning, visit www.nia.nih.gov.

The Senior LinkAge Line

1-800-333-2433

www.MinnesotaHelp.info

The Central Minnesota Council on Aging

www.cmcoa.org, www.cmcoa.org/helppublications.shtml.

Minnesota Board on Aging

www.mnaging.org, a detailed planning ahead guide is available at mnaging.org/en/Advisor/~/media/MNAging/Docs/Planning-Ahead-Booklet.ashx.

Minnesota Home Care Association

mnhomecare.site-ym.com

LeadingAge Minnesota

www.leadingagemn.org.

Phyllis Greenberg

Associate professor, department of gerontology at St. Cloud State University.

320-308-3156

[email protected]

CentraCare Health

For more information about Advanced Directives, please visit lightthelegacy.org/health-care-directive-forms or contact CentraCare Health Home Care & Hospice at 259-9375, ext. 28762.

Further reading

"On Being Mortal" by Atul Gawande.

"Letting Go: What should medicine do when it can't save your life?", "The New Yorker" article by Atul Gawande, a surgeon, writer and public health researcher.

"The Gray Zone: When Life Support No Longer Supports Life," by Deborah Day Laxson, a St. Cloud author.

"How to have 'The Talk' with your Parents: Words to use -- and avoid -- when discussing tough issues," by Paula Spencer Scott, caring.com.

"Wallet Safety: Wallet smarts that preserve an older adult's dignity and security," by Paula Spencer Scott, caring.com.

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