One day, our parents won't be able to drive, to climb stairs, or maybe even change their own clothes or feed themselves. As painful as thinking about this might be, we need to prepare to help them be comfortable and safe in their last stages of their lives. Here are some key issues to consider.
The release of the Intergenerational Report this week reminds us of the increasing role aged care will play in our society. Yet few people want to think about their parents declining, much less talk about it.
It's the elephant in the room. It's also one of the most important, difficult subjects you and your family will ever face. Sadly, your parents could one day be fine and then suddenly the next day need a great amount of care, so the more prepared you are in advance, the less stressful this might be for your whole family.
Arrange A Family Meeting For "The Talk"
This isn't a conversation that you can just bring up out of the blue one day over the phone with your parents and siblings — "So, mum, have you thought about moving to a nursing home?" — or during a holiday visit, when stress and family conflicts are already more likely to arise. It's better to plan a family meeting with your parents and siblings (if you're not an only child) and prepare for it by reassessing your own financial situation and feelings. (That could be the hardest part — getting through your own grief as you contemplate your parents' last years and no longer having them in your life. Have a box of tissues on hand.)
When arranging the meeting, you can say: "The purpose of this meeting is to talk about getting mum and dad the best care for their needs and wishes as they get older" (or something similar but less awkward). Your parents or your siblings might be reluctant to have this talk, but make it a point that it's important everyone is involved.
Shelly Sun, CEO and co-founder of BrightStar Care, offers these tips:
- Have the conversation in person. Video chat, phone or email won't provide you with honest emotions or feedback.
- Prepare questions in advance so you won't feel rushed or scrambling to get your thoughts together. (See below for some questions to ask.)
- During the conversation, provide undivided full attention so it won't seem like you're forcing an agenda.
- Write important points in a notebook to record details and to reference in the future.
Depending on your family, this could be a very heated conversation, a very quiet one, or maybe one that drags out every emotion you have. Whatever you do, listen. This might be the best example of a time when you need to stop thinking about what you'll say next in order to truly listen to what the other person is saying.
OK, so what do you need to discuss? The big question is where your parents will live out the end of their days and how to pay for it. You'll want to talk about: your parents' current well-being, what their plans or hopes are for when they can no longer live independently, their financial resources, and how you (and your siblings) can help. The information below could help make this uncomfortable discussion go more smoothly.
Find Out Your Parents' Needs And Wishes
During the discussion, find out what your parents' plans are, if they have any. Do they want to "age in-place" (stay in their own home) or move closer to one of their kids? Would it make more sense to move to a less expensive home — perhaps a retirement village? Or would their needs be better served by an assisted living residence or a nursing home? (We'll explore these options in a minute.)
You and your siblings should also observe your parents' current health and ability to live independently, so you'll know if they need assistance now. Stacey Hilton of Visiting Angels tells us to look for these warning signs:
- Poor eating habits — weight loss or no appetite — are they able to still cook for themselves? Do they stock their fridge with healthy foods
- Poor hygiene — do they have body odour? Are they bathing and changing their clothes like they used to? Are they neglecting their nails and teeth?
- Neglecting their home — is it not as clean as you remember?
- Forgetfulness — a good indicator are scorched pots and pans, which show they may be forgetting that dinner is cooking on the stove. Also, are they missing appointments or have lots of unopened mail? Are they losing money, paying bills twice, or hiding money?
- Support system — Do they have a strong support system in town to lean on if they need help?
- Mobility and driving — Are they still mobile? Can they get out of bed, up the stairs and into showers without slipping or falling? Can they still safely drive themselves to the supermarket, doctor appointments and so on? (One good way to determine this is to check their car for new dents or scratches.)
One of the more dreadful subjects, but one that might need to be broached sooner than the others, is that "car key conversation". If your parents aren't able to drive safely anymore, you'll need to persuade them to give up the car keys.
Weigh The Options
Your parents might be quite independent today, but chances are one day they will need that long-term care (by one estimate, at least 70% of seniors will). There are several types of long-term care solutions, ranging from assisted living communities to in-home aid and nursing homes. The options that will be available to you will depend on several factors: the amount of money you can spend, the available facilities in your area, and the level of medical attention that's needed.
The earlier you start exploring options, the better: many retirement facilities have long waiting lists. Making a choice ahead of time is much less stressful than being forced into a less preferable alternative if there's a medical emergency. The government My Aged Care site has a useful overview of the options.
Decide On Whether Or Not To Be Your Parents' Caregiver
With the costs of long-term care so high, the most affordable option might be to care for your parents in their own home or move them into yours. If you have a strong relationship with your parents, it's also the option you might lean towards first, since sending your parents to a home can (unjustly) feel like you've abandoned them. But there are some very important considerations here.
The emotional toll: Being the primary caregiver and living again under the same roof with your parents is an enormous role reversal. Now you're taking care of mum and dad, the people you've counted on for support and strength but whose health and quality of life might be deteriorating before your eyes. Not everyone will have the emotional — and physical — strength needed to provide the day-to-day care, like bathing, feeding, or dressing elderly parents, particularly if they're frail, have a serious illness, or can't remember who you are. It's devastating just thinking about it.
Logistical problems: On top of that: you might not have much room in your home to begin with, you might currently be living and working thousands of miles away, and your workplace might not be very flexible with time to tend to your parents (who could be considered dependents just as much as your kids would). There are a number of sacrifices you might have to weigh, similar to ones parents have to make for their kids, but in some respects even harder.
Splitting "the burden": If you have siblings, it gets even harder: Who will take the responsibility? The sibling doing most of the caregiving could easily get resentful of the others, and those who aren't doing the caregiving could feel guilty. In this case, Diane Carbo, RN, suggests setting up a family care contract, in which the family member taking responsibility of the elderly parents gets paid from family funds. This reduces resentment and can offer other benefits:
Having a formalised care giver contract can allow the ageing senior to utilise their assets to remain at home, receive quality care and financially reward the individual that is providing that care. This can provide the family caregiver with protection should the other family members pursue legal action after the ageing senior is deceased. It is unfortunate, but it does happen more often than you think.
(Why is being part of a family so hard??)
Ultimately, your parents' health and needs should influence this decision the most. If they need 24/7 care or have complicated health issues, they will likely be better off with long-term care housing. On the other hand, if you are able to take care of them, there's something to be said for spending as much time with your parents before they die as possible. Whatever option you decide on with your family, remind everyone that it's about keeping your parents' best interests at heart.
Get The Financial Resources In Order
To pay for your parents' care, you'll need to tap their retirement funds and other assets, and possibly your own savings. You'll need to identify their current sources of income (superannuation, pensions and other investments), as well as how much they might make from selling the family home. Those numbers provide the baseline for what's possible. On top of that, you may still end up making your own contributions.
If you have siblings, again, it can be both a more difficult and easier situation. Should you all contribute the same amount for the sake of fairness or on a sliding scale if one sibling makes more than the other? This will depend on your family dynamic.
Support Your Parents Emotionally And Care For Yourself
Finally, maybe it won't be just one Big Talk — it might be a series of them. Both you, your parents, and your other family members will likely have a hard time talking about it, because, frankly, the situation sucks and there are so many things to consider. Candi Wingate, president of Care4Hire advises:
Be supportive, as your parents will likely grieve through this process. This transition represents letting go of the home where they raised their family, embracing the fragility that comes with advancing years, saying goodbye to friends and neighbours, and coming to terms (at least in part) with ageing and mortality. You and your siblings too may grieve through this process similarly. Support each other. Love one another. Forgive freely as tempers may flare as an expression of grief. Additionally, the support of friends and extended family members is crucial. The facility to which your parents are moving may offer the services of a counsellor who can help you and your family cope with the transition at hand as well.
As with every other difficult life decision, the best thing you can do is get informed and communicate honestly with those involved — be brave, be strong, and be patient. And although the focus here is on giving your parents the best care, make sure you take care of yourself as well during this tough time.