LONG TERM CARE: Starting the Conversation about Long-Term Care with Your Loved One

When a loved one who is aging at home, particularly one with a chronic or disabling condition, begins to exhibits signs that help is needed, it’s best to initiate a conversation as soon as possible. This discussion can be difficult for all family members and initiating the exchange may be stressful and uncomfortable.
Your loved one has worked hard all of his or her life, and has made many sacrifices in order to be able to enjoy the “golden years”.  They may exhibit concern about personal changes in health and how these changes may affect their future independence. Most older adults prefer to live out their aging years at home.
While many fear moving to a skilled nursing environment, most can avoid this by getting the assistance needed at home, before a crisis occurs. Adult children can be helpful by identifying increased isolation, as well as any decline in their parent’s health and functioning level. For example, they may notice changes in cognitive functioning, such as short term memory loss. 
It is important to begin the conversation early to recognize the values and lifestyle your loved one wants to retain. Explore how your parent is handling fundamental self-care activities when assessing the potential need for in-home care.  These basic daily activities include hygiene, eating, health care needs and other daily living tasks, as well as tending to finances, transportation, and care for their home. Once you have identified the areas that may create a risk of your loved one losing their independence, you have a good starting point for the conversation.
Beginning the Conversation
Pacing and timing will be crucial in determining how the conversation is initiated and conducted, and may affect a successful outcome. Start the conversation over time, and in doing so, take it slowly. In these conversations, identify and confirm your loved one’s values, goals, and fears. This will enable you to create an empowering experience to help break down any obstacles that may exist. Practice empathy and imagine being in their position.
When beginning the conversation, use open-ended questions, such as “How are things going around the house? Or “How are you managing your/your loved one’s illness?”
The two largest factors that appear to be most important to older adults are the loss of independence by having other people seemingly control their lives and having a strange person in the home. Along with that comes the fear of the unknown, particularly when there is the possibility of receiving care at home or moving into a facility.
Family Meetings
Before having a family meeting, determine who should be involved directly or indirectly in any decision-making. Involved people may include extended family members, close friends, or a physician. Consider including an independent third party as a mediator, such as a member of the clergy or an Aging Life Care Professional. Making use of a third party can reduce the burden on adult children. A care manager can answer detailed questions about the process of having in-home care and can speak to the benefits that will be provided to your loved one. They may also help in pinpointing a schedule to provide the necessary safety, oversight and assistance needed to reduce the risks of a potential fall, hospitalization, medication error, or any other factors that may threaten your loved one’s ability to remain at home.
Determine the best place to have the meeting. It is most important that your loved one feels safe and comfortable in the environment where the meeting is to be held. 
Use the first meeting as a time to explore the values, goals and fears that may exist. Speak slowly and make sure you are in a comfortable atmosphere with ample time to have the conversation. Do not have these conversations on the telephone, or in a rush.
Older adults often need “pacing,” in that they may take a longer period of time to digest information and respond.
The meeting can then approach the topic of home care in a more focused discussion that can lead to a plan.  
Prepare an agenda ahead of time to help you stay focused. The agenda should include:
o   Identification of values and fears of your loved one
o   Daily care needs to ensure your loved one can remain at home safely as long as possible
o   Discussions of quality of life and changes that can be made to improve it
o   Financial concerns
o   Roles each person would like to assume
o   Strategy with a timeline of tasks and goals to move forward
 At Home Care Assistance, we focus on not only providing assistance with the basic activities of daily living. Our goal is to reconnect our clients with the hobbies and ideas they love and may not have access to due to health changes. We focus on matching caregivers to the clients as we believe our clients must enjoy the company of the care provider to feel comfortable in a long-term relationship.

Submitted by Carol White, Owner of Home Care Assistance at Depot Marketplace in Prescott, (928) 771-0105, www.HomeCareAssistancePrescott.com.