"We need to talk"

Tough conversations about aging

Alison Delory - December 10, 2013

PlainPicture/Image Source.
PlainPicture/Image Source.

This article was first published in the Fall 2013 issue of Dalhousie magazine.

When her mother died suddenly, Dal alumna Sarah Ross* of Halifax had to come up with a plan — and quickly — to look after her 87-year-old father. An otherwise agreeable and quiet man, he was adamant about one thing: he didn’t want to move into a nursing home. “He saw that as having one foot in the grave,” says Ross. “He wasn’t there.”

Ross’s dad insisted he could stay in the apartment where he’d been living with his wife of 56 years. Ross, who’s 41 and single, knew differently. She’d already been visiting her octogenarian parents every other day and doing their errands since neither of them drove. She decided to move her dad into her home. The problem was, she knew he wouldn’t come if he thought he was a burden.

“I needed him to believe he was helping me,” says Ross. She told him he could pay rent to help cover her mortgage. “I had to take it on the chin at my mom’s funeral. My dad was telling people he was doing me a favour by moving in with me.”

Ross has since learned her dad’s health is worse than she or her eight siblings realized. He has 20 per cent kidney function, and takes blood thinners that make him dizzy. He risks bleeding to death from a small cut.

Ross works full time but now spends evenings and weekends at home with her dad. There have been difficult conversations around his limitations, Ross says. He requires a special diet and needs encouragement to take his medications, maintain his hygiene and keep a regular sleeping schedule. They negotiate whether he can leave the house to go to church or if he must climb stairs with his cane.

Closing the communications gap does not come easily to many people with elderly parents. Whether it’s health care, housing or finances, according to the experts many families simply don’t have these conversations early or often enough.

Says geriatrician, medical professor and Dal alumnus Dr. Kenneth Rockwood (PGM’91), “Not having the conversation, just hoping it will work out, is not the way to do it.” He recommends being pragmatic, and predicating these conversations on the certainty of death and likelihood of a preceding period of illness. “Adult children and their aging parents are both responsible for these conversations,” Dr. Rockwood says.

Here are several possible scenarios you may have to face.

SCENARIO 1:

While living in Vancouver, you get a call at 3 a.m. from a Halifax hospital. Your elderly father is in intensive care, comatose. His doctor recommends disconnecting his ventilator. You are confused and overwhelmed and without knowing his wishes tell the doctor no—keep him alive, whatever it takes.

According to Dean Tom Marrie, Faculty of Medicine, the most important thing is that children understand their parents’ end-of-life care wishes. “Ask them: ‘Do you want to be resuscitated?’” Dr. Marrie (MD’70) says. He recommends having this conversation at least annually, as people’s wishes can change, and writing their stated preferences down.

Generally it is best to ask these questions at calm moments — not in the ER in the middle of the night, says Dr. Rockwood. He says uncertainty can put families into conflict with medical professionals, and this scenario could land your parent in a vegetative state against his wishes. “In the middle of the night you might make a decision you’ll later regret,” Dr. Rockwood says.

SCENARIO 2:

You try to initiate a conversation with your mother about your father’s obvious memory loss. She tells you everything is fine and changes the topic.

If your parent resists, be firm and lay out some forced-choice alternatives, Dr. Rockwood recommends. “For example, we can talk about it now or tomorrow, or with a doctor or clergy member. But this conversation must happen.” An external person, who could also be a friend, psychiatrist or counselor, can provide support and help broker disagreements. If you’re uptight, rehearse. “Make sure the words coming out of your mouth sound good to you,” Dr. Rockwood says.

Dr. Marrie advises choosing your words carefully. For many seniors, “nursing home” is an unwelcome term that connotes dependency. Today, there are many levels of assisted living, from apartments that offer light housekeeping and meal preparation, to hospice-type care. He also says moving a parent in with you may be the best option, as it was for Sarah Ross.

SCENARIO 3:

You’ve watched your parents compare grocery flyers and clip coupons, but you don’t know if this is a hobby or necessity. They mentioned losing money when their stocks nosedived in 2008, but you don’t have a clear understanding of their finances.

“You have to have a conversation around financial security with aging parents. It is so important,” says Dr. Greg Hebb (MA’95), director, Rowe School of Business. He cautions there is no one formula for determining how much money they need to live comfortably and securely, today and into the future. It depends on their lifestyles and plans.

“Ask them: ‘Do you want to sit on the deck or do you want to travel the world? Do you want to spend every last cent you have before you die, or do you want to leave a big nest egg for your kids?’” Dr. Hebb recommends.

It might be smart to involve a financial advisor in these conversations, depending on how capable and interested your parents are in managing their own estates. It’s also important for children to remember it’s not their money to manage. “They (your parents) have earned it. They get to decide what to do with it.”

SCENARIO 4:

Your father predeceased your mother and now your mother has died, too. You and your siblings gather to read her will, and learn she divided her estate unequally between you.

Often, according to Dr. Marrie, even in big families care for a parent falls disproportionately — even up to 90 per cent — onto one child, and parents want to thank that child with a larger inheritance. But fights arise because a parent appears to have preferred one child to the others.

Lawyer Augustus Richardson, a guest lecturer at Dal who also works as a mediator and arbitrator, deals with such disputes regularly. “Conflict is inevitable, especially in families, especially when parents die. Parents are often the hub that holds the wheel together. Once the hub goes, all these things that were held together by that hub start to fly apart.”

Richardson advises that parents drafting a will, if distributing their estates unequally, explain why in a separate document. If this explanation is absent or insufficient and a dispute arises among children, he strongly advises pursuing mediation over litigation — the price of the latter can drain all inheritances away. Richardson, too, recommends talking. “I think it’s a reasonable question for children to ask their parents. ‘Do you have a will? Have you thought of a power of attorney in the event you need someone to look after you?’”

* * *

So the question that remains is when does old age — and the need to begin having these awkward conversations with your parents — begin? Again, there is no magic number because people have different levels of frailty, says Dr. Rockwood. They may also have chronic health conditions at any time in their lives that force families to address these issues sooner. But the good news is that with advances in medicine, better environments, daily exercise and increases in education and socioeconomic status, people can now stave off the effects of old age for longer than ever before. The day, however, will still come when your parents’ physical or mental health are incapacitated to a point that they can no longer make sound decisions for themselves. On average, Dr. Rockwood says, people start having more health deficits at around age 65, which in turn increases their risk of dying starting at around age 67. You should start these conversations, therefore, when your parents are in their mid-60s.

Dr. Marrie would like these conversations to begin even sooner — when a parent is 55 or 60, before any clouding of judgment sets in. He says it doesn’t need to be so anxiety ridden or dire, saying today people mostly enjoy fulfilling and long lives. “Getting old is not bad,” he says. “Think of the alternative.”

*Name has been changed at this source’s request to protect her family’s privacy and father’s dignity.


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