Enlightened Conflict

dealing with aging parent issues

August 14th, 2010


Several people have asked me to write about my experience with my mother as we discussed, reached a decision and actually moved her from independent living in her own home to a full care “cruise ship in a building” senior complex and my move to the west coast.

Well.

This is a complex discussion so I have attempted to break down each phase of the process as I, and my sister, encountered it (and tried to not make it a list but rather give a glimpse of all the behind-the-scenes stuff going on.

-          Having the conversation: getting started (sucking it up and beginning the conversation with your parents even if they don’t want to)

-          Translating the Conversation hieroglyphics: you think they are thinking and saying words you recognize but it is entirely different language

-          Managing the discussion: before you can reach a decision there will be dozens of discussions addressing a wide variety of objections and concerns (and you will come back to them again and again)

-          The Key Issue: you are thinking freedom to enjoy the last phase of their lives … they are simply thinking death

-          The dreaded Money Discussion: money is always uncomfortable to talk about and this discussion will do nothing to disprove that thought

-          The Purging Phase: moving means purging things … and how ‘the purge’ can unravel everything you have discussed and agreed on up to this point.

It is a complex multi variable discussion.

But.

Hopefully this will help isolate several key things to focus on throughout the process and you can land on a decision to insure your parents get to enjoy what should be their golden years (and you can stress a little less and live your own life).

Having “The Conversation”

If I had to choose one reason to suck it up and start the discussion it is that discussion uncovers the timing rather than having events drive the timing. As I will talk about later there is a window of time to transition your parents that is “right” (or maybe better said as good timing as you can get) and it is only some discussion that will uncover it.

What exactly is “having the conversation”?

Well.

First I am specifically talking at this minute about the first step. Opening up the conversation. It is fraught with peril. Suffice it to say estimate 90% of what you will say upfront will be wrong, taken wrong or lead to the wrong next discussions.

But, hey, you got 10% right. But even with the 10% you have to stick with it and start getting higher percentages.

Secondly.

Having the conversation is 2 years. Okay. Or however many years or months it takes to have the conversation. My sister and I talked with my mother about this off and on for over 2 years <or longer> I would bet. Maybe even three. As with anything the more we did it the better we got at it. And upfront I believe both my sister and I helped ourselves out by knowing we weren’t pushing toward an imminent decision but rather gathering information and discussing options for an inevitable decision.

I would imagine the best thing I can suggest on having the discussion is that the discussion IS inevitable. You cannot avoid it.

So. You may as well start it sooner rather than later.

The summary of this particular thought? It’s not just one conversation.  Even in a crisis situation it is not one conversation.

Oh.

If you are waiting for your parents to initiate this conversation you may wait a very long time. They may (but don’t count on it). They may drop some hints on concerns or “what is the plan” (but don’t count on it) or they may share future thinking in discussing something they fear <loss of mobility, hearing, sight, etc.> But. This is simple (if difficult to actually do). If you don’t start the discussion than you will never know what they are thinking and be sure everything is all thought out.

-          “the fishing expedition”

Ok. So in the beginning it helps if you aren’t trying to reach any decisions but begin by “fishing.” I guess it’s a little bit about you and a little bit about them. Of course, me being me, I err on the side of referring to my handy dandy Buying Process thinking mostly because it helps me slot issues and thoughts in tidy compartments. Then I can isolate what is most important and refocus time and time again on certain aspects (just in I have to return to an issue – of which you will).

What I am specifically talking about here is Predisposition and Stimulus. In the initial fishing expedition you are looking around for what your parents feel about options. Where there head is at. What options do they consider and why (and what ones they don’t and why). This also helps you think about your own pre-conceptions of alternatives. This initial discussion will bring up a range of information tidbits which somehow you need to store away once you shift activity into the “so let’s start considering options” phase later on.

You also get to assess emotional versus functional things. Emotionally what are objections. Emotionally what would make them happiest. Emotionally what scares them. Functionally what help or assistance is going to be needed (or do they even believe they will need help at some point). The functional aspect is very important because it helps you understand the Stimulus phase. In other words, what needs to happen in their minds before they would be stimulated to even consider moving.

Lastly. The fishing expedition helps you and what is going on in your own head. What you may want for your parents. How you feel about the options. What can you afford to do. What role you are willing or can play.

Step one is hard.

Because it is hard on both of you.

They don’t want to think about ‘the end’ and you don’t want to think about your parents not being around forever. But. You are doing it to insure time is maximized. Yours and theirs. So get going.

Translating the Conversation Hieroglyphics

Wow. This one, conversation vocabulary & issues, really took some thinking and mental gymnastics to get a grip on. I was thankful I have had lots of experience in organizational behavior management as well as focus group (or relevant consumer research) experience. But. In general it didn’t matter. You don’t get a Rosetta Stone for these hieroglyphics (sure … you can read some things like I am writing and other more scientific things and they all help). This is truly listening & responding type stuff. You may have some things in your own pea-like brain to discuss with logic wrapped around it but you are kind of at mercy of what words and thoughts are being produced by your parents. And in that we are the ‘lost generation’ <that was a joke with a grain of truth>.

Why “lost” in this situation? Think experiential. We just don’t have the personal experience. The best example I can come up with is dealing with teenagers versus our parents.

With teenagers they have their own language and angst and issues that we are completely lost dealing with (or understanding at their level). But. We have been teenagers ourselves. Stored away in the back of our minds conveniently tucked away so we don’t have to relive all those horrible teenager moments are the experiences we and our friends had when we went through it. At least (if we pull some of those memories back out again) we have some foundation to leverage from in order to deal with teenager even if their world and language is hieroglyphics to us.

Our parents? Not so much. We are guessing what they are going through because we have never been there. And that makes it tough because you don’t know how you will feel when you get there. I believe (in general terms) in middle age we are “living life and planning for the future” and seniors “living their future”  … and that future is a sharp edge of reality and time. I would imagine by this time they have all the memories they want and that the only thing that is real to them is the future – or whatever is left of it.

Look. It is very easy for me to say now “hey, when my time is up my time is up.” But when I am 78 do an additional 5 or 10 or even 20 years look a little more valuable to me? Do I get a little scared of reaching the finish line?  The answer I would guess is yes on both of those. And unlike dealing with teens you can’t put yourself back in any shoes to think about it. You are trying to put their shoes on (and it is uncomfortable).

Let’s compound the issue by Depression year’s learnings. Ok. Sure. We are currently in a depression, oops, recession, but we grew up in a boom time. We are so far out of our comfort zone right now it is nuts. And all of a sudden we are trying to communicate with a group of people who grew up with depression memories and behavior patterns. It makes the experiential aspect even more challenging.

Managing the discussion

Think in 3’s. That is what I always tried to tell my groups when presenting innovative ideas to clients. You never “close” in one meeting. In general I have seen it takes three meetings to discuss a topic or an idea for it to settle in and have the idea transfer from the presenter to the presented.

Now. Here’s the hard part with this discussion. It’s not just one idea. It’s a larger idea with multiple components. So when I say think in threes that is three for each component (or maybe instead of component think of it as “parent objection/response benefit”). So if there are 10 different components you are discussing this over 30 discussions or so.

On top of that (as I always tried to tell my groups)  … no discussion is closed until an action is taken. What I mean by that is be prepared that even though you have had your three discussions on say “I can’t afford to move” or “I can take care of myself” and you have resolved it, the topic will arise again and you will need to remind your parent of the discussion and provide affirmation for the decision “they made” from that discussion.

Remember. I said upfront this is an elongated discussion. And, frankly, I don’t know why we wouldn’t expect it to be. In the business world the truly innovative difficult decisions typically take a year cycle. Present, discuss several times, table because other important issues come up and then it “boomerangs” back in about a year or so. Each component discussion you have will “boomerang” again. It’s not a big deal. Just be aware of it.

Oh. Hint. Don’t say “we talked about this” every time it comes up. They know that. They want to talk about it again and seek some reassurance it was a good discussion and decision.

The Key Issue (s):

My sister really nailed the second key issue (or let’s says she identified it more clearly than I) but here are the two key issues I see:

1. Associations with death.

While I fear I am going to make a generalization based on my own experience my gut tells me everyone will be facing at minimum a derivative of this key issue.

Death versus Freedom.

2. Role of Home as part of their identity

How your parents see their existing living space as part of their identity will set the foundation for future decision-making with regard to “where do I park my butt” as I near the finish line.

Ok. Let me explain both.

Associations with death.

I like trying to encapsulate the issue into one word response statements. As soon as you start discussing where your parents will go from their current situation … they begin to think “so, you want me to move somewhere so I can die.”  While you are thinking “I want to get them someplace so they have freedom to live life to its fullest.”

I don’t care how many logical reasons you attach to a transition from current home to a new home (assisted, independent but safer, full care, etc.) it will come down to “My last move. Going to the place I will die.”

Period.

Whether they have the guts to say it out loud or it is in their minds it will be rattling around in their heads as they go through this process. Deal with the fact you won’t ever overcome it (because they are literally correct). All you can do is minimize it. And how do you do that?

Well. Freedom revolves around the concept of assistance, or help. What I mean is “as you get older you will need help.” The sooner you start talking about his with senior parents the better off you will be. My sister and I got very lucky in that our mother had a doctor who spoke about that often (in realistic non confrontational, non ‘hurrying’ ways). So we could have realistic conversations about her increased need for help at some point, the possible timelines for that help and when was the best time to insure she had access to that help (like before she needed it or when she actually needed it).

< By the way. I am leaving money out of this portion because I have an entire section on that topic. >

Timing is tricky. Senior advisers always say (kind of flippantly I may add) “it is always better to put yourself in position to get help before you actually need help.” Well. No shit Sherlock. But this is a balancing act you learn in the business world.

Too soon to market and sit around regretting the rush to be there (and wasted resources).

Too late to market and you get crushed under trying to catch up.

The trick in the business world is recognizing the window and getting through it in the approximate right time (doesn’t mean you have to hit it dead center just somewhere in the window).

I won’t even attempt to tell you what the appropriate timing is. It will be different in every family’s judgment. I am simply telling everyone that this isn’t about insuring you get them somewhere to insure they have the help for maximizing freedom in their lives  … it is also about when it happens that matters. And a doctor really cannot help you much on this early in the process. Because being a doctor often means he/she cannot be specific on timing (despite what we want they do not have a crystal ball) they are forced to say things like “at some point you will need ‘this’ kind of help but it may be 6 months or 6 years, however, you WILL need ‘this’ kind of help.”

Unfortunately that means unless you are in the throes of a health crisis, you, the one having the conversation with your parent, have to assess timing and the window I am talking about.

Oh.

Then there is Part 2.

Home as part of their identity.

If the house is inextricably linked to your parents’ identity then it makes these decisions hard to almost impossible.

If your home is important to you but not your primary way of defining yourself then the transition can be easier.

Our grandfather was “easy” because he worked outside the home. His home was a place that he was proud of but that wasn’t his identify.

Our mother was sort of easy because she moved as an adult, worked outside of the home, etc. She was and is proud of where she lived but it wasn’t what defined her.

On the other hand some people, though they had many outside interests, defined themselves by their home. Their home was their identity.  Top 3 was family, home, and church. I’m not sure if I could put them in rank order since they all could be equally important at times.

So. My sister, who has been through four personal experiences, each a different situation, suggested I outline them this way:

a.  Grandpa was relatively easy.  He understood Mom wasn’t going to move to NY and yet he also knew he couldn’t stay in New Hyde Park alone. He clearly was thinking about it since there was a short discussion about him moving and sharing a home with another relative.  That never got beyond the mentioning phase but it was there.  We had a little crisis in the house selling phase (his town tried to assess him for the fireplace saying he installed it 50 years ago) but I think the actual moving out of the house was more traumatic for everyone else. He was ready to move and start a new phase of his life.  We certainly would have had a completely different experience if this had been Grandma.  I’m not sure we ever would have gotten her to move until a crisis occurred. (See point c.)

I think it is partly generational and partly life experience but what I mean is Grandma never worked out of the home and so her home was her identity.

Grandpa had a career and so his home was a place of pride but not his identity.

b. Mom had been talking about moving for several years.  I think it helped that someone she knew was there so she could see that it was a “cruise ship” and not a nursing home.  Mom’s identity was not her home. She moved several times as an adult and worked out of the home.

She also ran the home while Dad traveled and then was well prepared to do the same after he died.  She also picked where she wanted to move to.  I can only imagine how horrible the discussion would have been if she didn’t like the location she ended up liking but felt she had to move to “a place like that”.  The key was she felt she was in control and was (at least in some part) driving the process.

c.  My husband’s mother never moved to a retirement community.  She went from her home to a nursing home. She would never consider anything like a retirement community.

Why?  Her home was a big part of her identity.  She had outside interests but really didn’t work outside the house after she got married and she never moved.  Also her house had many memories of her family and husband.  This may be a generational thing but we heard many times “the only way I’m leaving this house is when you carry me out”.  And, no surprise, that’s what happened.

d. My husband’s aunt (the older sister of his Mom).  She had no children and had been talking about moving into a retirement community several years before her sister died.  She worked off and on outside the home. Her home was important but I never felt it was her “identity”. She spent several years touring retirement communities and finally had picked one (she said if she had to move she wanted to go to a specific “shopped” location).  She then fell and had to leave her home. The good news is that we knew where she wanted to move to so the family was able to sell her home, get her an apartment at the chosen location, and get her settled quickly.  There was no “where does she want to move to” discussions. We knew where.

Okay. Last part about timing.

Yes.

Age and health matters.

Our grandfather was 90 when he moved.  Other than his hearing he was healthy and active.  He walked without assistance and was able to stay active.  The hearing issue was a drawback but he was genuinely interested in people and life and thus made friends.  He attended any and every program the location he moved to offered. His mantra was “If they come the least I can do is attend”. Was he lonely at times? Yes, especially after his friend died (he played shuffle board with Jack) but on the whole he was the “poster boy” for assisted living.

Our mother is in her late 70′s. She is relatively healthy.  She still can drive and get around on her own.  She also is able to get involved in activities at the location she moved to and thus make friends (and also meet the “mean girls”).  She is slowly starting to attend activities.

Husband’s aunt moved into the retirement community at age 90.  By the time she moved in she needed to use a walker and is quite deaf.  She has made 1 or 2 friends but spends most of her time in her apartment.  Alone. Waiting for visitors.

But.

In all cases there is a close relative(s) to help.

Mom for Grandfather. Son for Mother. Son and uncle for Aunt/sister.

It really helps if someone is nearby and within close driving distance to help with the paperwork (which can be very overwhelming), selling the house, getting financials in order, medications set, etc. etc. etc.

Ok.

Next.

The Dreaded Money Discussion

Remember. Parents moving into the “I need help and what do I do” phase is the generation who were dramatically affected by America’s Great Depression. And they carry the weight of that experience even today. The stories of people who spent the rest of their lives saving aluminum foil or hoarding tea bags and notepads aren’t folklore, but the long-lasting results of preparing for lean times to reoccur. They have lived simply, with a sense of risk-aversion, and “financially secure” isn’t a concept they accept easily.

Me? I hate money (I like having it … I just hate the discussions and issues it creates).

The issue that lurks in the backs of this generation’s minds (your parents): “They want my money.”

I am telling you it is there.

My mother knows we don’t want her money. We have stated numerous times we hope that she runs out of money the exact day she dies so she can use everything she has. We want her to spend every penny she has on herself and her life. But it lurks. I have talked with several friends who have started discussions with their parents and the issue lurks there too.  All you can do is constantly be aware this issue lurks and constantly, when given the appropriate opportunity, say and do things that reinforce your parents’ money is theirs to spend (and if they run out you will do whatever you can to insure they won’t be sleeping under some bridge).

This lurking issue makes the money discussion even more difficult because to truly assist in the decision you have to do a little financial planning. What can they afford and for how long and all that stuff. But. Here’s the deal about the money discussion. You have to have it regardless of whether they insist on staying where they are or they decide to move. Because, once again, “they will need help.” And you need to assess what position they are in to afford the help they will need.

I really cannot add much here other than to warn you this is a horribly uncomfortable discussion. And suggest that no matter what you take the ‘high road’ within the discussion and take nothing personally and focus on the destination not the journey.

Oh. One last thing about money.

Interestingly … money can help you overcome one topic. “Why can’t I/we just move in with you” or “why can’t you move closer to help.” If there is one thing this generation understands it’s the value of earning and saving. If you tie your own earnings or “being prepared for lean times” with the “why can’t” questions you have a fighting chance to overcome it (if that’s what you want to do). Once again remember even that discussion thread is a balancing act. You need to be sure your own “preparation for a lean time’ cannot be construed as “I want some of your money.”

The Purging Phase

Ok. You have run the discussion and decision gauntlet and have lived to tell the tale.  Your parents are moving. Somewhere. The ‘purge’ begins. And if you are not careful it is the beginning of the end. Purging is painful. Purging sucks. Purging is costly (value to actual dollar). I have written an entire post on Purging Sucks and the two aspects of it (the second part is more positive experience than the first part).

There you go. I could provide significantly more detail on each aspect but this is an overview to get you prepared and going. My thoughts are certainly skewed by my own experience but I imagine my business experience has permitted me a little “broadening” of perspective. Some aspects I share, especially in the purging, are extremely personal to my situation but they should serve as examples of what you may face. I will end this by saying my mother is now in a full care complex (I think that simply means she will never have to move regardless whether she stays in her current active healthy independent living space life or reaches a situation where she needs to be shifted to a full care nursing environment. She is still struggling to be comfortable in a more “communal” living environment instead of her own home but each week she seems to be better about where she is.

Hope this helps.

Oh. Lastly. A sobering note. This was actually a thought from my sister in commenting on what I wrote.

“You left out the drama.  As you point out none of the discussions are easy but at times they are downright horrible.  Crying, yelling, slamming of doors, accusations, acting out…all of that happened and will continue to happen. I’m not saying that drama is constant but there is drama and it can be wearing for everyone. There is humor too but that is often lost in the heat of the moment and, sadly, usually what is remembered.  My guess is we’ll all remember the drama a lot longer than we remember the funny moments.”

As we get older and our parents get older … nothing gets easier. And it’s a shame. It doesn’t mean that it won’t work out or there won’t be incredibly happy moments but it isn’t easy.

Good luck.

All I can really say is that it is unequivocally worth it. Every moment. Every little painful moment.

It is worth it.

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  • Gail McGonigle says on: August 19, 2010 at 3:23 pm

     

    I laughed, I cried and I nodded my head a lot. Everyone encounters these challenges. That is if they are lucky enough to see their parents into their elder years. But there is one option you did not discuss. Keeping your parent in his or her home, that one that is an extention of their identy. More people than you might think really want to stay there. And really don’t want to (or have to) deal with the purging. yes, we the children do, but we have to eventually anyway.
    There are lots of benefits to providing the necessary care in the home (there are many excellent care agencies – we don’t have to be the delivers of care – just oversee it). Care facilities, whether assisted living, skilled nursing, or continuum of care, are expensive. If you can hit the real estate market just right and sell your parents’ home, and there is enough equity in it, then you may be able to afford it. But in this market, that’s called “Luck”.
    Professional care managers and organizations specializing in elder care at home or aging-in-place, are a much more affordable option. The discussions become a little more easy (I say only a LITTLE easier.) You are not asking them to make a major lifestyle change. And you gradually increase the care as needed. It is not an all-or-nothing situation.
    That’s what I did with my dad, and then I wrote a book about it. DAD’S HOME ALONE, Caring for Your Elderly Parent.
    Check it out at http://www.DadsHomeAlone.com, or see it at http://www.amazon.com.

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