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When it's time to discuss geriatric care

Published Sep. 2, 2005

Some people aren't ready to admit that they or a loved one can no longer care for themselves. Here's what experts in geriatric care have to say about making these difficult decisions.

Planning is essential

The best time to discuss elder care is before a catastrophe strikes. Ask parents about their wishes and preparations. Do they have advance directives, such as a living will or power of attorney? What will their finances allow? Parents should inform a trusted family member about where important records and documents, such as insurance policies and wills, are kept.

Keep communication open

Elder care reverses the traditional parent-child relationship, creating a difficult psychological adjustment. Denial on the part of parents or adult children can create conflict. To make communication easier, Dr. Gary Small, director of the UCLA Center on Aging, offers the following tips.

When family encounters put you in a sour mood, reflect on the cause. Are you overreacting now because of unresolved conflicts from the past? What strategies have you employed in the past that have defused stressful family situations?

If a family meeting has been called to discuss your parent's care, determine in advance what you're willing to give and what you're willing to give up. During the discussion, don't just talk _ employ active listening. Finally, be prepared to compromise, Small said.

If family discussions become contentious and reach an impasse, experts recommend bringing in a neutral third party or mediator. This can be a trusted family friend, a minister or rabbi, or a social worker affiliated with a multipurpose senior center.

Know when to seek help

When is it time to intervene? Experts say to look for signs of change or decline. Mom no longer practices daily hygiene habits. Dad gets lost in his own neighborhood. Your parent has no interest in cherished activities and appears depressed, irritable or anxious.

The next step is to take your parent to the doctor, preferably a specialist in geriatrics.

Adult children who live in another city may want to hire a geriatric case manager to conduct assessments and coordinate services. The local Area Agency on Aging, multipurpose senior centers and other senior service organizations can provide referrals.

Keep environment supportive

When addressing a problem, allow your parents to maintain a sense of dignity. Don't make them feel incapable.

Maybe Dad's vision is starting to deteriorate and you don't want him to drive. He's likely to get upset if you threaten to take away the car keys. Try explaining that his eyesight is a concern and note that his friend down the hall was able to get cab vouchers.

"You're solving the problem together," Small said. "Empower the older adult with some degree of decision making so that the balance of power isn't completely shifted."

If needed, enlist allies _ influential family members or friends _ who can help persuade your parent to accept assistance.

Foster healthy relationships

Not all siblings are the best of friends. Geographic distance, child-rearing and careers may have caused you to drift apart. To weather the demands of parent care, try to engage in enjoyable activities with siblings outside of care-giving obligations.

Care-giving can be both time-consuming and stressful. To avoid burnout, caregivers should strive for balance in their lives through hobbies and friendships.