The Conversation – How to Talk to Loved Ones About Elder Care Issues

Advance Directives

I recently met with a loving grandson, who needed some advice regarding his grandmother. His grandmother currently lives in another state. She was recently diagnosed and treated for cancer, but in the process was also diagnosed with dementia. She moved into an assisted living facility after her cancer surgery, and is not likely to move back home. Her only child lives here in North Carolina, and so a move to a North Carolina assisted living facility is likely the next step.

The grandmother does not have much income or assets, so paying for her care is a top concern. Before we could truly discuss options and develop a plan, though, I would need a more accurate picture of her finances. While I would need to meet with the grandmother personally to determine her legal capacity to make decisions and sign documents, I suggested that she have Powers of Attorney in which she designates who can make financial and medical decisions for her. The grandson mentioned his grandmother is hesitant to give up control, and that she’s been expressing fear and distrust lately where there was none before, possibly resulting from the dementia. He asked what happens if she doesn’t sign one, then declines to the point she can’t sign one, and the facility decides she needs someone to make decisions for her. I explained that guardianship – the court process of determining someone incompetent and appointing a decision-maker – might become necessary.

Then the grandson said, “Okay, well, do you have any tips on how to talk to her about this? How to start the conversation?”

I took a long pause and thought about it. I wish I had a great answer. It’s not because I haven’t thought about it before. In fact, I’ve thought about it a lot, lately for my own grandmother. And I recently watched my husband and his family struggle with it for his grandmother. The right answer will be different for different families. And THE conversation varies as well. For this grandson, THE conversation was the Powers of Attorney and overcoming his grandmother’s fear. His grandmother had already made the move to the assisted living facility, though, and wasn’t pushing to go back home. For many families, THE conversation is about the move or the need for more care – Time to downsize? Time to move closer to family? Time to hire in-home help? Time to move to the retirement community, assisted living facility, nursing home?

For the grandson’s situation, my advice was to start the conversation by expressing his love and concern for his grandmother. That he wants to help her, make sure she’s safe, and relieve some of her worry and fear. Then let her know that there are Veterans Benefits and other assistance out there that can help her pay for her care. That he and his mother want to help her, but in order to do so, they would need her permission to access her financial information. Let her know that by signing a Power of Attorney, she is not giving up control; rather, she’s taking control of her situation and her future by declaring who she trusts to make decisions for her.

Unfortunately, it was too late to give him some of the best advice, which is that this doesn’t have to be, and in most cases shouldn’t be, THE conversation. Start a conversation earlier than you have to, before the crisis, and then pick it up again and again until it becomes easier to talk about and you have a string of conversations to guide you when the difficult decisions have to be made. Check out this NPR segment to hear others’ stories about how they approached the conversation with their parents:

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