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Holiday harmony: take advantage of the season to assess seniors’ health, plan for future needs

‘Tis the season to celebrate family…a special time when generations gather to share meals, exchange gifts and reminisce about holidays past. Because it’s also a time when family members from distant locations are all together in one place, the holidays present a unique opportunity to evaluate the physical, mental, emotional and financial status of its eldest generation.  Holiday gatherings also may be a good time to hold a family meeting to discuss whether they need help – and to talk about how to go about providing it.

According to the U.S. Centers for Disease Control and Prevention, more than half of older people have not communicated their wishes for caregiving arrangements, end of life care, estate planning and other critical issues to family members, even though nearly all believe it is “extremely important” to do so. Although the natural tendency of many seniors may be to avoid such discussions, talking about these issues as openly as possible when the family is together can make life’s inevitable transitions less stressful for everyone involved, and help to answer some of the many questions surrounding aging and senior care.

How are mom and dad doing?

If some adult children don’t see their aging parents often, they may be met during the holidays with the sobering reality that the health of one or both has worsened since their last visit. Other siblings who live close by may be aware of changes in their parents’ daily needs, but may not be ready to fully acknowledge them. Time spent together during the holidays can reveal a parent’s changing health status, which can be assessed in several general areas, according to AARP.

Physical health:  Is the parent showing signs of worsening chronic disease, including weight changes, incontinence, constant fatigue, or swollen feet or legs?  Is he or she having balance problems that may increase chances of a fall? Are his or her vision and hearing normal?

Mental health: Is the parent experiencing mood swings or showing signs of forgetfulness and confusion?  Is he or she consistently feeling sad or lonely, engaging in fewer social activities than before or having difficulty maintaining friends?

Daily life: Does the parent have adequate ability to dress himself, prepare meals, bathe and drive safely, shop for food and other necessities, pay bills and complete other activities of daily living?

Medication use: Is there a list of all medicines, vitamins and supplements taken, and is the parent able to take them without being reminded?

Appearance and hygiene: Is the parent dressed in clean clothes that are appropriate for the weather and occasion? Is he or she able to maintain personal hygiene?  Has his or her overall appearance declined?

What type of care do they need?

If family members have serious concerns in any of these areas, a family meeting can allow everyone to be open and honest about their observations of a loved one’s condition and future needs. Aging experts advise that the elderly parent should be included and consulted throughout this meeting whenever possible. Its purpose should be to have a collaborative discussion about concerns and next steps, not to simply “talk at” an older person who has long been a leader in the family unit.

Gerontologist Jeannette Franks, Ph.D., author of “To Move or To Stay Put: A Guide for Your Last Decades,” notes that the roles assumed by adult children in the care of aging parents are influenced by a variety of factors, including gender, birth order and how far away they live. For example, one sibling might volunteer to assist with lawn care and snow removal, but that same sibling might not be at all comfortable with personal care needs such as bathing and dressing.

Often the issue of overall safety in the home is the primary factor in a family’s decisions about how to help an aging loved one. If it is determined that parents can no longer live alone without assistance, a whole new set of questions must be answered, a process which will necessarily take some time. However, the family can at least begin to address them in the initial meeting.

Will the parent be better served by staying at home and receiving home care assistance; by moving to an assisted living apartment or senior living community; or is he or she likely to require nursing home care in the near future? What specific tasks can each family member do to help? Who will make decisions [financial, medical, hiring caregivers, etc.] and how will they be made?

A written document that notes the decisions made at the meeting can be a helpful reminder for family members. Distributing a follow-up “to-do list” of responsibilities and commitments also can help each person honor the agreements made. For example, Franks suggests coming up with a list of three possible senior living communities for family members to further research and visit, if the family is considering that option.

What about the money?

Financing the care of aging parents also is a key discussion to have, and leads inevitably into questions about the parents’ estate and what the adult children and other family members will eventually inherit. If the money for any necessary care is coming from their estate, who will be the executor? If not, who will pay for the necessary care? All family members should be as comfortable as possible with these decisions as well.

Estate planning experts agree that it is absolutely necessary for family members involved in caring for elderly parents to know the location and specifics of their wills, trusts and other estate planning documents. These documents should be reviewed every other year to ensure they remain effective.

It’s also important to name a healthcare proxy and durable power of attorney for each senior; this can be crucial should an emergency require a family member to make time-sensitive health and financial decisions for a parent. An elder law attorney can help with financial and estate planning matters, as well as long-term care and end of life planning issues for seniors.

A family meeting also may provide an opportunity to discuss what will happen to a parent’s personal possessions openly and honestly, while also giving the parent the pleasure of gifting them him or herself. In addition, having this discussion together can prevent siblings from later claiming that certain items belong to them because “She wanted me to have it” or “He knew I needed it more.” Attorneys recommend that seniors keep a personal property memo with their will and make reference to it in that document. The memo should be as specific as possible when describing items and beneficiaries.

Perhaps the most important holiday gift adult children can ask of their parents is a family meeting to discuss the many decisions associated with aging. This special family time can be used to plan ahead regarding care arrangements, sort out finances, locate documents and discuss the parents’ wishes. This invaluable gift “can be called a gift of peace of mind,” said Lisa Kaufman, a senior care consultant and owner of an aging life care planning firm.

“Many times, parents will say they don’t want to involve their kids because they don’t want to be a burden to them. But when you don’t do things and it becomes a crisis, that’s a burden,” Kaufman said.

Prepare to Care: A Resource Guide for Families is available online at aarp.org.

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