Just as children need their parents to care for them and keep them safe as they grow up, aging parents need help from their children or other caregivers as they grow old. It’s a natural part of the cycle of life – but that certainly doesn’t make the transition an easy one.
In her role as a family nurse practitioner at BJC, Lisa Nelson, MSN, FNP-C, has seen just about every scenario related to aging parents and their children. Based on her work with senior patients and their families, she offers the following guidelines:
Look for the signs
First, it’s important to rationally assess the parents’ situation, including whether they need assistance or may no longer be safe in their home.
Some of the more obvious signs include more frequent bruising, skin tears or general unsteadiness, indicating an uptick in falls. New scratches or dents on the car can mean that reaction time, vision and driving ability may have declined to unsafe levels. A look through the refrigerator can help assess nutritional intake.
“‘Is there enough food? Is it appropriate? Is a lot of it spoiled?’ are key questions,” Nelson said. Additionally, signs of weight loss like baggy clothing are another red flag, along with indicators of poor personal hygiene like stains on clothes, not shaving, a lack of hair care, or infrequent bathing.
Get on the same page
Once you’ve determined that a parent needs more assistance, meeting with other family members to present the facts and establish some common goals is key.
“What’s the most important priority? Is it dementia, a heart problem, not being safe to live at home anymore?” Nelson asked. “Whatever the issue, it’s important to get on the same page about getting mom and/or dad taken care of physically, mentally and financially.”
If there are disagreements among siblings, it’s best to be patient and calm while focusing the discussion on safety.
Nelson suggested the following conversation starter: “I know we would all like to continue on like Mom was 10 years ago, but I’m seeing some changes and I’m worried. Here’s what I’m seeing … what are you seeing?”
“Then, be quiet and listen to what they have to say,” she suggested.
Start the conversation – then repeat
When it’s time for family members to have an initial conversation with the parent, Nelson advised doing so “via whatever method works for your family … you know your parents the best. Do they listen to one child more than the others? (If so) have that child approach them,” she said. “The first conversation may be kind of a shock to them; they have been hiding these signs of aging, many for quite some time, and they’re very fearful of losing their independence.”
That conversation will also likely be the first of many, during which the child can reinforce the message that the children are not trying to control the parents’ lives, but want to be a helpful resource and keep them safe, just as they once did for their children, Nelson said.
Engage outside resources
If your parent doesn’t listen to family members, the next move may be to involve their primary care physician – a neutral third party they already trust, Nelson advised.
“If you can focus on health issues versus not driving or moving to an assisted living situation, and you can do this with the help of their primary care provider, it really goes a long way,” Nelson said.
There also may be a family attorney who has a long-term relationship with the parent. It may be appropriate to meet with him or her on your own if advance directives are in place. In cases of dementia or Alzheimer’s, having power of attorney papers, advance directives and living wills before the condition advances is crucial, Nelson said.
Other community resources, often with help available online, also can be extremely useful. These include the Alzheimer’s Association, the state’s Agency on Aging, the Department of Health and Human Services, and long-term care ombudsman services. Nelson advised sticking mainly to .gov and .org websites while avoiding .com sites as those are generally marketing a specific facility or for-profit service.
Accept the situation
Despite your best efforts, aging parents may continue to resist your help, which can be painful.
“I remind children of seniors not to take it personally … things can get ugly and a lot of times it’s because both parties know each other very well, and they see the situation in different ways.”
Sometimes it takes a crisis or “near-miss” event to persuade a parent to accept help – and sometimes that can’t be avoided.