In our mission, vision and values statement, we talk about being a resource to families regarding all aspects of aging. In writing those words, my intent is to be available to anyone in the community who is attempting to age well, and anyone involved with an elder who is aging.
Over this 8-year journey, I see two situations arise often, and have come to believe the situations are worth working on as a community.
In the first case, the common scenario involves an elder who has not given instruction to his or her family caregivers about preferences when he or she can no longer live independently in a safe and healthy manner. To be fair, the family caregivers have often not broached the subject with the elderly person before a crisis arises.
The result of this scenario follows a similar pattern, creating guilt in the family unit, as the elders may no longer be able to make sound decisions or may be in denial about their ability to accomplish their activities of daily living and instrumental activities of daily living. Often there are one or more activities that are problematic including bathing, grooming, using the bathroom, dressing, eating, walking, transportation, shopping, household management, medication management, financial management, communicating and maintaining positive feelings of mental health.
Often the elders’ children explain to one or both parents that they are not safe or well-cared for living independently, but the elders are many times unwilling to move from their home, and resistant to others caring for them in their home.
In the second case, the elder is willing to admit they need assistance, but the adult children are in denial of the true decline the parents have experienced. Again, no substantive conversations about aging may have been engaged in between the elder and the family caregivers, resulting in an unwillingness to discuss the issues at hand.
Fear is common in these situations for both elders and their families. Appropriate preparation goes beyond having the elder see an attorney to document their wishes in a will and a living will, designating powers of attorney and executing an order not to be resuscitated. Questions to be asked and answered include but are by no means limited to the following:
- Is the family committed and able to provide care for their loved one at home, or in the caregivers’ home, should the elder not be able to care for themselves?
- What finances are available within the family unit to provide the desired level of care?
- If long-term care is necessary, what kind of environment does the elder desire?
- Does anyone in the family unit understand the concepts of both palliative care and hospice care, their differences and the advantages of each option?
This short list of issues is difficult to discuss in a family unit that operates in a healthy manner. When the family is experiencing dysfunction, which is not unusual, the work can be excruciating.
The best outcomes happen when the elder makes his or her wishes known while healthy and not cognitively impaired by overcoming procrastination. Similarly, when adult children are aware of their parents’ aging issues and able to accept inevitable changes in the health and living arrangements for a loved one, the process is easier to navigate.
While it is challenging, the rewards of exploring these issues as a family are well worth the effort.