One of the more painful memories in my life was telling my father that he was no longer capable of driving or living alone. A tall, physically active man, Dad had worked since his teens in the Great Depression, fought in World War II, married and raised two boys to manhood, and dealt with the death of his spouse, burying his wife of more than 50 years. He was a proud man, always ready to help others and capable of handling life’s setbacks with equal measures of grit and grace. To him, being a man meant being able to take care of yourself.
Over the previous decade, I had watched his physical and mental faculties gradually fade. The decline was slower in the beginning, but reached a faster pace as he approached 80 years of age. After a minor car accident in which he had turned into the path of an approaching vehicle, the attending policeman called me aside and insisted that I take away his keys.
As the eldest son and his only living relative within the state, the responsibility of care fell to me. I struggled with the irony of our situation, the reversal of natural roles where parent directs child. Despite my trepidation, however, taking away his car keys was for his own safety and others on the road – a loving child has no good alternative in that position.
Aging and Its Consequences
While everyone ages at a different pace, the consequences are inevitable for everyone. As you grow older, you are likely to experience some or all of the following physical and mental changes:
- Hearing. Aging can make high-frequency sounds harder to hear and changes in tone and speech more difficult to discern.
- Vision. Lenses in the eyes become less flexible, making close objects difficult to see. Night vision and visual sharpness decline, glare is more troublesome, and cataracts and other eye diseases are more likely.
- Bones. One effect of aging is the thinning of bones and the possibility of osteoporosis. Falls easily result in fractures, and many people lose height due to compression of the spine (women tend to lose more than men). Joints lose cartilage and are more susceptible to injury and arthritis.
- Muscles. Perhaps due to weaker blood flow, muscles generally decrease in strength, size, flexibility, and endurance. A contributing factor can be lack of exercise, which is a lifestyle decision.
- Metabolism. Many older people gain weight as they age, due to a lower metabolism. As muscle mass declines, the body needs fewer calories to maintain weight. Unless diet is cut back, body fat increases, as does risk of heart disease.
- Memory. Less blood flow to the brain has a negative effect on memory. In particular, episodic - the “what,” “where,” and “when” of daily life - and longer-term memory decline with age, making learning new things and attempting to do more than one task at a time more difficult.
Critical Conversations to Have With Your Elderly Parents
Elderly parents frequently deny difficult truths and resist conversations that they feel may result in the limitation of their freedom. Despite any misgivings for the task at hand, keep in mind that your parents faced similar occasions in their care for you as a child – you might recall your first injection, visit to the dentist, or paddling when you played in the street.
Recognize that the earlier these conversations are held between elderly parents and their adult children, the better. Addressing issues before they become problems can help lessen tension, allay parental fears about interference, and allow both parties to work together toward a mutually satisfactory outcome.
1. Driving Skills
Some families live far from essential destinations, and in many cities public transit systems are not a viable option for the aged. As a consequence, seniors frequently fear the possibility that they may have to give up driving for good, leaving them feeling trapped and isolated.
Unless your parents are incapable of driving safely, the conversation does not have to be an “either-or” proposition. An effective approach might be a reduction in driving miles, times, or routes based upon their needs and capability. In Dad’s case, he recognized that some instances caused him more stress than others and he did not want to be a danger to others. At the same time, though, he would not accept a total loss of driving mobility.
As a consequence, he continued to make short trips to the grocery store and church during weekdays and Sunday mornings, periods of less traffic and lower stress. He continued to take old friends who relied upon him for their transportation, but agreed to not drive with grandchildren unless it was an absolute emergency. By the time I had to take his keys away later in his life, he was ready to give them up.
2. Financial Condition
Many adult children do not know the financial condition of their parents – the source of their income as well as their expenses, savings, and obligations – until a death or incapacity makes learning about them necessary. In recent years, retirement assets for many Americans have declined sharply and have yet to fully recover. At the same time, seniors must cope with rising food prices, higher property taxes, and unanticipated healthcare costs.
Consequently, a growing proportion of senior Americans are falling below the poverty level, often having to choose between buying food or medicine, paying a utility bill, or repairing their home. Many forget to pay bills and some fall prey to scams that target the elderly. Too often, the damage has been done before the children are aware of the problem.
Explain to your parents that knowing certain things about their financial condition can enable you to help them. If they are reluctant to talk initially, perhaps worried that you may be critical of their decisions, you can point out examples of other seniors they might know who have left unnecessary complications solely because the subject was uncomfortable. If you have siblings, bring them into the conversation for support and to avoid any suspicion or family conflicts down the road.
During the conversation, ask these essential questions:
- Legal Matters. Have they done any estate planning? Do they have a will, trust, or powers of attorney for finances and healthcare? Who are the executors for their estate, if any? Where are these documents located? Do they have a home mortgage? What are its terms and where is it kept? Can you have permission to speak with their attorney?
- Income and Expenses. What regular income do they have? What expenses do they pay each month, and do they do so electronically or with checks? Where are records kept? Do they have other assets, including any that need active management? If so, do they have a financial planner or stock broker? Can you contact them?
- Financial Records. Where do they keep past years’ tax returns, and who prepares them? Where are bank, savings, and credit union accounts? Where are their records kept? Do they have a safe deposit box? Who has access to it, and what does it contain? Where are the user names and passwords kept for any online financial accounts? Do they have a trusted insurance agent? Where are the documents kept for any life and property insurance policies?
- Health Insurance. Do they have healthcare policies in addition to Medicare? Do they have dental insurance? Long-term care insurance? If so, what are the terms and where are the policies kept? Are they enrolled in any medical or drug trials? Have they prepared for the possibility of assisted living, and, if so, what are the financial arrangements?
3. Health Issues
Unfortunately, bodies wear out with time and become susceptible to disease and infection, which means good health becomes increasingly important with age. Experts recommend that any person over the age of 65 who lives alone should, at a minimum, have access to a continuously monitored medical alert system. If a parent has a debilitating disease that restricts mobility or requires regular attention, a caregiver is a likely necessity.
If your parents have mobility issues requiring a cane, walker, or wheelchair, they should consider modifying their home to accommodate their conditions, if their assets allow. Your parents should also consider alternatives if one requires specialized regular care, and the possibility of dementia or Alzheimer’s Disease is always something that should be addressed and prepared for.
4. Living Assistance
There is now a continuum of care that was not available to seniors in the past. Options run the gamut from homes and apartments in senior living communities, where care is limited, to nursing homes that provide 24-7 assistance to their patients. In addition, thousands of American seniors continue to reside in family homes and receive part-time assistance from caregivers.
According to the National Center for Assisted Living, there were more than 750,000 seniors in assisted living environments in 2010. Services provided in these facilities include the following:
- Meal preparation
- Medication management
- Transferring (movement)
About 70% of residents come from private homes or apartments and stay in a facility an average of 22 months before moving into a full-care nursing unit or passing away. While no one relishes a move into an assisted living or nursing facility, it is an increasingly likely possibility as one passes the age of 75, suffers from dementia or Alzheimer’s disease, or lacks the financial capability of paying for private nursing care.
Have your parents considered the possibility of living in an assisted living facility? To help arrive at the right decision, ask what is the most important aspect of their lives, what gives them the most pleasure, and what they hope for. Most importantly, how do they want to live? It may be necessary to discuss their limited options if cost is an issue.
5. End of Life Instructions
While uncomfortable for their children, many seniors relish the opportunity to prepare for a graceful exit from this world. In fact, it is likely that they have already made some plans – but those plans may have gaps due to lack of knowledge or being unintentionally overlooked.
In addition to such matters as a will or trust, parents should consider the application of a living will or “do not resuscitate” (DNR) instructions for their last days of care, which release loved ones from having to make that difficult decision during one of the more emotional periods of life. Be sure to ask the following questions concerning end-of-life instructions:
- Religion and Burial. Are your parents members of a specific church or congregation? If so, who should be contacted? Are funeral arrangements (burial, cremation, other specifications) in place? If so, where are the instructions and policies?
- Bequests. Do they have special legacy assets not distributed or special bequests in the will that should go to specific people? Are the instructions written? Where are copies kept?
- Ongoing Instructions. If they have a pet, a person who has been dependent upon them for care or money, or a special needs child, are there any particular wishes or instructions to be sure those entities receive their needs?
6. Forgiveness and Reconciliation
Perhaps the most important conversation for you and your parents lies in resolving old issues, hurts, or misunderstandings between you. Resolution does not have to mean rehashing old arguments, opening wounds, or pointing fingers at who was right or wrong. It is a time to let bygones be bygones and to understand that no one makes it through life without mistakes, despite their best efforts.
Accept that what happened in the past stays in the past. Whatever else they may be, your parents are the reason you are in the world today. From their viewpoint, you and your siblings are the most significant sign of their lives once they have departed. Do not miss your chance for forgiveness and reconciliation.
Like many fathers and sons, my dad and I had a number of disagreements over the years, some leading to months of estrangement. Fortunately, when I became a father, I understood him and his actions better which made forgiveness easier and the last decade of his life a joy to both of us.
I will never forget his last questions to me and my brother: “Do you love me?” and “Do you know how much I love you?” I was happy I could answer both questions with a resounding, “Yes.”
Sometimes, the more difficult tasks are the most rewarding. Pressing your parents to discuss these six issues could protect them from physical and financial harm, simplify the time and energy needed to perform their last wishes, shepherd their estate, and clear the slate of any emotional scars. Call your parents today and arrange a time to discuss their future, their hopes, and their expectations. It is a win-win proposition for both of you.
Have you had any of these conversations with your elderly parents?