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Choosing the right words can help adult children have conversations - rather than fights - with aging parents about living circumstances.
Ideally, families should be talking about elders' goals, values, and priorities long before their health becomes shaky, experts said. It may take years and many talks to convince parents to accept outside help.
Before a crisis, families should discuss contingency plans if an elder breaks a hip or develops dementia, said Barry Jacobs, a Delaware County psychologist who specializes in family caregiving. It's good to tour different types of facilities together.
Seniors may respond better if their adult children bring up the topic of housing slowly, simply, and without a lot of drama.
Work with facts. Experts suggested getting a neuropsychological and medical evaluation for a parent with cognitive problems or disabilities. Experts can also evaluate driving ability.
"I often find that my job is just kind of the arbiter of what's going on," said Jason Karlawish, a University of Pennsylvania dementia expert. "That can help remove the child from being diagnostician, prognosticator and decision-maker." He often suggests that patients just try adult daycare for a while. That gives caregivers a break and could ease the transition to new housing.
Adult children need to approach the parent as an ally, not an adversary.
"[The message is] 'Hey, I'm on your side,' " Jacobs said. "I'm not setting myself up as the person who's taking over your life." He often meets with sibling groups, so they can approach difficult conversations in a unified way.
"The more the child pushes, the more the parent pushes back," said Steven Zarit, a Pennsylvania State University professor emeritus and psychologist who specializes in aging.
He suggests a nonconfrontational style that lets the parent think about alternatives. "[Try saying] 'I'm concerned about your safety here,' " he said. " 'I know you're getting around and everything is fine right now. I wonder if we could talk about some things we could do if you need more help.' "
Jacobs has experienced challenging caregiving himself with his late stepfather and mother. His latest book, written with his wife, therapist Julia Mayer, is Meditations for Caregivers, Practical, Emotional, and Spiritual Support for You and Your Family.
Done correctly, these conversations should be "in the spirit of love and cooperation," he said.
Here are some other things Jacobs suggests saying:
"I love you and I care about you and I want the best for you. I want to know what you want for yourself."
"I want to help."
"As much as we might hope things could stay the same, that's not realistic."
If a parent won't talk, the adult child can describe how that makes her feel:
"You're making me anxious. I'm going to have to respond to a crisis and I don't want to respond to a crisis."
"I'm old enough and mature enough to be part of this conversation."
"We're at a point where we need to do this together."
Donna Rasin-Waters, a psychologist at the San Francisco VA Medical Center, agrees that this is about working with the parent. Even though many adult children feel they have switched roles, this is "not reverse parenting," she said. "That's not really [the parent's] perspective."
She said families need to have frank discussions about their values and fears. A lot of adult children are worried about how they'll feel if their mother falls, but they often won't ask her how she feels about dying.
The questions need to be direct.
" 'Is it OK for you to die on the floor? Is that how you want to die?' " Rasin-Waters suggests asking. But, she acknowledges, "That's a tough conversation to have."