1 - 888 - 746 - 2107

Mon - Thurs: 9am to 8pm ET, Fri 9am to 5pm ET

Expert Topics

Alzheimer's, Dementia, and Parkinson's Disease

- Douglas Scharre, MD

Asset Protection & Financial Management

- John Greener

Cancer Care

- Richy Agajanian, MD

Caregiver Challenges

- Sue Salach-Cutler

Communication Through The Generations

- David Solie, MS, PA

Diabetes

- Joy K. Richardson, RD, CDE

Elder Care at Home

- Ethan Kassel, MSW, LCSW, C-ASWCM
- Steve Barlam

Elder Law

- Howard S. Krooks, JD, CELA, CAP
- Ellen Morris, Esq.
- Shana Siegel, Esq., CELA

End-of-Life Issues

- Vincent Dopulos, MA, LPC, RDT

Fitness

- Deborah Quilter

Geriatrics

- Robert A Murden, MD

Home Care Solutions

- Emma R. Dickison

Home Health Care & Palliative Care

- Pamela Fishman, LCSW

Home Health Modifications

- Connie Hallquist

Senior Housing Solutions

- Tiffany Wise
- Mike Campbell

Incontinence Issues

- Brian Christine, MD

Integrative Medicine

- Rashmi Gulati, MD

Live In Care

- Kathy N. Johnson, PhD, CMC

Managing Medicare

- Ross Blair

Memory Care

- AnnaMarie Barba
- Crystal Roberts

Mobility Issues

- Nick Gutwein

Nutrition Know-How

- Dr. Gourmet, Timothy S. Harlan, M.D.

Quality of Life

- Joan Garbow, MSW, LCSW, CCM

Safety and Hospitalization Concerns

- Martine Ehrenclou, M.A.

Senior Healthcare

- Archelle Georgiou, MD

Senior Medical Issues

- Chris Iliades, MD

Senior Transitions

- Mary Kay Buysse, MS

Communication Through The Generations

David Solie is an author, educator, clinician, coach and thought leader on the developmental psychology of the second half of life. His best selling book, How To Say It To Seniors, Closing the Communication Gap with Our Elders, offers a transformational perspective on the psychology of older adults.
Q:

My mother in law is 84, has Parkinson's and colon cancer. She has lived alone until today. Her oldest son and his wife moved in following retirement out of state. His desire is to help the other 4 siblings that have been dividing up the responsibilities of dr. appts., shopping, etc. She is of sound mind, cares for her large home, cooks, and manages pretty well. The issue is she has told them since she doesnt sleep in her bed since her husband passed away 6 years ago, they could have her bedroom, share the huge walk in closet and private bathroom.(there is another one on the same floor). The other 2 bedrooms are upstairs. She has fallen down the basement steps several times and is not suppose to go up them. My issue is her privacy, she has given it all up just so they would move in with her. Now she is not so sure, but doesnt want to "rock the boat". Is there a publication with questions on it for siblings in this situation? It is a close family and I am afraid no one will say anything. There are 4 boys and 1 girl and the in-laws. I have voiced my opinion that they should all have gotten together and discussed this before the move took place. I know the sons do not think about mom's privacy, it's the daughter in laws who are worried she is getting pushed aside. What if she gets sick or just wants some quiet time. She has her shows and music she likes to listen to, but it is not what they like and I am afraid she will just sit passively by and let it happen. I need something to give them for guidance. I know I will say something and it probably won't be received well, but I don't care about their feelings, I am concerned about her feelings. She has voiced concern over these issues. She has pretty much gotten rid of most of her clothes and stuff just to make room for them. She is a very giving, loving woman and I just want to see her final years in the home she has lived in most of her life. Sorry this is so long, but i needed to get it off my chest! Thank you for any help. 


Lori from KS
A:

Older adults are engaged in a battle for control in all aspects of their lives. Most of these battles are over dilemmas that have no easy answer, like "where am I going to live?" In your mother-in-law's case, she has opted to give up control of her privacy to maintain control over where she lives. She needs on-site help to navigate the demands of being older and diminished health. But the on-site help comes with a price. This is the nature of dilemma solutions: messy and always, repeat always, in need of revision.

What her children and their spouses need to appreciate are the psychological developmental tasks of the last phase of life: control and legacy. This link gives you an overview of these critical tasks:  http://www.davidsolie.com/blog/the-final-mission-of-life/ Once they have a better understanding of your mother-in-law's "need" for control, they can revise their approach and offer her more choices, including the choice of more private space.

Best regards,

David Solie, MS, PA 

  Back To Top
Q:

Both of my 80+ year old parents are so anxious to communicate their experiences that we never have a chance to communicate things that are happening in our lives. Not just daily activities, but special events and major presentations. They interrupt and start in on something they deem is more important. I have lost any desire to communicate with them. Why is this happening and do I address this with them? Or let it be? 


Lyn from TN
A:

This is a common occurrence in the world of aging parents. It is in part the end product of the shrinking universe of aging. While your world is still expanding and filled with overt growth and accomplishments, their world is contracting and moving internally. This doesn't mean communicating with them is pleasant. It just means you are better served changing your questions about the experience. Instead of asking, "why are they so inconsiderate," you may want to ask "what are they wanting?" In a world of diminished status and purpose, I suspect they want to assert their presence however awkwardly when the opportunity arises. This also points out another dilemma of aging parents that impact adult children. Their parents may no longer be able or wiling to give them the nurturing they have in the past. This is a painful loss but part of the fallout of the process of getting ready to leave. The higher ground for this dilemma is what you suggest at the end of your question: let it be. It will be easier on both of you... 

  Back To Top
Q:

How do I respond to my 89 year old father who demands much of my attention and doesn't understand that I have other responsibilities besides him? He lives in a senior residence five minutes away from us, where he is safe, gets meals, has nursing staff available, and other residents with friendly faces. I am his only living child. Guilt, guilt, guilt…


A:

When older adults give up their primary living environment, they feel out of control. Even if the new facilities and support staff are ideal, they cannot eliminate the psychological discomfort of being in a new space creates. For most elderly adults, their primary living environment represents the last area of control they have in a world of mounting losses. It sounds like your father is trying to assert some control as he comes to terms with his new living environment and you have become his primary focus.

While this is a natural response, it can be very taxing on the primary care coordinator (PCC) of the family. Unless you find a way to “rebalance” his expectations, you will exhaust yourself trying to ameliorate his discomfort. For his transition to be successful, you both need “breathing room.”

One-way to do this is to offer your father what I call “preferred choices.” Preferred choice is a way to say to aging parents “you matter” but that you are not at liberty to ignore or renege on the other responsibilities in your life. Even though your resources are limited, you will insure that your aging parents retain a priority status in how they are allocated.

The set up for this strategy is straightforward. Despite the day-to-day demands of trying to get everything done, you are giving him first choice whenever you can regarding his visits, appointments and outings. If you can only come for a single visit on a given day, what time would he prefer? If you only have time Monday and Thursday this week for his next doctor’s appointment, which day would he prefer? This sends a clear signal that he is of central importance in your life and is not being left out. But it also sends a signal that there will be times when you can’t drop everything and take care of his needs.

This is not say that your father will be the thrilled with the “preferred choice” system. But it will reset his expectations and give him clear choices as to when he gets your attention. Without these boundaries, he will not be motivated to seek out other sources of support and attention in his new environment. Like you, he needs a new structure to rebalance his over dependency on one person to meet his needs.
 

  Back To Top
Q:

An older adult is ready to move into an independent living community and undergoes a "pre-placement" health assessment by the facility’s physician. Based on the findings, the physician indicates that the older adult “needs assisted living.” The older adult and her family object to the “needs assisted living” classification. They meet with the sales professional at the senior living facility and strenuously argue against the recommendation. “I don’t need assisted living” the older adult tells the sales professional point blank. Now what?


A:

The transition between living spaces is always a dilemma. The loss of control, the need to let go, and the disorientation of the new surroundings are difficult enough without a surprise and unwanted change in competency (i.e. you need assisted living). In this case, the facility stuck with the physician’s recommendation, the family balked, and the move was “off.” But there were other options, albeit more time consuming and requiring more creativity, that could have helped both parties work their way towards an acceptable solution:

1. Map out and better understand the details of the health assessment. What were the specific ADL issues in the health assessment that led to the “needs assisted living” recommendation? Were they dramatic deficiencies or “entry level” limitations? How is the aging parent currently managing these issues in her living environment? The goal of this conversation is to help the family understand the scope and degree of the ADL concerns and, at the same time, help the facility understand the context and history of the older adult’s functionality.

2. Consider a PT enhancement program to improve overall functionality. Deconditioning is common in older adults and undermines all aspect of their functional ability. Have the older adult’s physician order a PT consult to assess movement, strength, and gait. Then have the PT professional map out a treatment plan that combines PT sessions with at home exercise program. This type of intervention returns control to the older adult (i.e. you have choices to improve your functional status) and can have a significant impact on ADL status and overall wellbeing.

3. Consider a “stealth” assisted living program. This option requires a committed engagement by local family members to supplement the independent living environment with hands-on support. While the main benefit is an initial placement in independent living (with a little help from family and friends), it also provides a softer approach for adding assisted living in the future.

4. Consider a trial period of independent living. Sometimes only a trial period will suffice. Opt for a 30-day trial period of independent living, track the details, and then assess the outcome. While this may be a short-lived trial, it provides the dignity of choice and the kindness to admit that none of us want to be seen as “in need of assistance” if we can safely avoid it.
 

  Back To Top