Senior Transitions

Critical to this developing situation is, does the daughter (or someone) have Mom's Power of Attorney (POA) for both healthcare and finances? As many forms of dementia are degenerative in nature, someone must secure the POA now, before Mom's confusion progresses to a point beyond which a POA can be obtained. The person creating a power of attorney, also known as the "grantor," can only do so when he/she has the requisite mental capacity to do so.

One of the most distressing aspects of dementia is the fluid movement of remembering/not remembering persons, thoughts and actions. This cycle is frustrating for both the older adult and the family. Without knowing the current status of Mom's cognitive health, I would recommend 1) A family member obtain Mom's POA at the earliest opportunity and 2) Have a family member speak directly with Mom's physician to acquire a greater understanding of her physical and cognitive capacities at this time. The result of this discussion will tell everyone a great deal more.

While the move to senior living is the catalyst for this question, other areas of concern are part of the whole picture here. The answer, ultimately, may be a move to a congregate living community, but the family must learn Mom's ability to even make this life-changing decision.
 

FMLA applies to all public agencies, all public and private elementary and secondary schools and companies with 50 or more employees. These employers must provide an eligible employee with up to 12 weeks of unpaid leave each year for, including to care for an immediate family member (spouse, child, or parent) with a serious health condition. Employees are eligible for leave if they have worked for their employer at least 12 months, at least 1,250 hours over the past 12 months, and work at a location where the company employs 50 or more employees within 75 miles.

One notable requirement: For FMLA leave purposes, “parent” is defined broadly as a biological, adoptive, step or foster parent or an individual who stood in loco parentis to an employee when the employee was a child. An employee’s parents-in-law are NOT included in the definition of “parent” for purposes of FMLA leave. More information on FMLA is available on the US Department of Labor website at: http://www.dol.gov/whd/regs/compliance/whdfs28.htm
 

If we are fortunate enough to have parents who live into their 80s and beyond, we will likely confront injury, frailty and even loneliness that can affect our parent's overall wellness. A 2007 AARP survey, however, found that nearly 70 percent of adult children have not talked to their parents about issues related to aging. Some adult children avoid this most intimate of conversations because we believe our parents do not want to consider the future. Others believe they already know what their parents want. In both cases, the opposite is likely true. These are difficult conversations to have with our aging parents, and even harder to start. Some tips:

The best strategy is to begin the conversation with our siblings before a crisis. When approaching an older parent about making a transition of any kind, all siblings and family members must have a single voice and philosophy. One rogue adult child or sibling who is encouraging the status quo can make a new transition nearly impossible.

Gather a list of your own questions and ask your siblings to bring their concerns to the table. We, as adult children, should consider our approach to introducing topics, as much as the topics themselves. Often siblings will collaborate and decide what we believe is best and present it to our parent(s). Raising issues as shared conversation or as seeking advice is less confrontational (and more productive) than presenting parents with a ready-made plan. We must let our parents know the conversation is about them and their wishes for the future. Respect is a key ingredient for a successful outcome. Adult children can best start the conversation by simply listening to our parent(s).

Family discussions should honor the experience and feelings of everyone involved to achieve a successful outcome for the entire family. From the older adult’s perspective, the desired results generally involve feeling secure, maintaining personal freedom, having peace of mind, making their own choices and having family and friends nearby.

Consider the possible reasons for your parents’ reluctance to talk about a change. Are they trying to be difficult or is it something else? When someone is “being difficult,” they are often responding from a place of fear: fear of change and fear of the unknown. What if I move and I don’t like it? What if I don’t fit in? What if I can’t afford it?

Each adult child also must be honest with their parents (and siblings) about the depth and breadth of help we can provide. We, as the adult children, need to acknowledge our own limitations and then be prepared to make arrangements for the tasks remaining. Honesty is critical. This particular part of the conversation will often be the most productive in achieving focus and direction. It also offers our parents (and siblings) some insight into our own family obligations, career challenges, etc., which may preclude us from helping extensively. Once everyone understands the scope of the unmet needs, a lifestyle change is often the obvious choice – for both the older adult(s) and the rest of the family.

Lastly, we need to realize there is no such thing as “a” conversation about aging. Caring for an aging parent is generally not a sprint; it’s a marathon. Even after the smallest crisis, we are all living with a new uncertainty. The future will not be resolved in one afternoon. The good news about having these difficult conversations is that we may find we are truly connecting with our parents at the best possible time.

Moving to a nursing home is a difficult transition for the older adult and family members. The responsibility of helping a loved one adapt to any community living environment is shared between the family and the new residence. A few tips to assist in this later life transition:

• Both the family and the nursing home can encourage the older adult to make a new friend (or two). Survey the scene and help identify individuals whom he or she might engage in conversation.
• The nursing home can also connect potential friends during the congregate dining time. Routine is part of the landscape in nursing home life, and sharing this routine with a companion makes it a more positive experience. (Close friendships are often formed in the senior living setting, due to the sheer number of shared experiences.)
• Personalizing the room almost immediately helps it become “home.” The nursing home should encourage the older adult and family members to bring a few, well-chosen mementos—photos, a stuffed animal, a favorite afghan, for example. Carving out one’s own space is critical to overall quality of life, and the nursing home experience is not any different.
• The nursing home should also encourage an extra helping of family visitation during the early days of the nursing home transition. Older adults truly fear “being left” in a nursing home, and frequent visits from family members will dispel this anxiety from the outset.
• Once the initial transition period is over, family members should establish regular visiting days and hours. It provides the older adult with an exciting event they can anticipate, and it helps create a more positive interaction when the appointed time arrives.
• The older adult should also observe constructive interactions between the staff and their family members, as it offers the peace of a “caring connection.”
• Everyone—both family members and nursing home staff—need to be responsive to the new resident’s concerns or questions. Listen well and allow the new resident to be heard.