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When the hardest advice to give is your own

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By Mark Friedman

I own a Home Care agency that routinely works with families – adult children of seniors, and the seniors themselves, in forming and reconciling their checklist for aging in place successfully. The “place” should be wherever they designate, and I have learned “home” has many definitions. I have become increasingly aware how difficult this process can be and how long the “checklist” can look. For several years and for many clients I have witnessed how complicated it is for families to define an action plan for a loved one, and to clarify who does what. My recent challenge was to apply all I have learned to help my own loved ones – “have the conversation.”

My personal story goes something like this.

Last month I had the opportunity to visit my parents in southern Virginia.   You may have seen them; the adorable, radiant couple on the cover of my agency brochure.  I am blessed. They are amazing individuals and an amazing couple.  They are in their early 80s and are very successfully aging in place at home.  Yes, they have their typical health events but all are self-managed and well-managed.  Like many seniors, they do not have adult children living close by but are surrounded by lifelong friends and extended family. My sister, brother, and I agree that our only desire is that our folks age on their own terms, and that all of their resources be dedicated entirely to that one goal. Most importantly, we are lucky in that as a family we trust and respect each other.

I am an expert but where do I begin THIS conversation? 

As I was getting ready for my visit, I looked at the list of questions we customarily ask families about their aging in place process. I quickly realized that as a family we could not begin to clearly answer all of them.

As I rehearsed in my head the discussion for my visit, it hit me that ideally we siblings should all be together for this “talk” (my fault Jo and Ben!). I did not plan as well as I could have, but I had prepared.  I used my acquired expertise to write out a set of questions. I had laid the groundwork – and previewed the questions with my folks. I had made it crystal clear that my only goal was to “help you get what you want.” Yet here I was still nervous about how the conversations would go.

The Value of Ah Ha Moments.

What struck me before getting on the plane to Virginia was this. While I had played a valuable role in helping my clients define their criteria for successful aging, my siblings and I were clearly not role models in coordinating the conversations like the one I was about to have with our parents.
How could we know how to help them get what they wanted when we don’t know what those things are?

  • I did not know what trade offs they were or were not willing to make.
  • What documentation needed to be completed, and where were the critical documents?
  • Is planning for Medicaid something to be considered or not? If not, how does that impact future decisions?
  • If my siblings and I needed to make decisions, who was going to make them?
  • How would they expect differences of opinion to be reconciled?
  • Who would be the “lead” for different types of decisions?

The list went on and on. It was part of very rational, orderly plan; easy to write out, read, categorize and advise others about. The fact is, my parents had thought out most of them, but at a high level.  With changes in tax laws, medical (Medicare and Medicaid) insurance qualification rules and other systemic changes in our healthcare system, it was now essential to review documents in some granularity. (And yes, know where critical documents are located!)

During these initial conversations I came to appreciate my parent’s experiences and biases towards different types of financial planning and advice tools. We had emotional discussions about control and decision-making when looking at autonomy and independence strategies and trade-offs.

Expect the Unexpected.

I knew this particular weekend with my parents would be emotionally charged. I was unprepared for just how much so. These few days were the beginning of a longer set of conversations we will all continue to have.
I thought I would share my reconciled map of how I see these complicated, critical, yet difficult dialogues. Because that is exactly what these are. Powerful communications that can significantly impact the ability of loved ones to age successfully.

Have the conversations before there is a crisis – do not wait.

  1. Do not go in with answers, go in with a set of questions. You do not, cannot, nor will ever be able to comprehend what the world looks like from another person’s perspective. Even if that person is your mother, father, best friend, partner, or longest living loved one.  Ask questions, listen with intention, learn with eagerness, and think positively. Take notes!
  2. This is a process that will set the stage for a loved one aging successfully: A “set” of discussions; a continuous and ongoing dialogue. It is not a “one and done” conversation. Be patient, but at the same time be persistent.
  3. Be respectful, not authoritative. There is no one right or one answer that works for everyone. Answers must fit the priorities and perspective of your parents or loved one – NOT YOURS.  Make sure, and reassure them – they are in control.
  4. Be Transparent: There cannot be hidden agendas either with your parents or siblings (or others involved).   Creating an atmosphere of trust and transparency may require some negotiations and even outside perspectives. Be open to this.
  5. Be clear – this is not about taking control. This is about what you can do to help loved ones define and achieve the highest level of priorities they set for themselves.
  6. Together create a plan for next steps:
    1. Support your loved ones getting outside expertise for help. Even if you have the specific skills to do things yourself (financial advice, legal advice, etc.), this may not be the right role for you in this particular context.
    2. Schedule future conversations – keep this dialogue going and determine who in the family and extended circle needs to be part of conversations going forward.

Treasure the Times.

As I replayed this first visit with my folks, I was grateful to rely on substance I had learned as the owner of my Home Care agency. I realized I had acquired deep insights from powerful resources. Honoring Choices of Massachusetts,for which we are a proud partner, is one of them. Before my visit I had referred back to copious notes I have from hours of conversations with professionals in elder law, elder care management, financial, and Medicaid planning. The fact is I had a tremendous leg up in my conversations, but it didn’t make me any less apprehensive as to how my visit would ultimately turn out.

As I boarded the plane back to Boston, I recognized, however, we had triumphed as a family. We had started the conversation, asked the questions, listened well and respectfully. We had begun to empower a plan together.
What a treasure this particular weekend was for me as a son.  I still learn from you, Mom and Dad.  Thank you – you have again helped me grow personally and as a professional.

About Mark Friedman: Mark Friedman is the Owner of https://www.seniorhelpers.com/southshorema/ Boston and South Shore. Passionate about seniors and healthcare, the goal of his agency is to set a new standard in home care in Massachusetts. First by delivering an exceptional home care experience in a combination of highly trained and high-touch caregivers. And secondly by becoming a significant connection for elders to resources and services in the 75 communities his company serves. www.SeniorHelpers.com/SouthShoreMA. Contact Mark: MFriedman@SeniorHelpers.com

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