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Talking With Your Adult Children

2/28/2020

After my last blog post about how to talk to your aging parents, my friend’s dad (a faithful reader of my blog!) wrote to me and said “the flip side of this is for parents to learn how to handle the often inevitable conversation with their children. Y’know: How to have the conversation that you don’t want to have but know that you eventually have to have.”

It turns out that there is a whole lot of advice out there for adult children who need to have difficult conversations about aging, caregiving, and safety with their parents but very little advice for the reverse. How can aging parents be more open to having their adult child(ren) approach them about these topics? A Google search found one related article, What Aging Parents Want from Their Kids, which offers anecdotal observations and advice — with a theme being that aging parents often feel as if they’re constantly being assessed by their children. (An amusing, and close-to-home takeaway from this article is that apparently aging parents don’t like it when their children and grandchildren go through their refrigerator pointing out everything that is past the expiration date!)

The above article referenced a 2004 SUNY-Albany study where older parents were asked in focus group interviews about their relationships with their adult children. Here are the main findings:

“When discussing their adult children, participants reveal strong desires for both autonomy and connection, leading to
     ambivalence about receiving assistance from them. They define themselves as independent but hope that children’s
    help will be available if needed. They are annoyed by children’s over protectiveness but appreciate the concern it
   expresses. They use a variety of strategies to deal with their ambivalent feelings, such as minimizing the help they
   receive, ignoring or resisting children’s attempts to control, withholding information from children to maintain clear
   boundaries, seeking others as confidants, and rationalizing children’s unavailability. They actively strive for a balance in
their relationships with children.”

What does that mean in plain language? Family relationships and feelings are messy!

So, if you’re an “aging parent” and your adult children are trying to talk to you about difficult issues, what can you do to help the conversation go well?

Realize that your children are raising these topics out of love and concern for you. Even if it makes you angry or upset. They’re probably pretty nervous about the conversation. Maybe go a little easy on them. Then again, you could decide it’s payback for the difficult conversations you had to have with them when they were kids (just kidding!).
If you feel caught off-guard by the conversation, suggest postponing it so you can be prepared as well. But be sure to commit to a mutually agreed upon date, time, and place for it.
Be direct about your worries, your wants, and your needs. What is most important to you? What are you willing to “give in” about and what do you feel you have to stand firm on? But also recognize that your children may have valid safety and financial concerns. Be open to creative solutions that hopefully address everyone’s interests.
If the parent-child dynamics are just too difficult, suggest having another family member, friend, or hired professional help with the conversation. Or it may be better to have the conversation with one of those people instead of your adult child(ren). Sometimes taking the emotion out of a situation can be the most productive option.

Bottom Line: It’s all about communication. And - same bottom line as last month’s article - BOTH adult children and aging parents should take the time to plan for and start having these difficult conversations before there is a crisis. You’ll be glad you did.

Talking to Your Aging Parents

1/23/2020

I was eavesdropping on a conversation the other day. Two women were discussing how one of them was trying to convince her dad to move from the home he’s been in for decades to an independent living community. I eavesdropped because I was already working on this blog post, after recently sharing an article, Parenting Your Aging Parents When They Don’t Want Help, on this topic on LinkedIn, and was interested in how she navigated the conversation.

The article generated a lot of conversation, both on- and off-line. While I’m not a fan of the use of the word “parenting” in the title (I doubt aging parents want to feel like they’re being parented by their kids!), I think the article is filled with important, spot-on advice for having difficult conversations. I encourage you to read the entire article if you’re facing a situation where you need to talk about a challenging topic. Difficult conversations with your parents include wanting them to move out of their home, hire a caregiver, discuss their end-of-life wishes, share their financial situation, and more. (Note: this post assumes that your parent has the capacity to make their own decisions.)

The woman I referred to above (and who gave me permission to use her story in this blog) shared that one of her dad’s arguments for wanting to stay in the house was because he had so many wonderful memories there. He thought he would lose the memories, the feelings that go with the memories, if he moved. She responded by telling him that she completely understands that feeling. However, she pointed out that she hadn’t lived in that house since college but still holds on to all the memories from her childhood there. That was a great response. She acknowledged the validity of his concern, shared that she truly understands the issue, and let him know that the memories stay with us wherever we go. Her dad was then willing to continue the conversation.

Some thoughts on having difficult conversations with aging parents:

It’s not one conversation, it’s many conversations. Suppose you think your parents should move to an independent or assisted living community. Do you think you’re going to call them up one day out of the blue, tell them you think they should move, and they’ll say “Okay. We’ll start packing.” Not likely. It’ll probably take many carefully thought out, in-person conversations, with time to reflect in-between. Even then, they may never agree to it.

Put yourself in their shoes. Think about how you will want to be approached about this and other difficult topics by your kids when you’re older. Consider the emotions and fears they are struggling with regarding loss of independence, facing their mortality, leaving the place where they raised their family and lived with a spouse who may no longer be here, and more.

Make it their decision. You may be initiating the conversation, but it won’t have a good outcome unless they feel like it’s their choice (to move, to get a caregiver, etc). Work together on identifying the problems and potential solutions. Ask them what they want and what’s important to them. What matters most to them and what are they willing to give on?

They’re still your parents. Show them that respect.

Remember that you can’t force them to do what you want. If they want to stay at home despite your objections and best persuasion, you need to accept it. You can make your case, offer your assistance, even talk about how it affects you and set limits on the amount of help you can provide if they make a choice you don’t agree with, but ultimately it’s their decision.

What happens if they don’t agree to get a caregiver or move or get a medical alert system or whatever you are hoping they will do… and then they, for example, fall and break a bone. This may cause you a lot of stress and missed work days and more - but remember, it’s not your fault. You don’t need to feel guilty (although I realize that’s easier said than done). The silver lining is that they may become much more open to listening to you!

Bottom Line: Take the time to plan for and start having these difficult conversations before there is a crisis. You’ll be glad you did.

Questions to Ask Your Doctor

11/21/2019

A friend recently sent me a great TED Talk titled: 4 Questions You Should Always Ask Your Doctor (by Dr. Christer Mjaset*). She knew I’d be interested because I speak to community groups about how to talk to your doctor.

The 4 questions Dr. Mjaset recommends we ask our doctors are:

Is this really necessary?
What are the risks?
Are there other options?
What happens if I don’t do anything?

These questions work in all sorts of situations:

Prescribing a new medication
Recommending surgery
Whether to get an MRI or other medical test
Deciding on a new treatment option

Your concerns may be medical/clinical (e.g., are there side effects?) or they may be financial (e.g., will my insurance cover it or will I have to pay out of pocket?). While you may not think you can question your doctor’s advice, trust me, you can!

Examples:

Several years ago, I had unexplained vertigo-like symptoms for months. No doctor could figure out the problem (or frankly, seemed that curious, but that is perhaps a topic for another newsletter!). Several doctors wanted to prescribe migraine medication for me. However, I did not have migraines and the side effects of the medication included dizziness and lightheadedness - which were exactly the symptoms I was complaining about! So after asking questions and evaluating the responses, I chose not to take the medication and instead kept searching for an answer.
An elderly client had stage 4 lung cancer. The doctor ordered an MRI. My client was extremely anxious at the thought of having to lie still for the MRI considering she coughed nonstop whenever she was lying down. It was also challenging for her to get to the hospital for the test. I called the Radiology department and spoke to a manager/technician about whether there were any options that would allow my client to be more comfortable during the test. I then called the oncology nurse navigator to discuss how important the test was and whether it would change any of the care my client was receiving. It was decided and agreed upon by all parties that there was no benefit to my client undergoing the MRI.
My son broke his finger a few months ago. It hurt badly enough that he actually asked me to take him to the doctor. The doctor looked at my son’s finger, said “yep, it’s broken” then proceeded to tape it up with a splint. He then said I should take my son for an x-ray. I’m on a high-deductible health insurance plan, and it was late on a Friday afternoon, so I told the doctor that and asked “what will you recommend we do differently based on the x-ray?” He said he wouldn’t do anything differently, thought for a moment, then said that if it’s still bothering my son in a week, THEN I should take him for an x-ray. (Note that I love and take care of my kids and if the doctor said my son definitely needed the x-ray, I would have taken him for one!) Meanwhile, the next day, my son untaped his fingers, took off the splint, and went out and played football with his friends. I would not have been happy if I had spent hundreds of dollars on an x-ray!

As I emphasize when I speak to community groups, it is okay to ask your doctor questions! It is extremely important to understand what is being prescribed or suggested, the risks and benefits of it, and whether it fits with your goals and preferences.

*Christer Mjåset, M.D. is a neurosurgeon, author, columnist and lecturer who currently works as a Harkness fellow in Health Care Policy and Practice at Harvard T.H. Chan School of Public Health in Boston studying value-based health care models.

Health Insurance Check-Up Time (Open Enrollment)

10/18/2019

Choosing the right health insurance plan can be overwhelming. It may be tempting to just keep the plan you currently have rather than look at spreadsheets and dense, hard-to-decipher descriptions of coverage options.

That’s a mistake. Whether you’re over 65 and inundated with advertising about Medicare open enrollment options, getting your insurance through the Marketplace, or working for a company whose annual open enrollment is taking place this fall, it’s imperative that we review our current plan and see what our options are for 2020.

Here are some things to keep in mind regardless of where you get your health insurance:

It’s not all about premiums. To get a sense of how much you may spend during the year, you need to look at all costs including deductibles, co-pays, co-insurance, out of pocket maximums. Click here for an article that defines these and other key health insurance terms.
The provider network may or may not matter to you. It’s a personal decision whether you want to trade lower costs for having to switch doctors, travel further, or have a smaller network to choose from.
Look at the health care services you think you’re most likely to need and try to find a plan that meets your specific needs. For example, if you know you’re going to need a lot of physical therapy (PT) next year, it may make sense to pay more in premiums for a plan that provides better coverage of PT visits.
Do you have a second home in another state? Provider networks will be important in this scenario.

Medicare

Medicare Open Enrollment started October 15 and you can’t watch TV these days without seeing commercial after commercial about different Medicare insurance options. During Medicare Open Enrollment you can:

Switch from Original Medicare to Medicare Advantage
Switch from Medicare Advantage to Original Medicare
Switch from one Medicare Advantage plan to another Medicare Advantage plan
Switch from one Part D (prescription drug coverage) plan to another Part D plan

A few tips:

Be sure to check the formulary (list of covered medications) in your current Part D plan and any Part D plans you are considering to make sure your medications are included. You can do this on Medicare Plan Finder.
If you’re in a Medicare Advantage plan, be sure to check whether your providers will still be in network next year.
You can download the 2019 Guide to Medicare Open Enrollment from the Medicare Rights Center.
This article, 3 Ways to Prepare for Medicare Annual Enrollment 2019, has helpful advice.

Health Insurance Marketplace and Employer Health Plans

Open enrollment for the Health Insurance Marketplace/Exchange is from November 1 - December 15.
Open enrollment timing and options for employer-based plans vary.
For either, here is some helpful advice about Choosing A Health Plan from FAIR Health.
More general advice about open enrollment for health insurance and other benefits from Forbes and U.S. News

Bottom line: Be sure you understand your options, get your questions answered, and know your preferences (cost, access, convenience, willingness to accept risk, etc.) before you make a decision. Contact me if I can be of help.

Is This Credible Health Information?

9/18/2019

“My doctor put me on XYZ medication? Do you think I should be taking it?”

“My 3 year-old has a rash and is throwing up. My doctor said to bring him to the office. What do you think I should do?

“My dad sometimes seems confused and sometimes doesn’t. Does he have Alzheimer’s disease?”

The above are simplified versions of actual posts I have seen on community Facebook groups. Then 50-100 people respond with their opinion. While these groups are useful for many things, the people responding are not medical experts — and if they are health care professionals, they do not know all the specifics of your situation. If you want credible health information, you need to go to credible health sources to get it.

So, what is a “credible health source?”

Your doctor. You might not like what your doctor has to say, or you may not feel the information you get from your doctor is complete, easy to understand, or right for you, but your doctor/health care provider should be a credible source of health information. If you don’t feel that way, it may be time to try a new doctor.

SOME sites on the Internet. Not all. How do you know the difference?

The National Institutes of Health provides information for evaluating whether a website has reliable health information. The photo on the right shows a summary of what they suggest you look for.

The NIH’s National Center for Complementary and Integrative Health also has great information about evaluating health information on the Internet, social media, and mobile apps. There is also a section on Are You Reading News or Advertising?

The U.S. National Library of Medicine also has a number of resources on their website. They even have a tutorial that takes you step-by-step through evaluating two websites.

Look for information from nationally known health centers (e.g., Mayo Clinic), trusted disease-specific associations (e.g. Alzheimers Association), government sites (e.g., National Institutes of Health), or academic institutions (e.g., Harvard Medical School health newsletters).

A good rule of thumb is that if the site is filled with “BUY NOW” links, it’s not a reliable, unbiased source of health information. Find another website!

Source: National Institutes of Health. https://www.nia.nih.gov/health/online-health-information-it-reliable

In The News: Death & Chocolate (Larger Than Life Conversations)

8/16/2019

This Chicago Tribune article perfectly captures the spirit of a program psychotherapist Allison List Hutner and I have been facilitating. Please contact me if you’d like to learn more about the program or have us facilitate a session for your organization, book club, family, or friends. You can also participate in this program at the Vernon Area Library on Wednesday, October 2 at 7:30pm (register here) or the North Suburban YMCA on Thursday, November 7th at 11:15am (register here).

Read the entire article here.

Important Information for Older Adults

8/16/2019

I recently came across two important articles for older adults and wanted to share them with you.

This article provides an excellent framework for having an honest, helpful discussion with your surgeon before deciding whether to have surgery. It provides questions that really address and explore a patient’s values about quality of life. I encourage you to take a few minutes to read it.

Did you know that many regularly used medications can cause confusion in older adults? Be sure to read this article to learn more about anticholinergic drugs (eg, antihistamines) and how they can be harmful. Searching the Beers list for potentially inappropriate medications use in older adults is also a must; if you see medications on the list that you or a family member is taking, don’t hesitate to ask your doctor about it.

June is Alzheimer's and Brain Awareness Month

6/24/2019

Did you know that every 65 seconds someone in the U.S. is diagnosed with Alzheimer’s? It’s the 6th leading cause of death and affects 10% of people age 65 and over. In addition, family and unpaid caregivers provide over 18.5 billion hours of care - and have high levels of physical, emotional, and financial stress as a result. (More facts available from Alzheimer’s Association.) This month’s blog provides resources about Alzheimer’s and other dementias including symptoms, care options, and caregiving support.

First, it can be confusing when people talk about Alzheimer’s and dementia. Are they the same disease? Dementia is an umbrella term that includes Alzheimer’s disease, vascular dementia, Lewy body dementia, mixed dementias, and frontotemporal degeneration. Alzheimer’s disease is the most common form of dementia. If you're concerned about yourself or a loved one, be sure to consult with a health care professional.

Wondering what signs and symptoms you should be concerned about versus what is considered “normal aging?” Here is a link to 10 early warning signs to watch out for, courtesy of the Alzheimer’s Association. Symptoms can range from frustrating, difficult to manage, or harmful for the person as well as for family members and friends. For example, hearing someone tell the same story over and over can be frustrating but it’s not harmful; however, wandering off in the middle of night can be extremely dangerous and needs to be addressed appropriately. This article has a lot of detail about symptoms, stages of the disease, and coping tips.

Caregiving is tough as well as rewarding. An important message caregivers will hear, regardless of the illness, is that self-care is critical. A wise person once told me, during a health crisis, to remember what we hear every time we go on an airplane: you have to put your own oxygen mask on before helping someone else put their’s on. In other words, if you can’t breathe, you can’t help somebody else breathe. Look for local caregiver support groups, find someone to give you a break so you can run errands, exercise, have dinner with a friend, or do whatever reenergizes you.

If you are caring for someone with Alzheimer’s or a related dementia, take time to learn tips and techniques for maximizing cognitive symptoms, engaging the person in meaningful activities, and having a person-centered care mindset. Techniques for caring for and helping someone maximize their cognitive function include:

Be present in the person’s reality
Avoid arguing
Compliment the person
Avoid embarrassing the person
Match the person’s behavior
Set the person up for success
Do tasks alongside the person, not for them

There are options for getting help with caring with someone with Alzheimer’s or related dementias including in-home caregiving, adult day care, respite care, and memory care communities. Don’t feel like you have to do it alone. Search for options that work for you and your loved one. These can be expensive options but there may be programs in your area that provide free or reduced services depending on financial need, veteran status, or other factors. If you’re considering placing your loved one in a memory care community, here are some questions to ask when touring the communities.

If you have long term care insurance, be sure to know what services and options are covered. Usually, someone with Alzheimer’s or related dementias will need to provide evidence that (1) they have severe cognitive impairment, and (2) they need substantial assistance with at least 2 activities of daily living (ADLs) such as bathing, eating, dressing, and transferring. Read your policy ahead of time and be sure to work with your physician to document these needs appropriately.

If you’ve been reading my blog, you know I often talk about the need for advance care planning, making your end-of-life wishes known to family members. It is critical to have these conversations and have documents in place before a person’s Alzheimers or other dementia gets too advanced and they no longer have the capacity to make these decisions. You don’t want to find yourself in a situation where you are wondering what your loved one would have wanted you to do. Find resources here.

Forms Every 18+ Year-Old Needs

5/24/2019

A few months ago, my friend’s daughter, a freshman in college, had a health scare. Fortunately, everything turned out okay! But my friend hadn’t had her daughter fill out any of the necessary forms to allow the doctor and hospital to release information to her or even to speak to her about her daughter’s medical concerns. Trying to get a busy (and uninterested) college student to fill out the necessary forms while in another state in the middle of a semester was not quick, easy, or painless.

There are privacy laws (HIPAA) that restrict what a health care provider can share about any adult 18 years or older. Yes, this applies even if your adult

child is still on your health insurance plan. Please refer to this article with advice from a lawyer about what forms - and an explanation of each form - you should have your 18+ year-olds sign. You can complete these forms on your own or meet with an estate planning attorney. (Special thanks to Emily Rozwadowski of Spencer & Rozwadowski, LLP for reviewing this information.)

Briefly, the four important documents are:

Health Care Power of Attorney - allows you to designate someone to serve as a your proxy or agent in case you are unable to make medical decisions on your own (Illinois form)
HIPAA Authorization - a document that allows health care providers (and others) to share specific health information with people who you designate to receive that information (sample form from the American Bar Association)
Durable Power of Attorney/Power of Attorney for Property - allows you to designate someone to act on your behalf for financial matters
FERPA Release (Family Educational Rights and Privacy Act) - permission to access educational records (more info and model forms here).

If your adult child is attending college in another state, it may be safest to fill out forms for each state. Some colleges have their own forms as well (e.g., the University of Illinois has this authorization to release confidential health information form); this is something worth asking about at parent orientation.

Once you’ve filled out the forms, keep them in a secure place. Also, be sure to scan them so you can easily access them from your phone as well as from your child’s phone.

So, while you’re checking towels, sheets, comforter, etc off of your college packing/to do list this summer, please add “fill out important forms!”

Disclaimer: this blog does not constitute legal advice. If you have specific questions about what forms to use or how to fill them out, please contact an estate planning attorney.

Let's Talk About... Death Over Dinner?

4/26/2019

Do you know what conversation most Americans are NOT having with their loved ones that they should be having? It’s actually not one conversation but a series of conversations… about end-of-life issues and about life-issues… How do we want to die? This is really about how we want to live, what is important to us, what we want our family and friends to know. After all, it’s hard to have a “good death” without having a good life.

I recently became intrigued with a program known as Death Over Dinner. No, it’s not a murder mystery party. And it’s not as depressing or morbid as the title may suggest. It’s also not just for older people.

Last week, I facilitated this program with an amazing group of women in their 40s and 50s. Many of them were hesitant and skeptical ahead of time. We discussed deep, important topics. “if you had an hour left, what would you feel was unresolved?” A discussion on what we would say if we had to give our own eulogy. And more. Some of the comments after the program included “that was so worthwhile” “can we do this again?” “this was hard, thought provoking and inspiring.” “I felt exhausted when I got here but energized when I left.”

The long term goals of the program are multi-fold:

Start thinking about your own mortality, share your end-of-life wishes with your loved ones.
Feel more comfortable having the conversation with your aging parents, your spouse, your adult children. Gain ideas about how to start those conversations.
Think about how you’re living your own life and whether there are changes you want to make.
It doesn’t hurt if, as a result of having this conversation, you decide to get your advance directives (healthcare power of attorney, living will, POLST documents) and estate planning in order!

My colleague (and traveling Medicare-certified social worker), Allison List, LCSW, and I will be facilitating this program at the Vernon Area Library and the North Suburban YMCA this fall (click here for program dates), and are talking with several other organizations. If you’d like us to facilitate a program at your organization or for your family/friends, please contact me.

Resources to help you start the conversation… and fill out your advance directives:
The Conversation Project
The Five Wishes
State-specific Advance Planning Forms from the American Bar Association

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