Making Decisions For Elderly Parents

Relationships can be strained and even broken as the elderly and their adult children negotiate the inevitable reversal of roles and as very difficult decisions are made.

Let’s face it. Each of us wants to be free to make the decisions we want, even if they might sometimes seem self-endangering. The debate in the US over helmet laws for motorcyclists is an example. Yet every day, millions of families agonize over when is the appropriate time to begin stepping in and making decisions on behalf of their older loved ones. For most families, transitioning from the “parent-child” relationship to an “adult-adult” relationship takes place naturally, and once the grown child is married and has children of his or her own, there is usually an unspoken acknowledgement of the “adulthood” of the grown child. In some families, of course, there can still be unhealthy signs of immature emotional dependence on parents (and an unwillingness to speak the truth), or a hurtful need for the elderly parents to dominate, criticize, or even punish their adult children.

Even given the most harmonious relationship between senior adult parents and their grown children, the transition in roles as the parents become increasingly frail is fraught with pitfalls.

The process often begins with observations:
Mom is forgetting to take her medication
Dad is less aware of his surroundings while driving
Mother is not bathing as regularly as she always has
Dad has unusual physical symptoms and refuses to see a doctor

For the adult children, it now becomes obvious that their parents are slipping in some potentially dangerous areas and some interventions are necessary. Here are suggestions of possible steps, beginning with the least intrusive, in an effort to maintain a good relationship.

Start with verbalizing your observations to see how the elderly respond to them. Making observations may lessen the resistance you encounter more than suggestions or directives.
Next, involve the parent in problem solving: “Dad, what do you think would help you to see signs on the highway
Make specific recommendations in the least authoritative way possible. “Mom, do you think it would help you to have a timer medication dispenser?”
If making gentle specific recommendations does not have the desired effect, it will likely be necessary to become more direct in trying to ensure a safe environment for your parent(s), perhaps eventually enlisting the help of a doctor.

Be aware of your parent’s possible feelings of embarrassment, shame and impotence as more decisions are made for them. Use humor, self-deprecation, and a positive outlook to help the elderly from focusing on their loss of independence. Find a positive side of any negative occurrence without belittling what elders are going through.

The pitfalls for caregivers are many. These are situations ripe for misunderstandings, misinterpreted intentions, sibling disagreements, hurt feelings, feelings of powerlessness and constant worry, and the inner conflict of wanting to love and honor our parents while sometimes having to act against their wishes.

I suggest several principles for families facing these caregiving decisions.

Give elderly parents every opportunity to continue to make their own decisions. It may take a crisis, but at some point it will become clear to all involved that a change in level of care is necessary. Hopefully the crisis will not result in permanent physical damage.
Recognize that sweeping changes may not be necessary. Sometimes smaller modifications like Occupational Therapy or a change in medication may be all that is needed.
If someone believes a change in level of care is necessary, call a family meeting that includes the parent(s). Do not try to control the discussion, but see that all medical reports and personal opinions are heard. Ask how each can help in their own way.
Certain family dynamics will almost certainly play out: the daughter living closest will take most responsibility; a son living away will tend to minimize the crisis; the daughter living farthest away will question most intensely the judgment and decisions of the closest caregiver. If you are the closest caregiver, it is important that you not take criticism personally, but stay focused on the facts and the needs of the parent(s).
Get as many medical/social work/home health care opinions as you can for the family meeting. Work towards a decision by consensus. Again, do not try to control or push for a certain outcome, but make sure all facts and opinions are presented and fully discussed.
Be aware of your parent’s possible feelings of embarrassment, shame and impotence as more decisions are made for them. Use humor, self-deprecation, and a positive outlook to help the elderly from focusing on their loss of independence. Find a positive side of any negative occurrence without belittling what elders are going through.
Reminiscing helps the elderly focus on past events and eases the pain from current difficulties. Find happier times to talk about occasionally to ease the tension.

Caring for our aging parents and negotiating that inevitable reversal of roles requires planning, understanding, patience, thick skin, and a sense of humor. And that is undoubtedly what we would want in our caretakers as we approach later life.

Reprinted with permission from Village Streams, an e-News letter of Advent Christian Village. Rob Crankshaw, PhD. is a licensed marriage and family therapist. He is the VP for Youth & Family Services at Advent Christian Village (ACV), a non-profit retirement community that offers a complete continuum of care and is located in north Florida, on the banks of the Suwannee River. To learn more about ACV or to sign up for Village Streams, visit www.acvillage.net.

by Rob Crankshaw, PhD, ACV Vice President Youth & Family Services

Comments are closed.