Preparing for Aging Parents

Aging brings with it new decisions which has the potential become stressful when not discussed ahead of time. Often times in an emergency situation these decisions become the responsibility of the family, whether it be a spouse or children. Honor Hospice social workers utilize their knowledge and experience to help navigate some of these uncharted territories, but planning ahead as a family and having the discussions prior to a stressful emergency situation can greatly assist in adjusting to this new phase of life. As you have this discussion be sure to ask clarifying questions. As a family you want to ensure you are listening to your loved one fully and utilizing summarizing statements of their wishes to ensure understanding. A good place to start is setting up a family meeting with the entire family unit that may be involved in decision making. The focus of the meeting is to learn about your parent’s care wishes, and ensuring the entire family is on the same page going forward.

Things to consider during the family meeting include:

1. What does your parent want?
Seek an understanding of your parents wishes and care needs. Ask clarifying questions about various topics that may come with aging. Topics you may want to consider in this discussion may include:

• If your parent wishes to have life prolonging measures like life support or if they would want CPR to be completed in the event their heart or breathing should stop.
• Understand if they want to focus on aggressively and exhaustively working towards curing a disease that may arise or focusing on quality of life and living comfortably with their loved ones. Discuss what point they would want to transition to hospice care. Insert link for what is hospice page
• Understanding their care goals prior to an emergency can help the family gain peace knowing that the wishes are being considered and followed. This is also a great time to discuss creating an advance directive. Advance directives include living wills (not recognized by Michigan law), do-not-resuscitate declarations, and durable power of attorney for healthcare.

Do-Not-Resuscitate Declarations are written and signed document expressing an individual’s desire not to have resuscitative measures in the event that breathing or heartbeat should stop.

Durable Power of Attorney for Health Care documents allow your parent to indicate an individual as a patient advocate. This patient advocate will make medical decisions on your parent’s behalf if your parent becomes to sick or cannot make the decisions on their own. Without a chosen patient advocate, decisions will be made by your family members. If your family members have trouble making the decision or cannot agree a judge may appoint an advocate to make decisions for you. While a living will is not recognized by Michigan Law, the durable power of attorney for health care document may include a list of specific wishes for use by your advocate to assist in making decisions. Speak with our social workers, your lawyer, your doctors, or family and friends if you have questions regarding the advance directives. You can also visit the State of Michigan website for more information and additional resources regarding these documents. Of note, there is a separate durable power of attorney for finances. Often times, families may think these durable power of attorney documents are interchangeable. 

2. Who will provide care?
Discuss who will provide care in the event your parent is no longer able to care for themselves. Discuss your parents’ preferences whether it be living in home or moving to an alternate living facility. There are varying stages of independence your parent may work through over the course of a lifetime. As a family make a list of who will provide care at each of these stages. There may be times when assistance is needed a few hours a day for chores, or in some instances monitoring may be needed 24 hours a day. In some instances, a spouse or child may be able to assist in care, but after learning your parents’ desires, be realistic about the care the family can provide. Are you able to provide the care as a family, or do you have medical circumstances of your own leaving you incapable of safely providing the care? Discuss the options honestly as a family and set realistic expectations.

3. Where does your parent wish to receive care? What are the housing options?
Your parent may wish to remain in home for as long as possible, in which case a further discussion should be had about who will act as the primary caregiver. Options may include utilizing family, support systems, hired private caregivers, or a mix of these. For those with more needs an assisted living, memory care, or nursing home may be an option.

Assisted Living Facilities are best suited for the parent that may not be able to live independently but may not require constant medical monitoring and care. Assisted livings are great for your parent as they allow for a level of independence in their own apartment, with increased social opportunities with others in the living community through meals and scheduled activities. Assisted living facilities often include meals, light housekeeping, transportation, laundry, assistance with bathing, dressing, and grooming, and medication management.

Memory Care facilities are assisted living facilities tailored specifically for those with dementia and memory loss. The specially trained staff at these facilities deliver all of the same care that is found at the traditional assisted living facility, but also have the added benefit of managing many of the unique challenges that may arise in the face of memory loss. In addition, these facilities often have increased safety measures to prevent your parent getting injured or wandering and getting lost.

Nursing Homes are best for parents with requiring higher levels of medical monitoring and care. Nursing homes have licensed nurses on staff and in this living arrangement your parent will monitor and assisted around the clock.

Care at Home can include care at your parents’ home or within a family members home. Care in home may be delivered by a spouse, family member, friend, neighbor, or other from your parent’s support system. Additionally, a privately hired caregiver may be used to assist to varying degrees. Private caregivers can assist for a few hours with specific tasks like dressing, bathing, household tasks, laundry, or meal preparation, or for longer periods up to 24-hours if constant supervision is needed. Some families like to use private caregivers to supplement the care the family is providing and fill in gaps when needed. Discussing care at home is also a good time to touch on any home modifications that may be necessary for safety. Think specifically on high-risk areas like the bedroom, bathroom, and living areas. Would grab bars near the toilet and shower be beneficial? Is a transfer bench needed for getting into and out of the shower? Would a raised toilet seat be safer? Remove or secure any trip hazards like rugs and ensure proper lighting, especially on the way to and from the bathroom. Take this time to discuss any modifications you may need to ensure your parent is safe in their environment. Our team would be happy to discuss the options to ensure your environment works for you.

4. What are the financial requirements? Can my parent manage their finances?
Talking money can often be uncomfortable but addressing finances can help you to make the best decisions regarding your parents’ care going forward. Look at your parent’s financial situation and discuss retirement savings, social security, pensions, owned assets, and any additional sources of income along with living expenses and any outstanding debts which may include house payments, car payments, or credit card payments. Look into their current and projected monthly living expenses if circumstances changed or they moved to an alternative living solution as highlighted above. Does your parent have any long-term care insurance to assist covering these costs?

This may be an ideal time to discuss if your parent may need assistance with management of their finances. This may included designating one family member as a primary assistant in finances, whether informally or formally through a durable power of attorney for finances or a living trust.

5. What support systems are available?
Take an inventory of the support available to your loved one in their current situation and detrmine the willingness and ability of each party to assist. This may include informal support from spouses, family members, friends, neighbors, members of a church, fraternity, or connections made through other organizations as well as more formal support from organizations like meal delivery or caregiving agencies.

6. Is everything organized?
With aging brings a large volume of paperwork. Keeping all documents organized will help in emergency situations or through various changes in health. Compile birth certificates, marriage certificates, social security cards, insurance information, passports/driver’s licenses, durable power of attorney papers, financial documents, military records, medical history, and medication lists. Make sure these documents are stored in a safe, yet easily accessible location like a fire-proof safe. Some families choose to scan these documents and upload them onto a computer and secure them electronically for easy access. It is important to know some documents will require a physical copy so keeping both the physical and electronic copy safe will be necessary. 

In conclusion, be prepared, conversations about changes with aging can be difficult and bring mixed emotions from various family members. Some elderly parents or other family members may be resistant to or anxious about having these discussions. Honor Hospice can support these and guide you through them as a family and help the entire family cope with the changes. As a family, we highly encourage you to periodically re-visit these discussions to ensure your parents wishes as well as your families’ situation has not changed to ensure you are doing all you can to honor their wishes as they age. For additional resources for family caregivers please visit our caregiver education resource library or contact our team for additional information.