By Michele Parente | JUNE 22, 2015
In his decades as a San Diego elder care attorney, Stuart Furman helped his clients prepare for the latter stages of life by getting their financial and legal houses in order. But all the estate planning in the world didn’t equip him for his own parents’ failing health and capacity.
“The same things I was advising people on, I suddenly was faced with. But it’s totally different on the other side of the desk,” said Furman, author of the recently released “The ElderCare Ready Book.”
For all of Furman’s knowledge of complex matters, his father’s 15-year struggle with dementia and his mom’s need for assisted living underscored the importance of a simple concept: People need to talk to their parents about their care in the long term.
Furman and other experts advise that it’s best to have these conversations about care as early as possible, before decisions have to be made in the midst of a crisis or before parents lose the ability to make decisions for themselves.
“Mom would go the hospital and they’d ask me what medications she was on, and I had no clue,” Furman said.
Getting a clue isn’t easy, though. Several studies have shown that more than 60 percent of adult Americans feel uncomfortable talking to their parents about elder care and only about 42 percent have actually done so.
“It’s an abstract concept, planning for long-term care, ‘what do we want, what do we need,’ ” said Danielle Glorioso, executive director of the Center for Healthy Aging at the University of California San Diego.
Glorioso and Furman noted that when children take on parentlike responsibilities, it can be an awkward, sometimes contentious role reversal. And while the conversation might center on housing options and advance care directives, what’s not being talked about can be more difficult to deal with.
“It’s also facing mortality. … If you’re saying, ‘what will your needs be,’ you’re acknowledging end-of-life issues,” said Glorioso. “If you see that someone is losing their cognitive ability, it can make them feel very vulnerable.”
The consequences of avoiding the subject can be serious, according to a 2013 study on dementia and financial decision-making conducted by the Federal Reserve Board.
“Cognitive impairment of a financial decision-maker can lead to financial mismanagement,” the study said. “The emergence of difficulties handling money can be extremely problematic if one does not have assistance with this task. … (However) a cognitively impaired individual often continues to make financial decisions even after he is aware of his difficulties handling money or has even received a diagnosis of a memory-related disease.”
Furman and Glorioso offered these tips for talking about long-term care:
• Initiate the conversation as early as possible, before there are problems, when you can still talk about “what if,” not “what now.”
• Use hypotheticals to explore a topic, such as pointing to a friend’s situation and asking what they would want if it were them.
• Don’t try to cover too much ground with one talk; have an ongoing dialogue.
• Don’t be confrontational; remember it’s ultimately the parents’ decision.
• Do your research on all the options, say, in housing or transportation, so the parent feels like he or she has choices and isn’t being forced into a predetermined outcome.
• Be inclusive, not secretive, to build trust; try to get siblings on the same page.
“Elder care will happen to everybody eventually,” Furman said. “Don’t fear it; just be prepared for it.”