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Preparing for a Crucial Conversation with an Aging Parent

Dear Crucial Skills,

I have an aging mom who needs to be moved into an assisted living facility, but she just won’t hear of it. How can I have a conversation with her to help her understand that she needs to move so we will know she is safe?

Concerned

Dear Concerned,

Your mother is lucky to have a loving child who is concerned about her well-being and safety—enough so that you’re willing to step up to what many believe will be one of the most difficult conversations they’ll ever have. After all, you’re about to ask an aging parent to step away from a comfortable situation, complete with a familiar collection of belongings and friends, and enter a situation that could be not only novel, but even frightening.

After all, in her mind, the new home may not be a home at all, but an institution full of people who treat their customers in an institutional way. It’s filled with strangers. There are rules and restrictions of all sorts. Plus, who knows what view your parent has of assisted living facilities. For years, the industry was peppered with horrible places that were often used to hide away the ailing aged—forgotten by loved ones, ruled by the local version of nurse Ratched from One Flew Over the Cuckoo’s Nest, and smelling of urine and alcohol. At least, that’s how movies portrayed the places. Your mom may have even visited such an institution—perhaps the horrible place that housed her mother or grandmother.

The place you have in mind, in sharp contrast, provides lovely circumstances, delicious food, the possibility of companionship, and lots of fun group activities. Why just look at the van parked out front filling up with active seniors on their way to the mall for a shopping trip. Also pulling up out front is a group of high school kids who’ve come to put on a luncheon show of musical numbers and poetic recitations. At the ready, you’ll find a qualified staff of medical assistants who will ensure that the food everyone eats is healthy and in the right proportions while simultaneously monitoring medicines and special needs.

There’s the rub. Two people hold two very different views of the immediate future and two very different opinions about what choice to make. If you’re not careful, you’ll end up trying to convince each other that your view is correct, while fighting off the other person’s incorrect view. As a result, neither of you will change your opinion and you will either continue with the status quo, or you will take your mom to the care center kicking and screaming.

This sort of stand-off reminds me of a time I watched my eight-year-old daughter attempt to convince a neighborhood kid who had just moved to America to taste a bowl of chocolate ice cream. The new neighbor hadn’t tasted ice cream before and the brown blob she was being offered wasn’t the least bit appealing to her. My daughter kept saying, “Trust me, you’ll really like it!” And then when that didn’t work, she’d state: “Honest, you’ll really, really, really like it.” The friend would shake her head no and steel her will against what she assumed was a circumstance similar to the time her mom told her to eat a suspicious looking new food (liver) and not to fret because it was really, really good—only it was liver. Essentially, my daughter was talking ice cream and her friend was hearing liver.

Here are some steps you can take to avoid such a standoff. I’m assuming that your mom’s medical circumstances demand that she move to an assisted living center—for both her safety and your peace of mind. That means whether she moves isn’t open to discussion. How, when, where, and under what conditions are indeed open and require healthy dialogue.

Enter to learn, not simply to teach. Before you start the conversation, don’t merely prepare your arguments, prepare your willingness to listen. You’ll need to understand your mother’s concerns in order to openly discuss and resolve them.

Explain why you made the decision. Don’t start by suggesting that you’re thinking about her moving into assisted living. If you leave that door open, you’ll spend most of your time debating if, when the if is no longer up for discussion. Start by explaining that you and your siblings have decided that, for her own safety and well-being, it’s time she moves. Then share the circumstances that led you to make the decision. Explain the impact her actions have had on her and on friends and loved ones. Let her know that you’re trying to help her find a place she can enjoy while she still has most of her faculties, not a place to stow her away.

Ask her to share her concerns. End your description of why she needs to move with an invitation for her to share her concerns. Some will be accurate, some you’ll need to research, and some will be way off base. Restate each concern to ensure that you understand exactly what she’s saying. Many of the concerns will be about genuine losses of independence and convenience. Discuss ways to mitigate or minimize these disadvantages. When she shares what you perceive to be an inaccurate perception, explain that you see it differently and then share your view.

Quickly call for a study and visit. Rather than try to verbally persuade your mother of all the benefits of assisted living, involve her in selecting a facility—including a visit to some of the choices. Match your mother’s issues with the place that best suits her needs. Play the role of a good realtor—don’t sell the place, let the place sell itself. What do you like? What don’t you like? How might we change that to suit your needs? Talk with existing residents and see how they like it. Where possible, call or visit old friends who are currently living in a care facility and see what they think about the situation. Choose friends who face similar circumstances and they’ll be able to share insights about what to expect and what to do to avoid potential disappointments.

Allow for a trial visit. Many facilities let you sample their services by signing up for a short test period. This is often the point at which the senior begins to realize that having others of the same age around, support from medical staff, prepared meals, less area to clean, and the like, more than offset the loss of living in one’s own home.

Check for success. Once your mother selects a place and settles in, visit frequently—by whatever means possible. Check to see what is working and what isn’t. Where possible, make further changes to match her needs to the facility. Finally, live up to the promise you made to yourself. You meant it when you decided that you wanted what’s best for your mom. Whether this turns out to be true depends a great deal on how often you make contact with her once she’s found a new place to live.

Kerry

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Kerry Patterson

Cofounder of VitalSmarts, Kerry has coauthored four New York Times bestselling books as well as co-designed the company’s line of award-winning training programs. As author of our most popular column, Kerrying On, Kerry shares his vision, experience, and advice through fun and insightful stories from his past. read more

8 thoughts on “Preparing for a Crucial Conversation with an Aging Parent”

  1. I’ve been reading this blog for years now, and I have to say this is the first time I’ve ever strongly disagreed with the advice. My disagreement stems from the belief that the children get to decide that she needs to move into assisted living, and that she has no choice. I see no mention of a condition that has affected her ability to reason. The last time I checked, an adult, even one who is a senior citizen, has the right to make their own choices pertaining to their lives. I can assure you that if I tried this with my mother, it would cause a huge rift in our relationship that would be very difficult to mend. Why do we treat the elderly as if they’re stupid, and incapable of making their own decisions? Their life experience should lend their decisions and opinions greater weight. Instead the recommendation is to treat them as children. I really expected a response that talked about building mutual purpose, and trying to help the mother come to the best decision for her. This ‘resistance is futile’ approach is very disappointing.

  2. While the sequence of conversation was reasonable your response assumed that all decision making and autonomy was removed form the aging parent. In reality, many assited living and elder care facilities are still rife with abuse and low care standards. It is much better for elders to age in place with support and often times less expensive for the family. It was negelectful of your column to assume that assisted living is beautiful and the only option as well as not trying to assure the dignity and safety of elders. Check the research on what is best for elder care….it is not to leave their homes if at all possible.

  3. Hi, I agree at least in part with bluefergus17 above. It’s a tough decision and if the elder adult is still competent they shouldn’t be forced into assisted living if it is against their will. Many people who go in against their will get depressed and don’t live that long anyway. There is always something to be said about having independence even if it is not “as safe” as assited living. On the other hand , sometimes assisted living could be a great source of socialization , new friends etc and the parent might like it. Another option would be live in home support. PS: I took care of people living in assited living for over 10 years and both my parents spent a month or so in a nursing home before dying. My mother was alert and very independent( and stubborn) and wanted to live independently. She only went to the nursing home after getting hospitalized. If I had it to do again, I wouldn’t change anything.

  4. I agree wholeheartedly with the 3 responses above. We elders (I’m 72) are not necessarily stupid, and may want to make a choice to stay at home despite the worry we cause our children. Our children need to learn how to handle that worry. My goodness, we elders have had to “worry” about the choices our kids make, some of which ARE stupid and lead to tragic ends, but we’ve learned not to butt in with meddling, unless asked for our opinion. If our children have some new technical gadget that sends an emergency alerts them, or a central agency when we elders push a button, maybe that would help our kids live with our decisions. I’d go that far. Furthermore, why wait to have these conversations? I initiated a conversation and plan to continue them as I age. For example, my children know I’ll gladly give up my keys long before there’s a risk that my aging might kill someone. I am not even close to needing to be “housed”, which means these conversations are non-threatening for each of us. We all agree that Mom is a long way from moving day. I speed walk 2-miles a day and hiked 4.5 miles with my kids, up steep hills, during Spring Break! That helps them recognize “my time” is not close at hand. I must admit, your answer to this inquiry made me bristle.

  5. I agree with the reservations expressed by the other commenters. In his response, Kerry Patterson seemed to be assuming that the need to place the aging mom in an assisted living facility was not in question. And maybe that is in fact the case (perhaps there was more information provided from the questioner than was stated in the article). However, the wording of the question itself (“How can I have a conversation with her to help her understand that she needs to move so we will know she is safe?”) leads to another possible conclusion.

    Could it be that the real motivation is to reduce the worry on the part of the child? Could the reality be different? Is Mom’s safety really in jeopardy? Rather than starting the conversation by establishing that Mom is going no matter what, and the only choice she has is where, why not start the conversation by exploring alternatives that would allow her to stay in her own home? Depending on her condition, it could be something as simple as a Life-Alert device or as involved as home health care.

    It would seem this approach would make Mom more involved in the decision and accepting of the outcome, whatever that is.

  6. We have an opportunity in the “Golden Years” of our parents to love, respect and help them stay in their home as long as possible. If you really want to be of assistance, start planting the seed by building conversation. “Mom, have you thought of moving?” “Dad, things appear to be more stressful for you. Have you thought about…?” Have open conversations instead of trying to fix.
    If health related issues surface, where falls are happening and then a few hospital visits, eventually, change starts to automatically happen.
    Sometimes, a parent or parents, decide it’s time to make life easier and they are part of looking for a “nice” place to live. Planning is key – as long as it takes and as long as life allows for choices. Then there is the health issue where the mind and body are not working in sync.

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