When aging parents can no longer decide about elder care issues for themselves, someone has to make the choices that will make them happiest. Here’s a process that can help.
Are your aging parents either unwilling or unable to engage in the process of making decisions about the future?
Perhaps they’re in denial about needing to make changes. Or maybe their condition — cognitive decline, depression, compromising medical issues — prevents them from being able to play an active role.
In either case, you suddenly find yourself thrust into the role of decision-maker, like it or not. It’s a role you are most likely unprepared for, at both an emotional and a practical level. The responsibilities can be daunting. We all want to do the right thing for our elderly parents, but we’re not always sure how.
How do you navigate this uncomfortable new role in a way that will help produce the best outcome for your parents and the family while keeping the peace?
In my 30-plus years of working with families and their aging parents, I’ve learned that there’s one crucial guiding principle to follow:
The decisions are not about you. They’re about your parents.
What may be most comfortable or convenient for you or other family members is not necessarily going to be the best choice for the ones who need the care.
Look at Things from Your Parents’ Perspective
Time, cost, peace of mind, quality of life, convenience, control, respect—these are factors we consider when making decisions about elder care. They are tied to our core values, and so they are primary considerations for us. But what’s important to us—our priorities—may not be so crucial to our elderly parents. When we make decisions for them, we have to look at the situations through their lenses and take into account what matters most to them.
Take Sandy, for example, the daughter of an elderly woman I worked with. Sandy had a durable power of attorney for her mother’s healthcare and had some difficult decisions to make. Her mother was living on her own but was showing signs of dementia. She continually forgot names, misplaced things, and repeated stories. The situation came to a head the day her sister called to tell her that their mom had been in a car accident and was in the hospital.
She didn’t know whether it would be best for their mom to return home once she was out of the hospital, to move to a senior residence, possibly even a nursing facility. Each prospect came with its own set of concerns: would her mom be happy leaving home? What if she refused to move out of her house or even accept any care? And if she stayed home, would she need some care or supervision? Was it at least time to take away her car keys?
Sandy worked full time, had two high-school-age children at home, and was involved in several community organizations. So, having her mother move into an assisted-living community that was close by would be the most natural solution for Sandy. It wouldn’t be a time-consuming chore to visit, and the community’s staff would coordinate and handle her care.
Fortunately, Sandy and her mother had already been having ongoing conversations. So Sandy knew her mother wanted to continue living in her own home. Her mother had even given her a reason why: She had a bad experience when she moved her mother—Sandy’s grandmother—into a so-called retirement home many years earlier.
Because she could see things from her mother’s perspective, Sandy was willing to honor her mother’s wishes and find a solution involving in home care that allowed her elderly mom to continue living in her own home.
3 Steps That Will Help You Decide What’s Right
Developing thoughtful responses and plans that are consistent with your parent’s wishes requires advanced planning. The following steps can help you reach decisions that the entire family can feel good about:
Have the difficult conversation with your parents long before you get to the point where they can’t make decisions about healthcare or other issues. Better yet, have conversations—plural—with them, and when you do, be sure to address these topics:
- Who do they want to make medical and elder care decisions for them if at some point they can’t do so for themselves?
- Who would they like to put in charge of making financial decisions in their place if needed? (This may not be the same person as above, as they might feel that a particular family member is well suited to one role, but not necessarily to the other.)
- What are their wishes if something should happen that prevents them from articulating these? Do they want in home care, or would they instead move to an assisted living community? What kind of medical treatments do they want to receive? Which ones would they decline?
Remember, ongoing discussions with your parents will be far more helpful—for you and them—than just a single conversation.
Formalize Your Parents’ Wishes
After you have learned your parents’ wishes, meet with an attorney who specializes in issues related to caring for elderly parents. He or she will be able to prepare a legal document based on the decisions that came from the conversations with your aging parents. Should your parents become incapacitated, the document will give you the well-recognized authority to make medical or financial decisions on their behalf.
Always Do What Your Parents Would Want
If you’ve assumed the decision-maker role, let substituted judgment guide your choices. This is the concept of making decisions that are consistent with the conclusions your parents would make if they could.
Again, it’s not what you think is the right thing to do, but instead, what your parents would want to do. Whenever possible, include your parents in the decision-making process, even if they are impaired in some way. If they’re able to play even a small role, retain some sense of control, it’s likely they’ll feel better about the outcome.
It’s not easy being the decision maker. You might feel overwhelmed by your expanded responsibilities and a new role. So remember: you’re not expected to go this alone. You can ask other family members for help or consult a third-party professional such as an Aging Life Care Professional™ or a geriatric care manager. With their support, you and your family can more easily come to a consensus and feel good about the choices you’ve made.