Dear Mrs. Hughes March 21

Dear Mrs. Hughes,

My widowed mother is getting older and frailer. For instance, she is at the point where it is often difficult to get out of a chair. She lives out in the country far enough that home care assistance isn’t available. At some point, it is likely we will have to have a conversation about her moving to somewhere that offers some assistance.

Unfortunately, one of the fears she has been stating for years is that her kids will “put her in a home.” While we don’t want to do that, we also want her to be safe. How do we respectfully have these conversations?

Worried About Mom

Dear Worried About Mom,

Don’t wait! Have that conversation as soon as possible. While none of us relish the idea of having this particular conversation with our parents (it takes courage!), numerous health agencies recommend having this conversation as early and as often as possible before any real need sets in and one’s parents are of sound mind and body, usually around 70 years old. It is less threatening to contemplate alternative living situations when they are a future consideration and not an imminent crisis. It is important one’s parents have as much voice in this conversation as possible and as much agency choosing their next, and in all probability, last home. Losing one’s independence and personal decision-making authority is a terrifying part of getting older. Given your mother’s stated fears that her kids will “put her in a home,” I can understand your reticence.

I wanted to give you the best advice possible, so I looked up how to have these conversations. It turns out there is a recommended approach, which reminds me a lot of how to have an effective intervention. Here are some tips condensed and taken unabashedly from AI and AARP:

• Prepare in advance – Know your topic. Research available living situations that fit your mother’s budget. Anticipate her questions and concerns.

• Get support – You said, “her kids,” so I assume you have siblings. It would be ideal if you could all be on the same page before approaching your mom. Brainstorm possibilities and who would be responsible for what.

• Choose the right time and place – Have this conversation somewhere your mom feels safe, when both of you are in a calm and grounded state of mind.

• Your approach matters – Be sensitive! Be respectful. Imagine how you would feel if the situation were reversed. Be kind. Be gentle. Express your love and concern for your mother’s wellbeing, Try not to come off as confrontational or knowing all the answers. Find out what your mother is afraid of. Find out what is important to her. Remember, this should be a team effort, all of you together working towards a shared goal.

• Communicate effectively – LISTEN. Active listening is when you really hear the other and are not just waiting for your turn to speak and get your point across. Reflect back to your mother that you grasp her concerns. Make sure she feels heard and understood. If this can be a group effort with your mother as an equal decision maker (or better yet, the main decision maker) all the better. Use “I” statements (“I think…”, “I feel…”, “I believe…”) to emphasize your own experience and avoid sounding as if you are passing judgment or placing blame.

• Be patient – Once again, imagine if this were you. This is an enormous transition for someone to consider, let alone to make. Allow your mother to get used to the ideas you and your siblings are suggesting. Offer her options. Visit places together. Ideally, give her the time she needs to come to a decision on her own. There is a geriatric assessment evaluation that considers many different physical and cognitive functions to determine if an elderly person is safe living on their own. It includes areas such as: physical mobility and safety, emotional well-being, medication management, memory, hygiene and self-care, vision and hearing, social isolation, falls, cognition, mood, financial management, legal concerns, keeping up with mail, etc.

The first time I tried talking with my mother about this, it did not go over very well. I was all gung-ho after learning about this assessment in a clinical inservice and came off as a know-it-all. I had learned about the assessment, but not about how to prepare for this discussion. My mother was insulted.

In hindsight I can see how I was over-zealous and insensitive. In my exuberance of learning something new and “being an expert in the field” I completely overlooked how this conversation, coming out of left field as it were, might be upsetting to my mother. I hadn’t done my homework. I was too matter of fact. I hadn’t anticipated her fears or taken into account how she might feel. Luckily, after my eating of a healthy serving of crow, she was able to forgive me. In my own clumsy way, I was at least able to convey my love and concern and it did open the door to future conversations.

In the end, my mother and I did get to a place where we talked frequently and openly about this issue. It reassured both of us that I knew my mother’s wishes and that she trusted me to uphold them the best I could.

In all honesty, my stepfather was another story. Eight years older than my mom and approaching 90, he didn’t want to hear anything about it. Every time I tried bringing it up, he accused me of “trying to kill him.” Having been his sole caretaker for years, this broke my heart. I waited too long to start the conversation with him. He felt too vulnerable. He never wanted to talk about future inevitabilities. Who knows, it might not have mattered in the end. His dementia might have gotten in the way of him remembering anything about the conversation. I do think having something in writing,maybe a folder of future plans that he signed off on, could have helped him feel more in control.

I want to end with this…

I have a good friend whose elderly dog has been getting increasingly frail and stubborn. He can be cantankerous and is riddled with arthritis and other old dog maladies. He smells. He still does love to go on walks, but can’t go very far. My friend used to rely on her walks with her dog for her exercise. At some point she realized she would have to find another way to fulfill that need.

Now she lets her dog walk her. She lets him decide which way to go. If he wants to roll around on the grass and sniff dandelions for 20 minutes, she lets him. This is his time and their sacred time together. My prayer is that my kids value me as much as my friend values her old dog and treat me as reverently, tenderly and respectively when I get to that age.

Good luck with talking to your mom. If you come from a place of love and respect, letting her know how much you value her and her input, you are off to a good start. Remember, this is hopefully just the beginning of many conversations to come. Hopefully it will get more comfortable once you break the ice.

Yours most truly,
Mrs. Hughes

About Mrs. Hughes

Mrs. Hughes is the pen name of Raizel Weiss Heizer, a licensed professional counselor, officiant, sacred passage doula and grandmother in Colorado Springs. She also has a background in the performing arts. Send your questions on life, love, money, parenting, difficult neighbors, or any sticky situations to dearmrshughes@pikespeakbulletin.org. No topic off limits, though publication is not guaranteed. Use a pseudonym if you wish.