Talks ease families into emergency care

By Josette Keelor

Important health conversations aren’t easy for aging parents and their children, but area professionals say such discussions are essential.

At Home Instead Senior Care in Winchester, the free program “40-70 Rule” offers conversation starters for children and their parents on topics like end of life wishes. It encourages these discussions to take place by the time children are 40 and their parents 70, to address concerns before an emergency happens, said Cheryl Strickland, Home Instead community services representative.

“A lot of people put things off, and it’s just all about being prepared,” Strickland said.

Though parents sometimes initiate these conversations with their grown children, Catherine Galvin, executive director of the Shenandoah Area Agency on Aging in Front Royal, said it’s usually the other way around.

“Older adults hesitate to take the initiative to take this sort of planning,” she said. “[It’s] very difficult for them to know how to approach it.”

“In my experience it’s better when the adult child or caregiver takes the initiative,” she said.

Approach the subject cautiously and, when possible, honor parents’ wishes, Galvin explained.

“I think that’s the opening,” she said. “Put yourself in your parents’ shoes.”

Doing this helps form emotional connections, said Jennifer Behm, a clinical mental health counselor and educational specialist at MindSpring Counseling & Consultation in Winchester.

“It’s very, very lonely at that stage of life,” Behm said. Care for ailing seniors can resemble care for young children, “only you have with you all the maturity and cognitive awareness of an adult.”

“So whatever is communicated, I think that respect and dignity is a very big part of that,” she said.

Hot-button topics for families include continuing care facilities and driver safety, and Galvin recommended a thoughtful approach.

“In rural areas, driving is a last vestige of independence,” she said. “The adult child does not want to say to mom, ‘Hey, you should not be driving anymore.'”

In the case of a medical concern, such as the driver’s slower reaction time or impaired alertness caused by an imbalance of blood sugar levels, children might defer to a physician’s expertise.

“If a physician can intercede … it takes the heat off of the adult child,” Galvin said.

Although she knows of desperate children deferring to the Department of Motor Vehicles, she said planning ahead for a possible drivers’ license surrender makes the transition much easier.

Make specific goals, she said, like coordinating travel for a parent who agrees to relinquish a drivers’ license.

That way, she said, “everyone knows what’s going on. That way, the older person is safe and also maintains their independence.”

Because defensiveness stems from fear, Behm said discussions should begin with questions about a loved one’s expectations for disease, death and the afterlife.

“Be truthful about what the future is going to likely be,” she said, and “keep hope realistic. Encourage them to hope on a goal that’s a realistic goal.”

Realism includes not making promises you can’t keep, Galvin said, like “I will never put you in a nursing home.”

“Never say that because you never know what can occur,” she said.

To help ensure seniors have some control over end of life, she said discussions should include specific desires on resuscitation and life support that children agree to follow whenever possible.

Behm agreed: “Set the plan out ahead of time, and then it’s easier when you get there.”

Home Instead Senior Care’s 40-70 Rule program is a free, ongoing information initiative. Call 540-722-8750 to learn more or receive a free copy of the book “Action Plan for Successful Aging.”

The Shenandoah Area Agency on Aging would consider offering programs on crucial family conversations, if the community is interested. For more information, call 540-635-7141.

Contact staff writer Josette Keelor at 540-465-5137, ext. 176, or

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