Helping Families Navigate Elder Transitions
Stacey J. Drubner, JD, LICSW, MPH
EAP Ask the Expert: Barbara Moscowitz, LICSW, Founder and Associate Director of Education and Support, MGH Dementia Care Collaborative
According to the Wall Street Journal, life expectancy increased by 63% (48 to 77 years) in the 20th Century. Future medical advances may make it common for more people to live to 100 and beyond. Even today, many have several healthy years after retirement. This is good news, but it also provides a reason to rethink how we approach aging and how we view and help our older relatives.
Our eldercare expert for this feature, Barbara Moscowitz (see “Spotlight” below), advocates for a different approach. Getting older is about more than disease, medications, and burden. Aging is a normal part of the life cycle, with goals and opportunities to enjoy life. Broadening our scope to focus on thriving, not just surviving, allows for building a fulfilling life in older age.
The key is to engage in advance planning and honest discussions about lifestyle preferences, living situation, finances, and health care. This is not always easy when you consider some of the barriers:
• Current perceptions which define aging as just a disease
• Family dynamics
• Avoidance of difficult or awkward topics
• Time constraints and competing responsibilities
• Financial limitations
The potential consequences of not planning:
• Unmet expectations
• Giving up choice and self-determination
• Low satisfaction with life
• Considerable stress on the family
The discussion below offers guidance for navigating transitions in the twilight phase of life and provides eldercare strategies for families.
Spotlight: Barbara Moscowitz, LICSW
Founder and Associate Director of Education and Support, MGH Dementia Care Collaborative
The EAP turned to Barbara Moscowitz, from MGH to understand how to best help elders with transitions related to aging.
It’s OK and even helpful to acknowledge that planning for eldercare is not simple. Conflicts and hurdles are a normal part of the process. If your family has entered this stage, then you probably already have a sense of how challenging this can be. Barbara recommends striving to be practical and realistic, not perfect.
Preparing for Eldercare Planning
Manage expectations in advance
Part of what makes helping older relatives hard is that many family members want to impose their ideas about what they think is best. This is often met with resistance, avoidance, and resentment. If you let go of the responsibility of having to run your relatives’ lives, you will be less disappointed and more successful in helping. Remind yourself that:
• Parents or older relatives are adults and should not be treated like children
• They are allowed to make their own decisions
• You should respect their autonomy
• You don’t have to agree with all their decisions, even the “bad” ones
• Like all of us, elders have different ways of navigating life and not everyone will age on the same path
• Your role may just be to inform and pick up the pieces when needed
Identify the people and factors which can impact the planning process to identify barriers or assets
• Consider the personalities of your older relatives – are they:
– Planners or spontaneous
– Risk-takers or more conservative
– Homebodies or travelers
• What are the family dynamics?
– Cultural norms and priorities (for example, do grandparents typically live with family?)
– Individual roles
– Alliances and challenging relationships
Tips for Communicating with Elders
• Start with the idea that eldercare planning is no different than planning for any other life stage or milestone, such as college, marriage, retirement or having children
• Highlight that there are many experiences in between retirement and end of life
– Elders should utilize opportunities to make decisions about what lies between now and being unwell, also known as “healthy decision” periods
• Communicate your intention to be a partner in helping relatives live the life they want, rather than making decisions for them
• Planning doesn’t mean readiness for a transition; it is a necessary step to be aware of and to have options available when/if needed
• Tie planning to preserving their ability to follow their path of choice
• It is easier to plan when you are not in the midst of a crisis
– This is especially true with senior living. In a 2020 survey, conducted by WebMD and Capital Caring Health, nearly 90% of adults over age 50—across all age, race, income, and health status categories — reported a desire to remain at home and age in place. Anticipating needs will make this more attainable
– You may want to review these resources from AARP and Aging in Place to learn how to accommodate transitions in mobility and maximize accessibility in the home
– For some, living at home will not be feasible, due to either finances or health status. Identifying options, understanding eligibility, and having choice in community living also requires advance planning
• Engage the help of PCPs, other clinical professionals, clergy and trusted friends
– Sometimes relatives are more receptive to input from outside the family
• Suggest that elders check in with friends (who may be at the same life stage) to learn about what steps they are taking to live a fulfilling life
• Sometimes the parent who has less health challenges may put up barriers as they feel they can manage the care of their spouse
– Barbara recommends engaging the parent with the health challenges to understand their wishes. This may be helpful when negotiating with the caregiver parent
• It’s OK to communicate when you are concerned or worried
• If parents do not want to engage, accept their decision, and provide support when needed, to the extent you are able
– Try not to personalize or view resistance as an insult. Typically, this is related to a desire to maintain autonomy or reluctance to address aging and all it represents
Do your homework on Resources, Systems and Processes
As discussed, you may or may not be able to get your older relatives to see things the way you do. For some families, this can be a roadblock and paralyze all eldercare planning. “The best offense is a good defense”. Barbara strongly recommends educating yourself on all things eldercare. Learn the “lay of the land” and know the options, tools, and resources in advance.
This puts you in the best position to build a framework to help your loved ones and to be prepared when a need arises. You can do an approximate projection of what the future might look like and fill in the details when you have them. Of course, you cannot predict everything. The goal is to be flexible but arm yourself with enough knowledge, so you don’t have to start from scratch in the middle of a crisis. This will save time, minimize stress, and allow for faster resolution of issues.
The EAP offers a full range of Eldercare Resources on the website. Here are a few you might find helpful:
• Support for Family Caregivers
• Understanding care in Hospitals and Rehab
• Resources on Common Medical Conditions in the Elderly
Minimizing Stress between Family Caregivers
It’s helpful to remember that family dynamics are often magnified, not resolved during stressful situations. Managing expectations can go a long way. Barbara suggests the following:
• If possible, include your older relatives in assigning responsibilities
• Ask them to choose a Healthcare Proxy or Power of Attorney
– This serves to clarify their wishes and minimize conflict
• Meet with all potential family helpers
– Discussions are useful to share information and determine who can contribute. Different family members may have a pulse on areas such as social, medical, or financial
– Be realistic and honest about your own ability to help
– Don’t expect that everyone will have the same capacity or desire to provide assistance
– Avoid establishing competing alliances
– Keep the lines of communication open as needed
– Utilize a mediator, care manager or other community professional to help navigate conflicts or get objective input
• Fill in the gaps after family capacity to help is exhausted or not available
– Hire help (aides, care managers) as finances allow
– Use benefit-covered or State affiliated services such as:
Aging Service Access Points (ASAPS), – private, non-profit agencies which provide elder services and programs
Visiting Nurse Associations – provide home healthcare and hospice services through a network of nurses, therapists, social workers, and others
– Engage community systems such as volunteers or religious organizations
When should Families Intervene, even if they cannot Negotiate with Older Relatives?
It is important to know the line between your relatives’ bad judgment and competency to care for themselves. These circumstances relate to cognitive impairment (including dementia) or frailty, when safety and well-being are compromised. You should trust your knowledge of your relative when determining if something seems off. Below is some guidance to use as a barometer:
• How do Parents respond when you ask them what they will do if there is a fire in the house or a stranger at the front door?
• Are there signs of appliances being left on?
• Are they paying their bills?
• Have they been repeated victims of Fraud or Scams?
• Are they taking their medications properly or are they in disarray?
– Check pill packs
• Are there signs of lack of attention to medical needs?
– Look for bruises, swollen ankles, breathing distress
• Are there signs of a decline or neglect of personal hygiene or the home environment?
About the MGH Dementia Care Collaborative
The Massachusetts General Hospital Dementia Care Collaborative is committed to improving the experience of patients and families living with Alzheimer’s disease and related dementias by changing the way our healthcare system understands and treats these individuals. The program is a resource for patients, families, and clinicians and provides education, clinical co-management services, and emotional and social support.
Help from the EAP
The Mass General Brigham EAP is available to help with concerns about yourself or someone you care about. The program offers free and confidential services for employees and immediate household family members. EAP records are separate from medical and HR records. Contact the EAP at 866-724-4327, or request an appointment via our online form for confidential assistance.