Getting Started

Starting the Conversation

Many people worry about raising these issues. They may mentally rehearse having "the conversation," but are never able to actually do it. The following guidelines can help you to start the process—the first step in becoming a caregiver.

Define the Need

Ideally these conversations should happen before there is a crisis. Usually they are prompted by a decrease in an elder's ability to do certain things she or he has always handled independently. Many elders also find it difficult to talk about these issues—but not always for the reasons you may think. In fact, they may be relieved to talk about their fears and concerns once the issues are raised. Don't assume that you are the only one who wants to talk.

You may want to start the conversation by telling the elder that you read an article, watched a film such as Caring for Your Parents, heard a speaker on the topic, or spoke to a friend whose parents are in a similar situation. This helps remind the elder that he or she is not the only person whose life is changing—others are experiencing the same changes and confronting similar issues.

Who Should Be There?

Consider how to make the conversation as caring and productive as possible. Although you don't want to bring too many people into the conversation—you don't want to overwhelm the elder—who is included in the conversation depends on family dynamics and the personality, marital status, gender, and health of the elder. If possible, talk together with your family before meeting with the elder in your care. Give everyone the chance to discuss their own needs and concerns, and what role they want to or are willing to play as part of a family caregiving team. Decide if:

  • The elder's spouse should be present
  • All, some, or one of the adult children should be present
  • A favorite family member, such as a niece or nephew, should be included
  • The elder's sibling(s) should be present
  • A family doctor or other respected professional, such as an attorney, should help facilitate the conversation

Where and When?

Assess what the best circumstances are for an elder to hear about your concerns and voice his or her own opinions. If the elder tires easily late in the day, you may want to meet in the morning. You may want to begin the conversation after a meal. Is there a favorite chair, room, backyard, or park where the elder feels especially safe and comfortable? The context for the conversation can have an impact on whether the elder can truly "hear" your concerns.

Small Steps

You probably do not want to begin with the "big picture." Start with small steps, small decisions, and small changes. It is important to be direct and specific about your concerns, next steps, or even solutions.

Sometimes an assessment by an "outside expert" can be a good way to start. For instance, if the elder has stopped showering, you might suggest bringing in a social worker or occupational therapist to assess the elder's ability to do daily tasks and make suggestions about how to make things easier and safer.

What About Denial?

At first, the elder in your family may deny that there is a problem at all. This is very common. Concern about the elder's ability to continue driving is a particularly sensitive topic. (See To Drive or Not To Drive?) However, a "successful" conversation does not mean that you both reach complete agreement. You have made progress simply by starting the conversation and beginning the process of change and planning for the future. Be prepared to have several talks over a period of time. Being supportive and sympathetic about the difficulty of change and the elder's fears, as well as his or her loss of independence, will help ease the elder's defensiveness and make him or her more receptive to what you are saying.

Listen Carefully

Remember that the elder is still the expert on her or his situation. Listen thoughtfully to his or her ideas as you present your concerns and suggestions. Rather than telling the elder what he or she must do or change, ask the elder to help you assess the problem and welcome her or his input on possible solutions. The elder must ultimately "own" the solution. You may be surprised to discover that he or she is also worried or feels unsafe, and is comforted to learn that support is available.

For more tips, see the Caring for Your Parents handout It Starts with a Conversation (PDF). For concerns about driving, the MIT Age Lab and the Hartford Insurance Company have prepared a guide called "Having the Conversation" to help families discuss changing driving skills, risks, and alternatives. The site includes useful worksheets and links to other resources.

Continue to Preparing for Caregiving...