If you're one of us—somebody born between 1946 and 1964—and if either of your parents is still alive and still living at home, there's a challenge waiting for you: mom or dad is probably going to have to consider a change of circumstances, which might include a transition from the family homestead to a much different kind of place—a senior apartment, perhaps, an assisted living facility, or even a nursing home. Unlike previous generations that automatically brought an aging parent or two into their homes, many of us don't have that luxury. We're still earning a living, which prevents us from being the best caregivers even on a part-time basis.



Worse, we don't like to think about aging. We much prefer denial, which means we tend to delay this conversation about a potentially unpleasant course of action until we're forced to do so by mom or dad's sudden health crisis. Now, calculate the emotion and tension they add to the conversation and you are far more likely to make mistakes, hurt feelings and carry the burden of the resulting guilt.

How comfortable are you with the reality of initiating the conversation with your parents about the need for their possible lifestyle change? You may perceive they need more help to live at home or you may think they have to move somewhere with medical oversight, but do you know what they think? Are there other family members who need to be part of this discussion? The earlier you have a talk--or a series of talks--the less difficult it will be.

While mom and dad are still healthy, the Big Talk is really about who they'll become when they get “old.” At the time that mom breaks her hip and her physician tells the family that she cannot go home, you are forced to make a decision in the midst of a crisis. Serious business, indeed, and one for which few of us are prepared.

This is an ideal time to think about your children. Why not tell them all the things they need to know? This is a great generational exercise, wherever you are on the family tree. Fortunately, others have gone before us and dropped breadcrumbs along the way as a guide.

Starting Out. Nobody wants to talk about getting older, the inevitability of aging and what lifestyle changes will be necessary for the elderly parent. Worse, it's particularly difficult when the truth-telling comes from the children.

The most important part of most relationships is the ability to actively listen to each other. “Active” listening is a term that is tossed about at work, one that's highly recommended when dealing with a teenager or a best practice in a good marriage, but what does it really mean to “listen actively?”

Active Listening. Simply put, “active listening” is a way of listening that's intended to improve mutual understanding. When you actively listen, you focus your entire attention on the person who is speaking. You try to block out other distractions and thoughts--especially those about your own beliefs and what you are going to say next.

You often check with the speaker to make sure that you understand what is being said. You might respond by saying something like this: “What I hear you saying is…” This works very well in emotionally-charged situations where the parties do not necessarily agree. It gives them the chance to internalize and process the other's position and make clear that they have heard--and understand--his or her perspective. The listener focuses, not merely on the words being spoken, but also on the body language and conversational tone that's being used. So, responses might also be, “You seem to be frustrated (unhappy) (angry) (sad) right now; can you tell me what that is about?” This type of listening can help to resolve current problems and ward off future conflicts.

Here are some suggestions for getting started talking to parents about their future and what it might hold:

Refer to someone else's unfortunate experience. Many of our parents have recent and unpleasant memories of the difficulties that friends or relatives have had in this situation. Maybe it was the elderly cousin whose health precipitously deteriorated and required the nieces and nephews to scramble to get him into eldercare. Perhaps it was the neighbor who broke her hip and her son in Australia had to take a month away from work to solve the problem without any guidance.

Considering the situation as a necessary conversation for your own peace of mind is essential. The family—not just the parent, but also you, your spouse, your siblings and the extended family—shares this challenge. This approach broadens the focus of the discussion and preserves mom's or dad's dignity.

Newspaper or magazine articles can be used to start the conversation. We are usually able to find a related letter in a Dear Abby or other advice column in our local paper. You might begin like this: “Gee, Dad, I guess I don't know anything about what you'd want me to do if you discover that you're unable to live at home. I'd feel a lot better if you would tell me, so I won't have to guess.”

One step at a time. Some parents will be outraged at the very thought of giving up their home and moving into a strange environment. That's perfectly understandable. After all, the emotional attachment to home—“There's no place like home.” “Home is where the heart is.” “The green, green grass of home”—runs deep in all of us. Sometimes, it is just a matter of processing on the part of everyone involved.

The state of denial is overcrowded and it's possible that it's not just the parent who lives there. You may find that siblings or other family members find aging and the inevitable change it brings difficult to accept. As in most relationships, this may be an exercise in negotiation and compromise.

Everyone has a solution in mind, and we all think that ours is best. Try to begin with an open discussion about perceived problems and possible solutions. In your early discussions a small victory may simply be a recognition that a problem exists. Only then can you move on to consideration of likely solutions. The focus must always be on your parent's health, safety and happiness.

Open the parties to possibilities. If you, your siblings and parents each believe that there is one solution to a perceived problem--and it is his or her solution—you'll make little progress. Be open to the consideration that more than one good option may exist, and it's just a matter of finding one that works best for your parent and the family.

Take whatever time is necessary for everyone to get used to the idea that change is imminent. As we age, many of us tend to be increasingly risk-averse. Our sight, hearing and body may begin to fail, and the world around us starts to shrink. Familiarity is comforting and change is scary. So start out by simply exploring possible alternatives.

Many of us have discovered that convincing our parents to experiment with the idea of senior living (“Let's drive over there for a few minutes just to see what it's like”), rather than trying to steamroll the decision, pays off. Perhaps a visit can stimulate real interest that will in turn motivate a change. After you've had a visit or two to a senior facility, ask for impressions. What is it they want? What are their interests? What are their needs? Do they perceive that a move could improve their life?

Now, given what you learn, you are better prepared to determine the best way to proceed. Many residents of assisted living facilities tell us that they were staunchly opposed to a move until they were hospitalized and needed to recuperate in a transitional facility. It wasn't a permanent move, so they discovered that they were pretty open to the experience. They learned, much to their surprise, how much they liked the environment. After the healing and the return home, it was actually the parent who initiated discussions about a permanent lifestyle change.

It's said that lawyers never ask a question to which they don't already know the answer. That may be exactly what you are doing. If you are blindsided and/or encounter seemingly insurmountable resistance, seek help. Third-party experts can be blended into the experience. Sympathetic strangers—clergy, experienced friends, geriatrics experts, compassionate health care workers—can defuse the situation and provide useful guidance.

Next Steps.

Now that you've got the conversation underway, what are the questions you'll want to ask to prepare for the housing transition? Let's start by examining the elder's current living situation.

•“Mom, do you want to live where you are as long as you can? Are there some improvements to your house we should begin to make so this will be possible?”

•“I know you love your home, but even with the kids mowing the lawn and taking you shopping, are you finding the other chores more work than you want to tackle these days? What would you think about moving into a more manageable place—a condo or a smaller apartment--at some point?”

•“When you feel living at home is no longer a good option for you, would you want to live with me, or someone else in the family? Would some form of senior housing be an acceptable option for you? What do you know about senior housing, say, assisted living, and those kinds of options? Maybe we could make a list of the things that are most important to you and see if we could find a good match. Does that sound like a good idea?”

Turning to questions about health:

•“Dad, do you find you still have the energy to do the shopping, prepare meals, do laundry and personal care, and still continue to keep up the house and yard?”

•“Do you feel comfortable driving or taking public transportation to do the things you need to do?”

•“Are you having any trouble doing the exercises your doctor has recommended? Are you remembering to take your medications?”

•“Would you be willing to let us talk with your doctors about your health? Could we go with you to your next doctor's appointment to find out more about your medications and any problems you're having?”

•“Have you made any decisions about the kind of medical care you may want in the future? Would you want someone else to make these decisions for you if you are unable to do so for yourself? What are your thoughts about assistive devices—ventilators, feeding tubes, for example—to keep you alive? Do you have records of the decisions you've made? Where do you keep them?”

We know that the world is an imperfect place where many concerned adult children find themselves up against a brick wall in these situations. When they attempt to start the conversation, the response is something like this: “Oh, sweetheart, why do we have to talk about those kinds of things now?” Or the parent simply changes the subject or becomes really angry.

Put yourself in their shoes. You, too, would hate the idea of getting old or of having some disease ravage your perfectly good body--and you probably wouldn't want to talk about it. So, don't lecture, but don't avoid the issues forever. If you decide to back off for the moment, that's okay. Just don't quit. Go at it again, on a different day, soon.

If you are in a crisis situation, you may not have the luxury of time. Get any help you can from your parent's “influential circle”--compassionate health care providers, ministers, and friends--someone your parent will listen to.

During this struggle, remember that the only person you can change is you. Dad isn't going to have a life-changing epiphany at his age. And if you continue to try to change him it will only frustrate both of you. Seek an accommodation that, if not perfect, is at least palatable and most important, one that you and your parent selected together.

And remember this, too: others have successfully navigated these rough waters. You'll do so as well.