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Getting It Right (the first time)

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By Sylvana Rinehart, MA, Certified Concierge Care Advisor

Recently I wrote about the importance of establishing a framework when looking for the right place for one’s loved one. Three main factors were cited: care, location, and management. In this article, I would like to convey that once we have a framework to start with, we would be well advised to listen to each family member or stake holder’s input because the objective is not to find out who is right or wrong, the objective is to figure out how we can be right for our loved one’s next phase. This could be staying at home with in-home care, moving to a retirement community or a smaller environment in a group home. We want to get it right.

Families who use our services for advice on how to effectively navigate a transition from the status quo include us in that decision making process, and together we engage in listening to the different perspectives. Including the senior in question, when there is no cognitive deficit, it is most beneficial to the process so that he or she can listen to what is important to each person. This should not be looked at as interference but as involvement and engagement to help come to a consensus without finger pointing or blaming.

We generally will listen to all involved and have each person give us his or her opinion, desires, fears, and hopes for their loved one. This can be time consuming, but it is crucial to a successful outcome. Siblings may not communicate their true feelings to one another, either because they are too close to the issue or because they don’t want to hurt someone’s feelings. I am reminded of my own family’s situation. Many years ago, when I was living with my parents, my father was bedridden with pneumonia. His brother, who was a physician, suggested withholding all aggressive medication realizing that the pneumonia is what would take him.  My mother and I were in full agreement, but when my sister who was living elsewhere learned of this, she was absolutely against withholding medications. She did not comprehend what we had been going through with our father’s prolonged illness. We understood her reaction, but it threw us all off balance and generated much pain in a moment of crisis.  Unfortunately, she never got to listen to all sides as there was no time for discussion or consensus. My sister wanted to be right instead of doing the right thing for our father. This was several decades ago, well before there were living wills and advance directives, which put the burden on my mother to make the painful decision.

A few years ago, I was working with siblings who knew that the right thing to do for their parents, who were failing at home, was to have them move to a retirement home. As it often happens, one of the two is ready to move and the other one is not. In this case, their mother was ready, but their father was absolutely against moving. He was used to making decisions for his wife and for the family. Being a military Commander, he was used to giving orders and having others follow. We had several meetings around their large dinner table with each family member, including the parents, each talking about how they saw their lives unfold. I would remind them that my role was to make them think not only about tomorrow but also next month and the coming years. Their daughter couldn’t take the one-sided discussions and stopped visiting them. It took months before there was a change. The change came with a crisis with the hospitalization of their mother and their father realizing that living at home and falling was not sustainable. Reluctantly, he moved into a very nice retirement home of their choice.  When I visited several weeks later, he was actively engaged in sharing his hobby and passion with other residents. Again, that senior wanted to be right and not do the right thing for the couple and the family. This was probably my most reticent senior but certainly provided the most rewarding outcome.

Many of these tough decisions revolve around finances and as advisors, we might have to talk about the realities of care costs.  It is our task to make sure that we do the right thing for the senior, whom we represent, and have the responsibility to guide the stake holders in the right direction. Be it staying at home with care or moving out of the home. With the best intentions in mind, some families will insist on having their loved one in an Assisted Living that they may not be able to afford in the long run.  It is our role to clarify that most Assisted Livings do not allow a senior to stay should there be no more private pay funds, and guide them to the only alternative we have in our State which are Adult Family Homes.

There are often many factors to consider in these situations, as most readers will readily acknowledge. Here, my main takeaway is: It can be very helpful to “let all voices be heard,” a practice that will guide us towards a consensus for the best course of action for the senior.

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