Talking with loved ones about change is often difficult, regardless of the circumstances. As family caregivers, conversations with loved ones about transitions in their care plans can be especially daunting. There are ways to approach the discussion which can make it easier – both for you and for those you care for.

Transitions in care may include:

  • Remaining in their home (or your home), or returning home from the hospital, rehabilitation center, or skilled nursing facility with increased supports (such as adding paid caregivers, using technology to assist, or making home modifications).
  • Moving to independent living, assisted living, or a nursing facility from home.
  • Going from the hospital to a rehabilitation facility, assisted living, or skilled nursing facility instead of going back home.

Keep these five things in mind when planning to talk with loved ones about a transition in care:

  1. Approach them with love and respect. Remember that you have common goals: for your loved ones to remain safe, with the optimal quality of life and the best care possible. Avoid telling them what to do or speaking to them like you are their parents; no one reacts well to that and putting them on the defensive is not an effective approach.
  2. Do your homework ahead of time. Planning ahead is key; avoid impulsively starting the conversation when emotions are high or you’re in a crisis. Start by observing your loved one’s abilities and evaluating their support system. Note specific concerns; generalized statements such as, “This isn’t a safe place for you anymore,” are not helpful. Investigate various options for filling gaps in care. For example, if your loved ones are declining due to unmet nutritional needs, options may include home-delivered meals, a family member or a paid caregiver preparing meals, or moving to a senior community where meals are provided. Consider the costs, effect on quality of life, and your loved ones’ preferences.
  3. Plan the logistics of the conversation. Include the right people (such as trusted family members or friends they rely on for decision-making), or experts (such as their doctor, attorney, or accountant; a geriatric care manager; or a social worker). Consider their health and cognitive abilities and choose times when – and places where – they have optimal energy, comfort, and focus. While a direct approach works best for some people, others react better to an indirect approach. For example, mention an article you read, relate a friend’s experience, or share your own future plans. Brush up on your communication skills, including making “I” statements (e.g., “I’m concerned that…”, or “I’d like to help you…”), and avoiding “you” statements (e.g., “You can’t handle this anymore…”, or “You need to…”).
  4. Make realistic goals for the conversations. These are generally not one-and-done conversations; expect multiple conversations before coming to decisions. When my parents needed 24-hour care, I investigated many options, and then I had a series of conversations with them, laying out various courses. We decided the best choice was for them was to move in with me. Dad had Alzheimer’s and Mom had aphasia from a stroke, so communication was difficult and necessitated many gentle conversations and reminders.
  5. Listen and validate. Make it a two-way conversation. For example, ask them how they feel they are doing with specific aspects of their current situation, or if they ever feel overwhelmed or want help. Discuss their long-term wishes. Change can be scary; they may feel vulnerable, and the fear of the unknown can take over. Be patient and validate their feelings, even if you don’t feel the same way about it. Work together toward a solution and reassure them they will not be alone; your role is always to be supportive.

Amy Goyer is a caregiving expert and author of Juggling Life, Work, and Caregiving. A passionate champion for caregivers, she has also been one her entire adult life, caring for her grandparents, parents, sister, and others. Connect with Amy on FacebookTwitter, and LinkedIn.

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