How To Talk With Family Members About an Older Adult's Care

Discussions help families understand and respect older relatives' wishes, share information and make decisions together. Focus family discussions around the older adult's needs, wishes and priorities. Before suggesting a family discussion, ask yourself:

• What do I want to get out of this family discussion?
• Do I have concerns? If so, what have I seen or heard that made me concerned?
• What don't I know? What assumptions might I be making?
• Am I trying to convince others to do what I think is best? Am I open to other possibilities?

Be honest about your reasons for wanting a family discussion. Acknowledge that others might see the situation differently. Good conversation starters include facts, friends' or family members' experiences, or news stories. For example:

• "Frank always says how much it helped them to have monthly calls with Aunt Ellen. What do you think about doing something like that?"
• "Barb says she spends a day or two a week helping her mom, but no one in her family realizes that. Let's talk about what each of us is doing to help the older adult."
• "Did you know that most families don't discuss who will do what to help their parents or grandparents? How would you feel about discussing plans for our family?"

Set a small goal for your first family discussion. For example, your goal could be to update family members on the older adult's needs or to ask everyone what they're doing or could do to help out. During the discussion, focus on understanding other people's points of view. Don't push for decisions or actions right away. Don't try to cover too much in your first family discussion. Try to end on a positive note. If you can, agree on next steps, like sharing information or opinions on a certain topic.

If the Older Adult Can’t Take Part

Sometimes, older adults aren't able to fully participate in family discussions, due to dementia or other health issues. However, older adults tend to be happier if they are included in family discussions and decisions at some level. For older adults living with dementia, it can help to keep discussions short, take breaks and focus on one question or topic at a time.

Asking older adults about their plans and priorities early helps families understand and honor their wishes. During discussions, family members can consider the older adult's:

• Values and preferences, such as connecting with others, enjoying favorite activities or following religious, spiritual or cultural practices
• Personality, whether it's adventurous or cautious, outgoing or reserved
• Relationships, including with family, friends, neighbors and community groups
• Physical and emotional condition, including how stable it is and likely changes
• Finances and other resources, including how the older adult managed finances
• Past decisions, including who the older adult asked for advice and whether independence, cost, quality, convenience or something else was more important

Talk to and try to include the older adult's official decision-makers in family discussions, such as:

• Healthcare power of attorney or proxy
• Power of attorney for finances
• Court-appointed guardian or conservator
• Veteran’s Affairs fiduciary or representative payee

These decision-makers should be familiar with the older adult's preferences and health, financial or legal situation. Official documents can also provide guidance. For example, an advance directive or living will describe the older adult's feelings about certain medical procedures.

Responding to Negative Reactions During Family Discussions

Discussions about helping older family members can bring up strong emotions. Some family members might feel overwhelmed or resentful that they're doing too much. Others might feel left out. Old sibling rivalries or bad feelings might affect family dynamics.

If discussions become difficult, encourage family members to be honest. Speak calmly and clearly, using phrases like, "I am concerned" or "My feelings are." Focus on what you can agree on and how you can work together to support the older adult.

Focus family discussions around the older adult's needs, wishes and priorities. Family members might have different ways of thinking or speaking about something. Discussions can be difficult when:

• You disagree about whether there is a problem, or what the problem is.
• You disagree about what's most important. For example, you might want to make the older adult's home safer, while your brother is focused on finances.
• You disagree about what's a good solution.
• You use or hear words differently, so you say and mean X, but someone else hears Y.
• You have different communication or decision-making styles.
• You want different people included in discussions, or have different interpretations of expert advice.
• How you respond to each other is shaped by family patterns or social roles.

If you can't agree, drop the subject and bring it up again later. To understand the dynamics, ask family members:

• How do you think our family discussions are going?
• Are we communicating well? Are some people talking too much? Are others too quiet?
• What assumptions am I making?
• Are we treating everyone fairly and recognizing their contributions?
• What would help our family discussions go better?

If you understand why the last discussion was difficult, you might be able to find a different way to approach the topic next time.

Keeping the Family Discussion Going

Your follow-up discussions can help family members work together to support the older adult. Follow-up discussions can be good opportunities to:

• Share and discuss new information
• Ask if the older adult's needs or wishes have changed
• Weigh the pros and cons of different options
• Make a decision
• Ask how past decisions are working out

If family members agreed on next steps during your first discussion, it can be easy to start the next one. For example: "Did you find a healthcare power of attorney form?" or "I'd like to hear what you think about this home safety program." Other ways to start a follow-up family discussion include:

• Building on a specific point from the previous discussion. "We all agreed to help the older adult eat healthier meals. So, how can we do that?"
• Discuss a different topic: "the older adult's interested in a reverse mortgage. How can we find out about them?"
• Try to understand one another's point of view: "It sounds like we disagree about the older adult's housing options. I want to hear more about what you all think."
• Explain why a topic is important to you: "It may seem like I'm overreacting, but an emergency could happen anytime. I want to make sure we know what to do."
• Space out conversations: "It's been a month since we talked about taking turns visiting the older adult on weekends. How's it going?"

Encourage family members to share thoughts and opinions by asking open-ended questions like, "What do we need to make good decisions together?" If you ask lots of leading questions-like "Isn't this option really the best?"-it can seem like you're just trying to get others to go along with what you want.

It is important to give family members time to get and consider new information. If you make decisions or plans, make sure that everyone understands what will happen and their role in it. Taking and sharing brief notes can help. It can help to ask if anyone wants to make changes to their task list. However, avoid discussing helping the older adult every time you see family members. Try to balance the "serious" talk with time enjoying each other's company.

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