By Angela Hill
Oakland Tribune
7/19/2011
Photo by Michael Conti
It's the age-old question: When and how do we have "the talk?"
No, not that one, but the dialogue on the other side of the lifetime spectrum, often just as difficult and delicate -- the one about an aging family member's driving abilities, housing transitions, costs of long-term care and even end-of-life instructions.
Most of us, on either side of the discussion, would rather chew on nails than delve into these subjects. Yet as more and more baby boomers step into senior citizen territory and life expectancies continue to increase, such issues loom large.
Even so, these talks don't always have to be harrowing. While each individual, each family, each situation is different, most in the field of geriatric care agree the process is easier the earlier you start -- when all parties are fully engaged -- and say you should approach loved ones with respect and compassion, appreciating an individual's need to retain independence.
Chris Scott, 52, of Pleasanton has been involved in smooth and not-so-smooth transitions with older relatives.
"With my wife's grandmother, we learned the hard way how not to handle aging issues," he said. "We all waited too long to make some of these changes, so everything we did had to be reactive rather than proactive."
It was about 10 years ago when Scott's wife's grandmother, then in her mid-80s, began to slow down, developing health problems. She insisted on staying in her own apartment, but when it got to a point where she was found confused and wandering through the housing complex, she was asked to leave.
"We ended up moving her a lot," Scott said. "It wasn't always a place she wanted to be. And often it was not a place that served her changing needs. The options were limited because of getting into this so late in the game."
In contrast, before his own mother's health began to decline, the family started talking with her about her wishes, taking her to visit various facilities over the course of a few years. She now lives in a senior residence in Livermore that offers different levels of care.
"But you can't just walk in off the street and get that," Scott said. "You have to do research, get on waiting lists, plan years ahead. And not everybody can afford just any place they want.
"Talk to your parents," he added. "Work with agencies. It's hard, but it has to be done."
Growing up and old
Indeed, by 2030, the number of people over 60 in the Bay Area is expected to double as baby boomers age. And many will face serious financial challenges with little saved for retirement.
Sandra Cohen and Roger Cormier, who write the Getting Older column published in this newspaper, own an Oakland-based consulting firm for seniors in transition. Denial is a big problem, Cormier said. Many who grew up during the Great Depression resist any help other than what family members can provide. And the role reversal -- the child now telling the parent what to do -- is often offensive.
"But realize that someday, you may be in their shoes, and your kids may be having these very same conversations with you -- and how would you like to be approached on these subjects?" Cormier asked. "Basically, what we suggest is -- you know your parents, you know what kind of relationship you have and if you're able to discuss these things or not. And if not, you have to come up with a plan B."
Such a plan could involve inviting a close family friend, a pastor, rabbi or sometimes a primary care physician to approach the individual instead. "If a doctor tells them to do something, they usually do it," he said.
"Everyone, regardless of age, should prepare advance directives, a 'living will' or power of attorney for health care," said Elinor Davis, at the Center for Elders' Independence in Oakland. "And one way to bring up the subject of planning for such future care needs is to tell an aging loved one that you are filling out such a form for yourself and you thought it would be a good idea to complete one for them at the same time. That makes it more of a collaborative effort."
Harold Lustig of the California Estate & Elder Planning Center in San Rafael recently wrote a book called "Naked in the Nursing Home," due out in August. It lists specific topics that people should ask their loved ones, questions such as: How much income do you have, and is it enough to maintain your standard of living? What happens to your income if a spouse should pass away? Do you have enough to pay for long-term care? What types of insurance do you have? Are your legal documents current, such as medical and financial powers of attorney? Do you have a will, and is it current? Do you have a health care directive? How old is it?
Once these questions are answered, Lustig says the next step is to meet with an elder law attorney and firm up plans legally.
"The time is now to talk about this. You never know when someone's health will change," Lustig said. "And really, it's the younger person who has the issues with addressing these subjects. They're afraid their parents will think they're just after the money. But I've found the parents don't think that. Seniors are thinking about these things all the time. So it's usually not a surprise to them to address this."
Driven to distraction
Making financial plans is one thing. But giving up driving is another major hurdle. Driving performance, not age, dictates when it's time to step away from the wheel, experts say. But if a loved one at any stage of life is showing problems on the road, it could be time for "that" conversation.
Virginia, 55, from Sunnyvale, who asked her last name not be used to prevent any embarrassment to her mother, said her 84-year-old mom would become so upset when any mention was made of not driving, that Virginia avoided the topic -- until fate intervened. One evening about five years ago, her mother drove to the store then sideswiped three parked cars on the way back.
"No one was hurt, thank God. She was OK, but shaken up," Virginia said. "Fortunately, though -- and I really mean fortunately -- her big blue Buick was considered totaled. So she had to give it up."
Virginia admits she should have worked with her mother on this issue sooner. "But can you imagine someone telling you that you can't drive anymore? That you can't have your freedom?" she asked. "I can't imagine that."
Even so, elder care professionals at CEI say it's better to acknowledge the problems than risk an accident. But the advice is to "go easy." Expect to have several conversations about this. Show your concern for maintaining your parent's ability to get around and participate in life activities.
One idea is to practice using alternatives. Work toward zero driving. Have family members and friends provide rides more often. Make it natural by saying, "Let's go shopping together today." Join Mom in trying public transportation. Arrange for home delivery of goods and for automated bank deposits/payments.
If Dad doesn't follow through with promised changes, you need to take further action. See if the doctor will set limits. Remind Dad his behavior puts others at risk. Impose family restrictions, such as telling him he can no longer drive when the grandkids are in the car.
DIY planning
A lot of senior citizens say they don't want to leave these decisions up to their adult children anyway -- to prevent such choices from being a burden on relatives, but also to maintain control.
Maagy Maagy, 83, a retired theater arts professor who lives in her own apartment in Alameda, has made very conscious, matter-of-fact decisions about the aging process. Her two children live in other areas and are not directly involved in her life. So she contacted various social service agencies, gets Meals on Wheels, signed up with CEI's Program of All-inclusive Care for the Elderly (PACE), and has also made funeral and burial arrangements.
"Getting old is something you don't want to admit," she said. "Being independent all your life, it's really hard to give that up. But I came to the conclusion that everybody has to die. It's not something said to sound morbid. It just happens. You have to deal with it and take responsibility yourself."
Starting 'the talk'
Ready to begin "the talk" with your parents? Experts offer these tips:
Start discussions early, while faculties are still strong.
Be patient. Forcing help is counterproductive.
Be sensitive to concerns, possible anger and frustration.
Avoid "shoulds" and judgmental comments.
If immediate intervention is necessary, it's often best received from a trusted family friend, clergy member or health professional
Realize you may be in your parents' shoes one day.
County Adult & Aging Services:
Alameda: 510-577-1900
Contra Costa: 925-229-8434
Santa Clara: 408-975-4900
San Mateo: 800-675-8437
Monday, October 24, 2011 at 12:00PM 
