Life is a voyage that is homeward bound.  –Herman Melville

This holiday season, many of us will be heading home.   Back to the place where we grew up, where we learned to ride a bike, where our buried treasures are still in the backyard, where we walk through the front door and the memories of being a kid are still in the air.

But, you are not a kid any longer.  Your parents are getting older and this year might be a different homecoming.  According to the National Alliance for Caregiving, of the 44 million family members caring for a loved one over the age of 50, approximately seven million are long-distance caregivers who live two hours or more from their loved one.

On this holiday visit, you may feel that mom is complaining more about her arthritis and can no longer reach the top shelf for the gravy boat.  She has also lost a lot of weight and looks more fragile navigating the stairs.

Or perhaps dad, once gregarious and cheery, is forgetting where he keeps putting his car keys or has become withdrawn, quiet and cannot complete his thoughts during conversation.

You realize somehow that things have changed.  While you will soon be returning to your life and routine after the holidays, you are worried about what these changes might mean for the future care and safety of your parents.

The 10 Signposts on the Road to Caregiving

How do you know when changes are serious and may signal the need to have the conversation about caregiving?  Before you head home this year, you may want to review some of the signs that indicate your parent or parents need more care – whether they want to continue “aging in place” in their own home or may have to consider alternative living options to ensure their health and safety.

Many organizations have developed signs to look for – the National Association of Area Agencies on Aging, AARP and Caring From a Distance to name a few.  Here is a compilation of some of these signs to watch for (or click on the links to get their complete lists):

1. Changes in eating habits, weight gain or loss, drinking more alcohol than usual
2. Neglecting personal hygiene (body odor, bad breath, soiled clothes, neglected nails or teeth, unattended skin sores or rashes)
3. Not taking medications or taking too much, wrong doses or frequency
4. Cluttered or unsanitary home (mail or newspapers piling up and unopened, a lot of expired food in the refrigerator, dirty dishes piling up in the sink, bugs or pests not addressed, lots of dust or dirt)
5. Behavioral changes (more loud or quiet, paranoid, agitated, withdrawn and uncommunicative)
6. Social rituals have changed (no longer going to religious services, book club, bridge game or social gatherings, avoiding friends or neighbors)
7. Physical injuries or problems such as a recent bad fall, burns, bruises, trouble walking or navigating stairs, trouble hearing or seeing
8. Mishandled finances (past due notices, overpaying bills or paying twice, hiding money, documentation that points to big financial changes for no reason – refinancing home, pension fund depleted, etc.)
9. Unusual purchases (especially any signs of entering unusual amount of contests, online or home shopping network purchases, telemarketer schemes, etc.)
10. Forgetting important things – leaving the stove on, leaving front door wide open, getting in the car and forgetting where they are going (also see my September 20^th blog on Alzheimer’s and Early Detection – the 10 Warning Signs.)

If you feel your loved one is experiencing any of these signs – it is time to take action.

How to Have the C-A-R-E Conversation

The first thing you need to do is talk with your older loved one.  If your mom, dad or other loved one is incapable of having this conversation, you will want to talk with your other parent who may be doing the primary caregiving.

Many parents do not want to worry their adult children and take on this caregiving burden all alone.  As discussed in several of my blogs, if both your parents are still living, you want to sit down and talk to both of them.  Often, the parent who is the caregiver can become as ill as the loved one they are caring for if they do not get help and support.

Or, if only one parent is still living, you want to ensure your parent that you are here to help.   It is because you are concerned about their future care that you want to have this conversation.

How do you get started?   I call it the “C-A-R-E” Conversation:

C = Create a conversation around caregiving.

Start with either a personal story or recent news (this can be the story of a friend who has been caregiving or recent news such as Meredith Vieira caring for her husband with multiple sclerosis.

This will spark dialogue between you and your loved one on a less personal level and allow them to give opinions.  Once the conversation gets going, you can start to ask more pertinent, personal questions relating to your family.

A = Acknowledge your loved one’s wishes. 

There is a great document called “The Five Wishes” from Aging With Dignity which helps elders and caregivers start the conversation about what they want to have happen as their physical and mental capacities fade.

What is important is to ensure your loved one that you want to do what is best for them – by having this conversation now, rather than being in a crisis when a sudden illness or other event forces the issue, you will be better equipped to help them when the time comes.

R = Review what is already planned. 

Ask your loved one if they have a long-term-care (LTC) policy, legal documentation such as Powers of Attorney or Health Care Directives already set up, Wills, etc.  Make sure you know what is covered, and more importantly, what may not be covered.

Some seniors might feel like they have taken care of these plans, but very often LTC and other documentation does not cover everything and the fall-out is left to the caregiver.  This can cause both emotional and sometimes financial challenges.  If your loved one has a legal or estate advisor, you may want to meet with them to review your questions regarding the plans in place.

Again, make sure your loved one is comfortable with this idea – the purpose is to not invade their privacy but to have them understand this is a “partnership” for their elder care and you are going to possibly be acting on their behalf so it is important to know everything.

E = Engage the whole family.

While you might be the one to take the initiative of starting the caregiving conversation, especially if you feel you will become the primary caregiver, you want to ensure you include any siblings, your other parent, or even your own family (spouse and older children), in the caregiving plan around your loved one.

This helps everyone prepare for their role and will help ensure the primary caregiver does not become burned out or bankrupt when they take on caregiving.

Family stress and strife, especially among siblings who do not agree on their parents’ care, is common especially as family emotions run high when a caregiving crisis hits.  You can hopefully avoid this when the time comes by having these conversations when everyone, including your loved one, can be involved, thus ensuring all these issues are discussed and decided upon ahead of time.

If the family dynamic will not allow you to lead the discussion easily, you may want to think about retaining a neutral party who is an expert in this area of elder care – a geriatric care manager.  You can find these professionals and more information about the help they can provide from the National Association of Professional Geriatric Care Managers.

By having the C-A-R-E Conversation and doing a little planning ahead, you will be better prepared to balance caring for yourself while you also care for everyone else.