I’ve dealt with many families over the years but few tug at my heartstrings more than those who wait too long to ask for help. Why did they wait? Because they promised their loved one to never put them in a nursing home. These situations break my heart when the loved one clearly needs more care than the caregiver can manage, and it’s taking its toll on the caregiver’s physical and mental health.

My first experience with this phenomenon was observing my mother care for my father.  I was in the Navy and arrived home on leave to find my mom physically frail and emotionally drained trying to take care of my father who was suffering from several different, complex medical conditions. He was also non-communicative and in the hospital. We finally convinced her that Dad wouldn’t want her to get sick because of him. It took a lot of frank conversations, and I’m not sure she ever got over the guilt of breaking her promise to him, but in the end she agreed to place him in a long-term care facility.

There are a few things to consider if you or your parents have made promises to each other regarding care:

• It’s okay to promise as long as you have a guilt-free escape clause contingent upon the safety and health of all parties.

• If your loved one is at home but needs care, it’s okay to ask for help from family, friends, or a professional home care agency. The goal is to protect the health of the primary family caregiver, whether that caregiver is the spouse or adult child, so that they will be better equipped mentally and physically to advocate for their loved one as long as possible.

• The time to have critical conversations regarding care is before any cognitive or physical decline. Make the call to an elder law or estate planning attorney to complete advance directives. It’s never a good idea to assume you know your loved one’s wishes. Sometimes they can surprise you!

• Be mindful of who is appointed as a healthcare proxy or as executor of the estate. Sometimes, the logical choice isn’t the best. I’ve seen the eldest child chosen based solely on birth order when the wisest choice would have been a younger sibling, and I’ve seen a spouse chosen when they clearly weren’t physically, emotionally, or mentally capable.

• Let family members know where estate plans and advance directives are located. My rule of thumb is if you don’t know where these documents are located, they don’t exist. If you can’t locate them in the best of times, you won’t have a clue where to look in the worst. In times of emotional crisis, people seldom think clearly, and you want to ensure your or your loved ones’ wishes are fulfilled. 

• If the situation changes for whatever reason, such as death of a spouse or child, divorce, or critical medical diagnosis, you should revisit your promises, decisions, and advance directives and have another conversation with your loved one(s).  You can change your mind about your documents and have as many conversations as you want. Situations are fluid.

• If you’re a business owner, you should have an estate plan, advance directives, and a business succession/transition plan ready to implement in an emergency. It’s the best gift you can give your family. 

If you need help broaching the subject of advance directives and last wishes, I  recommend Hello, The Conversation Game About Living and Dying Well and What Matters Most, designed by Common Practice, which can be found at https://commonpractice.com/products/hello-game. It poses some interesting questions in a non-threatening way. 

You can also reach out to me. I’m happy to help brainstorm ways to start the conversation about advance directives and the benefits of asking for help. I can also help guide you through a succession or transition plan.

#transitionplanning #familycaregiving