Difficult Conversations Baby Boomers & Aging Parents

1. Difficult ConversationsBaby Boomers & Aging Parents Gail Henson, Ph. D. Hospice Institute Bellarmine University

2. Goals • What are stressors for the baby boomers? • What are the difficult conversations? • Why are they difficult? Barriers, issues, roles • How can we have them? Models

3. Facts about baby boomers • Born 1945-1964 • 2000 Census Figure: 61,952,636 • US percentage= 22% • Kentucky: 45-64= 23%;

4. Have not had same kinds of hardships as did parents Did not fight in World War II, Korea Did not live through Depression We expect a high standard of living Paying for children’s education Saving for retirement We have big mortgages, debt We’re overweight We like to eat out We like to travel We’re really tired Baby Boomer issues

5. So here you are-- • The baby boom generation’s latest, and in some ways most agonizing, life crisis • What to do what the parents who once took care of you can no longer take care of themselves. • What hats do you wear? Name them!

6. What are the difficult conversations? • When do they arise? • Why are they so difficult to have? • What can help us have effective family conversations about difficult topics?

7. Difficult Conversations Exercise 1 Individual surveys Group discussion & activity

8. Difficult conversations: health • Use of pain medication • Advanced directives (living will, use of CPR, artificial feeding, breathing, hydration) • Power of attorney • True status of own/loved one’s/parent’s health • Where to die

9. Safety • Driving • House • Food • Memory

10. Conversations about personal conduct • Hygiene • Exercise • Finances • Care of home

11. Difficult conversations: end of life • Family relationships that need resolution • Death • Funeral plans • Burial, cremation plans • Wills • Naming an executor • What to do with possessions after death

12. Religious concerns about death Why is life so fragile? Why is everything living transient? How do I deal with suffering? How can I deal with pain or discomfort as I die? Do I fight death or do I embrace it? Why am I suffering? What is quality of life? What is the meaning of my life? What is my legacy? What is a good death? What will the hour of my death be like? Can I prepare for death? Does anyone care about my death? Does my death affect anyone? What loose ends need to be tied up before I die? Conversations –Religious & philosophical

13. What will happen to my body after death? Will I continue suffering? Will I be reborn into a new existence or into a cosmic nothingness? How do I go into the next stage? Is it dark or light? Is there a life after this? What is heaven (or hell) like? Will there be angels or demons? Will I see God (or a devil)? Will there be a judgment? Will there be people, places, or animals I know? More conversations…

14. It’s tough to talk with your parents Many factors affect any conversations How can you prepare for the challenges? Consider such factors as relationship, culture, communication patterns, verbal communication, and nonverbal communication

15. Family Relationships • Defined roles • Commitment to preservation • Recognition of responsibilities • Shared history and future • Shared living space

16. Family culture • Religion • Politics • Education • Economic level • Race & ethnicity • Geographic culture • Values • Communication patterns

17. Roles that have been played such as…. Boundaries long established Feeling it would be disrespectful Fear Anger Embarrassment Not knowing how to begin Geographic distance Dislike or disgust Not having the emotional energy to do this Not motivated Personality clashes So why is it so hard to have tough conversations?

18. Perhaps these conversations are tough because…. • You don’t know how to begin— • You’re surprised, confused, upset at what has happened--- • You’re anxious about what you might hear or see— • You’re anxious about death itself--- • You’re afraid your parent might get mad at you! For example----

19. Let’s get serious—have these situations ever happened to you? • Your parent wants all your time & attention • Makes unreasonable demands • Is inflexible, critical, and negative • Complains about real or imagined physical symptions • Uses inappropriate/foul language • Exhibits bizarre behavior

20. It’s tough to have conversations with a parent who • Has become suspicious and paranoid • Is experiencing increasing levels of memory loss • Makes up silly lies, exaggerates, cries wolf • Stays in bed, does nothing—waiting to die • Refuses to take showers or change underclothes • Gets furious if something doesn’t happen at a specific time

21. It’s tough to have conversations with a parent who • Gets mad when told “No” they can’t do something • Is a danger on the road but refuses to give up driving • Needs but refuses to allow any caregiving help in the home. • Wants to eat constantly or only wants to eat the same thing

22. It’s tough to have conversations with a parent who • Can no longer take proper care of their bills, insurance, finances • Refuses to see a doctor/dentist, but is not getting adequate care • Needs to see a psychiatrist but refuses to go • Acts completely normal and charming in front of others (Jekyll & Hyde)

23. It’s tough to have conversations with a parent who • Fakes illness at the Adult Day Care to avoid staying • Cannot be reasoned with when they go into an illogical rage • Has pushed me to feelings of resentment and guilt • Is completely unmanageable and needs to be placed into a home • Refuses to allow a cleaning person into the home

24. May feel you’re selfish May seem like you’re being disobedient If you set boundaries, you may be hurt by the consequences If you set boundaries, you may hurt others You may think that boundaries mean you’re angry You may feel so obligated to your parents that you may feel guilty You may feel like boundaries are permanent Difficult conversations lead to drawing lines—settingboundariesSometimes it’s hard to establish boundaries with your parents

25. Before the conversations beginCheck family communication styles • Avoidant— unable to ask for help, recognize own needs, let others in; withdraw when have needs • Compliant—onecan’t say no • Controller— sees others “no” as a challenge-can’t respect other’s limits; don’t take responsibility for own lives • Nonresponsive:don’t pay attention to responsibilities of love; beyond insensitive

26. What kinds of boundaries exist between you & your parents? • Functionalboundaries—a person’s ability to complete a task or job: Performance, discipline, initiative, planning Can your parent remember to wash his/her clothes? Eat? Pay bills? Take pills? • Relational boundaries—your ability to speak truth to those in a relationship

27. Fear of hurting your parent’s feelings Fear of abandonment Fear of their anger Fear of punishment Fear of being seen as bad or selfish Fear of being shamed Fear of being unspiritual Fear of your own overstrict, critical conscience Can you say, “No” without one of these fears? If you’re a compliant person, you may have a hard time, due to fear

28. Fears of elderly or terminally ill • loss of self image • loss of control over life • loss of independence and fear of abandonment • fear of living alone and being lonely • fear of death

29. So you have a difficult conversation coming up? Is this how you feel?

30. What’s in your toolbox of strategies for conversation? “If the only tool you have is a hammer, you tend to see everything as a nail.” Abraham Maslow

31. Oasis • Open— crisis, planned, casual, spontaneous • Articulatethe question/problem/issue (does the person perceive there to be an issue/problem/question) • Search for solutions • Integrate options into action • Study and evaluate

32. O.A.S.I.S. Search for solutions Articulate Integrate Opening Study & evaluate

33. So here’s the difficult conversation Goal is it to understand? is it to feel a certain way? is it to do something? Context Context: planned, unplanned—crisis, spontaneous Perceptions Barriers & boundaries Physical—verbal Nonverbal-- Relational--Roles Gender Comm Emotion Culture Work Finances Children Culture Adult child Conversation Parent

34. Challenges to plan for before the conversation • Risks • Verbal—actual understanding of situation, technical level of language, physical ability to hear or concentrate • Nonverbal—tone of voice, gestures • Context—what’s going on at the time of conversation • Past patterns of family communication

35. Are you sure they hear you? Do they understand the words you’re using? Do they understand things in a way you did not intend? Lesson 1 Meanings are always in people Lesson 2 Meanings are more than words and gestures Lesson 3 Meanings are always unique, one-time Lesson 4 Meanings have both connotations and denotations Lesson 5 Meanings are always context based Do your parents understand what you mean? Perhaps not….

36. Nonverbal matters that can help or harm your conversations • Paralanguage • Listening • Touch • Gestures • Dress • Physical environment

37. Nonverbal issues and your parentsWhat are the bodies saying? • Body orientation (facing toward or away from each other with body, face, head) • Posture • Gestures • Face and eyes • Voice

38. Nonverbal: paralanguageHow you say things counts! • Stress on words, syllables • Pitch (shrill, high, low) • Rate (fast, slow) • Volume (loud, soft) • Rhythm • Examples: crying, whispering, moaning, belching, yawning, yelling, screaming “Don’t use that tone of voice with me!”—Parents of the world

39. Getting through the barriers • Fences with gates, not walls • Try to determine the fences in advance • Learn how to open the gate…….

40. Things that often don’t work well Avoiding the topic Minimizing the issue Blaming the person Silencing the person Gunnysacking—saving up all the issues and dumping them Beltlining Force Personal rejection

41. Listening and your parentsObstacles can take the form of… • Preoccupation with self • Preoccupation with external issues • Taking a “you’re with me or against me” attitude • The law of least effort

42. Giving feedback Honesty Immediacy Appropriateness Clarity Receiving feedback Sensitivity Supportiveness Open-mindedness Being specific Listening and your parentFeedback is important

43. Nonverbal issues with families Your face speaks volumes Intensifying De-intensifying Neutralizing Masking

44. Nonverbal issues The eyes have it. Eyes may indicate…. • Positive or negative responses • Dominance or submission • Interest or fear • Involvement or withdrawal • A signal to turn the conversation • Feedback Compensation for distance Signal nature of relationship

45. Nonverbal: touch • Expresses positive or empathetic response • May be ritual • May express control • May be task related • May be playful

46. Which part of the body does the touching Which part of the body is touched How long the touch lasts How much pressure is used Whether there is movement after contact is made The situation in which the touch occurs The relationship you have with the parent Nonverbal issues to consider with your parent

47. Nonverbal: gesturesWhat do the hands say? • Illustrators—scratching your head, snapping your fingers; decrease when someone is cautious • Emblems: nodding head for “yes” or putting a hand to your ear “I can’t hear you” • Adaptors—nervous habits—fiddle with hair • Too few gestures may be significant as an indicator of a mixed message as too many.

48. Factors Hair Dress Body odor Grooming Assumptions Moral character Attitude Trustworthiness Success Level of sophistication Note: assumptions not always accurate! Nonverbal issuesAppearance leads to assumptions

49. Exercise 2 What’s your nonverbal communication style with your parent(s)?

50. Allow your parent to talk about whatever—they may give you an opening… “When I’m no longer here, I want you to have this…” “It seems like every friend I have is gone…” Answer such leading statements with responses that invite more conversation “You seem to feel that life is getting short…” “It must be getting very lonely for you…” So you have to talk—how to get started