When it is time to have a difficult conversation with the older adult in your life, how you approach the conversation may dictate the outcome. If you use the ABCDE approach, you are more likely to have a productive conversation that leaves everyone satisfied and preserves relationships.
A – Advanced Preparation
Know options that exist to make this decision easier. For example, if you are suggesting hospice, make sure you have read up on what hospice entails so you can respond when you hear, “Hospice causes you to die.” If you want the person to give up driving, look for transportation options so their freedom is not taken away entirely.
Do not have this conversation during a crisis. Sometimes this is unavoidable, but if it is not, don’t wait until a crisis occurs. If your healthy mother is living independently ask what her wishes are if she is no longer able to do so. People think clearer when there is no stress to make an immediate decision.
Know what the outcome is, and make it general. For example, you want to talk about options because you sense the person is in danger living alone. The goal should not be to convince her to go to the assisted living you have chosen for her.
B- Build a Therapeutic Environment/ Relationship
Think of who you want to have in the room with you. Not all siblings are created equal. They fulfill different roles, which could be comforter or instigator. You may want to ask clergy to attend if the situation warrants.
Do not give ultimatums or yell. Make sure this is a calm discussion between adults, where all parties respect the other’s opinion. Again, picking a calm time to talk helps. Make sure the environment is conducive to talking (during a one year old’s birthday party is not) so parties can speak openly in private without interruption. And for heaven sakes, turn off the T.V.
C – Communicate Well
Use the “I and we” method. “I love you and I am concerned for your safety.” “We have seen your driving skills and we are worried you may hurt yourself or someone else.” State the problem then ask for their input on solutions first, then add your own if needed.
Give the person some control. Ask them to visit independent living facilities with you. Let them come up with a reasonable timetable to stop driving. Let them interview different caregivers.
D- Deal with their reactions
Once you bring the problem to light and suggest that the situation needs to change, give the person a chance to digest what you have said. Don’t pressure them for an immediate response. You are proposing something important that might need time to sink in. Anticipate what they might say and come up with responses in advance. Make sure to bring in the research you have done if there is resistance. If they absolutely refuse to deal with the issue, mention that it is a big decision but one that needs to be dealt with. Let the know the results of not dealing with the problem, such as a car accident, fall or having a decision made for them when they cannot. You may need to continue the discussion. Agree on a time to do that.
E- Encourage and validate emotions
No one wants to be told how they should feel. You are discussing difficult, potentially life changing decisions that you probably have not experienced yourself. Ask how they are feeling about this decision and do not dismiss their reaction, rather validate it. You need to say outright you know how hard this decision is and how upsetting it could be but it needs to be discussed.
Summary
As you may realize, when you have important discussions you need to talk to your older adult and not at them. Come to the discussion with a general outcome in mind, not a specific one. Do advanced preparation. Let them have control in looking at options. Acknowledge the importance and difficulty of the topic. Reschedule the discussion if it is too emotional.
If you follow all of these steps there is no guarantee of success. Unless you are the legal guardian of that person you cannot force them to do anything. However, approaching these important discussions the wrong way may not only not give you the desired result, it could hurt your relationship permanently.
I thank Jill Smith from Buckeye Hospice for teaching me about the ABCDE method.
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