Perhaps your parents are getting to an age when they are leaning on you for additional support getting to medical appointments. Maybe they’ve just received a diagnosis that means they’ll be requiring some additional support in the future. As our loved ones age, it often becomes important to be more involved in their healthcare.
Tryon Medical Partners internal medicine specialist Dr. Reshma Vora provides some guidance on how you can start a conversation with your senior parents or loved ones about their health and end of life plans.
When should I think about getting involved?
There are several ways that Dr. Vora sees adult children or family getting involved in the health care of their loved one as they age. Helping them to communicate with their clinician on the portal, keeping track of medication, and making sure the home environment is as safe as possible are important ways that families can be involved. Dr. Vora also mentioned that adult children and caretakers are important advocates in the healthcare setting for making sure clinicians are getting the whole story at their visit.
“A lot of times, the actual senior patient will minimize what is going on. If they come in by themselves, they may not be totally transparent or may minimize their condition. The presence of adult children and caretakers can help ensure we are getting the full story.”
Why should I get involved?
“When I worked in the hospital setting, I would see patients come in with heart failure or a bad stroke and the family would have no idea what the patient wanted for their goals of care. Now they’re in a crisis, asking, ‘Would they want to be resuscitated? Or on hospice care?’ That type of situation is the worst time for the family to make those decisions, they are often under duress, and differing opinions among family members can create discord between them. If the patient has clearly laid out what they want, this can be avoided.”
So how can you be prepared? Dr. Vora recommends asking your loved one if they have the following documents in place:
- DNR (do not resuscitate) and DNI (do not intubate) orders. “Resuscitation” is the medical term for the treatments or actions that healthcare providers perform to save one’s life. DNR and DNI orders tell medical providers not to attempt CPR or resuscitation measures. A DNR/DNI order is a legal document signed by your loved one and their healthcare provider. It tells all medical providers that they do not want certain treatments if their heart stops beating.
- A living will. This is a specific type of advanced directive in which your loved one will clarify the medical treatments, procedures and medications they do or don’t want to receive to keep them alive. If they can’t speak for themselves, their providers can refer to healthcare instructions in the living will document that will cover several items, often including DNR and DNI orders and specificities around end of life care. This process may require some straightforward legal assistance to create.
- A healthcare power of attorney. A healthcare power of attorney appoints someone to make decisions for you if you are unable. This document can communicate the preferences of your loved one and enact the DNR/DNI orders. This is often as simple as writing it down and getting it notarized.
How should I start that conversation?
The involvement of family and caretakers is not always welcomed by the senior patient. Elderly adults often struggle with support because they do not want to lose agency or be treated like a child.
To make this increased involvement as smooth as possible, Dr. Vora recommends starting with a conversation about your desire for a greater presence in their healthcare. Before conducting this conversation, consider the three Ps:
- Patience. Be patient with your elderly loved one as you engage in this transition. It will be a big change for them, so make sure to come from a place of “I’m here to help you. That’s my goal.”
- Partnership. Make sure, in your conversation and moving forward, that you are working with them. Be as open with them as possible and keep the conversations candid.
- Passionless. Talking to your parents or loved one about their health is bound to be an emotional topic. Try to keep it as unemotional as possible to keep the conversation pragmatic and alleviate any guilt they may feel about your involvement.
“I know it’s not always possible, but to the extent they can be involved, involve them. It will be a difficult transition for them to allow you to step into making decisions they once made for themselves.”
What can I do to support myself as I support them?
As the proverbial wisdom goes, it is important you are getting the care and support you need to keep supporting them. It can often become a 24/7 job to take care of a loved one as they age. Advocate for yourself by getting extra help when you can and involving any other siblings or family members who may have time and energy to help.