Last year I went to a conference on accepting the limits of being a caregiver. It was attended by mostly hospital-based healthcare professionals who have to deal with suffering and loss on a daily basis. The focus of the program was on finding and sustaining a balance between compassion and equanimity.

Compassion was defined as the tenderness of the heart that responded to suffering, the pain we feel when we see others, especially our loved ones, suffer. Equanimity was defined as a spacious stillness the accepted things as they are, the realization of what we can and cannot control. Finding a balance between the two allowed caregivers to care without being overwhelmed and all to often undone because of that caring.

The program presented a number of phrases that could be used in prayer or meditation to enhance the “art” of this delicate balance. This one caught my attention:

May I offer my care and presence unconditionally, knowing it may be met by gratitude, indifference, anger, or anguish

As caregivers will tell you, your best efforts to care and be there for aging parents can generate all of these responses from the same person, maybe on the same day. Because there are so many emotions swirling around the drama of aging, it’s easy to chase the negative ones to make things better. Despite noble intentions, this can prove to be an emotional sinkhole with very little to show for it. Better to focus on compassion tempered by equanimity in the midst of emotional storms. Better for the aging parent; better for the adult children.

I call this practice transformational kindness. It is not easy, and first attempts can fall apart repeatedly, but the effort work beyond the emotional responses is in itself transformative for all parties. It reduces the fear and panic of setbacks and constant bad news. It offers a higher level of stability. Most important, it signals that unconditionally means just that, unconditionally.

What encourages transformational kindness? Certainly a kind heart lies behind this love and compassion for others, but I also believe there is another important factor that makes this possible: gratitude.

Our suffering or the suffering of love ones can easy isolate us. But a closer look at the situation always reveals there are many helping hands, some we see, some we don’t see, who are offering their skills, resources, love, and support. When we feel the presence of this helping network, our capacity for unconditional care and presence is expanded and we immediately feel less isolated. To offset the isolated mind set of suffering, it is helpful to read “gratitude prompts” that recalibrate our perspective. One of my favorite is from Einstein:

How strange is the lot of us mortals! Each of us is here for a brief sojourn; for what purpose he knows not, though he sometimes thinks he senses it. But without deeper reflection one knows from daily life that one exists for other people – first of all for those upon whose smiles and well-being our own happiness is wholly dependent, and then for the many, unknown to us, to whose destinies we are bound by the ties of sympathy. A hundred times every day I remind myself that my inner and outer life are based on the labors of other men, living and dead, and that I must exert myself in order to give in the same measure as I have received and am still 

I love the line “whose destines we are bound by the ties of sympathy.” As caregivers of our aging parents, we are bound to do the right thing. The healthier goal is to do the right thing in a way that offers compassion and equanimity for all parties in the drama.

What if they held a retirement planning meeting for financial advisors themselves and no one showed up?

Sound odd? It was, but that’s what happened. We set up a meeting for a group of financial advisors to discuss their own retirement planning. It was part of consulting project to determine why financial advisors were getting so much “push back” from clients on the subject of retirement. The plan was to see where the advisors were in their own retirement planning. We sent out invitations to “second half of life” advisors. No one responded. When we pressed for why they didn’t respond, the message we got back was “we don’t want to talk about retirement,” which was both insightful and prophetic.

If client-facing advisors were having misgivings about the idea of retirement, how did they engage their clients in conversations on this topic? Apparently not very well. When we asked financial advisors for specifics why the reacted so negatively to the invitation to discuss their own retirement planning, they said the following:

Retirement is an outdated idea
It doesn’t acknowledge the reality I am living
I’m never going to retire
Retirement is the beginning of the end
I have too many responsibilities.
I can’t think in these terms
I’m at the peak of my game
What would I do if I didn’t work?
I need health insurance

These comments suggested that retirement may not be a good starting point for a planning conversation with second half of life clients. So we decided to start with the reality financial advisors and their clients were living and come up with a new framework that didn’t necessarily reject retirement but rather offer it as one option in a “bigger conversation.” The problem in our mind as the lack of a new, engaging planning conversation that didn’t assume everyone wanted to, could, or should retire. We were right.

We tested our new model on a focus group of financial advisors and struck a chord. “That’s it,” was their first response. “That’s what I need to be doing, that’s what my clients need to be doing,” they said. So we created a presentation that offers financial advisors a new perspective on planning conversations with second half of life clients. It combines insights on what these clients are experiencing with new strategies to create engaging long term planning conversations. You can see a summary of the presentation here: http://www.davidsolie.com/i-can-hear-you-now.html

THE HOME FRONT MIND MAP (click graphic to enlarge)….Partnering with aging parents requires planning and coordination along with the “art of the handoff.” Here is a simple, one-page tool that allows all involved parties to manage the home front be it a house, condo, or apartment. The goal is to document the dwelling’s “operational code” so any of the involved parties can step up, make a call and help right the ship. This type of visual, strategic planning reduces the persistent complexity of “keeping everything together…”

Find more resources like this at www.facebook.com/AgingParentCoach

Working with healthcare providers requires navigating a variety of personalities, settings, and protocols. Here is a simple, one-page mind map that helps aging parents assess how they view their fit with a healthcare provider and his or her team. The Good Fit mind map’s focus is on rapport and attitude. Given the demands and complexity of healthcare for older adults, finding and sustaining a good fit with a healthcare provider can make all the difference…See more resources at www.facebook.com/agingparentcoach

For the last twenty years, my work has involved helping adult children find a new rapport with their aging parents. This work was the outgrowth of my own search to find a better way to partner with my mother after my father died in 1989. It has been a fascinating and deeply rewarding journey, but I would be the first to admit that it has been predominately helping “us” speak to the “them.” While I considered and ultimately reframed the psychological developmental tasks of aging parents, my coaching was clearly for adult children. But that has changed, and here’s why.

I recently received an email from a colleague regarding a palliative care presentation he attended. The presentation included expert panelists, (physicians, attorneys and researchers) discussing palliative care and family issues. He said all the experts concurred there was a significant communication problem with aging parents and their families, especially regarding end of life decisions. Based on these comments, he said I needed to consider writing a book about how elderly parents can say it to their family.

I surmised he was suggesting a book that might be entitled “How To Say It To Adult Children: Closing the Communication Gap with the Next Generation of Elders.” It was an intriguing and eye opening idea. Based on my own experience, my assumption has been that all the heavy communication lifting was on the adult children side of the conversation. They were the ones that didn’t get it. They were the ones that needed to change their hearts and their words. But in retrospect, it was a narrow and limited perspective that missed the complexity that aging parents have to overcome to communicate with their families. Simply put, this was not easy for them, and it was time to consider communication coaching for the elders and, as important, for those boomers about to become elders.

So I have begun working on a new project to create a “How To Say It” communication coaching book for elders. The goal will be to provide elders with insights and strategies for working with their adult children. Part of the work will be to educate elders about the development tasks of middle age and, based on these tasks, which words and themes are the key to effective communication with their adult children. Part of the work will be to map out openings, scripts, and settings for conversations about the predictable dilemmas of aging especially at the end of life. These prompts won’t make the choices any less painful or messy, but they will offer a perspective and context to start and sustain conversations, a critical starting point to engage dilemmas that are here to stay.

To be clear, many “disconnected” adult children don’t step back in. For them, there is no going back. The outside world may judge them harshly, but it matters not. I have a friend who walked away from his family at an early age, and refused the urgent call in his fifties to reconcile with his dying mother.

Cold hearted? Depends on whose reality you choose to inhabit. In an unusual moment of transparency, he shared with me his childhood trauma. It was raw and left me distressed. He broke away in his mid-teens and never went back. Understandably, he spent many non-linear years trying to outrun his demons and scars, but finally, with help, righted his thinking and his life into a stable success story. Then he got the call.

His mother was dying. She wanted to see him. He refused. “I barely survive her once,” he told me. “I can’t take a second round.” And he didn’t. Her deathbed request went unanswered. His family condemned him. He has no apparent regrets.

But others change their minds. Unlike my friend, they see an opening that allows them to return and lend a hand. Some find their ability to forgive is big enough for both parties. Some find an all too familiar disappointment they recognize from their childhood. I think all of them hope for some form of a better ending for their story about their earthly parents. And that, I think, is the key to those who return and those who won’t.

At some point in the parent-child disconnect, you decide its time to let it be. It’s over and probably for the better. That point may be death, but for many, it comes much earlier in the saga. These early adopters resign their affiliation and call it a day. It’s not a case of good or bad, but what is necessary given the players and the circumstances of the family drama. Those who leave but don’t disinherit their family keep the door open for some form of reconsideration. What is important for adult children is to recognize that both choices get the job done. Bad connections are one of life’s nasty dilemmas, leaving all parties unsure of what to say, do, or expect. In the end, we all wind up doing our best, as we understand it. Nothing more. Nothing less. Accepting that, proves to be another matter…

In most cases, our aging parents passed on when we well on our way in middle age. With each loss, our world became more sober as the reality of being “next” in line collided with the world of sixty-something. But a new emotional tipping point in the drama of being older occurred with the unexpected death of the first cousin.

It’s not that we hadn’t experienced the loss of peers in childhood or as young adults. And then after fifty, the news of friends, friends of friends, and people we simply knew about being suddenly gone began occurring with a prophetic regularity. While it was disorienting and disturbing, it initially spared our family network of adult children. But when the first cousin of the surviving herd died at sixty-something, all that changed.

While it was a single loss, we knew it was a cautionary tale about our generational position and predicament. Despite the density of our modern lives, we could no longer afford to ignore this new vulnerability, a realization that haunted our awareness. We knew we were never going to reclaim the frequency or closeness of childhood. That was another life that had served us well, but was gone. We also know that the meaning and import of our early years now took on legacy proportions with the threatened loss of its primary players. We felt compelled to undertake a “cousin audit” of the history that defined so much of our early family life.

We spoke out loud about what meant the most to us and why. We disagreed about chronology but respected personal importance. We confessed our bias, preferences, blind spots, selective memory and the out and out rewriting of history. But most of all we saw, from the end of middle age, how complicated life was for our parents, like it or not. We didn’t gloss over the unsavory and pathological events we would have gladly avoided, but the easy assessments of “they could have done better” lost its steam. Life turned out to be hard for everyone, including us.

What would be helpful at this juncture is a simple way for boomers to assess personal stability, a tool that could provide them with:

1. An overview of the status of key personal resources
2. Feedback about strengths and deficiencies
3. Insights to set realistic expectations and goals

I have created a new self-inventory questionnaire that does this called “The Stability Survey?.”

The Stability Survey? is a yes-no questionnaire that provides a snapshot of boomer transition assets. There are no right or wrong answers or scoring, just a “holding its own” (stable) or “not doing so well” (unstable) assessment of six broad sectors that impact both quality of life and optimal aging.

Here are the six survey questions:

How is your health?
How is your family?
How are your friends?
How is your career?
How are your dreams?
How are your finances?

Here are some of the implications of the answers for each sector:

Health Status
Stable health usually means no medical issues or medical issues that are under control. Unstable health usually means emerging medical issues or existing medical issues that are either drifting or officially out of control.

Family Status
Stable family usually means normal or abnormal family issues that are under control. Unstable family usually means normal or abnormal family issues that are either drifting or officially out of control

Friends Status
Stable friends usually means close friends who provide comfort and support. Unstable friends usually means issues with close friends that are undermining comfort and support

Career Status
Stable career usually means implementation of a personal retirement plan including post-retirement work. Unstable career usually means unresolved work issues or unsatisfactory retirement planning.

Dream Status
Stable dreams usually means the emergence and pursuit of longstanding or new passions, interests, callings, or pursuits. Unstable dreams usually means the loss of deeply personal dreams or the belief they are attainable.

Financial Status
Stable finances usually means implementation of a pre or post personal financial plan Unstable finances usually means unresolved financial issues or unsatisfactory financial planning.

The Stability Survey? is both a look back at where boomers have been and a look forward to the mission that lay ahead. In developmental terms, it shows which transition assets are in alignment with the tasks of the final phase of life: control and legacy. Conversely, it quickly highlights which of the six resources could potentially undermine them. This “big picture” view at the gateway to the next twenty and possibly thirty years could prove invaluable to boomers who are searching for clarity and direction to help them preserve quality of life as well as promote optimal aging.

New support services to enhance their “aging in place” environment
New lifestyle changes to protect and improve their health
New living accommodations to put more fun back to their lives as well as reduce isolation and loneliness
New long-term care options to better prepare them for major setbacks

But many times our attempts to discuss these and other “change topics” are met with extreme push back that includes indifference, rejection, and hostility. Despite the constant media prompting to have “the talk” with our aging parents and despite our best intentions, we wind up sending out the wrong signals that are show stoppers instead of conversation starters. Why is this happening and what can make it better?

An extremely valuable book written for healthcare professionals may hold the part of the answer. It is called Motivational Interviewing in Health Care: Helping Patients Change Behavior. The authors offer new insights and strategies for discussing change topics in a clinical medicine setting. It appears that their approach could be equally useful to adult children of aging parents. Here are some highlights from the book that seem especially relevant for all caregivers.

The Change Dilemma

It doesn’t matter how obvious it seems that change would make things markedly better for our aging parents; it is hard for everyone, period. There is a deep inertia to change that anchors all of us to what we have always done. With aging parents, there is the added inertia to change that comes from their developmental need to maintain control in a world where all control is being lost. Change is a threat to control and is viewed with suspicion. So it is unrealistic and impractical to assume our aging parents will suddenly be “change friendly” just because they are older and have glaring issues that could benefit from something new. But as Motivational Interviewing in Health Care so effectively points out, the real six-hundred-pound-gorilla in all of these conversations is the quagmire of ambivalence.

Ambivalence

The insights and practical advice on ambivalence alone is worth the price of Motivational Interviewing in Health Care. It turns out that ambivalence lurks behind all change conversations and can be provoked by our attempts to argue away our parents objections to change. These are those unsolicited lectures we give our aging parents to inform or direct them to do something different. I call this all to common habit of adult children the “better answer” syndrome. This is code for “I know what’s best, please pay attention.”

But instead of consensus, it only provokes the dreaded righting-reflex that entrenches our aging parents into arguing against the suggested change, moving the conversation from uncomfortable to communication gridlock. Thankfully, the authors offer an effective, non-intuitive approach to work around this all too common dilemma.

Change Rapport

Motivational Interviewing in Health Care makes it clear that our goal is to avoid triggering the righting reflex and make an honest effort to understand our aging parent’s point of view. This involves finding out what they are actually experiencing and then signal that we are listening and get it. Within this non-triggering conversation environment, we can begin to test open-ended questions about issues where change might be useful to increase long-term control. Here are some simple examples:

How are you doing?
What’s worrying you most today?
What do you think would make this better?
How have you been feeling?
Tell me more…
What’s new with your friends?
What do you feel like doing?

Open-ended question invite our aging parents to choose the direction of the conversation. Once they pick the direction, we simply reflect back their thoughts and comments to indicate we are listening and understand their point of view. Although tempting, we need to resist the temptation to interrupt. Interruptions only make matters worse. We need to hear the whole story on a topic. But as the authors point out, we are listening for more than the story. We are listening for “change talk.”

This may be the most important benefit caregivers receive from reading Motivational Interviewing in Health Care. Change talk is where aging parents begin to voice some interest in change. It is a soft signal, more a preliminary musing about what if, wouldn’t be nice, I really need to, it would be better if, and I am sure I can, all examples of change talk phrasing. The most important thing about change talk is that our aging parents are exploring the other side of their ambivalence to change, speculating on how or why it might be worth considering. How we respond to these pre-change-exchanges will have an enormous impact on whether or not change actually occurs.

Motivational Interviewing in Health Care offers a detailed explanation and ample examples of how to develop these moments of change talk into positive changes. Despite its focus on clinical encounters for healthcare providers, it offers adult children a compassionate and effective strategy to explore change topics in a non-threatening, parent-centric style. It is an approach could be a game changer for adult children searching for a new way to help their aging parents make positive changes.

I have read and reread this tale of estrangement, bitterness, regret, and the search for “repair” because I heard endless versions of it from friends, colleagues, clients, and audience members. I also lived it.

Below is the “comment” I posted to article’s website when I first read it in 2008. In the three years since I wote this, my opinion of my father has “expanded.” Much to my surprise, I have found a window into his suffering. This has given me new empathy for the gap between his dreams and where life finally took him.

Thank you for giving a voice to the bitter outcome many adult children experience with their aging parents before they pass away. We wish it were different but history and personalities bring the drama to its only logical conclusion. But was you pointed out, the death of the parent hardly ends the trauma of such a “poor outcome.” My father and I parted on similar terms, incommunicado and mutually sorry about our biological connection. As Joyce reminds us in The Dead, the departed usually prove more formidable after their gone. My father was not exception. I have danced for years with the guilt, anger, and loneliness of the events surrounding his death. The fact that our relationship was never right from the beginning is no comfort. Even his blatant failings, alcoholism, violence, and a perverse perfectionism are not enough for me to bid him a final and much needed adieu. Instead, my post-death relationship with has all the qualities of emotional quicksand. I scheme, struggle, and sink deeper into complexity. Like you, I find myself circling the issue of forgiveness but never getting it to stick. I think having a life with next to zero nurturing from him, it’s proving next to impossible to find the emotional release I need. This is why your story struck such a deep chord. Lastly, I don’t think it is either smarmy (wonderful word) or too late in the game to want relief. But I also think that these bitter ending are essentially Greek in nature, tragedies of accommodation not assimilation. They are familial dramas that leaves us with the task of orchestrating a “survivor’s compromise” that allows them to be who they need to be and finally gone.