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.

Start with the truth. Tell them the painful truth. Tell that you have run out of options. Their health and care issues requires a new level of support. It’s not what either of you wanted, but it is the new starting point that both of you are going to have to use going forward. You wish it wasn’t so, but it is.

Start with control. Make a working list of all of the choices your parent still retains despite being in a nursing home. Can they choose their own food and when they eat? Can they choose their activities and when they leave the facility on outings? Can they choose pictures to hang, a special chair, music, blankets, and when family and friends can visit? The more ares of control you identify and orchestrate for them to manage, the easier it will be for them to come to terms with the transition.

Start with legacy. Make a working list of the people connected to your parent’s life who can “rise to the occasion” and help with the transition. This could include neighbors, co-workers, friends, clergy, and of course family members. Tell them to come ready with a story, pictures, food, and news. We all want to know our lives make a difference, but when we wind up in a nursing home, it doesn’t seem that way anymore. The more connections you mobilize to interact your parent, the easier it will be for them to come to terms with the transition.

Make ample room for tears. The losses of aging break our hearts and all of us need room to grieve openly. It helps us come to terms with the things we cannot change; it makes room for courage and compassion. Let your parent have his or her feelings and let them see yours. It will provide both of you comfort and deepen your partnership for what lies ahead.

Here is my solution: Inspirational Walking. This is a simple, effective strategy that combines walking with a personalized soundtrack. It combines two powerful strategies that change thought patterns: exercise and music.

Exercise clears the mind. Even when we start out feeling overwhelmed, a simple thirty minute walk makes our thoughts clearer, gives us new ideas that help us cope, and leaves us feeling physically and mentally energized.

Music inspires the heart. Music has been a part of lives from early childhood, and we all have personal sound tracks of our lives. We mark people, events and the passing of time with certain songs. In the end, music helps us give meaning to our experiences and, as important, helps us cope.

Inspirational Walking integrates both of these strategies into one simple strategy. Here’s how it works:

1. Using iTunes, create a playlist that is thirty minutes long. Begin with a song that captures the reality, mood, or irony of being in a difficult caregiver situation. I personally like Van Morrison’s song “Stranded” with the lyrics “everyday is puzzle time again.” I can’t explain it, but hearing these kinds of songs makes me feel better. Then add songs that that offer courage, inspiration, and motivation. I personally like Jack Johnson’s “Upside Down,” Indigo Girls’ “Love of Our Lives, and Coldplay’s “Yellow.” The key is to find songs that speak to your heart, that pick up your mood and step, and that remind you that you are not alone with your life struggles. Don’t obsess about the order or the exact length of the first playlist. As they say at Nike, just create it.

2. Give your playlist a test run. Put on your most comfortable walking clothes and shoes and take an thirty minute Inspirational Walk. This is your thirty minutes off line. If you can, walk outside; it will have the deepest impact on your thoughts and mood. If not, use a treadmill or an indoor mall. Put the world on pause; it will have to make due without you for thirty minutes. Find your own starting pace and just go with the music.

Remember:

Everyone is stiff and tight the first ten minutes and wonders if this is a good idea.

Everyone feels remarkably better at twenty minutes and are glad they took a walk.

Everyone feels better as they bring it home at end of thirty minutes and are sure it was good for their body, brain, and heart.

3. Modify your playlist and build new ones. Maybe you want to change the order of songs, or delete some songs and add new ones. Maybe you thought of a theme for another Inspirational Walk playlist. Create playlists for those days when nothing goes right. Create playlists for those days you are grateful for the lessons. Create playlists for those days you are on point and things are falling into place.

Our minds don’t do well sitting and stewing. We need movement and music to break us out of our mental quicksand. Try Inspirational Walking for thirty days, three to four times a week. See where the music takes you. See how your body feels with some new, consistent motion. See how your brain reacts to new input. Lastly, share your success and playlists with other caregivers who, like you, need a little time off line to regain their balance.

Talking With David Solie
June 2008
Nell Bernstein, Caring.com senior editor

Caring.com advisory board member David Solie has spent his career of helping
seniors navigate their final years — as a geriatric psychologist, CEO and medical
director of a life insurance brokerage corporation, and author. His book How to
Say It to Seniors: Closing the Communication Gap with Our Elders is a wise and
insightful guide to helping adult children understand and communicate with their parents, based on an understanding of old age not simply as a “loss of faculties” but as a unique developmental phase with its own tasks and challenges.

Just as parenting experts can fall to pieces when faced with their own tantrum-
throwing two-year-olds, however, Solie found his eldercare skills put to the test
when the health of his fiercely independent mother began to deteriorate, and a
cousin “sounded the alarm” about her safety living on her own. To complicate
matters, she was a caregiver herself — to Solie’s adult brother, who has Down
Syndrome.

There were taxing moments – such as when Solie’s mother broke her wrist and
fired every caregiver he brought in to help while she recovered. But mother and
son were able to come to an agreement that ultimately brought them closer
together.

Q. Comments we hear frequently from readers of Caring.com are: “I think Mom should move and she doesn’t want to” or “I don’t think my parents are safe in their home any more, but I don’t know how to talk to them about it.” Have you found that these dilemmas are pretty common?

A. I hear about them all the time. There are probably ten versions of the
question, but they all come down to: “How do I talk to my parents about
moving?”

My mom just died last year at age 90, and my dad died in 1989, so I have a very
long “residency” in this myself. I am also part of a unique subset of the care-
giving community because I have a brother who has Down Syndrome. He was
living with my mother until she had a stroke, so the issue was not only the care
giving of an aging parent, but the complexity of having a disabled person riding
shotgun. If you think getting a parent to move is complicated, try getting them to
let go of a disabled child!

Q. What happened when you tried to get your mother to move?

A. At first, I was asking for my brother to be in a group home and constantly
talking her about transitional places for her to live — if not today, then when she
could no longer ambulate in the house. I’d find a place and show it to her, and
she would always say the same thing: “Maybe when I get older.” This was at
age 87! It was the perfect way to pull the rug out from under me.

Her decision – and the one I ultimately honored, though at times it was difficult
to do so – was that she did not want to move, even though her capabilities
started diminishing. She had osteoporosis, spinal compression fractures, and
difficulty ambulating, but she was tough. As the world sort of shrank around her,
the La-Z-Boy in the backyard was like the Alamo – she defended it to her death.
Then she had a massive stroke and had to go into skilled nursing for the last ten
months of her life.

Q. Were you comfortable with her decision to “age in place,” as so many of
our parents insist on doing?

A. Well, with other family members telling you what to do, you get to this point
where you feel some sort of spiritual or fiduciary responsibility if you don’t act.
My cousin, who lived closer to her, raised the alarm that my mother couldn’t
bathe herself, food wasn’t doing well in the refrigerator, and she was having
trouble with the stairs to do the washing.

My cousin mounted a big case and wanted intervention, and we showed my
mother some places, but she absolutely refused to move. She said, “No. This is
the house your father and I bought, and I’m not moving.” She was adamant. We
had bought a long-term care policy that included in-home care, but she
considered it a disgrace to have anybody in her home. So she did everything by
herself, in her own way.

Q. How did you come to understand her perspective?

A. At one point, I went to talk to our family attorney about what I could do, and
he said a wonderful thing. He said, “Look, you can go to court and try to get a
conservatorship. I think you’ll fail. I’ve talked to your mother. She’s coherent.
She’s articulate. She’s political. She’s insightful. She moves slowly and she
can’t open up a jar of food the way she used to, but here’s the thing: You’ll
destroy your family forever. So here’s what we do – we wait. You should know
this, because you write about it.”

I said, “I do know, but I feel guilty.” And he said, “OK, then wait with guilt.” And
after she died, he came to the funeral and said to me, “Good job. You did what
you were supposed to do. You waited.”

Q. What did he mean by that? What is “waiting with guilt?”

A. Sometime when we look at moving our parents from their homes, we think
we’re doing something helpful and healthy and safe, but we’re completely blind
to their internal architecture. Emotionally, they have a lot of secret scaffolding
that holds them up on so many levels. All meaning — everything — is tied to the
home. Once we yank ‘em out of that, it’s over.

When I went to my mother’s house and looked around, I could see she had her
world orchestrated. It was exactly her world. And I could not imagine her ever
being content anywhere else. I really feel we underestimate how important that
is.

That?s why, when we’re having this conversation ten years from now, we’re
going to be saying that aging in place has become the solution, not what I call
“production aging”: more assisted living, more nursing care. I think we’re going
to find a lot more technology allowing a lot more people to hold onto their
places. The home is going to undergo an organic modification, and we’re going
to be bringing a lot more to them in the home.

Q. But there are so many arguments on the other side ? that by moving to a retirement community, our parents will become less socially isolated, safer, and better cared-for. Why do you think the drive to remain in their own homes is so profound for so many older Americans?

A. In 20 years of working with seniors, I?ve come to know how deep the need for
control is in that age group, how little they ultimately wind up with, and how
closely control is tied to dignity and hope — not hope that you’re going to be
young again, but hope that you’re going to get some good days. These people
are not naive; they’re not the least bit unaware; they just want some good days.
Some days are better than others, but when you compare it to anything else,
days in your home – as long as you can cut it – are great days.

That’s what I found out when I sat down in my mother’s old, worn-out La-Z-Boy
with the tuner with the larger buttons and the Collier’s magazine from 1946. I
realized that in a world of great instability — her friends had passed, my dad was
gone, her neighbors were gone — this house was her anchor on so many levels.
Looking at that, I felt it was profound hubris on my part to be all knowing and
righteous about where she should live.

Q. But how do we balance respecting our parents’ need for control with our desire to keep them safe?

A. I built scaffolding around her. I took care of the wills, the long-term care
insurance, co-guardianship, and power of attorney for health when she got sick.
Then she fell and broke her wrist, and I couldn’t wait for the cast to come off
because she fired so many caregivers in a row. Three days and they were gone;
the agencies were exhausted. This fairly petite Norwegian immigrant had the
ability to exhaust whole tribes of people. She would take ‘em down in droves.
It was too much. It wasn’t necessary. Had I relaxed my hand a bit, my mother
wouldn’t have felt under so much duress, and wouldn’t have dug in so deeply.

Q. It sounds like you came to terms with this aspect of her personality by trying to see things through her eyes rather than trying to get her to see them through yours.

A. You have to understand what you’re asking of older people when you ask
them to move. You’re asking them to give up the equivalent of water or oxygen.
So if you’re going to take the bold step of being smarter than your parents and
telling them to move, there are two things you should know, that are borne out
by research and surveys. Number one, as a group, they are remarkably robust
and not afraid of death. And number two, they are afraid of nursing homes.

Q. It sounds like you made a lot of concessions to your mother’s point of view. Did you ask her to make any compromises?

A. I just said to her, “Mom, I know you want to be in control and independent,
and I know that, above all, this house is where you want to stay. But if we’re not
careful here, something could happen, and then all of a sudden your life could
be thrown out of control in a way you don’t want.”

So when I told her I wanted her to get a personal emergency response system,
she said “OK, I’ll meet you halfway because you’re not trying to stuff me into
assisted living.”

Q. Is there anything you know now, looking back, that you wish you’d
known while you were in the thick of the care giving experience?

A. I wish I had known that I didn’t have to be so anxious about it — that
ultimately, worrying about all these horrific scenarios didn’t change the outcome
or make me a better caregiver. We rev ourselves up so much to do the right
thing in the caregiver role that it can really become too much. I wish I’d relaxed
more and spent more time on what mattered the most.

If I were doing a post-mortem on the whole experience, I wish I had just told
myself, ‘Relax, it’s OK. There’s not a scorecard for you in terms of whether you
were the perfect care provider because you covered every safety base.’ What
our parents really need from us is comfort, and our friendship. It may be
counter-intuitive – it may seem that we need to convince them that we know
best — but they need to be accepted where they’re at.”

My father and I parted on similar terms, incommunicado and mutually sorry about our biological connection. As James Joyce reminds us in The Dead, the departed usually prove more formidable after their gone. My father was no 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 offered no comfort. Even his blatant failings, alcoholism, violence, and a perverse perfectionism were not enough for me to bid him a final and much needed adieu. Instead, my post-death relationship with him had all the qualities of emotional quicksand. I schemed and struggled only to sink deeper into complexity and emotional confusion.

Like all adult children who suffer bitter goodbyes, I found myself circling the issue of forgiveness but never getting it to stick once and for all. Having had zero nurturing from him during my childhood, it seemed next to impossible to find the emotional release I needed.

But as Kriger discovered, it’s never too late in the game to make one more pass at finding relief. My only word of caution is that these bitter ending are hardcore Greek tragedies of accommodation not assimilation. We can’t muscle away the trauma or will it into submission. These are first and foremost familial dramas that must be accommodated. The best we can do is orchestrate a “survivor’s compromise” that allows them to be who they need to be and finally gone.

In my experience, financial hardship demands an inordinate amount of time and energy just to understand and manage control issues. The battle to make sure you have food, shelter, and medications is a fulltime job. Understandably, your senior services professionals will spend the majority of their time helping your members think about and chose the best “control plan” based on the immediate circumstances. Poverty is unto itself a twelve-step program, one stressful day at a time.

Aging and diminished health create overwhelming complexity for seniors. This makes them feel confused, isolated, and out of control. Your senior services professionals can help simplify this complexity and become an essential “health management” partner for your members.

One aspect of the “control plan” they can offer is to help your members understand how they can control their health. They can choose to prevent new medical problems, slow down the progression of existing medical problems, and prevent complications. These are profound choices that give your members a way to control the quality of their lives as well as reduce their financial burden.

Intertwined in the control-focused conversations with your members, your senior services professionals will find an abundance of legacy moments. Despite the demands of just getting by, every senior is an active participant in an “involuntary life review.” This means they are sorting out their life story. It is a powerful current that is seeking an occasion to be expressed. It not a matter of high-functioning or low-functioning. We all want to feel our life mattered; we all want to tell our story.

Your clients will be telling your senior services professionals stories about their health issues. These stories will offer up ready-made on ramps for legacy questions about their family, their lives, and their dreams. While you won’t be able to solve their low-income problems, you can assist them in thinking about and telling their story. And in the telling you will find they have lived the heroic pilgrimage we all make through life. More important, you will offer them an empathetic ear and a rare occasion to “be known and recognized.”

I am not all that surprised by this finding. We all knew it would come to this, but I don’t think any of thought it would be this severe. We all sustained a high level of magical thinking that “things would work themselves out.” They have but in a far more punitive and draconian fashion. Now what?

I think the only hope for Boomers at this point is “total mobilization” of resources. This means creating an inventory of all actual resources and all potential resources that could be helpful. This could include family members, neighbors, religious organizations, city and state programs, and senior services professionals. It also include information about reverse mortgages, wills, power of attorney, probate, long term care, medicare billing, independent and assisted living, and fall prevention. Once you start it, it will take on a life of its own.

This “proactive inventory” will be robust and insightful. It will for the most part end magical thinking and give you a real assessment of how you are going to fund, organize, and manage the drama of your aging parents. It will also show where you need to do major homework.

My suggestion is to get a sturdy, accordion file that holds your inventory in progress. Having everything in one place will prove to be a miracle unto itself. A good example of this is the “What You Need To Know Kit” that was created by Camille Jayne for unlocking the mystery of wealth management You can find out more about the kit at Mattersathand.com . Camille’s insight is that chaos (i.e. important papers and reference materials scatted everywhere) only makes the process worse. I wholeheartedly agree.

The next thing you need to do is to set some modest but measurable goals. Your initial inventory will show you the obvious gaps. Your first goals should address these gaps. Organize your goals into 30-day timeframes. Most of us can barely think beyond next week. Don’t try and make up for past mistakes. This is not a marathon, pace yourself. A few goals that you can do each month will deliver major results in a year. Just work the 30-day window, log your progress, and recast new 30-day goals. Nothing fancy, just a steady, really effective goal setting ritual that will dig you out of a world of trouble.

Lastly, create a draft of a crisis plan. If your aging parents suddenly crash, what’s the plan? Who is in it. Who are the key medical, financial, and legal players? Do they know you? Do they know your are essential to the plan? Where are the funds, the phone numbers, and the keys to the house? Use your 30-day goal system to fill in the gaps.

This is just a start and certainly others have more elaborate systems for doing this. But here is what I know about how this works after twenty years of coaching adult children. Just starting turns out to be the magic bullet that can avoid a poor outcome. Most our us don’t start; we think about starting. If we do start, we don’t have a ritual to keep it going. What I am suggesting gives Boomers a way to start and keep it going. It also provides a realistic view of what’s possible, where there is immediate work to be done, and a much needed crisis plan.

Underlying this dense web of personal transitions is loss. While loss is traumatic at any age, it becomes especially painful and overwhelming in old age. As our aging parents struggle to maintain some semblance of control in world where all control is being lost, new losses destabilize and demoralize their outlook. What can be done to help our aging parents regain their emotional and spiritual balance after having experienced a difficult transition such as a setback in their health, the loss of a spouse, or moving into new living accommodations?

1. Make the reestablishment of their control system your number one priority. Our aging parents are dependent on family members, friends, and senior services professionals to be their “control facilitators” amid the upheaval of these difficult transitions. Control facilitators are advocates that protect and enforce our aging parent’s choices in the face of losses.

Control facilitators help aging parents “reframe” their thinking about both the meaning and the opportunity that is part of a loss. As important, they provide the energy, organization, and creativity to reestablish control systems that preserve a new form of independence and dignity.

Reestablished control systems are essential for aging parents to successfully navigate a major loss without giving up hope. While it may take a wheelchair to get mom around following a hip fracture, it doesn’t mean she has to stop going to places she loves. With the right planning, transportation and support system, diminished ambulation does not have to equate with diminish options.

2. Make the offering of tangible choices your number two priority. Our aging parents need to experience first hand that their reestablished control system is operational and effective. They may be initially overwhelmed by their new circumstances and be understandably skeptical that things will get better. Taking the time to stop and provide concrete choices, even ones that may seem unnecessary, can have a reassuring and positive affect. They offer our aging parents the comfort of being in charge as well as a reason for hope as they struggle to come to terms with major changes in their lives.

Emotional habits are habits that follow the emotional upheaval of our interactions with our aging parents. We tell ourselves we are going to be calm, objective, and detached only to abandon these habits within the first few minutes of struggling with them over even the most trivial matters. Why?

Part of the answer lies in the magnitude and source of the emotional energy that punctuates every aspect of the drama of our aging parents. It is helpful to step back and consider two these sources:

1. Childhood Adult children are not neutral players in the aging parents drama; they are forever the children of aging parents. They carry with them a wide range of emotions about their parents, all of them intense and complex. This is why it is so easy for them to feel panicked, angry and guilty at the same time. They are not just trying to care for their aging parents; they are tying to fulfill unspoken obligations that are unique to their childhood experiences and, even more painfully, ones only they truly understand.

2. Family Adult children are not isolated players in the aging parents drama; they are forever part of an extend family system that includes brothers, sisters, aunts, uncles, grandparents, cousins, and all the people they married. Adult children have many sets of eyes watching their caregiving efforts and all having opinions about it. So they wind up, consciously or unconsciously, frantically seeking layers of approval for contradictory and biased points of view that only escalates their emotional insecurities to unbearable levels.

Now what?

The first step is the gain an accurate perspective on the big picture. Most adult children are at an emotional disadvantage in working with their aging parents. This limits their objectivity, exaggerates their responsibilities, and increases the emotional vulnerability. Understandably, it makes them the primary target of their parent’s anger about in the “slings and arrows” of being old.

The second step is to gain an accurate perspective on the small picture. While adult children can not recast or ignore the emotional landscape the drama of aging parents, they can cut it down to size. While the complexity of the issues all beg a thousand things to worry about and to solve, the allocation unit of the journey is one day at a time. This should be the dominating insight that all adult children ask remember when they feel the pull of emotional habits. Here is the question they should ask themselves, over and over again: What is possible today?

Within this context, a number of important insights begin to surface:

1. I am in this for the long run and I need to make sure I am doing the things I need to do for myself that support the long run. Maybe this is just thirty minutes for a cup of coffee and the paper. Maybe this is a phone call to a “nutritious friend” who just listens. Maybe this is a surprising “no” when everyone expects you to say yes. Maybe this is a heart felt prayer that makes it clear you cannot do this alone. Within the day, you need long run moments that help you stay in the game.

2. I am doing the best I can do today with what I have. Tomorrow, next week, next month, next year will all arrive on schedule. But the allocation unit is one day. Only a few things will get done. Only a few calls will be made. Only a few needs will be met. Everything else will float into the future. No one can or should do more. Give it your best, engage in some long run moments, and see what tomorrow brings.

The goal is not to eradicate emotional habits; they are part and parcel of the drama of aging parents. The goal is to recognize them, resize them, and with patience and practice attenuate their impact.

Unfortunately, our aging parents may reject our attempts to be of help. In most cases it represents profound anger at their situation as well as their caregivers. Their outward displeasure and verbal affronts are the few tools they have left to exert control on their environment. When all else fails, control the caregiver with anger. It creates a miserable environment for everyone. You are hoping she will find some “happiness” and she is letting you know this is not going to happen and, more importantly, how angry she is at her situation and especially you. Now what?

You need to consider the boundaries of what you are trying to accomplish. Aging is a messy process and sometimes, despite our best efforts, things turn our poorly. It might help to tell your mother that you are doing “the best you can do” given the situation. She can choose to be angry, mean, and hateful. But it won’t change the situation or the opportunity you two have to work together. You don’t have the power to turn back the clock, make money appear, or correct all of the wrongs in her life. Your just trying to do the best you can to give her dignity and choices. No matter how angry she gets at her situation, the problems of being older won’t disappear. In fact, they get more complicated. The only thing that helps is working together to find the best choices.

Don’t expect your mother to jump up and hug you, apologize for her spiteful comments, and be a different person. But stay on script in a gentle and firm voice. Think of it as a campaign that you need to orchestrate over the next three months. Be compassionate, but stay on message and keep your words consistent.

Maybe you mother will not change her mind. If not, you at least are giving her a clear signal about what you can and cannot do. It returns a modicum of sanity to your world. Maybe she will tone down the anger part of the time, a small but significant reprieve. And maybe, just maybe, she may see the occasion to talk about her feelings and “test” how it feels to work together.