1. Begin the conversation with a clear acknowledgement that you understand that control is critical to their wellbeing and you fully support their need to have it.
Care giving conversations can quickly turn threatening to older adults who are hypersensitive to losing control. Why?
It’s the psychological agenda of the last phase of life that is made up of two powerful developmental tasks:
1. Preserve control in a world where all control is being lost.
2. Create a legacy in a world where time is running short.
The need for control is consumptive and unrelenting. Most power struggles between older adults and their families revolve around control issues such as where to live, healthcare, money, and driving. These conversations can quickly descend into standoffs with both sides feeling angry and misunderstood. Yet these conversations are unavoidable.
2. The goal is to signal you get it
“Mom and dad, I know you and both are proud of your independence and have always made your own decisions. I want to do everything possible to support your independence.”
The conversation should then move on to describe the behavior or circumstances that presents a “clear and present danger” to their control.
3. The goal is to signal you are concerned about a specific area of their life that is threatened by a loss of control.
“I don’t know anything about your finances or long-term care plans moving forward. I am worried that I unprepared to support your choices if something happens, an omission that could prematurely take away your independence.”
4. Give them a copy of When the Bottom Falls Out Mind Map (Click here for PDF version)
The goal of the mind map is to visually show your parents the scope and depth of decisions that you will have to be made if things fall apart. When you give your parents a copy of the mind map, tell them “these are the things we are going to have to decide with or without you.” No scolding. No lecturing.
Planning for diminished health with an aging parent may not go smoothly. The mind map diagrams the layers of decisions that will have to be made if things fall apart with our without parental input. It includes advance directives, onset of a disability, loss of driving, loss of home and inability to care for pets. It offers families a way to visually present the web of “unavoidable decisions” to aging parents as a prelude to opening up a new planning conversation.
And finally, it should layout how sharing information is a “control preservation strategy” to prevent this from happening.
5. The goal is to signal there’s a way to regain control and you are dedicated to helping them accomplish it.
“We can all work together to bring this situation under better control. Take a look at the choices on the mind map, and when you are ready, let’s talk about how you want your control preservation plan being carried out”.
This is not to suggest that these issues can be managed in one brief exchange. Rather it lays out a reframing sequence and signaling strategy that is crafted to resonate with the developmental needs of the aging parents. Control is essential to quality of life for older adults and unfortunately it could be unnecessarily lost. What steps need to be taken to make the situation better?
As the conversation progresses with questions and concerns about what has to change, this reframing provides a way to bring the focus of the dialogue back to the most pressing issue: preserving control as long as possible.
Lastly, successfully reframing money and long term planning issues as an opportunity to preserve control is only half the battle. Change is daunting at any age, but especially distressing for older adults who are experiencing losses on so many fronts. Even when it is clear that change is in their best interest, they may feel overwhelmed by what it will take to actually do it. They need realistic encouragement instead of false reassurance that “things will all work out,” or “don’t worry.” But the encouragement needs to come from a believable source, one with which they can have an immediate emotional connection.
The most effective signaling vehicle to accomplish this is a well-chosen story. Identifying “parallel stories’ of older adults, perhaps family members, who have faced similar challenges but persevered and regained a new form of control in their lives provides both comfort and inspiration.