By Sandra Cook

Reporter columnist

More and more of us are facing one of the most difficult situations in life: seeing our parents age and watching their health fail. As we experience this, the reality of talking to them about the inevitable weighs on us. And, we know this won’t be an easy conversation to have. As memories slip more and more, the condition of the house deteriorates, and missed medications and meals become an issue, our first reaction to an aging parents’ situation is usually denial. After that, denial gives way to fear and then, procrastination begins. As you can imagine, not dealing with this situation only compounds an already emotionally charged problem.

When is it time?

Something has been nagging at you after your recent visit with mom or dad. Things have changed. Maybe it is something as little as them mentioning they don’t go out anymore, or talking about being lonely or you notice weight loss or some other physical change. The once tidy house you grew up in is now filled with stacks of papers and the refrigerator seems a little too close to empty. Mom seems more forgetful than ever or dad can’t seem to get through a single story without confusing all the details. You sigh and think, “Maybe it’s just me, no one else seems to notice.” Remember what I said earlier about denial, fear and procrastination?

There are two issues governing the decision about whether or not it is time for a loved one to get additional help or to consider assisted living. The first is their physical safety. The second is their emotional well-being. You need to be honest with yourself about whether or not your parent living alone in their home presents a situation that may put them in jeopardy or if it is causing them to shut down and withdraw.

Recently, I heard a radio interview on the subject of dealing with aging parents. The host asked the guest, a newspaper columnist who had been dealing with transitioning her parents to assisted living, how they had planned for that eventuality. She answered the question this way, “My sisters and I went through a very typical process. We had a plan. Our plan was that no one in our family was ever going to get old and, certainly, no one was going to get frail.”

Unfortunately, far too many of us have the same plan. We fail to discuss what will need to happen or how we would like the process to go. We wait until we are in the thick of things. Crisis-driven decision making is not for the faint of heart. It adds layer upon layer of stress that could have been avoided simply by talking things through earlier and making clear-headed decisions. Understanding the importance of dealing with this early will allow both you and your parent to absorb information and adjust slowly to the idea of things being different. Notice I said “different” – not worse or better. Taking time with this decision will make the result far more appealing for everyone.

As you begin the process of talking to your parent about a new phase in their lives, you will find yourself struggling with a wide range of emotions. It is important to remember to be sensitive to your parent’s emotions at the same time. Adult children are often met with hostility and anger by their parents when the subject of senior care or Assisted Living is approached. They do not want to appear weak in the eyes of their children. It is important to remember that your parent has most likely lived a long, independent and meaningful life and they aren’t ready for that to end. Their struggle with their own aging process involves physical realities as well as the emotional realities of worry that include fear of burdening children and being abandoned. As you discuss any transition, it is critical that you validate and reassure Mom or Dad that this is about their safety and improving their quality of life not about putting them away somewhere.

It is generally a good idea to start things off slowly. Expect the discussion to take place in several “installments” – not just one conversation. In fact, you should plan for this to become an ongoing dialogue over time as you will find that Mom or Dad will try to change the subject as soon as you raise the issue. It is always good to focus on the positives, not the idea that your parent needs help. Mom or dad does not want to be reminded that they are getting closer to death! Understand the emotions of what they contemplate – giving up the home they perhaps spent most of their life in, raised the children in, and that holds so many wonderful memories of family life. These are your parent’s accomplishments and they deserve to be honored. A home – their house – is often is a key part of a person’s legacy. Be patient and take time to ease your parent into understanding that the most important legacy is the people in his or her life, not the material reminders. Offer to drive them to a community to see what is offered. Ask if anyone they know is now living in a community that they would enjoy seeing. Talk to people who have been through the transition before you and asked them what worked well.

What’s Out There for Mom or Dad

There are many options for senior care. Of course, I am a big fan of Assisted Living – it is one of the most popular options available today because of the flexibility and independence it offers seniors. But below is what is available:

Adult Day Services: This option provides health, social activities and therapy services. This is a great option for folks who still enjoy the social scene and want to continue to be active in their communities but need a bit of assistance with transportation, meals and other activities. About 150,000 Americans take part in Adult Day programs around the country. The average cost for Adult Day is about $75 a day, depending upon the activities and assistance provided.

Home Care Services: This option allows your parent to remain at home with care coming to him or her. There are a number of agencies that help people find providers of care under this model. However, home care is not licensed by the state. The type of assistance that is provided can range from housekeeping and meal preparation and assistance with daily activities. Rehabilitation services and nursing care can be added at additional cost. The average hourly rate for home care in 2009 was $19. That rate is going to be higher and if licensed medical professionals are involved.

Assisted Living Communities: This option bridges the gap between home care and nursing homes allows seniors to remain as independent as possible for as long as possible. It provides 24-hour care and supervision, but residents live in their own private apartments. More than 900,000 Americans enjoy living in Assisted Living communities with the social advantages that come along with it. Costs will vary depending on the services needed but the $3,700 monthly average does cover housing and care. Some assisted living communities in the area offer end of life care and very high level of care including secured memory care areas.

Nursing Homes: This option provides residents with a room, meals, personal care, nursing care and medical services. Nursing homes are primarily the choice for people with chronic conditions that require long-term care or for those who need short term care after hospitalization. A private room averages $104,390 per year. (*All costs from recent MetLife study)

How Will You Pay?

You might be asking how you or your parent will pay for this new expense. For most seniors, their home is their biggest asset. One option is to sell or rent the home and use the proceeds or rental payments to fund Assisted Living. Financial planners, CPAs and other trusted advisors are good source of information on maximizing your financial options.

There are also other ways such as long term care insurance or VA Aid and Attendance benefits for war veterans which can provide them with up to $2,000 per month tax free towards assisted living services/rent.

One of the best ways to plan for the eventuality of senior care is to purchase long-term care insurance now. This applies more for you than you parents. It is a good value if you are still middle-aged. Long-term care insurance is perhaps the best way to ensure you can afford to pay for what you will want later. Experts suggest consumers should begin looking at long-term care insurance at age 40 and have a policy in place by age 50.

Conclusion

Recognizing that your parent needs a change to remain safe or healthy can be traumatic – on both of you. The best time to talk to your parent is way before it is actually necessary. It is important not to rush the decision and to recognize that seniors want to hang onto their independence for as long as possible even though that may not be what is best for them. The good news is that there are options out there to help your parent get the care needed. And there are people to help you with the process. Your parent needs you whether they admit it or not. Continually reassure them that you are there for them and always will be. Throughout the process, keep your sense of humor and keep the communications lines open.