Article from the Boston Globe’s On Call Magazine, April 2002

By Helen Osborne, M.Ed., OTR/L
President of Health Literacy Consulting

While adults need to be mindful of their own health and finances – eating wisely, making healthy lifestyle choices, and saving money for the future – they also may need to be attentive to the needs of their aging parents. For many families, health and finances may have never been openly discussed before, and both parents and adult children can feel awkward talking about these topics. As a healthcare professional, you can help.

Mrs. M and her family need help talking about health and finances. Until a few years ago, 82 year old Mrs. M managed her own money, tended to her own healthcare needs, and maintained her own home. In recent years, however, she has been diagnosed with high blood pressure, cataracts, and macular degeneration. Mrs. M now is nearly blind, needs assistance caring for herself and her home, and takes numerous prescription medications. The HMO she belongs to recently dropped its drug benefit plan and Mrs. M. has had to pay out-of-pocket for all her medications. Mrs. M’s three children want to make sure that their mother is safe and well taken care of. But they are unsure about what to do or how to approach the topic.

Health professionals can help, says Mary Pierce, MSW, LICSW. Pierce is a clinical social worker at Brookhaven at Lexington, a continuing care retirement community located in Lexington, Massachusetts. Her main recommendation is that families should talk about health and finances while the parents are still healthy – before there is a crisis or emergency. “The longer families wait,” says Pierce, “the more likely the parents are to have health and financial needs.”

Here are some suggestions Pierce offers that you can use to help families like Mrs. M’s deal with potentially touchy issues before a crisis happens..

Help start the conversation about health and finances. Children are often uncomfortable broaching the topic of health and finances with their parents. Suggest they begin by talking about an article they read in the newspaper or saw on TV, such as a story about the high cost of nursing homes and long-term care. Encourage families to think about when and where to have these conversations, choosing a time when everyone who needs to be included can attend and a place where they are unlikely to be interrupted. Let families know that it often takes several months to make important decisions and to expect that they will have a series of conversations about health and finances.

When families meet, let them know that listening is as important as talking. Help families learn techniques to confirm that they understand one another, such as using their own words to repeat back what they hear someone else say. Encourage all family members to not only discuss what they need and want, but also what they fear. Mrs. M, for example, is afraid of being a burden to her children. The children, in turn, are worried about their mother’s safety. Once Mrs. M. and her children voice their concerns, they can problem-solve together about realistic and acceptable solutions.

Sometimes families cannot communicate with each other in a respectful manner. When this is the case, suggest they invite a neutral third party — such as a lawyer, family friend, clergy member, or health professional — to participate in the discussions with them. Let them know that it is important to select a third party whom everyone trusts and with whom everyone feels comfortable.

Encourage families to think about financial planning. Families have a lot to gain by planning ahead how to pay for healthcare. Pierce recommends that families learn about options such as long-term care insurance and financial trusts. She also suggests that they keep up-to-date with Medicare and Medicaid regulations. In the case of Mrs. M., health professionals can help by letting the family know about options they have to reduce the cost of her prescription medications.

Educate families about how to recognize healthcare problems. As people age, they most likely will be diagnosed with at least one serious illness or medical condition. Health professionals can alert families to common symptoms. Let children know, for instance, that if a parent suddenly stops paying his or her bills, burns pans on the stove, or looks uncharacteristically unkempt, there may be a serious problem that needs medical attention. In the case of Mrs. M, her children encouraged her to go for an eye exam after they noticed that she often wore her sunglasses and frequently chose to read large print books and magazines.

Suggest ways that families can divide up responsibilities. When a parent is diagnosed with a medical problem, the adult children may need to assume new responsibilities. This can be a challenge, especially when families live far apart from one another. Help them find ways to contribute to their parent’s care. For example, Mrs. M. has one daughter who lives nearby. The family might agree that she will be the primary contact for all healthcare information. A brother who lives out of state can offer to handle the financial affairs. Another daughter can be an excellent listener and should call her mother often, continuing to ask about her concerns, fears, and hopes for the future.

Help families understand the importance of documents. Pierce recommends that all families should know about three essential medical/legal documents: an advance directive (known as a “health care proxy” in Massachusetts); a durable power of attorney; and an up-to-date will. When completed, these documents provide ways for people to specify how they want their health and financial affairs handled and allow them to name someone to act on their behalf when necessary.

Be a resource for the family. In addition to letting families know about important issues to consider and ways to discuss them, you can also suggest books, Web sites, and community agencies where families can go to learn more.

When you help adult children talk with their aging parents about health and finances, Pierce says, you are truly offering a great service.

To Learn More:

Mary Pierce, MSW, LICSW, is a clinical social worker at Brookhaven at Lexington, a continuing care retirement community. You can reach her by phone at (781) 372-0217.

Resources in Print

• Adams, T and Armstrong, K. When Parents Age: What Children Can Do. New York: The Berkley Publishing Group,1993.
• Cloud, J. “The American Way of Death” (p. 60) and “Exit Strategies” (p. 65) in Time Magazine, September 18, 2000.
• Loverde, J. The Complete Elder Care Planner. New York: Hyperion,1997.
• Morris, V. How to Care for Aging Parents. New York: Workman Publishing, 1996.

Agencies

Massachusetts Extended Care Federation, Phone: (617) 558-0202 or (800) CARE-FOR (in-state only), www.masslongtermcare.org