This material has been developed by and is presented by The Sandwich Generation (r)
break the barriers to communicating
with an aging parent
By Carol Abaya, M.A.
COMMUNICATIONS is an integral thread in the fabric of society.Ý It is a two-way process that can positively impact quality of life and interpersonal relations or can have devastating effects on both.Ý Effective communications are especially important in Sandwich Generation-aging parental relations and in protecting the older personís health and financial well-being.Ý It is also important in protecting the ìIî Self of the Sandwich Generationer.
According to the American Speech-Language Hearing Association, 23 million Americans (almost 10%) suffer from speech, language or hearing disorders.Ý This number is more than those suffering from heart disease, paralysis, epilepsy, blindness, cerebral palsy, muscular dystrophy and multiple sclerosis combined.
This figure relates to physical communications kinds of disabilities among the general population, and the percent of older people affected is much higher.Ý There are no numbers available in relation to the emotional and psychological problems created by these disabilities that create communications barriers and major family problems in Sandwich Generation and parental relations.
Whether the communication barrier is caused by physical disability or psychological elements, it is real.
Communication difficulties can lead to feelings of frustration (on the part of both Sandwich Generationer and elder), elder isolation, and loss of elder self-esteem.Ý Impaired communication skills can interfere with social-verbal interaction and self-sufficiency.Ý Complete withdrawal from family, friends and society as a whole can occur.Ý
Communications breakdown can also leave older people at great risk, especially in health and financial affairs.
To fully understand possible emotional or psychological barriers, Sandwich Generationers need to understand the value system under which their parents grew up.Ý Todayís eldest generation (those in their 80s and 90s) is made up of fiercely independent people, who often are not gracious about accepting help - or advice - from others.Ý They are often less demonstrative when it comes to expressing affection and emotions than is the case with succeeding generations.
They are also a very private generation -- one that does not like to talk about bad health, money, death, loneliness, emotions or their anger that even daily chores are now troublesome.Ý They are of a generation where old age denoted knowledge and wisdom, respect and a deep connection to the spiritual self.Ý Growing old today in a different societal environment, older people often face loss of self-identity and erosion of self-image.
In most cases, there is not just one barrier to positive and effective communications, but a combination of factors.Ý There are physical disabilities that hinder two-way communication as well as emotional and psychological interpersonal relations issues.
Physical problems include:
Loss of sensory capabilities (hearing, vision, touch, smell and taste) interferes with communications, social relationships, personal safety and emotional well-being.Ý Isolation resulting from hearing and vision impairment, for example, can lead to depression and insecurity as well as suspicion.Ý The insecurity and suspicion factors often hinder effective Sandwich Generation-- aging parent relationships as well as impact the safety and well-being of the older person.
A professional medical evaluation can identify sensory capabilities loses, and a social work evaluation can identify possible emotional problems.Ý Both can lead to appropriate action.
Emotional and psychological issues often hinder communications between people in general, and more particularly between Sandwich Generationers and their parent(s).
Repercussions of Poor Communications
Parents often donít like to discuss important and sensitive issues with children (the Sandwich Generationer).Ý Children may also be reluctant to initiate such discussions, on Durable Power of Attorney, Living Wills, Testamentary Wills, alternative living arrangements, whatever.Ý Or when children do try to initiate conversations, the parent rebuffs such attempts.
So what happens?Ý Any number of scenarios come to mind.Ý And all of them could have been avoided with pro-active communications between Sandwich Generationer and parent.
Scenario: ÝA mentally competent parent is in the hospital and wants his or her social security check cashed.Ý Or the electric and telephone bills, the mortgage or real estate taxes have to be paid.Ý Or money needs to be withdrawn from a bank account for the food and care of the at-home spouse.Ý But the Sandwich Generationer has no legal authority to take care of these mundane chores.Ý The Sandwich Generation does not have Durable Power of Attorney (POA) for that parent.Ý Also the at-home spouse does not have POA for the sick spouse, and the bank account is in the name of the sick person.
Scenario:Ý Parents are on vacation.Ý There is a storm, and part of the roof is blown off.Ý Immediate repairs are needed to prevent further damage to the inside, to furniture, clothes and personal belongings.Ý A son lives nearby, but doesnít have the legal authority to negotiate with the insurance company or to hire and pay a repairman.Ý He does not have Power of Attorney to act for his parents or access their bank account to pay the bill.Ý So repairs have to wait until the parents come home - orÝ have to be arranged via long distance telephone.
Scenario:Ý One parent has a stroke and cannot talk or write.Ý A ventilator is being used to keep him or her alive.Ý Medical decisions need to be made - as well as bills paid.Ý But the Sandwich Generationer does not have the legal authority to act.Ý Even more troubling is the fact that the Sandwich Generationer does not even know what kind of treatment the parent would want or not want because desires, wants or a Living Will were never discussed.
Scenario:Ý A parent is in an accident and is in a coma. The family wants to hire someone to stay at bedside during the night.Ý The familyís vacation home must be sold to pay for this care.Ý But the Sandwich Generationer does not have the legal authority to sell the home.Ý Or, as happens thousands of times each year, the at-home spouse cannot sell the home because he or she does not have POA for the sick spouse and the deed is in both names.
All of these scenarios are real.Ý They can place the Sandwich Generationer in a bind when it comes to handling even the simplest day to day chores for parents and can create major financial and medical problems if the parent is sick for a long period of time.Ý And medical bills can become a tremendous burden if the Sandwich Generationer first of all doesnít know what care the parent wants or doesnít want or has to pay from his or her own monies.
What is critical is that in these scenarios the older parent is also at great risk because communications between Sandwich Generationer and parent either did not occur or were not effective.Ý Desired medical and care decisions may not be made.Ý So health well-being can suffer.Ý Utility shut-offs, mortgage and tax foreclosures are becoming more common.Ý Thus the older person can lose his or her home, which is generally the largest asset
Breaking the Barriers
Besides understanding the range of barriers noted above and identifying those that may apply to their own personal scenarios, there are other elements that Sandwich Generationers need to look at:
ìIf a person says the right words, but with an attitude of disrespect than a negative reaction will be forthcoming,î says Mary Lee Goldberg, MSW, Ph.D, a Princeton, NJ, clinical psychologist.Ý ìAttitude is most important.Ý The way words are said ...Ý If the Sandwich Generationerís attitude is disparaging, if the parent is ìput down,î then effective communication will not occur.Ý The Sandwich Generationer needs to ask himself or herself ìHow do I feel about this person?Ý Am I getting through to him or her?
ìMost parents want to know that they have been appreciated by their children.Ý A Sandwich Generationer needs to tell a parent that he or she has been appreciated and to identify positive influences and tell them to the parent,î she says.Ý Even if the parent was not supportive in the past and therefore there is little to appreciate, the Sandwich Generationer needs to look at his or her attitude and make appropriate adjustments,î Goldberg continues.
If the parent can no longer cook safely, for example, but doesnít like to accept help from others, suggest that someone come in for a couple of hours a day.Ý ìShort visits, rather than day-long help can often solve the problems, yet still allow the older person to feel in control.Ý And the elder should be part of the menu development process or establishing a schedule of what chores should be done which day,î Goldberg says.Ý ìOften a compromise has to be reached by everyone.Ý But the Sandwich Generationer does have to clearly say to the parent, ìI cannot allow you to be unsafe.Ý You can get helpÝ here in your own home or the option is ....îÝ Adult children still need to give the parent the choice, as long as the parent is mentally capable of making a decision.î
In the end, if a Sandwich Generationer realizes that something has to be done but the parentÝ continues to refuse, geriatricians all agree that a third party should be brought in.Ý A social worker can be brought into the parentís home as a friend, rather than as a professional, and discussions on sensitive issues can be developed.Ý Or if it is a legal issue, a lawyer friend of the family or the parentís own lawyer may be able to help pave the way for change.
TIPS TO EFFECTIVE COMMUNICATIONS
Whether or not an older person has physical impairments that hinder effective communications or is just aged and/or frail, he or she is vulnerable to outside pressures and can feel threatened by the very person (the Sandwich Generationer) who loves him or her the most.Ý The Sandwich Generationer may not realize the parent is feeling threatened.
Scenario: ÝThe older person is at the doctorís office or in the hospital.Ý The doctor or nurse talks to the Sandwich Generationer, ignoring the presence of the elder.Ý
You need to make sure the elder is invited to join the conversation.Ý You need to create a positive atmosphere by looking at the senior and listening to him or her so the person feels important.Ý If a person is ignored, the person may feel threatened.
Both the doctor and Sandwich Generationer need to be alert as to whether the older person is ìdrifting offî or is mentally distracted. ÝYou need to ask the older person if he or she hears what is being said and understands it.Ý Even if the person is somewhat confused or has minor dementia, he needs to feel included.Ý You might say, ìThat was complicated, what do you think of that?î
Scenario: ÝThe older person has difficulty in hearing and may or may not wear a hearing aid.Ý If there is a hearing aid, make sure it is turned on and working properly.Ý Face the person and talk directly to him.Ý Speak in a deeper voice because most people with hearing problems donít hear upper tones.Ý If a person wears glasses, they should be in place before the conversation begins.
Try to talk just a little louder than normal, but donít shout, and speak slower and clearly enunciate.Ý Shouting makes a person feel threatened.
Other things to watch out for:Ý If the Sandwich Generationer or other person communicating to the elder is tall or large and stands over the elder while talking, the elder may feel threatened and therefore not hear what is being said. Advice:Ý pull up a nearby chair so you are on the same level as the older person.Ý This makes the older person feel ìequal.îÝ Donít hover over him.
Scenario:Ý The elder has dementia and may not be able to understand change.Ý If the caregiver makes a radical change in the way she looks, the elder can not only become very confused but might get very upset.Ý The changes may make the caregiver seem to be a stranger.Ý In some cases, if the husband is the one who is ill, the changing of the color of the wifeís hair can be very upsetting.Ý Husbands have been known to reject their wife.Ý The husband may not recognize her as the woman he married.Ý So, caregivers should not make radical changes in the way they look.
Scenario: ÝSensory losses often impact elder actions.Ý The water from the bathroom and kitchen faucets are always dripping.Ý There is nothing wrong with the washers.Ý The caregiver feels the elder is ìdoing it on purpose.îÝ But, the elder may not see that it is dripping nor hear it because of sensory losses.Ý Or the elder may wash a dish and leave grease on it.Ý Their sense of touch may have deteriorated.Ý They donít feel the grease and often canít see it.
In such cases, if the Sandwich Generationer continues to bring up the leaking faucet or greasy plate problem, the elder ìfeelsîÝ threatened.Ý And if the elder is repeatedly corrected on this oversight, it might make him angry.Ý ìI never do those things.îÝ The Sandwich Generationer just has to accept the fact that the parent is not doing these things on purpose.
If hot water continually drips, the elder may burn himself or herself because not only has sight deteriorated but also the sense of touch is not what it used to be.Ý Reduce the temperature on the hot water heater to prevent burning.
Scenario:Ý The gas stove is left on, either visibly burning or half turned off.Ý Often the problem is that the elderís sight and sense of smell have deteriorated.Ý Paint the knobs of the stove with a bright color and match the Off buttons or arrows.
Or food is placed on the stove to be cooked, and the elder leaves the room and forgets about it.Ý In order to prevent fires, there are some stoves that have timing devices that automatically turn off the gas or electric after a certain time.
Scenario:Ý A person is hard of hearing but wonít admit it and wonít get tested or wear a hearing aid.Ý An older woman at the doctorís was straining to hear what he said.Ý He was very sensitive to her feelings and said, ìLetís give you a hearing test.Ý I see you are straining to hear me.Ý Youíre such an intelligent woman that it seems a shame if you miss out on hearing everything.îÝ He was appropriately feeding into her self-image and making her feel like a valued person.
Scenario:Ý An elder has fuzzy mental capabilities and may have slight dementia.Ý He is watching a violent program on TV or just the news and has nightmares or difficulty sleeping.Ý Because of mental deterioration and disorientation, he may feel personally threatened as if he is actually being attacked.Ý By having a separate TV for the parent in his own room and a VCR so that oldies movies can be shown, the parent feels safer and more secure.
Some general advice.Ý As long as a parent is mentally capable of making decisions, donít tell him or her what to do.Ý Give him enough information as to alternatives and why you think one course of action may be better than another.Ý Practice the wording beforehand and try to evaluate the word impact on the person with whom you want to communicate.Ý Help your parent make a decision either alone or with you.Ý Whether or not the parent can actually make the proper decision, it is important to include him or her in the decision making process and to make him or her feel included, not neglected
ÝTaking The Bull By the Horns
Sensitive Issues do Need to beÝ Discussed
Initiating discussions of sensitive issues, especially legal and financial ones, isnít always easy.Ý So, what should a Sandwich Generationer do if a parent refuses to discuss things that impact safety and financial and health well-being?
ìSandwich Generationers have to take the bull by the horns, have to initiate talks with parents and explain why they need to talk,î says Gina Shulman, MSW, CSW.Ý ìIt is important that discussions occur before a crisis.î
While it really is a parentís responsibility to do the planning and not put the burden on children, often this does not happen.Ý ìParents should be honest with children.Ý Itís important they are,î notes Shulman.Ý ìMost people have car and health insurance.Ý They should also give Power of Attorney to someone to act for them and have a Living Will and Testamentary Will.î
It should be the parent who controls what happens to himself or herself.Ý However, notes Shulman, if desires are not communicated to children then the children have no idea what the parent wants.
Shulman suggests that a discussion about Living Wills (medical POAs)Ý might be started with, ìThe parent of a friend of mine was in a car accident and is unable to talk.Ý My friend is at his wits end because he doesnít know what to do.Ý He doesnít know whether or not his father would have wanted to be kept alive on machines.Ý Mom (Or Dad) if you are in a car accident, what care do you want?î
Another approach might be, ìThere was an article in the paper the other day about Living Wills and the problem children have when parents get ill and they donít know what do.Ý We haveÝ discussed it between ourselves and have let Johnny and Susan (their children) know what we want if weíre in an accident or get sick.Ý But we donít know what you would want.Ý What would you like me to do if you become ill and canít make a decision yourself?î
Granting another person Power of Attorney (POA), which gives that person authority to act on oneís behalf in financial matters, can seem threatening to an older, independent person.Ý But as weíve seen, a Sandwich Generationer is not able to even pay everyday bills without a legal authority to do so.Ý The question to ask a parent, says Shulman, is ìMom, if youíre not able to pay the bills, who is going to do it?Ý It would help everyone immensely if we knew who you wanted to take care of such chores for you.î
Notes Shulman, the Sandwich Generationer is placing the decision making in the lap of the older parent.Ý ìThe objective is to make sure what the elder wants done gets done and that the elder still controls what happens,î she says.
In reference to a Testamentary Will (one that takes effect after death), a conversation might begin.Ý ìDid you hear about Ann and her brother?Ý Their mother died, and Ann and her sister-in-law are fighting over who gets what pieces of jewelry.Ý And they are fighting about who gets what stock.Ý Mom, you have several valuable pieces of jewelry and Dad left you some stock.Ý Who do you want to get them?Ý You know it would prevent fighting in our family if you put down all your desires inÝ a Will.î
Must Initiate Discussions
The objective in initiating discussion is to stimulate appropriate action on the part of the older parent.Ý Say professional communicators, ìGive them the information and tell them why itís important to act.Ý Tell them the benefits of acting and the endless problems that will be created for themselves as well as yourself if they donít act.Ý Itís an education process.î
This ìeducationî process will probably entail more than just one conversation.ÝÝ If the parent is resisting talking about the subject or doing something, the Sandwich Generationer should repeatedly broach the subject with new information or examples of bad things that can happen if no action is taken.
For example, one of Shulmanís clients was an older woman who could no longer take care of herself and had the money to hire help.Ý But she was borderline incompetent and refused to have anyone come into the house.Ý Her children did not have money themselves to pay for help nor did they have the authority to access her funds because she had refused to give them POA when she could have.Ý The result:Ý she lived in a dirty house without proper food, and was a danger to herself.
ìGive a parent a chance to digest what youíve said,î recommends Shulman, ìLeave articles on the subject with them or put the information down in a letter.Ý If a person sees in writing the repercussions of not acting, it often helps.î
In the end, it is the elderís choice, Shulman says.Ý ìAt some point Sandwich Generationers must let go and respect that ìno.îÝ It doesnít make it any easier, but itís the parentís decision.î
As long as the older person is mentally competent, he or she can refuse all help and to put the legal and financial pieces together that will protect himself or herself and enable the Sandwich Generationer to handle affairs efficiently when necessary.
More information on Communications Can be found in the Questions and Answers articles.
This material is copyrighted by Carol Abaya Associates and cannot be reproduced in any manner, print, or electronically.