Starting the Conversation on Long-Term Health Planning

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Starting a conversation with our loved ones and family members in regard to their long-term and future health planning can bring up mixed feelings. If you’ve never approached this type of conversation before, you may not know where to start. We spoke to geriatric and family health experts from UW, and they answered our questions on how to prepare yourself to begin these conversations, and what to expect.

Highlighted below are main takeaways from the following experts:

  • Emily Ishado, research coordinator at the UW School of Nursing
  • Dr. Susan McCurry, research professor at the UW School of Nursing
  • Dr. Tatiana Sadak, associate professor at the UW School of Nursing
  • Dr. David La Fazia, lecturer at the UW School of Social Work

It’s never too soon to start planning.

There was a unanimous consensus that, whenever possible, it is recommended to have these conversations early, before care intervention is needed. Beginning this dialogue early can help everyone become more comfortable with the topic before an urgent care need or decision arises and can help the person who needs care feel more empowered with the outcome.

“In general, it is best to begin plans ahead of time, as this will help if a crisis were to occur and an immediate decision needs to be made. By planning in advance, you and your family member will be better prepared for upcoming decisions and can better meet their preferences when and if the time comes to make a change.”

– Emily Ishado

Listen as much as you speak.

While there are many stages to long-term health planning, the first step is preparing yourself to simply open the conversation. Focusing on what the person who needs care has to say can help everyone feel more at ease and can help relieve you of feeling responsible to have all the answers.

“The first thing you will want to take into consideration is that it’s a conversation, not a talk. It is important to enter into the conversation with an open mind, ready to listen. Remember this isn’t about you, but rather it is about your family member.”

– Dr. David La Fazia and Dr. Susan McCurry

Be patient and expect to have multiple conversations.

All of our experts agreed that tangible results take time. While it can sometimes feel urgent to raise this topic – and you may feel anxious about results – it is helpful to remember that what brought you here is your desire to help your loved one, and your focus should be on what best supports them. This often means you should expect to talk about their desires and needs more than once.

“This is so important. We prepare families that this is not a one-time thing. Rather it is an on-going conversation and discussion.  If we prepare in this way, we take the pressure off solving all the problems at one time.”

– Dr. David La Fazia and Dr. Susan McCurry

Be prepared for possible resistance initially.

In addition to planning for the conversation to take place in stages, try to be supportive if your loved one feels hesitant to engage in this conversation on the first attempt, and follow their lead with setting the pace of the conversation.

“If there is resistance from the family member in discussing their own elder care, gently ask them to share their concerns and reassure them that you want to listen. Tell them why you want to begin having these conversations.

Allow them some space and either ask them for a better time to have this discussion or offer options for continuing this conversation [later].”

– Emily Ishado

Don’t forget to involve other loved ones.

Preparing for a conversation on long-term health should also include reaching out to other family members and close friends of the person whose care will be discussed. This way all relevant parties will not only have a say in planning, they will also be able to share any tasks and directives that arise, instead of just one person taking on everything.

“Begin with identifying who is on your care team and facilitating the conversation about key care issues and roles. It is important to engage extended family and friend networks early on during care planning and to involve the care recipient to the degree they are able.

This approach will allow you to establish general shared goals and to distribute care responsibilities.”

– Dr. Tatiana Sadak

If your initial planning involves a group of people, consider choosing just one or two people to initially try and open the dialogue.

“Too many people involved can be received as confrontational. If there are multiple siblings, children, friends, etc. who are involved with the family member, schedule a time to gather together to discuss issues and goals.

From this meeting, decide who it makes most sense to be involved in the conversation with the aging family member(s).”

– Dr. David La Fazia and Dr. Susan McCurry

Be ready to address family conflicts or differing views.

Sometimes, family members, friends and other members of a person’s care team may have differing views on when beginning a conversation like this is necessary. In circumstances like this, do your best to respect each other, and remember this is about honoring your shared loved one.

“Take some time to try to understand the other family member’s perspective. Actively listen to what they say and validate their concerns, even if you do not agree. Often times, validating another person’s perspective can be helpful in opening up space for dialogue.

If a conflict escalates, don’t forget that there are experts who can help you with your planning.”

– Emily Ishado

“In situations such as these, professional support from a geriatric case manager – usually a social worker or nurse – or other counselor/psychologist with expertise in aging issues can help facilitate these conversations and assist with coordinating care.”

– Dr. David La Fazia and Dr. Susan McCurry

Utilize a professional health care team as needed.

Bringing in healthcare professionals is also recommended in situations where the health of the person who needs care has already significantly declined, especially if they are unable to properly care for themselves.

“It is common for people living with early stages of memory loss to minimize or deny problems. It can be helpful to insist on an exam or evaluation and to obtain a diagnosis, so that a healthcare team can help support conversations about care needs.”

– Dr. Tatiana Sadak

These conversations are for us all.

Just because you’re young doesn’t mean these conversations aren’t for you, too. Dr. La Fazia and Dr. McCurry left us with one more suggestion to reflect on when approaching these conversations.

“We would encourage everyone who is thinking about having a conversation with aging family members for long-term care planning and managing health to ask themselves: Have I had this conversation with my own significant other(s) for myself?

It is also easier to have such conversations with aging parents when you have had them yourselves; it will increase your comfort level and confidence for how to proceed.”

UW resources that can help

UW’s Employee Assistance Program: Benefits-eligible UW employees can contact Family Care Specialists for help in preparing for elder care conversation or in finding care facilities that meet their family member’s needs.

Years Ahead: Through Years Ahead you can take a needs assessment online for your loved one, learn about elder care options, access elder care resources, and get guidance in finding senior care providers near you or your loved one. Years Ahead is available to benefits-eligible employees and UW students through Bright Horizons.

UWHR’s elder care website has up-to-date elder care resources that you may find helpful.