Difficult ConversationsBaby Boomers & Aging Parents

Gail Henson, Ph. D.

Hospice Institute

Bellarmine University

Goals

• What are stressors for the baby boomers?

• What are the difficult conversations?

• Why are they difficult? Barriers, issues, roles

• How can we have them? Models

Facts about baby boomers

• Born 1945-1964

• 2000 Census Figure: 61,952,636

• US percentage= 22%

• Kentucky: 45-64= 23%;

Baby Boomer issues

• Have not had same kinds of hardships as did parents

• Did not fight in World War II, Korea

• Did not live through Depression

• We expect a high standard of living

Paying for children’s education

Saving for retirement

We have big mortgages, debt

We’re overweight

We like to eat out

We like to travel

We’re really tired

So here you are--

• The baby boom generation’s latest, and in some ways most agonizing, life crisis

• What to do what the parents who once took care of you can no longer take care of themselves.

• What hats do you wear? Name them!

What are the difficult conversations?

• When do they arise?

• Why are they so difficult to have?

• What can help us have effective family conversations about difficult topics?

Difficult Conversations

Exercise 1

Individual surveys

Group discussion & activity

Difficult conversations: health

• Use of pain medication

• Advanced directives (living will, use of CPR, artificial feeding, breathing, hydration)

• Power of attorney

• True status of own/loved one’s/parent’s health

• Where to die

Safety

• Driving

• House

• Food

• Memory

Conversations about personal conduct

• Hygiene

• Exercise

• Finances

• Care of home

Difficult conversations: end of life

• Family relationships that need resolution• Death• Funeral plans• Burial, cremation plans• Wills• Naming an executor • What to do with possessions after death

Conversations –Religious & philosophical

• Religious concerns about death

• Why is life so fragile?• Why is everything living

transient?• How do I deal with

suffering? How can I deal with pain or discomfort as I die?

• Do I fight death or do I embrace it?

• Why am I suffering?• What is quality of life?

• What is the meaning of my life?

• What is my legacy?• What is a good death?• What will the hour of my

death be like?• Can I prepare for death?• Does anyone care about

my death?• Does my death affect

anyone?• What loose ends need to

be tied up before I die?

More conversations…

• What will happen to my body after death?

• Will I continue suffering? Will I be reborn into a new existence or into a cosmic nothingness?

• How do I go into the next stage? Is it dark or light? Is there a life after this?

• What is heaven (or hell) like?

• Will there be angels or demons?

• Will I see God (or a devil)?

• Will there be a judgment?• Will there be people,

places, or animals I know?

It’s tough to talk with your parents

Many factors affect any conversations

How can you prepare for the challenges?

Consider such factors as relationship, culture, communication patterns, verbal communication, and nonverbal communication

Family Relationships

• Defined roles

• Commitment to preservation

• Recognition of responsibilities

• Shared history and future

• Shared living space

Family culture

• Religion• Politics• Education• Economic level• Race & ethnicity• Geographic culture• Values• Communication patterns

So why is it so hard to have tough conversations?

• Roles that have been played such as….

• Boundaries long established

• Feeling it would be disrespectful

• Fear• Anger• Embarrassment

• Not knowing how to begin

• Geographic distance• Dislike or disgust• Not having the

emotional energy to do this

• Not motivated• Personality clashes

Perhaps these conversations are tough because….

• You don’t know how to begin—

• You’re surprised, confused, upset at what has happened---

• You’re anxious about what you might hear or see—

• You’re anxious about death itself---

• You’re afraid your parent might get mad at you! For example----

Let’s get serious—have these situations ever happened to you?

• Your parent wants all your time & attention

• Makes unreasonable demands

• Is inflexible, critical, and negative

• Complains about real or imagined physical symptions

• Uses inappropriate/foul language

• Exhibits bizarre behavior

It’s tough to have conversations with a parent who

• Has become suspicious and paranoid• Is experiencing increasing levels of

memory loss• Makes up silly lies, exaggerates, cries wolf• Stays in bed, does nothing—waiting to die• Refuses to take showers or change

underclothes• Gets furious if something doesn’t happen

at a specific time

It’s tough to have conversations with a parent who

• Gets mad when told “No” they can’t do something

• Is a danger on the road but refuses to give up driving

• Needs but refuses to allow any caregiving help in the home.

• Wants to eat constantly or only wants to eat the same thing

It’s tough to have conversations with a parent who

• Can no longer take proper care of their bills, insurance, finances

• Refuses to see a doctor/dentist, but is not getting adequate care

• Needs to see a psychiatrist but refuses to go

• Acts completely normal and charming in front of others (Jekyll & Hyde)

It’s tough to have conversations with a parent who

• Fakes illness at the Adult Day Care to avoid staying

• Cannot be reasoned with when they go into an illogical rage

• Has pushed me to feelings of resentment and guilt

• Is completely unmanageable and needs to be placed into a home

• Refuses to allow a cleaning person into the home

Difficult conversations lead to drawing lines—setting boundariesSometimes it’s hard to establish

boundaries with your parents• May feel you’re

selfish• May seem like you’re

being disobedient• If you set boundaries,

you may be hurt by the consequences

• If you set boundaries, you may hurt others

• You may think that boundaries mean you’re angry

• You may feel so obligated to your parents that you may feel guilty

• You may feel like boundaries are permanent

Before the conversations beginCheck family communication styles

• Avoidant— unable to ask for help, recognize own needs, let others in; withdraw when have needs

• Compliant—one can’t say no• Controller— sees others “no” as a

challenge-can’t respect other’s limits; don’t take responsibility for own lives

• Nonresponsive: don’t pay attention to responsibilities of love; beyond insensitive

What kinds of boundaries exist between you & your parents?

• Functional boundaries—a person’s ability to complete a task or job:

Performance, discipline, initiative, planning Can your parent remember to wash his/her clothes?

Eat? Pay bills? Take pills?

• Relational boundaries—your ability to speak truth to those in a relationship

If you’re a compliant person, you may have a hard time, due to fear

• Fear of hurting your parent’s feelings

• Fear of abandonment• Fear of their anger• Fear of punishment• Fear of being seen as

bad or selfish

• Fear of being shamed• Fear of being

unspiritual• Fear of your own

overstrict, critical conscience

• Can you say, “No” without one of these fears?

Fears of elderly or terminally ill

• loss of self image

• loss of control over life

• loss of independence and fear of abandonment

• fear of living alone and being lonely

• fear of death

So you have a difficult conversation coming up? Is this how you feel?

What’s in your toolbox of strategies for conversation?

“If the only tool you have is a hammer, you tend to see everything as a nail.”

Abraham Maslow

Oasis• Open— crisis, planned,

casual, spontaneous

• Articulate the question/problem/issue (does the person perceive there to be an issue/problem/question)

• Search for solutions• Integrate options into

action• Study and evaluate

O.A.S.I.S.

Opening

Integrate

Study & evaluate

Arti

cula

te

So here’s the difficult conversation

• Goal is it to understand? is it to feel a certain way?is it to do something?

• Context• Context: planned, unplanned—crisis,

spontaneous• Perceptions• Barriers & boundaries

Physical—verbalNonverbal--Relational--Roles

• Gender• Comm• Emotion• Culture• Work• Finances• Children• Culture

•

•

Challenges to plan for before the conversation

• Risks• Verbal—actual understanding of

situation, technical level of language, physical ability to hear or concentrate

• Nonverbal—tone of voice, gestures• Context—what’s going on at the

time of conversation• Past patterns of family

communication

Do your parents understand what you mean? Perhaps not….

• Are you sure they hear you?• Do they understand the words you’re using?• Do they understand things in a way you did not

intend? • Lesson 1 Meanings are always in people • Lesson 2 Meanings are more than words and

gestures• Lesson 3 Meanings are always unique, one-time• Lesson 4 Meanings have both connotations and

denotations• Lesson 5 Meanings are always context based

Nonverbal matters that can help or harm your conversations

• Paralanguage• Listening• Touch• Gestures• Dress• Physical environment

Nonverbal issues and your parentsWhat are the bodies saying?

• Body orientation (facing toward or away from each other with body, face, head)

• Posture

• Gestures

• Face and eyes

• Voice

Nonverbal: paralanguageHow you say things counts!

• Stress on words, syllables

• Pitch (shrill, high, low)• Rate (fast, slow)• Volume (loud, soft)• Rhythm• Examples: crying,

whispering, moaning, belching, yawning, yelling, screaming

“Don’t use that tone of voice with me!”—Parents of the world

Getting through the barriers

• Fences with gates, not walls

• Try to determine the fences in advance

• Learn how to open the gate…….

Things that often don’t work well

Avoiding the topicMinimizing the issueBlaming the personSilencing the personGunnysacking—saving up all the issues and

dumping themBeltliningForcePersonal rejection

Listening and your parentsObstacles can take the form of…

• Preoccupation with self

• Preoccupation with external issues

• Taking a “you’re with me or against me” attitude

• The law of least effort

Listening and your parentFeedback is important

Giving feedback• Honesty• Immediacy• Appropriateness• Clarity

Receiving feedback

Sensitivity

Supportiveness

Open-mindedness

Being specific

Nonverbal issues with families Your face speaks volumes

Intensifying

De-intensifying

Neutralizing

Masking

Nonverbal issues The eyes have it. Eyes may indicate….

• Positive or negative responses

• Dominance or submission

• Interest or fear• Involvement or

withdrawal• A signal to turn the

conversation• Feedback

Compensation for distance

Signal nature of relationship

Nonverbal: touch

• Expresses positive or empathetic response

• May be ritual• May express control• May be task related• May be playful

Nonverbal issues to consider with your parent

• Which part of the body does the touching

• Which part of the body is touched

• How long the touch lasts

• How much pressure is used

• Whether there is movement after contact is made

• The situation in which the touch occurs

• The relationship you have with the parent

Nonverbal: gesturesWhat do the hands say?

• Illustrators—scratching your head, snapping your fingers; decrease when someone is cautious

• Emblems: nodding head for “yes” or putting a hand to your ear “I can’t hear you”

• Adaptors—nervous habits—fiddle with hair• Too few gestures may be significant as an

indicator of a mixed message as too many.

Nonverbal issuesAppearance leads to assumptions

Factors• Hair• Dress• Body odor• Grooming

Assumptions• Moral character• Attitude• Trustworthiness• Success• Level of sophistication

• Note: assumptions not always accurate!

Exercise 2

What’s your nonverbal communication style with your

parent(s)?

So you have to talk—how to get started

• Allow your parent to talk about whatever—they may give you an opening…“When I’m no longer here, I want you to have this…”

“It seems like every friend I have is gone…”

• Answer such leading statements with responses that invite more conversation

“You seem to feel that life is getting short…”

“It must be getting very lonely for you…”

Open: Look for Opportunities to talk

• Circumstances or events can provide a chance for you to make statements that lead to difficult conversations– Death of friend of family– News– Article in a magazine or newspaper– “Dad, do you ever daydream about your

funeral?”– “Mom, what do you think heaven will be like?”

Articulate the issue

• Does your parent/the person perceive a problem or issue exists?

• What are the risks if this problem is not addressed?

• What are the risks of the conversation does not occur?

• Given the risks and problems that could occur, how is your goal affected.

Clarify the problem/issue

• Nature of the problem

• Effects of Problem

• Your desire for change

Search out options

• Use positive thinking to help solve problems• Understand the situation or condition• Decide if you need professional help• Plan what you will do• Consider obstacles and how to deal with them

creatively• Develop, carry out, evaluate and adjust your

plan From The American Cancer Society

Initiate the Conversation

• Context determines beginning

• Risks to autonomy, pride, self-concept affect the progress of the conversation

• Nonverbal and verbal issues affect the conversation

• So how can we manage the conversation?

Tips

• Refer to your own thoughts and feelings• Keep the conversation going with

– Facts– Ideas– Reflections– Descriptions of what you see or hear—use objective

language– Use provisional statements—asking questions rather

than judging—It seems to me that…or If I remember correctly…

• Summarize, paraphrase, bring closure

Listening to your parent

• Paraphrase what you heard to check your understanding—is this what you mean?

• Express understanding (if you understand)-empathy may be a challenge if you’re tired!

• Ask questions

• Try to get your parent to explore feelings

• Talk less• Affirm and validate

Strategies for Difficult Conversations

• Stop

• Step Out

• Step Back In

Warning! Don’t let anger sabotageyour conversation

Be determined NOT to get angry yourself (right)

Get on the same physical level as your parent

Be silent so you won’t say something you’ll regret

Express your concern nonverbally

Make appropriate empathetic statements “I think I can see why you are so upset”

DO NOT say

“I know just how you feel”

(can you read minds???)

Remind yourself that YOU control your emotions

Angry outbursts rarely change someone’s mind.

O.A.S.I.S. Eggshell Exercise

• Open—

• Articulate the question/problem/issue (does the person perceive there to be an issue/problem/question)

• Search for solutions

• Integrate options into action

• Study and evaluate

Suggestions for Reading

• Final Gifts***• I’ll Take Care of You• Are Your Parents

Driving You Crazy?• Aging Parents,

Ambivalent Baby Boomers

• Elder Rage: How to Survive Caring for Your Aging Parents

• Family Ties that Bind• Boundaries. When to

say YES;When to Say No to take control of your life. Workbook to Boundaries

• Boundaries Face to Face

• Crucial Conversations• Feeling Good

Difficult ConversationsBaby Boomers & Aging Parents

Gail Henson, Ph. D.

Hospice Institute

Bellarmine University