The Talk We -- and Doctors -- May Owe Our Parents

Americans should be carrying out The Talk with increasing frequency. After all, we're living longer, chronic illness is on the upswing, and the demand for long-term care is growing fast.
06/19/2014 11:36 am ET Updated Aug 19, 2014

Five years ago, my father, already in declining health at the age of 88, fell and broke his shoulder. Soon other health issues, chiefly dementia, set in, too, and threatened his lifelong independence. He could no longer climb the stairs in their house, much less otherwise take care of himself.

My mother, 12 years his junior and then responsible for his well-being, fell too and suffered a fracture in her spine. With her out of commission as his caregiver, something dramatic would clearly need to change.

Thankfully, my siblings and I had already started a conversation with our parents about long-term care and the options available, what I call The Talk. That should surprise no one. An estimated 70 percent of people over age 65 are expected to require some kind of long-term care, according to the U.S. Department of Health and Human Services. Baby Boomers are now turning age 65 at the rate of roughly 10,000 per day.

Americans should be carrying out The Talk with increasing frequency. After all, we're living longer, chronic illness is on the upswing, and the demand for long-term care is growing fast. Experts on the convergence of aging and caregiving agree that this intergenerational conversation is, in fact, more important than ever.

But new evidence suggests we're behaving otherwise. Indeed, more than half of American adults (61 percent) have never talked with Mom and Dad about the potential need for long-term care, according to a new Harris Interactive survey sponsored by our company, Amedisys Home Health And Hospice. This result illustrates a long-held suspicion -- that lack of communication between generations on this major health and lifestyle issue is widespread.

The survey raised other, equally serious, altogether related concerns. Of the adults who have this talk in the first place, only 40 percent ever bring up the different options available for long-term care, whether nursing homes, assisted-living facilities or health care at home. And adult children are more likely to feel prepared to care for their parents emotionally (56 percent) than physically (45 percent), spiritually (42 percent) and financially (27 percent).

In talking with my own parents about long-term care, I entered an unusual predicament, even a sort of dilemma. As it happens, I'm a registered nurse and daily oversee the delivery of care to 50,000 Americans at home nationwide. The professional had suddenly turned deeply personal. With my parents I would serve double duty as both a health care professional and as a daughter.

Now I'm urging all adults with parents 50+ to resolve to start this conversation, and then put a plan in place to do so. Let me offer some of the advice our own family followed.

Start early. True, your parents may be going strong right now, even doing most everything they've always done. But someday they may need help with the most basic everyday activities. If you wait too long -- until a crisis hits, maybe from a fractured hip, and action is required immediately -- you may rush your decision and make the wrong one. Far and away the best time to plan for long-term care is well before anyone really needs it.

Be a partner. Make clear to your parents that nobody expects anyone to go any of this alone, and that you'll be on hand to with advice and to help with logistics from first to last. Granted, long-term care is a subject already fraught with sensitivities, and a conversation between parents and children about it may be especially difficult. Your parents may find the whole idea embarrassing, resist feeling like a burden and be reluctant to discuss it (and you may feel the same).

Show some patience. Our in-depth conversations with our parents extended over the course of several years.

Involve others. If your parents hesitate to discuss long-term care with you -- after all, they're your parents -- bring in other trusted contacts, whether family, friends, a physician, an attorney or clergy. In our case, all seven of us brothers and sisters participated in the conversations to varying degrees, some in person, others by phone. At one point all of us dialed in for a conference call with each other about best next steps.

The same rules of the road apply to providers, too, especially physicians and nurse practitioners. Start early, be a partner and involve others as needed. Indeed, your parents are probably more likely to follow advice about long-term that comes from a health care professional. The older the patient, the more respectful toward physicians. For example, a parent might tell a child, "Well, let's see what the doctor says."

Ideally, a physician will talk with your parents first, or with you on hand, or both. The dialogue should be open on all sides. As it happens, even physicians and nurses, like adult children themselves, may be reluctant to raise the topic in the first place. In that case, the child might have to prompt the healthcare professional to get onboard.

In the end, my sister and I talked with the physician responsible for our parents. My parents saw her for an appointment and her support for our decisions eased the struggle all around. With loving guidance from us, my father received the care he needed prior to his death in a skilled nursing facility. My mother, now 81, is in an independent living facility and doing well.