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Difficult Conversations Baby 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.

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Difficult conversations baby boomers aging parents l.jpg

Difficult ConversationsBaby Boomers & Aging Parents

Gail Henson, Ph. D.

Hospice Institute

Bellarmine University


Goals l.jpg
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


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Facts about baby boomers

  • Born 1945-1964

  • 2000 Census Figure: 61,952,636

  • US percentage= 22%

  • Kentucky: 45-64= 23%;


Baby boomer issues l.jpg

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

Baby Boomer issues


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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!


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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?


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Difficult Conversations

Exercise 1

Individual surveys

Group discussion & activity


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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


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Safety

  • Driving

  • House

  • Food

  • Memory


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Conversations about personal conduct

  • Hygiene

  • Exercise

  • Finances

  • Care of home


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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


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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?

Conversations –Religious & philosophical


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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?

More conversations…


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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


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Family Relationships

  • Defined roles

  • Commitment to preservation

  • Recognition of responsibilities

  • Shared history and future

  • Shared living space


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Family culture

  • Religion

  • Politics

  • Education

  • Economic level

  • Race & ethnicity

  • Geographic culture

  • Values

  • Communication patterns


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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

So why is it so hard to have tough conversations?


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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----


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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


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It’s tough to have conversations with a parent who you?

  • 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


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It’s tough to have conversations with a parent who you?

  • 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


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It’s tough to have conversations with a parent who you?

  • 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)


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It’s tough to have conversations with a parent who you?

  • 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


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May feel you’re selfish you?

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

Difficult conversations lead to drawing lines—settingboundariesSometimes it’s hard to establish boundaries with your parents


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Before the conversations begin you?Check family communication styles

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

  • Compliant—onecan’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


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What kinds of boundaries exist between you & your parents? you?

  • Functionalboundaries—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 l.jpg

Fear of hurting your parent’s feelings you?

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?

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


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Fears of elderly or terminally ill you?

  • 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



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What’s in your toolbox of strategies for conversation? you feel?

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

Abraham Maslow


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Oasis you feel?

  • Open— crisis, planned, casual, spontaneous

  • Articulatethe 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 l.jpg
O.A.S.I.S. you feel?

Search for solutions

Articulate

Integrate

Opening

Study & evaluate


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So here’s the difficult conversation you feel?

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—verbal

Nonverbal--

Relational--Roles

Gender

Comm

Emotion

Culture

Work

Finances

Children

Culture

Adult child Conversation Parent


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Challenges to plan for before the conversation you feel?

  • 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 l.jpg

Are you sure they hear you? you feel?

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

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


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Nonverbal matters that can help or harm your conversations you feel?

  • Paralanguage

  • Listening

  • Touch

  • Gestures

  • Dress

  • Physical environment


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Nonverbal issues and your parents you feel?What are the bodies saying?

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

  • Posture

  • Gestures

  • Face and eyes

  • Voice


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Nonverbal: paralanguage you feel?How 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


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Getting through the barriers you feel?

  • Fences with gates, not walls

  • Try to determine the fences in advance

  • Learn how to open the gate…….


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Things that often don’t work well you feel?

Avoiding the topic

Minimizing the issue

Blaming the person

Silencing the person

Gunnysacking—saving up all the issues and dumping them

Beltlining

Force

Personal rejection


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Listening and your parents you feel?Obstacles 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 parent feedback is important l.jpg

Giving feedback you feel?

Honesty

Immediacy

Appropriateness

Clarity

Receiving feedback

Sensitivity

Supportiveness

Open-mindedness

Being specific

Listening and your parentFeedback is important


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Nonverbal issues with families you feel?Your face speaks volumes

Intensifying

De-intensifying

Neutralizing

Masking


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Nonverbal issues The eyes have it. Eyes may indicate…. you feel?

  • 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 l.jpg
Nonverbal: touch you feel?

  • 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 l.jpg

Which part of the body does the touching you feel?

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 issues to consider with your parent


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Nonverbal: gestures you feel?What 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 issues appearance leads to assumptions l.jpg

Factors you feel?

Hair

Dress

Body odor

Grooming

Assumptions

Moral character

Attitude

Trustworthiness

Success

Level of sophistication

Note: assumptions not always accurate!

Nonverbal issuesAppearance leads to assumptions


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Exercise 2 you feel?

What’s your nonverbal communication style with your parent(s)?


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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…”

So you have to talk—how to get started


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Open: an opening…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?”


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Articulate the issue an opening…

  • 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.


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Clarify the problem/issue an opening…

  • Nature of the problem

  • Effects of Problem

  • Your desire for change


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Search out options an opening…

  • 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


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Initiate the Conversation an opening…

  • 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?


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Tips an opening…

  • 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


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Paraphrase an opening… 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

Listening to your parent


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Strategies for Difficult Conversations an opening…

  • Stop

  • Step Out

  • Step Back In


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Be determined NOT to get angry yourself (right) an opening…

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.

Warning! Don’t let anger sabotageyour conversation


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O.A.S.I.S. Eggshell Exercise an opening…

  • Open—

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

  • Search for solutions

  • Integrate options into action

  • Study and evaluate


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Final Gifts*** an opening…

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

Suggestions for Reading


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Difficult Conversations an opening…Baby Boomers & Aging Parents

Gail Henson, Ph. D.

Hospice Institute

Bellarmine University


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