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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

Difficult ConversationsBaby Boomers & Aging Parents

Gail Henson, Ph. D.

Hospice Institute

Bellarmine University

goals
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
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

Baby Boomer issues
so here you are
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
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

Difficult Conversations

Exercise 1

Individual surveys

Group discussion & activity

difficult conversations health
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
Safety
  • Driving
  • House
  • Food
  • Memory
conversations about personal conduct
Conversations about personal conduct
  • Hygiene
  • Exercise
  • Finances
  • Care of home
difficult conversations end of life
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?

Conversations –Religious & philosophical
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?

More conversations…
it s tough to talk with your parents
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
Family Relationships
  • Defined roles
  • Commitment to preservation
  • Recognition of responsibilities
  • Shared history and future
  • Shared living space
family culture
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

So why is it so hard to have tough conversations?
perhaps these conversations are tough because
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
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
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 who21
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 who22
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 who23
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
slide24
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

Difficult conversations lead to drawing lines—settingboundariesSometimes it’s hard to establish boundaries with your parents
before the conversations begin check family communication styles
Before the conversations beginCheck 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
what kinds of boundaries exist between you your parents
What kinds of boundaries exist between you & your parents?
  • 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
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?

If you’re a compliant person, you may have a hard time, due to fear
fears of elderly or terminally ill
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
what s in your toolbox of strategies for conversation
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
Oasis
  • 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
O.A.S.I.S.

Search for solutions

Articulate

Integrate

Opening

Study & evaluate

so here s the difficult conversation
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—verbal

Nonverbal--

Relational--Roles

Gender

Comm

Emotion

Culture

Work

Finances

Children

Culture

Adult child Conversation Parent

challenges to plan for before the conversation
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

Do your parents understand what you mean? Perhaps not….
nonverbal matters that can help or harm your conversations
Nonverbal matters that can help or harm your conversations
  • Paralanguage
  • Listening
  • Touch
  • Gestures
  • Dress
  • Physical environment
nonverbal issues and your parents what are the bodies saying
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 paralanguage how you say things counts
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
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
Things that often don’t work well

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

listening and your parents obstacles can take the form of
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 parent feedback is important
Giving feedback

Honesty

Immediacy

Appropriateness

Clarity

Receiving feedback

Sensitivity

Supportiveness

Open-mindedness

Being specific

Listening and your parentFeedback is important
nonverbal issues with families your face speaks volumes
Nonverbal issues with families Your face speaks volumes

Intensifying

De-intensifying

Neutralizing

Masking

nonverbal issues the eyes have it eyes may indicate
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
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 issues to consider with your parent
nonverbal gestures what do the hands say
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 issues appearance leads to assumptions
Factors

Hair

Dress

Body odor

Grooming

Assumptions

Moral character

Attitude

Trustworthiness

Success

Level of sophistication

Note: assumptions not always accurate!

Nonverbal issuesAppearance leads to assumptions
exercise 2

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…”

So you have to talk—how to get started
open look for opportunities to talk
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
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
Clarify the problem/issue
  • Nature of the problem
  • Effects of Problem
  • Your desire for change
search out options
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
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?
slide56
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

Listening to your parent
warning don t let anger sabotage your 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.

Warning! Don’t let anger sabotageyour conversation
o a s i s eggshell exercise
O.A.S.I.S. Eggshell Exercise
  • 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
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

Suggestions for Reading
difficult conversations baby boomers aging parents62

Difficult ConversationsBaby Boomers & Aging Parents

Gail Henson, Ph. D.

Hospice Institute

Bellarmine University

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