The Background
In February 2021, after two years of investigating the efficacy of Australia’s aged care system, The Royal Commission into Aged Care Quality and Safety delivered its final report. The results were not good.
The Commission generated an alarming 148 recommendations for the reform of the aged care industry, which was a devastating blow to a system that was already under an immense amount of pressure.
Millions of older people around the country require some level of support, but the Royal Commission’s findings in 2019–2021—coupled with fears and uncertainties related to the COVID-19 pandemic—roused feelings of reluctance that the aged care sector is still recovering from.
But here’s the catch: reluctance doesn’t eradicate necessity. People still need care, and families still need help supporting their loved ones.
As a response to these developments in recent years, more older Australians are opting for home care. The demand for age-in-place options has increased substantially—as of 2022, there were nearly one million Australians aged 65 and over receiving home care.
Indeed, despite Australians’ seesawing hesitations regarding aged care, the number of people who need it only continues to grow as the country’s population advances in age. What the data doesn’t reflect is an invisible challenge: getting older people to accept help in the first place.
The Challenge
If we’re painting with a broad brush, elderly individuals can be resistant to receiving help. Understandably, they want to remain independent; they’re typically not keen to invite ‘strangers’ into their homes, and they’re certainly not eager to uproot their lives and move into a residential aged care facility.
At the same time, most older people sincerely loathe the idea of becoming a burden.
In our research for this article, that’s the word that appeared most often: burden. As in, ‘I just don’t want to be a burden’. It’s (unsurprisingly) a fairly universal sentiment.
The irony, of course, is that when older people steadfastly refuse help, that becomes the burden. Much of the time, adult children find themselves in an impossible dilemma where they need to protect their parents’ safety on one hand and preserve their autonomy on the other—all without damaging the relationship.
That’s because the emotional weight of having the aged care discussion can be quite complicated on its own. Such a conversation signals a complete role reversal wherein the child has to now parent their parent, and that tends to be a tremendously uncomfortable psychological twist for both parties.
The ‘Aged Care Talk’ overturns the fundamental familial dynamic. It can be particularly hard on parents since it’s always been their job to care and look out for their children. When the aged care conversation begins, they commonly react with opposition, anger and even willful indifference.
But hesitation can go both ways. Children of ageing parents wrestle with complicated feelings of their own, especially emotions such as…
- Guilt: Am I stripping my parent of their independence? Am I going against their will?
- Fear: What if I put my parent in a situation that isn’t safe? What if they aren’t happy?
There’s no exact science to successfully having ‘The Talk’ about aged care with your parents. Every situation is entirely unique, right down to the individual relationships you and your siblings have with your Mum and Dad.
The good news is there are numerous strategies you can utilise in order for these conversations to not only go smoothly, but for them to land in the desired destination: with your parent(s) accepting help when it’s necessary for their wellbeing.
The Process
As you prepare to start (or restart, or re-restart) the aged care discussion with your parent(s), here are five essential guideposts to consider:
1. Be early, not late: There’s never going to be a ‘perfect’ time to have the conversation. However, the ‘right time’ is almost always earlier than you anticipate: you want to approach these discussions long before necessity forces the issue. Importantly, an early start allows the entire family to get on the same page and brings dissenting opinions to light so they can be hashed out thoughtfully instead of hurriedly.
2. Pay attention to the signs: You know your parent(s) as well as anyone, and that puts you in position to notice signs of ageing and decline. Forgetfulness, weight loss and increasing isolation habits are all common—but sometimes the signs of ageing aren’t that obvious. More subtle clues could be an untended garden, difficulty managing finances and neglected housework.
3. Be realistic: Denial can be sneaky. If you notice your parent is slowing down, then that’s most likely the reality—even if your Mum is still winning her weekly card game, or your Dad still possesses his razor-sharp wit. The consequences of ageing eventually materialise for all of us; ignoring that fact and avoiding the aged care conversation in the interim can make things more stressful down the road.
4. Get some help: Outside resources such as doctors, physicians, nurse practitioners, clergy members, and even family attorneys can be impactful voices in aged care discussions. They don’t bring any emotional baggage to the situation, which enables them to share their opinions in an objective manner. Ageing parents often baulk at suggestions from their children because, again, it represents a role reversal that upends the family dynamic. Third-party professionals aren’t anchored by that context, so their insight carries more potency—even if they’re saying the same things you’ve already said.
5. Set attainable goals: The process of preparing for and then having ‘The Talk’ can have a lot of moving parts, and goals are often an afterthought. However, if you and your parent(s) can find common ground and agree on one or two primary goals—even if the goal is as straightforward as maintaining maximum independence—then everyone involved in the conversation has a shared compass to follow as the process and care needs evolve over time.
These common threads pop up frequently in articles, books, blogs and podcasts about this topic, but ultimately, they are merely a red carpet rolled out for the main event: the actual conversation. If you’re able to incorporate the above points into your process, though, you can set yourself up for success when the time finally comes to sit down and talk.
Now, let’s look at some strategies for that final step.
The Aged Care Discussion
The aged care discussion with your parents doesn’t need to be built up into a big, dreadful clash. At the end of the day, you know your parents and family dynamic better than anyone, and trusting your intuition while considering all of the different variables is always a good bet.
But over the years, sons and daughters just like you have become experts in this arena simply by living through it themselves. They share those experiences and the wisdom they’ve gained in hopes of making it easier for the next wave of families.
Melanie P. Merriman is one of those people.
Her award-winning book, Holding the Net: Caring for My Mother on the Tightrope of Aging provides a heartfelt account of Melanie’s experience guiding her elderly Mum through her latter years.
When we spoke to Melanie about having the aged care discussion, one of the first points she made was elementary: don’t try to convince your parent(s) they need help.
‘If you think about it that way’, Melanie told us, ‘then the entire conversation is about you making them do something’.
‘No adult responds to that’, she said.
Instead, Melanie suggests framing the conversation around what you’ve observed and strictly avoiding phrases such as ‘You should…’
‘If you acknowledge how the situation feels to you, and if you ask questions instead of telling them what they should do, then the conversation can unfold in an open kind of way’, Melanie said.
Coming to the conversation prepared is also essential.
Whether it’s in-home help, respite care, an aged care facility or something else entirely, your ability to present a sincere, well-researched solution could go a long way in setting the tone for the rest of the discussion.
Here are some additional strategies to consider.
Understand the options
Before sitting down to have ‘The Talk’ with your parents(s), spend some time researching, gathering information and understanding all of the potential options available. There are countless misconceptions about aged care, but with some preparation, you’ll be able to dispel falsehoods and mitigate fears—including your own—that could otherwise derail the conversation before it even begins.
In presenting those options, remember Melanie’s advice and try to avoid phrases such as ‘You should…’ Open up the floor and invite your parent(s) to be a part of the decision-making by asking about their opinions and feelings. Similarly, if you have siblings or other family members joining the discussion, it’s usually a good idea to formulate a plan with them before broaching the subject with your parent(s). That way the group can address dissenting opinions behind the scenes and demonstrate a united front when the big talk happens.
Mention the signs
An aged care conversation that gives everyone involved the opportunity to share how they feel leaves no room for interpretation. That’s important: inviting your parent(s) to voice their feelings is certainly part of it, but you need to speak up, too, and share what you’ve noticed and how those observations make you feel regarding your Mum or Dad’s health.
And the way you do that matters. When you tell your parent(s) how you’ve noticed some concessions they’ve been making, try not to frame it in the context of, ‘And that’s why you need help’. Simply let them know what you’ve observed and that it has you concerned for their wellbeing. Without that transparency from your side of the table, they might believe that everything is normal and support in any capacity is unnecessary.
Focus on the advantages
If there’s one thing that you and your parent(s) can probably agree on from the outset, it’s this: their independence and comfort are of the utmost importance. In a situation where ageing parents are beginning to show signs of slowing down, aged care services can help them maintain that independence.
Home care, specifically, can be a useful tool that not only preserves autonomy but also enables ageing parent(s) to live in their own homes late into life. Unlike aged care facilities, in-home care is a cost-effective solution with a wide spectrum of possibilities: maybe your parent(s) requires one-on-one personal care, or maybe they simply need help with chores around the house and meal preparation.
The point is, you and your family have options.
There are different care levers you can pull for different scenarios, and focusing the conversation on that flexibility and the fact that it actually promotes independence encourages ageing parents to see the situation from a more practical angle.
Try before you buy
In addition to focusing your conversation on the advantages of aged care, make it clear that decisions are not permanent. No matter what type of services your family needs, chances are, you can try different options before committing. Visit aged care facilities, experiment with respite care, hire an outside caregiver on a short-term basis—test the waters before jumping in, and while doing so, gain a better understanding of any reservations your parent(s) might have while quelling fears of your own.
‘It doesn’t always work with the first caregiver,’ Melanie Merriman advises. ‘So as the child, stay on top of it and make sure your parent is feeling comfortable—and if it’s not working for some reason, simply make the change.’
Indeed, the decisions made during these conversations don’t have to be permanent—and extra support doesn’t necessarily have to come in the form of aged care services. There is a great deal of adaptability in the marketplace, which empowers families to try different support options and make choices based on what’s best for their unique situations.
Tap in third-party resources
Unbiased third-party professionals such as doctors, physicians, nurse practitioners and occupational therapists can change the dynamic of the discussion. They not only have a trained eye to objectively evaluate the details, but they also have insight into what options might work best for each family’s specific circumstances. If your parent(s) resists support despite clearly needing some help, or if your family is at odds over what steps to take, tapping in an outside source can clear the logjam.
But it doesn’t necessarily have to be a professional.
Sometimes, a friend or someone close to the family who benefits from aged care services can be an even more impactful resource:
‘Mum, doesn’t your neighbour, Sheila, have in-home help a few times a week’?
‘Yes, and she swears by it’.
‘Don’t you think something like that could help you’?
An example like this normalises the decision and helps older people see that care services can actually be beneficial. That’s especially true if they’ve already started to make concessions and give up on activities they used to enjoy. Perhaps a caregiver can stop by intermittently and help them do those activities again, such as cooking, gardening and commuting to the recreation centre.
Have multiple conversations
Amanda Johnson is a Professor of Nursing at the University of Newcastle. She is also an aged care expert and co-author of Caring for Older People in Australia, which showcases Amanda’s vast research and teaches students in the sector how to deliver effective care.
When we asked her about strategies for having the aged care discussion with older parents, she said it comes down to one word: empathy.
‘It’s the notion of planting the seed and letting it grow’, Amanda said. ‘Choose the appropriate moment to plant the seed with a beginning conversation, and recognise the conversation can evolve over time’.
And what should be the goal of that initial discussion?
‘Raise your concerns, but allow your parent the time and space to reflect and think on it’.
Amanda’s point is that this is a big decision—for you, but also your parent(s). The suggestion that they require aged care services can feel like an affront to their independence at first.
‘Don’t go in like a bull,’ Amanda told us with a laugh. ‘Be empathetic, plant the seed, and let them recognise for themselves that they need support—and that they’re in control of the decision’.
Melanie Merriman offered similar guidance.
‘Don’t concentrate only on your next move like it’s a chess match’, she cautioned.
‘Pay attention to what your parents say and how they feel, and if [your family] doesn’t make it the first time, that doesn’t mean you’re doing anything wrong!’
In other words: ‘The Talk’ could actually be multiple talks, and that’s perfectly okay.
Conclusion
Having ‘The Talk’ with your parents about aged care can be complicated for everyone involved.
Melanie, Amanda and many other experts share their wisdom in hopes of making your experience smoother, and years from now, a new wave of authors, teachers and podcast hosts will be doing the same for your children.
It’s certainly circular in nature, but there’s nothing vicious about it: love sits at the core of these big decisions, and truthfully, your intention matters. If you’re having discussions about aged care with your parent(s) and family, or if you’re preparing to do so, it’s safe to assume that you only want what’s best for the people you love.
During our conversation with Melanie, she shared one of her breakthrough moments.
It came at a time when she was struggling with fear and caregiver guilt, and a time when she was uncertain about the way she was handling her Mum’s situation.
Melanie’s friend asked her a forthright question: Are you trying to preserve the autonomy that your Mother had at a younger age?
In that moment, it clicked for Melanie that her Mum was no longer able to live her life like she did when she was younger—not completely, anyway. The dots connected in Melanie’s mind that aged care actually gave back the autonomy that had started to slip away from her Mum, and that was the clarity Melanie needed: she was, in fact, doing what was in her parent’s best interests.
Such lightbulb moments are different for everyone, especially because no two people age exactly the same. Some parents start needing help a bit earlier, while others remain completely independent well into their 90s.
When you sit down to have ‘The Talk’ with your ageing parent(s), remember: you have options, decisions aren’t necessarily permanent, and if you don’t get things exactly perfect the first time (or the second time, or the third time), you’re probably just doing it right.
