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Difficult Conversations Baby Boomers & Aging Parents Gail Henson, Ph. D. Hospice Institute Bellarmine University.

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Presentation on theme: "Difficult Conversations Baby Boomers & Aging Parents Gail Henson, Ph. D. Hospice Institute Bellarmine University."— Presentation transcript:

1 Difficult Conversations Baby Boomers & Aging Parents Gail Henson, Ph. D. Hospice Institute Bellarmine University

2 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

3 Facts about baby boomers Born 1945-1964 2000 Census Figure: 61,952,636 US percentage= 22% Kentucky: 45-64= 23%;

4 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

5 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!

6 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?

7 Difficult Conversations Exercise 1 Individual surveys Group discussion & activity

8 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

9 Safety Driving House Food Memory

10 Conversations about personal conduct Hygiene Exercise Finances Care of home

11 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

12 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?

13 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?

14 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

15 Family Relationships Defined roles Commitment to preservation Recognition of responsibilities Shared history and future Shared living space

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

17 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

18 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----

19 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

20 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

21 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

22 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)

23 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

24 Difficult conversations lead to drawing lines—setting boundaries Sometimes 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

25 Before the conversations begin Check 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

26 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

27 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?

28 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

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

30 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

31 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

32 O.A.S.I.S. Opening Integrate Study & evaluate Articulate

33 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

34 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

35 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

36 Nonverbal matters that can help or harm your conversations Paralanguage Listening Touch Gestures Dress Physical environment

37 Nonverbal issues and your parents What are the bodies saying? Body orientation (facing toward or away from each other with body, face, head) Posture Gestures Face and eyes Voice

38 Nonverbal: paralanguage 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

39 Getting through the barriers Fences with gates, not walls Try to determine the fences in advance Learn how to open the gate…….

40 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

41 Listening and your parents 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

42 Listening and your parent Feedback is important Giving feedback Honesty Immediacy Appropriateness Clarity Receiving feedback Sensitivity Supportiveness Open-mindedness Being specific

43 Nonverbal issues with families Your face speaks volumes Intensifying De-intensifying Neutralizing Masking

44 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

45 Nonverbal: touch Expresses positive or empathetic response May be ritual May express control May be task related May be playful

46 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

47 Nonverbal: gestures 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.

48 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!

49 Exercise 2 What’s your nonverbal communication style with your parent(s)?

50 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…”

51 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?”

52 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.

53 Clarify the problem/issue Nature of the problem Effects of Problem Your desire for change

54 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

55 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?

56 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

57 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

58 Strategies for Difficult Conversations Stop Step Out Step Back In

59 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.

60 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

61 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

62 Difficult Conversations Baby Boomers & Aging Parents Gail Henson, Ph. D. Hospice Institute Bellarmine University

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