Difficult Conversations: Discussing the Need for a Move
Knowing that the need for move might someday arrive, it makes sense to discuss it with your loved one before a move is needed.
As a caregiver, you face many tough decisions. One of these is determining that your loved one can no longer live alone. This situation often brings a mix of emotions, including concerns about how you can best discuss this decision with your loved one. Thinking carefully about the conversation, and having key talking points and strategies set ahead of time, will help you feel better prepared for this.
BEFORE you start the conversation, there are two key questions to ask yourself.
1. What is my loved one’s current ability to participate in this decision?
If you feel your loved one can participate in the conversation and decision-making, then of course that is ideal. However, as a memory loss disorder progresses, most people will have difficulty making these kinds of complicated decisions. For example, they may need help understanding a complete risk/benefit analysis between staying in their current home and moving to a more assisted environment. In this case, you likely need to adjust your expectations of the discussion.
2. What’s the goal of this conversation?
Once the determination has been made of the necessity of a move, there are two common reasons for having a conversation about it with your loved one.
Having your loved one participate in making the final decision:
In this case, the conversation may take the form of “Mom, are you ready/willing to move to a new apartment, where you will get assistance?”
Inform your loved one of the decision:
In this case, you might open your conversation with something such as “Mom, we have a new apartment ready for you. Let me tell you about it.”
You will want to plan the discussion based on your loved one’s ability to participate in the conversation (see question #1 above), and this will inform your ultimate goal and how to conduct the conversation.
If your loved one is no longer safe living on their own and does not have the ability to make an informed decision then you, as their advocate and surrogate decision-maker, must make this difficult decision on their behalf.
In that case, you will want to work towards a conversation focused on informing them rather than involving them in the decision.
No matter the goal of the conversation, here is some additional advice.
Don’t Delay:
While none of us have a crystal ball to tell us when our loved one will need more supervision and care, we know it will happen eventually, and that their needs will be more specialized as their disease progresses. Knowing that the inevitable will someday arrive, it makes sense to discuss your loved one’s wishes, and the financial feasibility of such wish, long before a move is needed. If your plan is to move to a community setting, consider those that provide multiple levels of care, such as independent living, assisted living and memory care. If a higher level of care is needed over time your loved one can transition within the community.
Plan Your Approach:
Consider the time of day that your loved one is cognitively sharp. Next, think of what setting would be most comfortable: Ideally, a quiet and relaxing space. Throughout the conversation be mindful of your delivery. Maintaining a calm tone and positive outlook will go far in putting your loved one at ease.
As subsequent conversations occur and you start to plan the next steps, remember the need to think through how much detail your loved one can process. Watch for signs of anxiety and consider the “less is more” approach when sharing the details of the move, and the planning process.
Conversation Starters:
Take the focus off your loved one. Think of another family member or friend who needed to transition to a facility or move in with family, and use that example to broach the conversation. Or mention an article you came across about planning ahead for care needs to learn what your loved one’s ideal transition would look like.
Speak from Your Heart:
Emphasize that, as your loved one’s caregiver, you always have their best interests at heart. Speaking from a place of concern for their wellbeing, safety and quality of life will reaffirm this. However, keep in mind the stage of your loved one’s memory loss. If they assert that they are still fully capable of living alone, it’s best not to disagree. Instead find another angle.
If your plan is to move your loved one into your home, tell them how excited you are to be able to spend more time together. Or have a “purpose” for the move, such as your needing their help with taking care of their grandchildren.
If your plan is a move to a facility, focus on the positive aspects that might resonate with your loved one.
Talk about the potential for socialization and activities, if that would sound exciting to them.
Appeal to the fact they will be able to do less cooking and housekeeping.
Talk about how excited it is to have them so much closer to family.
Activate your Village:
Consider enlisting the help of others to facilitate the conversation and be sure everyone in the village is giving the same message.
If there is a family member or trusted physician that your loved one responds to well, ask them to initiate the discussion. Keep in mind you will likely need to have these conversations on an ongoing basis, especially if a particular plan is underway. Should the conversations become mired down, and a source of frustration for you, recruit other family members that can help reinforce the rationale and advocate for your plan.
Change is Challenging:
While it’s easy to get caught up in planning the logistics of a move, don’t lose sight of your loved one’s perspective. No matter what stage of memory loss your loved one is in, it’s likely they will have some fear and anxiety about discussing a potential move. Validating these feelings and providing reassurance will demonstrate you understand their concerns. Most people become emotionally tied to places and belongings, and for someone with memory decline this familiarity is especially hard to part with. They likely will express concerns about downsizing and having to leave behind belongings. Again, ensure that their feelings are validated, and attempt to redirect them in a positive direction. For example, if there is a piece of furniture that they cherish, which will fit in their new space, tell your loved one how wonderful it will look there!
An Unexpected Move:
While we try to plan and be proactive about our loved one’s future care needs, at times a medical event can expedite the need for a move. When it becomes clear that a return home after such an event is not feasible, be gentle in your conversations with your loved one. For example, if your loved one experienced a fall and is now recovering in rehabilitation, it’s natural for them to be under the assumption they can return home when the rehabilitation is over. Remain encouraging to them, but make sure to avoid making any final promises. Rather, keep moving the topic down the road into the future. If they aren’t safe to return home after the medical event, for instance, then possibly living in an assisted living facility, or staying with you “temporarily,” can be proposed as a next step. It’s likely over time your loved one will naturally acclimate to their new home.
For more information, see: Supporting Your Loved One Through the Transition to Assisted Living
