Caring Currents

How to Make Difficult Conversations Less Stressful

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Recently I talked to two different family caregivers about their frustration over incontinence "“ "accidents" was the term each used. For each woman, the issue wasn't "How do I know when there's a problem?" or even so much "What do I do about this problem?"

The thing each caregiver was grappling with was how to broach the subject with the affected parent. The prospect of a tough talk "“ whether it's about incontinence, driving, moving, or something else "“ can be tougher than the topic itself. And caregiving is fraught with one difficult conversation after another.

What makes it easier? Here are seven steps to try:

1. Appreciate why it's so hard.

You're probably not a coward or a procrastinator; you're a person who's in a very tough spot. Acknowledging this helps you not beat yourself up over the issue. Just look at all the reasons we find it hard to talk to our parents about delicate matters:

  • It's not our "place." Old family roles endure, and many adult children are conditioned to consider it inappropriate or unseemly to call our elders on certain topics, like their unsafe driving or slipshod finances.

  • Concerns over privacy. Many of us don't discuss money and personal hygiene with anybody, let alone a parent.

  • Lack of knowledge. It's challenging to talk turkey when you don't really feel comfortable with the material. Many adult children have little experience with financial power of attorney or hospice care until the topic emerges with our parents.

  • A close-lipped history. Weighty conversations of any kind are especially a challenge if you've never been on open-mic terms with your parent in the past. Makes it hard (though not impossible) to start having serious chats now.

  • Squeamishness. Some topics are simply ones we'd rather not think about "“ ever. Exhibit A: "Mom, you need to start wearing diapers."

  • Fear of consequences. Maybe Dad will hate you if you initiate his moving to assisted living. Maybe you'll be lonely. Taking action can lead to uncertain outcomes.

  • *Willful ignorance. Denial (you kindasorta know there's a big problem but, just for today, it's easier to ignore it) is an ever-handy way to avoid thorny issues.

  • And, drumroll please: There's the problem of not knowing how to start.

2. Remember that the consequences of not speaking up are usually worse than the talk itself.

Your parent with the erratic driving could kill someone. Your grandparent who forgets to turn off the stove could burn her house down. Your house will soon stink of urine 24/7. Focus on the worst that could happen if you said nothing and let that vision fortify you a little.

3. Consider that the person you're caring for might be having similar concerns.

Often people know when there's something wrong but have their own reasons to be reluctant to speak up. Result: A conspiracy of silence over that big white elephant knocking about your living room. Open up to the possibility that expressing your concerns might come as a relief to the other party -- because the first step in solving a problem is acknowledging it.

4. Think gains, not losses.

Another reason these are hard conversations is that they tend to be benchmarks for some kind of loss (driving, independence, autonomy, health). The grief and guilt over that colors our emotions deeply. Acknowledge that, but also focus on how you'll be making life better for the other person. Even in the grimmest of situations, there are small improvements that result, and that's part of what you're aiming for: to help the other person be more comfortable, safer, happier, and so on.

5. Get your ducks in a row.

Before you blast headlong into a potentially awkward discussion, prepare yourself with lots of facts. Learn all you can about the topic and the options. Talk to other caregivers, post questions on discussion groups. Have a vision of the outcome, or a couple of possible outcomes, you hope to work toward. This will help you seem knowledgeable and therefore more trustworthy. You'll feel more confident, too.

6. Pick the right moment.

I know. There can never seem like a "right" moment to discuss adult diapers or the possibility of elder scams. In general, though, pick the person's best time of day (often mornings after breakfast). Watch for a relatively good mood. Bracket the discussion with pleasant activities (breakfast and a foot rub, say).

7. Be candid.

When you finally plunge in -- use candor to keep things warm. Sample starters: "This is really hard for me to talk about and it's also probably hard for you to hear. But I've been really worried about"¦" Dad, I don't know how to talk about x, so I'm just going to dive in and tell you what I've been thinking"¦" Mom, I kind of feel like we've been ignoring something that we can't ignore any more"¦." Self-deprecating humor can help, with the right person, too: "I know if I were your nurse in a hospital you'd fire me, but since you're stuck with me, I was thinking"¦"

A wise nonagenarian I know likes to say, "We live in ages and stages." You can borrow that line, too, and explain that new stages aren't always fun, but there you are, and you want to make the best of it together.