Expert Spotlight: Dr. Jim McCabe on Authentic Conversations

I had a meeting last week with a client for some ongoing eldercare planning for her parents. In the middle of our discussion, she mused aloud that she could not recall when the conversation had changed. “As long as I can remember, my conversations with my parents were about me! My latest career challenge, a travel adventure, or what was going on with my kids. Now the discussion is focused on what is going on for them and how to get through the latest challenge of Aging!”

For the most part, I have found that adult children are poorly prepared to have productive and satisfying conversations with their parents about what they need as they age. There are the many reasons for that: denial, busy schedules, and distance. At the same time, many people struggle with the challenges of communication with a parent as a result of not knowing how to have what I call an “authentic conversation”.

Even in the healthiest family systems, communication can be difficult because of generational differences, lack of consensus about priorities and eldercare liabilities.

General Differences

Jim Comer* describes his experience of trying to help his parents with long-term care decisions as “walking at the speed of a walker!” It is not a process that can be hurried. His experience supports one of my cardinal rules when I consult with professionals about selling to seniors: don’t make a long story short!

Unfortunately, many elderly are so consumed with anxiety about making a bad decision, that in order to avoid making a mistake, they avoid making any decision at all!

Advisors and families are faced with the delicate balance of providing as much information as possible so that the senior can make an informed decision and, at the same time, structuring the process in such a way that there are deadlines for taking action. My most successful strategy for getting to a decision point with elderly clients is to lay out the risks of NOT making a decision in a timely way.

The process is also complicated by the fact that the tools used to make the decisions can be foreign to most seniors and compete with many of their values. The transactions are done on line (so there is no person to interact with), the purchase must be paid for in advance of getting the service (how do I know I am getting what I paid for?), and credit cards are the standard mechanism for making the purchase (credit debt is a sin!).

The Process of Communication

There are several critical steps that need to be addressed to have any chance of gaining consensus about the need for a conversation and getting seniors to buy into the process. Even before the conversation takes shape, three critical questions need to be asked.

1. What are the concerns?

Can all of the parties agree on what the primary concerns are? Much like a risk assessment that you do with your clients around estate planning, can we get inside the heads of the stakeholders to determine what they are concerned about? Two of the top concerns of adult children in relation to an elderly parent are safety and competency. Unfortunately, for their parents, the hot points are typically independence and privacy. So the staring point is reconciling these disparate concerns into one conversation?

2. What is the purpose or goal of discussing these concerns?

While almost all families would say they are after “what is in mom’s best interest”, personal agendas can be troublesome. The competition among three sisters has derailed the planning for one of my senior clients. In another family, a son’s unwillingness to share any information with his siblings about the parents’ finances has created hard feelings. Individually, each of these people has promised me cooperation, but when the actual conversation begins and emotions take over, it is almost impossible for them to rise above their own issues. Time and again adult children need to be reminded that the effort is about what’s best for mom.

3. What is getting in the way of having the discussion?

A couple in their 80’s was in my office recently complaining that their children did not want to talk about health care issues and concerns. Another client in her 80’s resented that her daughter had attempted to talk about a plan. “I felt that my daughter was measuring me for the black dress and I told her so!” In a follow-up conversation with the daughter, I found her devastated at her mother’s response.

Barriers to authentic conversations often have nothing to do with the presenting problem or specific needs of the elder family member. Typically, families struggle with the process either because there is little history of open communication among people or there is a history of conflict that presents so much emotional baggage that a civilized discussion is virtually impossible.

Families with a history of conflict really struggle with productive conversations. These conflicts typically revolve around guilt and/or money. Either the guilty child is struggling to make up for past behaviors that put him in a bad light with relatives or conflicts around money rooted in concerns about fairness derail the process.

 Liabilities

Emotional Liability

While authentic communication can be a healthy thing, facilitating the conversation can carry some liabilities. Much like the daughter who was chastised by her mother for “just trying to help”, the potential to be misunderstood is great. I have seen a number of cases where the child who is accused of “taking over” when he steps in to help and now is alienated from his parents.

Financial Liability

Getting involved in elder care giving can be very expensive. The cost of housing, health care, and other senior services can be overwhelming for family members especially if the parents are unwilling or unable to help with the cost of things. Adult children are often hesitant to suggest things for fear of creating a financial liability that they cannot meet.

Geographical Liability

Care giving at a distance can be the most challenging situation for an adult child who is trying to help an aging parent. The possibility of having the good conversation at a distance is limited because authentic communication requires both face to face visual and verbal exchanges to get through some of the tough emotional topics related to eldercare.

Familial Liability

Approximately one-fifth of the families I work with have underlying emotional issues that have resulted in such conflict that they easily lose sight of the goal of “doing what’s best for mom”. For some families, the costs of care giving for a son or daughter have not been appropriately appreciated. For others, past “sins” have placed their motives under suspicion. And while the vast majority of family members have good intentions for their parents, competition over who decides or who is in charge get in the way.

The Distribution of “Rights”

When families contract with me to help with these conversations, one of the first questions they ask is: should mom be included in the conversation”? My response is to go back to the initial questions to get a sense of where they are in the process. I want to have them tell me what they see as the concerns, goals and barriers around the conversations.

If the goal is to manage conflict or get consensus among adult children about how to proceed, I suggest that a meeting without mom might be useful because the initial meeting is clearly going to be about the interests of the children and not about what is best for mom. Once the children are able to agree on one or two issues, it is probably time to get the parent(s) involved.

Authentic conversations cannot take place unless the “rights” of all involved are addressed. Those include: getting everybody around the table to suspend the need to be “right”. There needs to be agreement that the purpose of the meeting is to come up with some possible options that might be “right” for mom.

I also believe that in cases, when a family member refuses to contribute to the discussion, he also relinquishes his “right” to be actively involved in the ongoing process of putting the plan in place.

Finally in order for any conversation to be truly “authentic”, It must involve the “person of interest”. Mom has a right, if she is interested, willing and capable, to be actively involved in decisions about how things will proceed, who will help with the process and what her role will be along the way.