Article appeared in the Australian Financial Review 16/1/2020.
There is nothing quite like a family get-together over the holidays to see first-hand how some older members are coping with everyday activities and life in general.
Holidays are important times for families to celebrate, but also present opportunities to face difficult questions so that everyone is on the same page should things start to unravel for elderly members.
Broaching the subject of whether someone needs help can be extremely sensitive and often unwelcome. But it is a conversation that may be crucial for establishing a common understanding in the event of a change of circumstances. For instance, what if you or someone you love has a heart attack or stroke, or develops dementia before any thoughts are shared?
You may not have to look too far for indications that act as a prompt for discussion and possible action.
Rotting or no food in the refrigerator, weight loss, lack of personal hygiene or attention to grooming, failing mobility, missed medication, changes in memory and cognitive ability are all worrying signs that may be opportunities for conversations.
Social isolation and the frequency with which someone is getting out or receiving visitors might be a way of gauging whether loneliness and the likely flow-on adverse mental and physical effects are an issue.
As distressing as these signs can be, taking steps to address them early is not as traumatic as events that may play out in the event of a crisis stemming from early signs.
According to the Productivity Commission, at age 65 the chance of needing aged care during their remaining lifetime is 68 per cent for women and 48 per cent for men. (Men have lower life expectancies and are likely to pre-decease their spouses, leaving their partner in a vulnerable position living alone.)
Longevity will only see these percentages grow.
Work through options
Aged care doesn’t have to mean residential care. But the only sure way of avoiding it is to know about other options and to have support systems ready to go if necessary.
This might come from family or privately funded arrangements, or through government-funded systems including the Commonwealth Home Support or Home Care Package Programs.
Demand is high for all home-based services, particularly transport, cleaning and personal care, so an understanding of what’s available and how to get access to help is crucial.
If residential care is on the cards, it is much better to have visited a few of the facilities and have a considered discussion around options, suitability and timing than to be doing it under stress and without a clear idea of someone’s preferences.
Assisting loved ones with dementia comes with its particular challenges, particularly if they are in denial that there is an issue.
Nicole Smith, Canberra-based gerontology consultant and founder of Community Cafe, says it’s important to find the right words, timing and the appropriate person to open that conversation.
Sometimes it’s best coming from a professional or someone other than immediate family members, she says.
Smith advises not to put a timeline on it – it’s all about planting seeds and offering information when the person feels ready to hear it. Otherwise, she says, it can be most unwelcome.
When planning for someone with dementia, ensure that the nominated enduring power of attorney (EPOA) is someone whose judgment you trust completely and who will make the best decisions – based on prior conversations (perhaps when more cognitive) – and a person who knows, understands and respects the person’s wishes intimately, she adds.
It’s also good to have a copy of these wishes with a trusted lawyer, as well as a good accountant and an up-to-date advance care directive.
An advanced care plan that provides direction to healthcare professionals if the person is not in a position to make and/or communicate their own healthcare choices may need several revisions during the ageing journey.
The duties of an EPOA should only start when the person is unable to express themselves at all.
Many people living with dementia seem to lose their rights to make decisions and be autonomous the minute they are diagnosed, Smith says.
Loss of decision-making and independence is a big deal for anyone, which makes discussion around how long a person should keep driving particularly sensitive.
Even if you’ve had a terrifying experience with a driver, discussing whether they should stop driving is an area family members may want to treat with caution and leave up to an outsider such as a health professional or the police.
Taking someone’s car keys away prematurely can have a significant negative effect on their self-worth and dignity, as well as lead to mental health issues brought about by loneliness and social isolation.
Anyone who has visited older relatives whose world has shrunk to their own lounge room would appreciate the benefits of company and connection.
It might be a time to explore one of the growing number of community cafes and intergenerational programs that globally are having a positive impact on the psychosocial and physical wellbeing of older people.
Conversations around the options available and future care needs and potential moves are one thing, but it is the follow-through action plan that can make all the difference to someone’s wellbeing.
If only the journey was as simple as “first you live, then you die”. As we all know, there is a lot to contend with along the way.