Monday, 29 January 2018

The Future Planning Talk

When I first started working as a hospital social worker many moons ago, it was not uncommon for people to ask that we complete nursing home papers for a loved one without their knowledge. It seemed as if there was a role reversal in play - the child had suddenly become the parent and thought they knew what was best. They believed that if they raised the issue of moving to a long-term care home with their parent, there would be disagreement and a negative reaction. This was a very short-sighted request and I have no idea how they expected to deal with a move to long-term care if it came as a surprise to their loved one. For those who are wondering, unless the person was incompetent, this was not something I would ever do or suggest to a client.
When CCAC created a standardized form, it became easier to deny this request - if someone was competent, they would have to sign the form and accept the bed. While there was 'push back' from many families, there was nothing they could do about it.
In all my years at the hospital, I don't think there was ever a situation where a senior or their loved one told me they had discussed future planning with each other.
Years later when I left the hospital setting and began giving workshops and lectures, I came to understand that healthy seniors often did want to talk about future planning with their kids but felt a resistance from the kids - the same resistance the adult children would tell me they faced. I developed a theory that most families considered that very difficult conversation taboo, and both sides were afraid to discuss it yet, if they did, they would see how freeing it was and made things so much easier when decisions did needed to be made.
This weekend I read an article that reminded me of all of this. Essentially, the article was about dictating lifestyle changes, like diet, for seniors in the interest of better health and living longer. Let's be honest here - how many 80 year old's are willing and able to change their diet when they have been eating a certain way for all their lives? Is it really something we can force anyone to do, regardless of their age? Ultimately, the answer to this question and the one so many children of seniors asked me so long ago is this - people have the right to live the way they want, even if it's in a situation we deem 'risky' as long as they are mentally competent. Present the information and then listen to what they want. I know when I am 90, I don't want my kids to decide anything for me if I am still able to decide for myself. What's important is that we have the difficult conversations before crisis hits; talk over time, when the person is healthy, about what they want. When the time comes, it's far easier to make a decision when you have talked about it, and perhaps even planned for it.

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