D IFFICULT C ONVERSATIONS : T ALKING A BOUT THE T OUGH S TUFF WITH O LDER L OVED O NES Carri Ratazzi, MSW Program Director Older Adult and Caregiver Services

A GENDA Introductions What is the “tough stuff”? Getting Started Conversation Tips Setting the Tone for Success Types of Conversations Questions

I NTRODUCTIONS Who am I? Who are you? Name and what are you hoping to gain from this session? Who’s in the room? How many of you are caregivers caring for spouse, partner, parent, friend? How many of you know someone that needs help but unsure how to start the conversation?

W HAT IS THE “ TOUGH STUFF ”? Money Moving, selling the home, downsizing Driving Taking help in the home End of life decisions Safety What else? Hint: If you are concerned about all of these, pick the most concerning and start there. If in doubt, call a care manager and request a consult to figure out where to start.

K EY S TEPS Getting Started: Organization and Conversation Tips Set time to meet/invite parent or loved one to talk Set the stage for success Have the talk & Set up next steps

G ETTING S TARTED : O RGANIZATION Get yourself organized – this will be an emotional conversation. Write down your concerns, your questions, your goals, what you want from the conversation. Be aware of the child-parent relationship flip and your role in the person’s life. You can use this role to help move the conversation forward. Understand the capacity of your loved one to have this conversation.

G ETTING S TARTED : O RGANIZATION ( CONTINUED ) Decide who needs to be a part of the conversation – is it best for just you to meet with your parent or loved one? Or to have another family member or friend present. Don’t create a situation where the person feels like they are “ganged up” on. Important! Decide what you want to accomplish, set a realistic goal for yourself. Be aware, however, that you may not get to the goal in one conversation)

G ETTING S TARTED : C ONVERSATION T IPS Never ever condescend. You are having a conversation as two (or more) adults who love and care for each other. Don’t give advice unless asked. Don’t threaten or bully. Listen hard and repeat back for clarity and understanding. Let your parent or loved one talk – don’t interrupt however you can guide the conversation back on track if it derails.

G ETTING S TARTED : C ONVERSATION T IPS ( CONTINUED ) Remain calm but don’t be afraid to express fear, anxiety and pleasure at this conversation. Accept that this is a process and will lead to more conversations – the solution does not have to come clear in the first conversation. When the conversation veers off course: Tell parent or loved one “I want to talk about [x] today. Let’s talk about [z] later. I will remind you.” Keep this phrase handy, you may need to use it a lot. Be direct but kind.

S ETTING THE S TAGE FOR S UCCESS Have the conversation in a place that is comfortable for all – if you have a regular time and place that you meet, ask if you can talk during that time/place about something you’ve been worried about. If you want to have others join you, ask your parent or loved one if they can be invited too. Invite your parent or loved one to talk with you. Say “I am worried about you and I wonder if we could set a time to talk.” Important! Decide what you want to accomplish, set a realistic goal for yourself. Be aware, however, that you may not get to the goal in one conversation)

H AVE THE T ALK & S ET UP N EXT S TEPS : T YPES OF C ONVERSATIONS Having a difficult conversation that ends up being easy Having a difficult conversation that ends up being really difficult Having a difficult conversation that ends up being a nightmare that you just want to stop

H AVING A DIFFICULT CONVERSATION THAT ENDS UP BEING EASY aka: your parent/loved one was just waiting for the moment when you would ask… Ask your parents/loved ones what they are worried about or what concerns do they have? Affirm and repeat back to them so that they feel heard and understood. If you don’t understand, ask for examples of what they mean. Share your concerns if they are in line with theirs. If they aren’t, hold your thoughts for another day. If, however, your concerns are safety, financial or health related, then ask if you can express your concern which are different.

E ASY ( CONTINUED ) Ask what ideas they have for addressing these concerns or worries. Ask if you can offer ideas or thoughts. If they are resistant, that’s okay, your chance will come up again. If it’s possible, develop an action plan together, decide who will do which task. If you don’t know or feel in over your head, offer to find help.

H AVING A DIFFICULT CONVERSATION THAT ENDS UP BEING REALLY DIFFICULT Consider the capacity of the person who you want to talk with. Some reasons why this conversation may not work; the person is: highly anxious, has dementia or other memory condition that prevents him/her from following a conversation, is frail and wears out easily If any of the above is true, seek help from a professional care manager. If your loved one can handle the conversation but is resistant, try Motivational Interviewing (next sheet)

P RINCIPLES OF M OTIVATIONAL I NTERVIEW Principle 1: Express Empathy Empathy: the ability to understand and share the feelings of another. Expressing empathy towards your parent or loved one shows acceptance and increases the chance of you and your loved one having an open and honest conversation. Principle 2: Develop Discrepancy Developing discrepancy enables your loved one to see that her present situation does not necessarily fit into her values and what she would like in the future.

P RINCIPLES OF M OTIVATIONAL I NTERVIEW ( CONT ) Principle 3: Roll with Resistance Rolling with resistance prevents a breakdown in communication between your loved one and you and allows your loved one to explore her views. Principle 4: Support Self-efficacy Self-efficacy is a crucial component to facilitating change. If your loved one believes that she has the ability to change, the likelihood of change occurring is greatly increased.

H AVING A DIFFICULT CONVERSATION THAT ENDS UP BEING A NIGHTMARE THAT YOU JUST WANT TO STOP Call for help. There are many professional care managers available to assess your situation and help resolve your concerns. Having an outside party involved can defuse tense family dynamics. Care Managers are trained in navigating hard conversations and are skilled at making change happen. You don’t need to do this alone.

Q UESTIONS AND T HANK Y OU ! Carri Ratazzi, MSW Older Adult and Caregiver Services Lutheran Family Services Rocky Mountains Providing quality and affordable Geriatric Care Management and Mental Health Counseling to older adults and families living in Central and Northern Colorado