A Baby Boomer’s Role with Aging Parents
Jan 30, 2014 10:49PM
By Linda Sechrist and Marilyn Eppolite
Approximately 2.6 million Baby Boomers celebrated their 65th birthday in 2010. Born between 1946 and 1964, this group of individuals joined the estimated 40.4 million men and women between the ages of 65 and 74, who are looking forward to enjoying an empty nest and using the freedom of retirement time to explore new possibilities, learn new skills, travel or find a new and a more leisurely routine. Unfortunately, running parallel to the retirement trajectory of many Boomers are very unusual statistics that impact their future. The U.S. Census Bureau projects that the senior population, age 85 and over, could grow to 19 million by 2050. Some researchers even predict that death rates at older ages will decline more rapidly than is reflected in the U.S. Census Bureau’s projection, leading to faster growth of this senior population. In other words, Boomerhood may now come with concerns regarding caring for aging parents.
While Boomers are likely excited and talking to friends and family members about their next stage in life, their aging parents may be doing the opposite. Fearing the worst case scenario regarding declining health, medical care, assisted living, long-term care, endof- life issues and financial resources, they are avoiding thinking or discussing theirs. Although often considered a precarious position, children or other family members can be instrumental in inviting their parents into conversations about aging with dignity in order to inquire about their goals, needs and wishes.
Time is of the Essence – Beginning the Tough Conversation
According to an eldercare specialist who has been featured in The New York Times and Wall Street Journal, many seniors “unrealistically believe that they can take care of themselves for the rest of their lives.” This expectation inhibits discussions about things that need to be addressed no matter what the age of the parent. Experts such as Kelly Kovaleski, a registered nurse, a Samaritan Healthcare & Hospice professional relations coordinator; Jeannette Kates, an Advance Practice Nurse specializing in palliative care who also works with Samaritan; Dorina Szczepanski, a certified senior advisor (CSA) and Director of Business Development for Vitacare Services; Stephen Goldfine, M.D., Chief Medical Officer for Samaritan; as well as Michael Newell, a registered nurse and president of Lifespan Care Management agree that there is no better time than the present to begin communicating about the future, especially with a parent, who has a serious illness.
The purpose of the tough conversation about the elephant in the room is not to make decisions for seniors but to shine a light on parent’s wishes and needs as well as the many possibilities, challenges and choices available. Opening the lines of communication around the kitchen or dinner table can normalize conversations that will likely include words such as Medical Power of Attorney, Five Wishes, Advanced Directive, and The National Physician Orders for Life Sustaining Treatment (POLST) Paradigm, as well as Hospice.
Medical Power of Attorney
A medical power of attorney (or healthcare proxy) allows an individual to appoint someone they trust as their healthcare agent—an individual authorized to make medical decisions on their behalf. Before a medical power of attorney can go into effect an individual’s physician must conclude that they are unable to make their own medical decisions. If the South Jersey nasouthjersey.com individual regains the ability to make decisions, the agent cannot continue to act on the their behalf. Many states have additional requirements that apply only to decisions about life-sustaining medical treatments.
America’s most popular living will, Five Wishes helps to start and structure important conversations about care in times of serious illness. It lets family members and doctors know who will be making health care decisions about medical treatment, comfort levels, treatment preferences and what loved ones should know.
An Advance Directive is a living will that allows anyone to document their wishes concerning medical treatments at the end of life. Before a living will can guide medical decision-making, two physicians must certify that the individual is unable to make medical decisions and that they are in the medical condition specified in the state’s living will law (such as “terminal illness” or “permanent unconsciousness”).
The National POLST Paradigm
POLST is an approach to end-of-life planning, which emphasizes advance care planning conversations between patients, health care professionals and loved ones; shared decision-making between a patient and his/her health care professional about end-of-life care; and ensuring patient wishes are honored. As a result of these conversations, patient wishes can be documented in a POLST form, which translates the shared decisions into actionable medical orders. This assures patients that health care professionals will provide only the care they wish to receive, and decreases the frequency of medical errors.
A POLST form is only for patients with serious illness or frailty. For healthy patients, an Advance Directive is an appropriate tool for making future end-oflife care wishes known to loved ones.
Palliative care (pronounced pal-leeuh- tiv) is specialized medical care for people with serious illnesses such as cancer, cardiac disease, chronic obstructive pulmonary disease (COPD), kidney failure, Alzheimer’s, Parkinson’s, and many others. It focuses on providing patients with relief from the symptoms, pain, and stress of a serious illness—whatever the diagnosis. The goal is to improve quality of life for both the patient and the family.
Palliative care is provided by a team of doctors, nurses and other specialists who work together with a patient’s other doctors to provide an extra layer of support. It is appropriate at any age and at any stage in a serious illness and can be provided along with curative treatment.
Hospice care is a type and philosophy of care that focuses on the palliation of a terminally or seriously ill patient’s pain and symptoms, and attending to his or her emotional and spiritual needs. Although the concept of hospice has been evolving since the 11th century, today’s model includes palliative care for the incurably ill given in hospitals or nursing homes as well as care provided to those who would rather spend their last months and days of life in their own homes. In the U.S., hospice is largely defined by the practices of the Medicare system and other health insurance providers, which make hospice care available— in an inpatient facility, assisted living or nursing home or at the patient’s home—to patients with who are medically certified to have about six months to live in their doctors’ best judgment if the disease follows its normal course.
Be Proactive – Take the Initiative
As Kelly Kovaleski provides educational community outreach at hospitals, doctor’s offices, and long-term care facilities, she advises everyone that filling out a Five Wishes, Advance Directive, or POLST form and sharing it with family members is a gentle way of initiating a conversation about aging with dignity issues. “
Anyone over the age of 18 should have an Advance Directive,” says Kovaleski, who cautions that accidents happen everyday and difficult decisions often need to be made by loved ones who have no clue about what their family member would have wanted. “If you have a Five Wishes form, keep the original copy at home, not in a safety deposit box. Someone in the household should know where the form is kept and it should be reviewed every couple of years,” explains Kovaleski.
Establish Realistic Goals
According to Jeannette Kates, POLST has become part of the healthcare landscape in New Jersey. “It doesn’t replace an Advance Directive, but it does open the door for communication between health care providers, patient and families regarding a loved one’s goals around end-of-life wishes. Sometimes the goals are simply ‘I want to see my grandchild graduate” or ‘I want to see my great-grandchild be born.’ Other goals that concern living independently, in assisted living or long-term care facilities, can be more complicated. It’s best to establish a parent’s goals first and then work backward to determine what it takes to accomplish them,” says Kates.
“It’s a delicate but necessary conversation and I unfortunately often see instances where a loved one is admitted to the hospital after a heart attack and no family member knows if he or she wants to be resuscitated if the heart stops,” notes Kates.
Be Observant and Gentle
Dorina Szczepanski believes that it is important to talk with aging parents while they can still play an active part in the decision making process. “It’s not good to wait until there is a crisis and a parent is hospitalized or too heavily medicated to make clear decisions about their future,” she says.
In Szczepanski’s experience with the home healthcare services firm, when adult children and parents spend a holiday together, it is an opportunity to notice subtle changes such as mom or dad is a little thinner, unopened mail or bills are stacked up, the car has a new dent, or the house is in disrepair. “Be proactive with these little red flags, which need to be addressed. Go gently. As people age, they are sensitive about losing their independence,” notes Szczepanski.
A Crisis is the Wrong Time
From Dr. Stephen Goldfine’s knowledgeable perspective, a crisis is the wrong time to discuss aging with dignity and quality of life issues. “People don’t always make good decisions when they’ve had a major stroke or been diagnosed with Stage 4 cancer. Discussing aging with dignity and quality-of-life issues from a perspective of determining a loved one’s expectations or setting goals and prioritizing what is of most value normalizes the conversation and insures that a loved one’s wishes are made known. It’s good to invite a professional to join the conversation because they can contribute their perspective as well as their knowledge of options, choices and possibilities,” he explains.
Bring in a Care Manager
Michael Newell, who also has a Master of Science in Nursing, is an experienced professional with insights that are invaluable to anyone preparing to engage in a conversation with aging parents. “Adult children are generally accustomed to deferring to mom and dad based on their emotional relationship with either of them. We think of our parents as we did when we were kids and they were in their prime. Now when they are 85 years old and we are 50, we have difficulty talking to them from a place of authority. In so many cases conversations become more neutralized when a care manager is brought in to assess the situation and to help mom and dad articulate their goals, given their resources, and to listen to family goals,” notes Newell, who adds that tackling tough discussions can yield positive outcomes that support a parent’s journey through the aging process as comfortably as possible.
This is a two-part article that will continue in the March issue, which will address the many aging-with-dignity options for home environments, home health care, transportation and health management.