SEP 2021: Having the conversation about needing care

There comes a time in most of our lives when a loved one – a grandparent, a parent, even a spouse – needs more care than they can receive at home. Having the conversation about needing care is daunting at best. Some of our residents recognised the need themselves, but it’s much more common that you, the relative, have spotted the signs that living at home is doing more harm than good. Here, we share some advice and ideas about how to discuss this most emotive and sensitive of topic.

What are the usual triggers for this conversation?

  • When someone is struggling to look after themselves, especially if family and friends can’t provide enough support and a visiting carer is not enough
  • If a fall or illness causes a major decline in health or mobility
  • When the layout or facilities in their home create potential hazards or make it difficult to receive care at home
  • When a doctor or social care assessment suggest that residential care would be the best solution
  • When the loved one feels isolated and lonely and seldom motivated or able to leave the house
  • When someone starts exhibiting frequent and worrying memory problems, particularly signs of confusion.

Planning the conversation

Choose the best time and place. At home is always best for emotional conversations. Few people could know the person needing care better than you. What time of day are they typically most awake, talkative and receptive? Late at night is never a good idea – it may not be a short conversation and tiredness is never a benefit in a difficult conversation. You need to allow enough time that the conversation won’t feel hurried.

Do you need moral support? This really depends on your relationship with the person you’re talking to. Are you their most trusted confidante? Would another family member be more tactful, empathic and positive? It can be useful to have another person for reassurance, but it’s vital that it doesn’t look like a ganging-up situation. People can be very sensitive about discussions going on behind their backs; too much involvement of others can make it appear like you’ve been having secret meetings.

Do your research. That means understanding the advantages of residential care over visits from a care worker, looking into how to pay for residential care, what sort of facilities and activities are available at care homes – and how easily and regularly family and friends can visit your loved one. Be prepared.

Starting the conversation

Once the subject has been broached, your preparation will help make for an informed, two-way discussion – providing you show a supportive, caring and open approach.

“There’s something I’ve been meaning to talk to you about. Let me just make us a drink. What would you like?” You’ve framed this immediately as a chat that’s serious enough to need ‘raising’ rather than mentioning in passing, but framed it as a something not so urgent you can’t make a cuppa and sit together to mull it over.

Next, ask the question: “How are you feeling in yourself? Is there anything that’s bothering you or which is making life harder?” This shows you’re interested in their wellbeing first and foremost. Be ready for a totally unrelated issue to pop up, which you may need to discuss – in brief – before returning to the reason for the conversation. Try: “It occurred to me that there must be ways we can make your life more comfortable or easier.”

Above all, be positive. Moving into residential care is not the beginning of the end, but a whole series of day-to-day living improvements. Stress that the reason you’re having this conversation is because you care. Because you want what’s best for them. Because you think they could be happier and get more out of day-to-day life.

What if they don’t want to talk about it?

Again, it’s not entirely uncommon. Reassure them that this is a positive conversation, looking for ways to help them. It’s fine to let them get used to the idea a little before talking again, but it’s a good idea to set a time to do that now. It may be, of course, that they’d rather discuss it with someone other than you. Try not to take this personally; they may just need the reassurance from someone else that this is the best thing for them. Help make that conversation happen, if it needs to.

If your relative outright refuses to discuss the situation and you’re concerned about their safety or health, it may be worth involving their GP.

Be honest

There are reasons you’ve felt the need to have this conversation, whether that be a decline in health or mobility, or signs of depression or dementia, or even just noticing that even basic housework or personal hygiene isn’t happening. You’re worried. And while the fact that you’re worried may worry them, it could be that you being concerned is evidence that they need to take your concerns seriously.

On your second conversation, it’s probably time to discuss actual care options and financing. It’s a good idea to have researched suitable care homes, but involve your loved one in the search. It’ll be their home, after all.

Each care home has different costs, of course, so you may find this article useful for advice on funding residential care, to help you both as you look at your loved one’s finances.

Good luck and remember the key message: your life can be easier and better.