Chapter 3: When You Are Concerned

One of the hardest things to witness is when a loved one’s quality of life starts to decline. It might trigger different emotions in you, such as disappointment, regret, denial, resistance, or avoidance – you won’t know exactly how you will react or respond until it happens.

So how do you prepare for the unexpected? How should you react? The answer is to consider starting a thoughtful conversation about the difficult what-ifs that lie ahead. This can be challenging – it might be hard to even know where to start.

“My family is doing well – we won’t have problems.”

“My parents have taken care of all that stuff.”

“I don’t want to be negative and think of possible problems.”

“Things are always changing, so why plan now?”

It takes a deliberate effort to have a realistic and honest conversation with family or involved loved ones. If something unexpected happens, do you know the wishes and expectations of your loved ones? It might be awkward or uncomfortable, but it’s important to find a way to start a discussion and prepare for a family meeting to create a plan of action (see chapter five).


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We suggest each of the family members who will be involved take the time to talk with Mom openly and compassionately. The initial conversation might be more comfortable with one person rather than having everyone there. If pertinent concerns are raised, they need to be shared with everyone who will help provide the care. You might ask, “Mom, how would you feel about telling John and Suzy what you just told me so we can get everything straight?” Plan to approach your loved one at the time of day they are at their best. For example, if you know Mom is a morning person, talk to her in the morning. Consider where and when you want to have the conversation – over dinner, on a walk, or sitting down with them in their living room. In addition, it’s helpful to talk in ways that make sense to them. If they like to get right to the point, start right in. If they prefer easing into difficult subjects, start with general topics and bring up your issue when the timing feels right.

Begin with the issue that is of concern, such as a change in health or financial situation, if it is time to consider moving, or if more assistance is needed. If this is a parent or spouse, you probably have a good idea as to their current mind-set, such as if they are pragmatic, in denial, or unable to comprehend the situation. Tailor your words for the specific issue and be sensitive to their personality, temperament, beliefs, and situation. For example, “Mom, I’m concerned. I can see how you are doing so much and wonder what will happen if Dad gets worse. I want to help support you. If Dad gets to where he has to move into skilled nursing, I want you to think about coming to live with me.”

There isn’t only one way to have this kind of a conversation, but hopefully you know your loved one well enough to know what approach will open the door to further discussion. Even a general question like “How do you feel about your health and what’s been going on?” can give you an idea of what they are thinking. If “Why are you asking?” is the kind of response you get, then you can move forward with the conversation. However, if the response runs more toward “I’m fine and I don’t want to talk about it,” then you know a different approach is needed.

Conversations about finances might also be shut down – “My finances are none of your business” or “Don’t worry about me.” But maybe you’ve noticed unpaid bills, medications not being refilled, or items like hearing aids, glasses, or dentures not being purchased when needed because they aren’t covered by insurance. Has there been an increase in medical appointments? Are they downplaying treatments and procedures? If they are in denial and clearly don’t want to talk about it, let it go for now. Approach them another time, or ask another family member or their doctor to talk with them. If they are willing to talk, be encouraging and give them the time to share any concerns and feelings. Be aware that for many seniors, tears come easily. It’s okay. Be fully present with them, and be supportive and gentle with your words.

But you also need to be ready to deal with their anger. Don’t engage or exchange angry words with them. It’s the time to be quiet and let them express; don’t escalate the conversation. Let it go with a simple “I understand that you are angry” and approach it another day using different words.

Compassion and hope play a vital role here. Be thoughtful as you consider how to approach the conversation and always keep the loved one’s wishes above your own. You may need to adjust your approach based on the relationship to the person, the nature of the current situation, and how open they are to discussing ideas.

Why am I talking about this now? Because most of the heartache I’ve heard over the years stems from a general lack of communication. There is always a story. The families that don’t talk about the adult-dependent child who absorbs much of the senior’s money, energy, and concern; or the family member who controls and delegates, but the senior who won’t speak up for fear of sparking a fight. I’ve listened to the frustrations and felt the anguish of the person who didn’t get help or support from other family members and feels all alone.

There are distinctive dynamics and personalities in every situation and every family. But the common thread is how problems can feel insurmountable when families are caught up in conflict. Everyone loses when there is a family struggle instead of a focus on care for the loved one.

When you are in the middle of a crisis, it’s hard to think of what to do next. It’s hard to think logically. This is when emotions often run high and everyone reverts to old habits and patterns. And this is why we encourage everyone to find another way and do it differently. When families have talked about the major issues and possibilities ahead of time, and worked through them honestly, there is much less stress and drama when something does happen. The best time to have these conversations is when things are going well. This is truly being proactive. Aging IS change!

On Noticing Changes

A typical response is to discount the changes someone is experiencing until something big happens that requires attention. “I never thought this day would come.”

The commonsense approach means learning to see changes from a fresh and more encompassing point of view. It understands the benefits of having an honest conversation with the family. It means relaxing your ideas about how things should be done and recognizing that expectations might need to be adjusted. It means learning to be more aware of change and how those changes impact the loved one and others.

Loretta Gilbert, left, owned and operated a small assisted living residence in Colorado. She served on the Colorado Department of Health Assisted Living Advisory Committee. She lives in Colorado with her husband and much loved animals.
Nancy Walker took care of her mother during the last 10 years of her life. Her background working for small businesses and global corporations taught her to be flexible while managing change. She’s a Colorado native.