CHAPTER FIVE

Setting the Stage

It was quite unnerving to see how quickly the winds of our parent care crisis morphed into a full-blown tornado, sucking in family members and family resources with relative ease.

—Thomas, focus group participant

Current conventional wisdom has it that our generation will age differently than our parents’. We will have a more active lifestyle, more dollars to spend on it, and more years to enjoy it.

But there is one aspect of aging in which we will surely follow in the footsteps of all previous generations. Like every elderly parent in the history of humankind, we will undoubtedly intone with somber and heartfelt conviction, “I don’t want to be a burden to my kids.”

Well, get over it. You probably will be! Because as we cruise through our last years of life, we will need help—and plenty of it.

Margaret, a social worker I interviewed from the south side of Chicago, gave me a sense of reality by laying out the breadth and depth of what’s involved:

It’s a full-time job when you are looking out for elderly people who have long-term care needs that are chronic and who have declining health … from the handling of their day-to-day care, to running the gauntlet of insurance, Medicare, and Medicaid forms and regulations, to learning about various diseases and the myriad of alternative (and often conflicting) treatments, to the managing of medications and doctor visits.

It’s a full-time job! And all this at a time when the adult child is scrambling to keep the many balls in his or her own life (like kids, spouse, household, career) from crashing to the ground.

Of course, the way to reduce the weight of this burdensome responsibility is to start now to have the Other Talk. By brainstorming and fleshing out the contingencies, preparing for the surprises, and making your last years of life a time for your family to enjoy together, not just a trauma to stumble through, you will be lightening the load considerably.

Yet there seems to be a catch-22 in play whenever this conversation is contemplated.

On the one hand, I have found that the basic concept and construct of the Other Talk meets with nearly universal enthusiasm, whether I’m talking with colleagues in the eldercare, hospice, and funeral service industries, with professionals in the publishing and academic worlds, or with members of my generation or even with their gen X kids. They get it: the wisdom of involving your kids in the issues and decisions that come up during your last years; the tremendous emotional benefits of avoiding family feuds, financial surprises, and philosophical disagreements; and the ability to focus on the living to be done rather than the dying to be feared.

On the other hand, I also know from my research with families that the theory of the Other Talk rarely translates into practice. It’s as if a locked door stands between the parents and the kids. One or maybe both parties may actually want to engage in the conversation. But what causes them to hold back are the very difficult emotional issues and various fears of the unknown that can bubble up around the end of life.

That’s why it’s critical that you do a good deal of emotional and strategic preparation before you are ready to open the door to the Other Talk.

There are four steps to setting this stage effectively:

1. Start with your own mental state.

2. Factor in the kids’ emotions.

3. Establish a frame of reference.

4. Adopt a comfortable tone.

Step 1. Start with Your Own Mental State

Just as they did when you sat them down for that first “birds and the bees” talk, your kids will take cues and clues from you on how open and comfortable you are in discussing your last years, which will influence how willing they are to participate in the conversation.

As a result, before you can initiate the Other Talk, you’ll need to confront and ultimately come to grips with two practical yet emotion-laden issues: role reversals and your finances.

Role Reversals

Many of us define ourselves by our accomplishments, our skills at getting things done, and our abilities to develop creative solutions to complex problems. These barometers of success translate into power and control over our lives and ultimately our sense of self-worth.

Therefore, when we agree to the reversal of roles with our kids, however willingly, we may tend to feel that turning over power and control for decision making will diminish our self-image. As a consequence, even for the parent who acknowledges the need and inevitability of role reversal, it can still carry the stigma of, “I am no longer who I was!”

A good example of this internal conflict is Dan, a successful entrepreneur in Seattle, who recently signed over financial and medical powers of attorney to his eldest son. In addition, Dan, along with his wife, Shari, moved out of their three-story house into a well-appointed assisted-living facility. He had done all of this voluntarily after several conversations with his doctor, financial advisors, and extended family, but clearly he felt a deep sense of loss:

I know Shari and I need assistance at this point in our lives, but, damn it, I feel like I had to give up a huge part of me.

I’ve always been proud of my accomplishments, growing the company from 2 to 200 people, attracting great young talent, positioning the firm as a player on the national stage. And I really enjoyed my success in the stock market.

Now my affairs are managed by my kids—and I deeply appreciate the time and energy that they put into it. But there are times when I want to stand up and scream, “You can’t tell me what to do. I changed your diapers!”

Clearly, the notion of role reversal can stir up some serious emotional reactions. That’s why the Other Talk puts it front and center in the conversation. The intended consequence is that when the time comes to shift decision-making responsibilities, it is accomplished more like the smooth transition of a pendulum, rather than an abrupt hitting the wall at the moment of crisis. To ensure a comfortable pendulum swing, you should reconcile yourself to role reversal on three levels.

First, openly acknowledge the inevitability of ceding the decision making and managing of the day-to-day responsibilities to your kids. This will focus you on planning to hand off these responsibilities, rather than grappling to hang on to them.

Second, establish ground rules on the potential circumstances or trigger points that will affect the change of responsibilities in key functions, such as bill paying, transportation, living arrangements, money and asset management, and medical decisions.

Finally, embrace your plan for role reversal as liberating, not denigrating. It’s not the loss of power and control; it’s the gain of security and freedom. It’s not about where the pendulum is swinging from; it’s where the pendulum is headed.

Full Financial Disclosures

The other hurdle that you need to get over is when and how much of your financial situation you are willing to share with your kids. (The irony, of course, is that your financial reality, good or bad, will end up on your kids’ plate anyway.) The short answer if you are serious about having the Other Talk is, “Now, and everything.”

This is apparently easier said than done. When I asked my research respondents whether they had shared their financial reality with their kids, they came up with a variety of excuses for why they hadn’t:

“It’s none of their business.” (My response: “It will be.”)

“I’m embarrassed that I didn’t save enough for retirement.” (My response: “That’s a really excellent reason why they should know!”)

“My kids aren’t capable of managing financial details.” (My response: “Your family definitely needs a plan and maybe some outside help.”)

“Telling my kids how large the estate is could have unintended consequences on their lifestyle and motivations.” (My response: “Discussing family finances now will be much better than waiting until after the sibling battle lines form.”)

To a large extent, the Other Talk is about contingency planning. Without having a thorough discussion with your kids now about your financial situation, you’re essentially tying one hand behind their backs just as they are getting ready to take on more responsibilities in your last years.

You need to prepare yourself to work with your kids now to understand what’s available financially, introduce them to any financial advisors you might have, and educate them on your asset allocation and spending strategies. That’s the partnership that the Other Talk is designed to achieve between you and your kids.

Step 2. Factor in the Kids’ Emotions

Once you’ve gotten your own head straight with the emotional hurdles of role reversals and financial disclosures, it’s time to consider the kids’ mindset on the eve of the Other Talk. As you get ready to unlock that door, swing it open, and invite the kids in for your first Other Talk conversation, it’s important that you think about how to prepare them mentally and emotionally for the subject matter.

To begin with, you need to recognize that every question or issue related to the end of your life, however mundane, is a mix of practical and emotional dimensions. In fact, you can expect a jumble of reactions that can be wide-ranging and, at times, contradictory: fear, sadness, nervousness, anger, queasiness, panic, and revulsion, to name a few.

Why this bewildering array of seemingly disparate reactions? Because you’re talking about coping with a period of undetermined time that may include several stages, but with an ending where your kids are left without a parent.

There’s also another emotional dimension to the Other Talk. Kids can become overwhelmed with feelings of responsibility, guilt, inadequacy, embarrassment, and resentment as the fear and foreboding of what is to come next pulls into view.

For both emotional traumas, loss of a parent and the burden of caregiving, it’s critical that you carefully prepare your kids for the Other Talk. You’ll need to think about which issues are troubling or even terrifying, and to which child. You’ll need to help the family get past the fear of confronting your mortality; of brushing up against the issues of power, control, and financial limitations; of visualizing what it will be like when you are gone.

My first suggestion to get your kids ready emotionally is only slightly self-serving, since it has been reported to be very effective by a number of families who have reviewed this book: give your kids a copy to read before you sit down for the Other Talk.

This technique seems to help pave the way because your kids are able to explore and embrace the philosophy of proactively dealing with possible events in your last years before they happen. It allows the kids to deal with the hypothetical events before confronting their eventual reality.

My second suggestion is that you discuss with your spouse how your individual attitudes, desires, and opinions may differ, sometimes markedly, and how they should be woven into the conversation in a way that doesn’t cause confusion or conflict. What you don’t want to do is confront all these issues for the first time in front of the kids.

My third suggestion is to encourage your kids to adapt the collaborative theme inherent in the Other Talk in terms of how they might work with their brothers and sisters during your last years. We know definitively that the impact of being saddled, often unexpectedly, with the burden of parental care can have serious repercussions among siblings.

In a National Alliance for Caregiving and AARP study, 17 percent of those surveyed said the responsibility of caring for their loved ones had taken a toll on their health, while 31 percent described the situation as emotionally stressful. Two-thirds of those caregivers who had jobs said they had gone to work late, left early, or taken time off because of their caregiving responsibilities.

It doesn’t have to be this way. Recently I witnessed how the Other Talk can help create a sense of purpose and cooperation with a family I spoke with in Phoenix. The son, Robert, assumed responsibility for his mother’s finances. Daughter Vanessa handled the medical appointments. The youngest child, Christy, acted as the day-to-day contact for the home healthcare nurses.

Creating a care arrangement as the family in Phoenix did can not only achieve collaboration of effort and commitment but can also prevent one person’s being overwhelmed as the primary caregiver, which typically is a daughter or the oldest child who lives closest to the parents.

Step 3. Establish a Frame of Reference

The next step in your preparation is to frame the conversation and the participants’ role in it so that you can achieve good outcomes and avoid panic and stress; manage your affairs the way you intend; avoid choices you don’t want; and ensure that everyone contributes in ways that match their interests, skill sets, and comfort level.

Additionally, it’s important to establish that the Other Talk is not a onetime event, à la “the birds and the bees” drive-by, with books on the bed and, “Any questions?” Rather, it is an ongoing, dynamic dialogue because your physical and financial conditions will likely change in unexpected ways, your assumptions and beliefs may evolve over time, and the availability of your kids may change due to shifting job and family responsibilities, resources, and geographic location.

Finally, because you want to be proactive in managing your last years, not just reactive to tomorrow’s surprises or emergencies, you and your kids should plan to commit time and energy to two fundamental functions: the knowledge base and trigger points.

Our Knowledge Base

As I mentioned in Chapter 4, the dynamics of geriatric care are going to change dramatically in the years ahead as a result of an escalating demand for resource-intensive healthcare, elderly and chronic care patients who will be living longer than in previous generations, the declining supply of geriatric practitioners, and the questionable availability of public resources for people who are elderly and disabled.

As a result, the rules of the game are changing, and to a large extent, you and your family will be on your own to figure out options and answers. You will need to learn a lot, be organized, and keep up with current trends. That’s why staying on top of your options, emerging medical treatments, and changing legal and financial regulations will become a critical ongoing function for the entire family.

I believe that the Other Talk is the place to start parceling out research assignments, and in subsequent Other Talks, it is the place where you all can come together to review, update, and cross-reference your knowledge base.

To give you a sense of how extensive this imperative will most likely be for you, let me introduce Carly, a 45-year-old accountant and daughter of a Parkinson’s patient:

I have a binder that’s about four inches thick, with all the things that I had to find out about in all these different areas, from insurance forms, rules, and regulations to new medical treatments, new sources of funding, and new living arrangements to speech therapists, occupational therapists, and physical therapists to Medicare, Dad’s pension, and Social Security.

It’s relentless, it’s overwhelming … and absolutely essential.

Trigger Points

Perhaps one of the most challenging issues that your family will face in your last years is how and when to shift decision making from you to your kids. That’s why a key dimension of the Other Talk is to establish criteria that will trigger the decisions to reassign roles and responsibilities.

The intent of all this is to avoid your feeling threatened and confrontational when the time comes to make a change because you’ve already agreed to it up front.

To begin with, it is important to recognize that role reversal doesn’t need to be a onetime wholesale changing of the guard. Rather, it can be a series of trigger points for the various functions of day-to-day living (paying the bills, moving out of your house, etc.).

The essence of establishing trigger points is that you and your kids thoroughly discuss and jointly decide how and when a particular responsibility is to be shifted. In this way, your entire family feels a part of the decision and can take ownership in its implementation.

While I’ll be discussing the trigger-point concept in later chapters, let me demonstrate how it can work with what is often the opening act in a family’s role reversal: giving up the car keys.

For your kids, the decision for you to stop driving has important practical implications. It means that your loss of mobility will require your children and you to come up with alternate forms of transportation: their chauffeuring you, if they live in town, or your depending on friends and neighbors, taxis, and public transportation.

For you, this change of life is more cerebral, more fundamental. Here’s my personal take on it:

I love driving, especially in my blue sports car, a Nissan 350Z.

I love the freedom of getting up and going whenever I want.

I love the sensation of smoothly shifting through six gears.

I love the power of the acceleration.

I love the control in taking whatever route I want.

I love the sense of pride in keeping my car in mint condition.

So when I contemplate the possibility that a time will come when I shouldn’t be driving, when my eyesight, motor skills, and reaction time reach the point that I’m endangering others and myself inside and outside the car, I get despondent and depressed. And then I get angry at the prospect of having one of my life’s great pleasures taken away from me.

But then I remember the near calamities that my parents experienced.

While wintering in Arizona, Mom came home from shopping one day with the entire right side of the car ripped up. She had no idea how it happened or that it had even occurred. It turned out that her rapidly escalating and undiagnosed Alzheimer’s played a central role.

And early one summer morning in Michigan, Dad, whose MS was causing vivid hallucinations, sneaked out at 4 a.m. to take a spin to his favorite park. Once there, he couldn’t remember how to get home, so he (fortunately) waited for us to come find him. It made for a frantic four hours for the rest of the family.

Rather than put our family in those situations, I’ve decided to establish criteria with my wife and daughter that will help me transition out of the driver’s seat. We’ve even put it in writing to avoid any misunderstanding on their part or backsliding on mine. I’ve agreed, as part of my yearly physical, to get a thorough eye exam that meets driver’s license requirements and to take a test for motor skills and mental acuity.

In addition, we’ve included an amendment to our agreement that recognizes that tests for visual, physical, and mental dexterity aren’t enough.

There can be complications from diabetes that may affect driving and create cognitive problems (that is, does the person forget how to make a left turn?), including dementia.

Further, prescription drugs that I may be taking could also have side effects on my driving ability. At a minimum, these qualitative issues, as well as my annual physical quantitative measures, will be part of our annual Other Talk.

Will I miss zipping around in my sports car when the time comes to become a full-time passenger? You bet.

But I also know that establishing this trigger point now and sharing it with my family will be far easier than scaring them into a “taking away the car keys” confrontation because of some crazy or even lethal driving stunt that I inadvertently performed.

Step 4. Adopt a Comfortable Tone

Now that you have thought through the emotional barriers for each of the participants and have created a structure that will bring the family together, you are ready to develop the atmosphere.

Of course, each family will approach the Other Talk in its own way and on its own terms. But I have found that the most productive and comfortable conversations occurred when the parents had spent time creating a welcoming and involving environment for their kids.

You will want to create a context with a number of dimensions:

Informal. To reduce potential angst and paralysis in your children, it’s important that you position the Other Talk as a relaxed, thoughtful, wide-ranging dialogue on a variety of issues that lie ahead.

Informative. Allow family members to engage in an open, honest discussion that clears away potential misunderstandings and wrong assumptions that could result in festering resentments and financial missteps down the road.

Collaborative. The Other Talk is about the rest of your life, not just the end of it. Use this unique opportunity to explore how you want to live your life and what experiences you want to share with your kids as it unfolds.

Productive. Stay focused on results. The more you and your kids anticipate potential twists and turns before infirmities set in, the more likely it is that all of you will navigate those last years with skill, creativity, and confidence.

Loving. Make sure the Other Talk strikes a balance between taking care of business and performing an act of love and affection for your kids.

Empowering. Recognize that while the Other Talk is about you, it also offers a number of life lessons that could benefit your kids in their own lives. It teaches them to be flexible and adaptable as things change in unexpected ways. It enables them to make the tough decisions if and when you can’t. It establishes a template from which they can discuss, explore, educate, and think about end-of-life issues with their own children. It demonstrates that “taking care of the kids after I’m gone” isn’t just a financial issue. And it adds a dimension to your family relationship that most kids will never know.

In essence, the Other Talk is designed to break the typical eldercare pattern of lurching from one crisis to the next. It gives your kids the self-confidence, knowledge, tools, and perspective to take on the responsibility when the role-reversal process begins to take place.

More important, by preparing for the decisions, the possibilities, and the responsibilities in the last years of your life, you and your kids can focus on the living to be done, the accomplishments that have yet to be achieved, and the memory and the legacy that will make the family proud.

Next Steps

To help you set the stage for your own Other Talk, I’d like to suggest a conceptual and a practical approach:

The Concept of Staging

In preparing for my first Other Talk with my family (Pam, Dakota, and Fernando), I found it helpful to picture myself as the director of an actual on-stage performance.

1. Preparing the actors. To begin with, I feel it’s important to ensure that the participants develop a thorough understanding of why we’re doing this. To answer the Why question, I asked everyone to read the first four chapters of this book:

“Defining the Dimensions of the Other Talk”

“Recognizing the Negative Consequences of Silence”

“Appreciating the Benefits of Family Collaboration”

“Navigating the Baby Boomers’ Perfect Storm”

2. Presenting the storyline. I believe there are three components to effectively communicating and motivating your participants:

Engage. Grab your audience’s attention for your concept in a meaningful way.

Inform. Provide information but also ideas and perceptions that will help your audience embrace your concept.

Involve. Keep up your audience’s stamina if you want to sustain their attention.

3. Creating the screenplay. To guide the participants to the How, you need to provide them with the words and the props. In our case, I created a binder of information, strategies, and contacts for each of our family members. (I’ll be discussing that effort in the next chapter.)

4. Visualizing a successful performance. I have found it useful, whether it be for sports, writing, public speaking, or even bridge and chess, to imagine a desirable outcome. For the Other Talk, I asked myself to visualize success for two scenarios:

What will a comfortable, open dialogue look like?

How will the kids express their interest and commitment to moving forward?

The Practical Approach to Partnership

Of course, setting the stage for the Other Talk is not just about taking into account the mental state of the participants and thinking through the atmospherics of that first get-together.

Because the Other Talk is about establishing a partnership, I encourage you to set ground rules to ensure that this family meeting works smoothly and effectively with a minimum of misunderstanding.

Here’s how my family approached those ground rules:

1. You are the managing director; after all, it’s your life.

2. The kids are full partners, not corporate minions, because after all their involvement is voluntary.

3. Each member of the partnership (including you) understands that responsibilities will change as your condition evolves.

4. The goals of the partnership are these:

To frame decisions now, before a crisis, to ensure better outcomes, less panic and stress, and almost no flailing around

To manage your affairs the way you intended and avoid choices you don’t want

To ensure that everybody benefits and everybody contributes