Most long term care decisions happen on the spur of the moment with little or no planning. The doctor says it is time for the loved one to leave the hospital, but they can't go home and live alone. Often the patient demands so much care they can't go home and live with family members giving care. The family has about twenty-four hours to make decisions that can have massive impacts on everyone involved. Sometimes they get lucky and find a great facility. Most of the time things don't work quite that well. Even if a great facility is found, there are so many areas that need to be talked through. The only way to avoid misunderstanding is to have an understanding, and there are far too many issues that have not been touched much less understood.  

I think we need to have family meetings well ahead and need to talk about how these issues will be faced when and if there is a need. I have advocated that for several years and even wrote a book to show the value of such meetings and suggestions for making arrangements and agendas. The book is called Aging Is A Family Affair*. This maybe the most practical book I have ever written, but it has been a hard book to sell. We seem to be very reluctant to have this kind of meeting. When I have mentioned the subject in the seminars where I speak, the audience visibly freezes. The idea must strike deep fear in the hearts of most of us.

Some of the reluctance comes from the comfort of denial. Denial allows us to rock along and never face reality until we are absolutely forced to do so. We read the stories, see it happening with our friends, hear about it all around us and somehow never let it dawn on us that it could possibly happen to us and it could happen sooner than we can imagine.  

I think most the avoidance comes from fear. It is hard to talk to the family. We can talk to total strangers far easier. Talking to family is far too intimate, and scary for comfort. These people have a unique place in our lives and emotions. We can't talk in the abstract to them. We can't talk without the feelings and sometimes the angers of a lifetime being involved in the conversation. It is scary to even consider a setting where we might have to openly confront our parents or siblings for fear that things might get out of hand and things be said we could never take back. Family members do not go away.We will be dealing with them in close quarters for the rest of our lives.  

It may be scary and intimidating, but it cannot possibly be as scary or as intimidating as the aftermath of a forced decision made on the spur of the moment with no advanced talk. Too often these decisions are not made by the whole family. Most families are scattered and there is not enough time for them to gather so the ones who live the closest make the decisions with little idea what the rest of the family think or feel. That is an invitation to disagreement. Maybe even worse, the decisions are made without the input of the loved one involved. We make far too many decisions about them and far too few with them. In these sudden needs, we may fail to take the time to even consult with them. Often they are too ill to communicate. So we decide and, tell them, and then try to sell them on a decision they had no say about. The only way I know to avoid these kinds of potential problems is to have a family meeting as long before need as possible.

I am 78 years old. I am in good health and still working. About 7 or 8 years ago, while my wife was still living, we asked my four daughters for a family meeting. Their response was, "We have read your books and heard your speeches, the first time you drool you're gone." We had a great laugh, but we did meet. My wife and I had the chance to tell them exactly how we wanted things to be handled when the time came for care. We explained that what we were saying that day should take precedence over anything we might say when the choices had to be made. We knew we were lucid that day, we do not know how lucid we will be then.

Neither of us wanted to go to a nursing home, but we had far rather do so than to move into one of their homes and disrupt their lives. We explained how we wanted medical decisions made if we could not have any quality of life. We have all of this covered in our legal documents so we went over them with the girls and made sure they knew where the documents are kept. We went over the will in detail, so there will be no surprises at the end. We made sure they realized we do not want to control anything after we are gone. I said I would come back and personally haunt them if I ever heard "Daddy would roll over in his grave if he knew we were doing this."  

Then we started the  process of check up meetings. Aging slips up on us. We really don't know how we are doing. The family agreed to meet on other occasions to tell us in frank and even stark terms how they see where we are. I did not want to stop driving my car, but I really wanted to know when I should do so. My father thought he was the best driver in town until the day he died, and he had no business driving anywhere the last several years of his life. I wanted to know. I wanted to know from my family.  

That is scary, but I am convinced the benefits of the understanding will outweigh the fear by a long shot.

*Aging is a Family Affair is out of print. Some of it has been included in our latest edition of When Love Gets Tough and we will publish it for Kindle and other devices in the coming months.