Communication is skill and art. Skills are specific types of verbal and nonverbal actions that help you get the results you want, including cooperation, joint decision making, and finding solutions to difficult issues. The art part is taking the skills and figuring out how to apply the skills to a specific situation. Your job as a caregiver is to decide what to use and how to use it.

When you are talking with aging parents and have some concern about how the communication may go, you are most likely talking about an important topic or an emotionally loaded topic. Important topics may be things such as figuring out where older parents should live, what kinds of help (if any) they need, who needs to know about their finances, what type(s) of health care services they should have, whether or not they have an up to date will or even whether or not someone else should have some legal power to act in their behalf, such as power of attorney or conservatorship.

Emotionally loaded topics are almost anything that leads to strong emotions being experienced and communicated. In any family, there are a specific and unique set of emotionally laden topics, including (but not limited to): who spends the holidays with whom, who is the favored child, who should get possession of various personal items in an estate, who has to take responsibility for care giving, and what is a fair share to be paid for gifts or care by various members of the family.

As a caregiver, you undoubtedly have a series of specific issues that you want to communicate about with your older family member. Some of these are emotionally laden, some are not. Some are easy to discuss in your family situation, some are not. Generally, when there is an emotionally laden and important issue, the following guidelines can help you focus your efforts to get the best out of a difficult situation.

The situation changes dramatically when the older adult has limitations, including dementia. A dementia patient would need more specific guidelines and principles, some of which will be addressed in a future article in this series. However, many of the principles listed below hold regardless of the cognitive limitations of your older family member..

Do's for emotionally laden situations

Think ahead of what you need to get (vs. what you hope to get) from discussions: That is, what is your bottom line? Do you need to get your parent(s) to tell you EVERYTHING about their possessions or do you really need to get them to confer with a competent attorney? Do you need to get your family member into a nursing home or do you need them to be evaluated by a competent agency, physician or other provider who may come up with options that may work for your older relative?

Answer the following question (and it’s a very important one): Are you doing this WITH the older adult or FOR them? That is, do they have both a say and veto power in the discussion? If the older relative has veto power, then he or she may disagree with you or even do something you are very uncomfortable with. At the same time, if it is really their decision, then you should not try to coerce or manipulate them into the decision.

• Think ahead as to when and where to have the conversation. Pick a place and time when older relatives can hear what you are saying without family and holiday distractions. I know of individuals who have actually made a special trip to another city to visit their parents just to have an important conversation.
• Use "I" statements. Literally, this means beginning any declarative sentence with the word "I". This means talking about "My view", "My perception", and especially "My feelings" rather than talking as if you have a corner on the truth and anything your parents says not only contradicts you but is wrong… "I" statements can lead to negotiation and sharing, "You" statements may lead to war.
• Consider having a mutual ally present when beginning important and emotionally laden discussions.- Having someone who is trusted by both parties may make things easier.
• Be clear about the topic of discussion with your family member.
• Give the others time to process and think about what you are presenting. Going too fast can lead to misunderstandings. You may have to have more than one conversation about an emotionally laden topic.
• Respect the rights of the others to agree and disagree.
• Stand your own ground. That is, you can be assertive and clear about your beliefs and your point of view without denying others their rights and own perspectives.
• Be aware of your own feelings and reactions to the situation and the others involved. Sometimes, this may mean taking time to go over your likely reactions and figuring out how to enhance reactions that might help the conversation move along and, at the same time, find ways to keep inflammatory reactions in check.
• Practice the conversation with a "coach", someone who can listen to you and let you know how you are coming across. A coach can be a spouse, significant other, family member or friend. If you practice, be sure to ask your coach what behaviors or actions you have that might give the wrong message to your older relative.
• Be prepared for the discussion to end before you want it to. Make every attempt to treat the discussion as a door opener, that is, an opportunity to get the ball rolling, rather than the time everything has to be decided upon.

Don’ts for emotionally laden situations

• Don’t blame others in either word or tone of voice. We often forget that our internal tension or concern may come across as judging others or being defensive, which in turn leads to their not paying attention to our care and thoughts about them.
• Don’t do all the talking. A rule of thumb is to do occupy no more than ½ of the airtime. It is important to listen and acknowledge the others’ concerns and questions. You don’t have to answer each and every point when it is made.
• Don’t go in with a fearful attitude, it will become your message. Being clear about your goals and having practiced what you want to say can help decrease anxiety.
• Don’t overload the table with old issues and hurts. A major mistake made in these conversations is that once the initial point is agreed upon, too much is attempted too quickly. It helps some people to think of their old history as a museum, don’t show all of the items at once, limit your exhibits.
• Don’t believe that disagreement means someone does not love someone else. I would even go so far as to suggest that a parent’s defensiveness (or our own) also does NOT mean that someone does not love someone else. Too often, people mistake defensiveness as a lack of love.
• Don’t believe that a quick agreement means the others will agree with you after reflection. People may go away from an involved encounter and think things over again, be prepared to revisit tough issues several times.
• Don’t go in with a "someone has to win" attitude, you are usually working together. People who are naturally competitive may find themselves competing with their aging parents rather than working together even with the best of intentions. One way around this is to be clear that the goal is for the "team" of both of you to figure out what is best for the ENTIRE family.

While hardly a complete list of all the nuances of family communication, these guidelines may help you evaluate how you want to have discussions as well as be an informal checklist to evaluate how you did after a discussion about an emotionally laden topic. Let’s take a look at an imaginary conversation (with some comments in parentheses about the dos and don’ts). Remember, these guidelines have to be applied by you in your situation. They will potentially take many forms, you have to be the final judge on how to apply these principles and ideas. Good luck!

Simple scenario and dialogue

An imaginary conversation about where mother is gong to live. Mother is 78, in fairly good health, but has had a few falls and has high blood pressure. She lives alone in the family home, a two story dwelling with all the bedrooms and the bathroom upstairs. The conversation is between daughter, age 45 (with grown children and a husband) and her mother.

Daughter: Mom, there’s something we need to talk about.

Mother: What is it dear?

Daughter: Well, I’ve been thinking about your house.

Mother: Oh?

Daughter: Well, the house is where we grew up and everything, but I was hoping we could sell it some time. (Not clear about the topic of discussion)

Mother: What? Sell the house? Why would I do that? Where could I live?

Daughter: (becoming a little nervous): Mom, you need to think about this before you say that. (blaming)

Mother: What do you mean, I don’t think?

Daughter: No, mom, it’s just that we want you to have what is best for you, you know. (defensive)

Mother: Have you talked to your brother about this?

Daughter: Of course not, I mean I should of, I hope he doesn’t get too mad about this. (includes old issues)

Mother: Now, now, dear, you two shouldn’t fight.

Daughter: We don’t fight, we don’t even talk. (brings up old topics)

Mother: Well, I certainly won’t sell the house if it makes you all upset.

Daughter: Mom, I am not upset, it’s just that I find it hard to talk with you about this. (is assertive)

Mother: Why, what do you mean? Are you saying I am difficult? Can’t I have my way?

Daughter: I’d like to have my way, just for once. (blaming)

Mother: You can, but not with my house.

Daughter (takes a breath): Mom, I’m sorry, but I really want to talk with you about your home and where you live while things are going OK for you. I care for you, I do not want to fight with you or my brother, I want us to talk together about how you can handle yourself. (assertive, clear about topic)

Mother: (reconsiders): OK, I believe you, what do you want to talk about?

Daughter: I am concerned about what may happen to you in the future if you stay in the house. (shares real concerns)

Mother: What do you mean?

Daughter: I mean that the house is designed for younger people, with the bedrooms and bathroom upstairs. If you fell and had to walk with assistance for any period of time, the house would not be a good place to rehabilitate.(Gives good reasons, is calm)

Mother: And, I think, if I had to go into a nursing home, the house might have to go to pay for my care.

Daughter: Unless you made plans in advance.

Mother: Which I haven’t done.

Daughter: So, where should we go from here? (Includes mother in decision)

Mother: Well, we should talk to your brother. Maybe I can talk to him first. Then we should talk to someone who knows about these things.

Daughter: Thanks, mom, I love you.