Touchy Topics, Sensitive Conversations

DIANE GASAWAY

Touchy Topics, Sensitive Conversations!

Touchy Topics and Sensitive Conversations! – Who wants to have one of those?

As a caregiver, at some point on the journey, you will likely need to talk to your care receiver about topics you would rather avoid. Your care receiver may want to avoid them as well.

Putting off conversations on sensitive or touchy topics will not help. Preparing for them will.

You may already have one (or two) in mind, but here are samples of touchy topics that caregivers may need to address and want to avoid:

• Loss of physical functions (the need to wear protective garments)

• Loss of mental functions (inability to do tasks they used to do)

• Loss of independence (giving up driving or the need for assistance with grooming or other activity they once performed)

• The bad news (a change in medical prognosis, or the prospect of going into assisted living or a nursing facility)

• Finances (not having enough money to pay for home healthcare aid or other needs)

• The need for legal documents such as a will, power of attorney, and advance directions for end-of-life issues

These conversations are put off for many reasons - to avoid conflict or avoid facing the feeling of loss or grief or regret that the conversation is even needed. Silence may be easier and may be golden, but it will not be beneficial.

Consider the benefits of having open, honest discussions about hard issues:

• It may reduce stress since you will be taking care of something that is important and it will no longer “hang” over you.

• You will gain clarity regarding your care receiver’s feelings and wishes and be able to make plans together.

• There may be a feeling of increased closeness that comes from sharing something so intimate and important.

If you are at the beginning of a journey of illness, acknowledge the possibility of having to address difficult subjects in the future. Talk about that possibility and agree early on in the journey that those subjects will not be avoided and will be discussed as they come up.

As hard as it may be now to think about the difficult times and discussions that may lie ahead, talk about some of the subjects that may eventually come up.

Discussing a difficult subject before the need arises may pave the way and make it easier to talk about it if and when the need actually comes up.

Consider making a pact that when a sensitive subject arises and needs addressing, each of you will willingly participate in the discussion. Imagine how you may start a sensitive conversation. You might even agree to have a code phrase to start any sensitive conversation “It’s time to talk about….” or come up with a phrase that is unique to your relationship.

Reassure your care receiver that you will always have his or her best interest at heart. That you will always listen to his or her concerns and that you will always honor those concerns, when possible.

Although you both may agree from the beginning that you will both be open to addressing the difficult subjects, that does not mean that when those subjects come up it will be easy.

Prepare for the Sensitive Conversation:

Before you bring up a topic with your care receiver, be clear in your own mind about why the conversation is necessary. It may help clarify the importance if you write down the answers to a few questions.

• Why is it important to have the conversation?

• What outcome do you hope to achieve?

• How does the outcome benefit your care receiver and you?

• What research have you done on the subject?

• What are your specific concerns?

• Clearly state the issue and solution you want your care receiver to consider, giving the person a few choices, even if some seem insignificant.

• If others are involved, have you discussed this with other family members, and do they agree with your assessment?

• If you do not have strong support, what steps can you take to get others on board?

• How emotionally prepared are you to deal with this issue?

Plan When & How To Have The conversation:

When and how you bring up an important subject can affect how beneficial the conversation is to both you and your care-receiver. Preparation does not always mean success, but it does mean you have done everything you can do to make success a possibility.

• Address an issue when it first comes up so you can talk about it more than once, if necessary.

• Pick a time to talk when your care receiver is alert, at his or her best, and feels emotionally the best he or she can be.

• Try to find a time when you and your care receiver are well-rested.

• Make sure you are feeling positive.

• Choose a quiet location with few distractions.

• Choose a time when you will not be interrupted.

• Be gentle and kind and take it slowly and lovingly.

• Remember, you have been thinking about this, but your care receiver has not.

Plan To:

Plan NOT To:

• Do not bring it up during an argument or when either one of you are upset.

• Do not bring it up when your attention is divided, and you are thinking of other things.

• Do not bring it up just before you go somewhere, or you know visitors are arriving.

• Do not bring it up if you have limited time and will have to rush through it.

Even with the best of planning and preparation, the conversation may not go the way you wanted. You may have to back off, regroup and try again later.

How to approach the conversation:

• State the issue and possible solutions in a neutral way.

• Discuss, do not debate the issue.

• Keep your emotions in check.

• Respond and do not react.

• Acknowledge that the topic may need more than one conversation.

• Look for points of agreement.

• Respect your care receiver’s opinion and feelings.

• Realize and honor your care receiver’s perceptions, beliefs, and values that may be different from yours.

• Be honest but kind in the conversation with the words and tones you use.

• Keep the conversation on the topic at hand and avoid other subjects.

• Remember to treat your care receiver as you would want to be treated.

Recognize that your care receiver has not had the time that you have had to think about the subject and formulate a response. The initial reaction may be resistance.

If there is resistance, you may want to table the topic temporarily, but let them know this is important and needs to be addressed. Schedule a time to discuss it after your care receiver has had time to think about it.

At least a discussion has been started and sometimes, just bringing up the subject is the hardest part. If things get heated or overly emotional, be prepared to be flexible. Step back, take a breath, take a break, and remember that you and your care receiver are doing the best that you can in a difficult situation that you have never had to face before now.

Remember, you are having these difficult conversations with your care receiver because you care about his or her well-being and future and you want only the very best for them.