My mom was his primary caregiver, and it took a toll on her. By the time he died, she needed a new hip. It took two and a half years for her to get the surgery. You could blame other things for the delay, but there were things she needed to do that she didn’t. She wouldn’t let her children go to some of her medical appointments, and she often would deny she had any health issues or that she wasn’t following the doctor’s recommendations.
When I was particularly frustrated, I reached out for tips from my friend Carolyn McClanahan, a doctor and CFP practitioner who regularly writes and speaks on the intersection of health and personal finance. She said it’s important to know what’s actually going on medically and get the information directly from the medical personnel involved. Patients don’t retain much of what they are told, since it’s so complicated, and even those who try to convey information accurately have trouble doing so.
It’s helpful to try and understand why the older person is being uncooperative, and healthcare surrogates can help with that. If there’s no surrogate, one needs to be put in place. It’s usually a family member, typically one of the patient’s adult children.
If the parent doesn’t want anybody coming into their medical appointments, a surrogate could say, “I really love you and want to make sure we all understand what is going on with your healthcare. In my experience, healthcare conversations can be complicated, and by me being there, it reduces the chance of miscommunication. Can you please share with me why you don’t want me in all of your appointments?”
The surrogate should expect some common answers. For instance, some older parents say they don’t want to burden their children. Others feel like the children will take over. Still others are embarrassed that they have problems they can’t fix or control. When you know what the reasons are, a senior will be more open to help.
Carolyn offered a few examples of things you can say to the person in need:
“Mom, helping you isn’t a burden at all. It is a much bigger burden worrying about you and not knowing what is going on with you.”
“Mom, you are totally in charge of your health decisions. My bigger concern is understanding what is going on so I can help you if something ever happens where you can’t make decisions for yourself.”
“Mom, we all have our issues, and no one is perfect, especially when it comes to taking care of ourselves. There is no reason to be embarrassed, and I promise I won’t share anything I hear with anyone else.”
If those conversations don’t work, surrogates can write a letter to the doctor with their concerns. They should identify themselves as healthcare surrogates and explain that they understand the privacy issues. They should also ask the doctor to encourage the surrogate’s involvement when talking with the patient.
If that doesn’t work, it’s worth asking if a geriatric care manager could be hired, an objective person the parent might listen to.
McClanahan says, “If the situation gets dire and they are not doing well, ask the doctor to intervene directly. If that doesn’t work, and they won’t allow you to bring in a geriatric care manager, your next step would be to get help determining capacity.”
“Dire” is a good word here. In Florida, we have the Baker Act for such circumstances, but the bar is very high for the courts to invoke it. The best course is to create a plan, not just to get documents in place but to discuss health and quality of life situations when everyone is well. That won’t prevent all problems, but it can set the psychological tone for how people will act in the future.
Dan Moisand, CFP, practices in Melbourne, Fla. You can reach him at [email protected].