The Start of the Aged Care Journey - Navigating Aged Care Podcast Ep.1
Posted 31st May 2024
Written by Jesse Gramenz 
Aged care family member Brian (left) and Sheridan (right) on the Navigating Aged Care Podcast set
In this episode of "Navigating Aged Care," host Nicole interviews Grace and her daughter Sheridan about their experience with the decision to move into aged care.
Grace initially went into aged care for respite but decided to stay longer because she enjoyed it. Sheridan talks about the transition from being a caregiver to being in a more equal adult-to-adult relationship with her mother.
"It was just taking that first step, and I think once I took that step and got used to the idea that, hey, it's not so bad, and you slowly merge into these things and I think that's what I did."
Aged Care Resident Grace on her move to aged care
They emphasize the importance of open communication and honesty in their relationship. The episode also features experts in the field, including a geriatrician and a psychologist, who discuss the signs that may indicate the need for aged care and offer advice on how to have conversations about this topic with aging parents.
The experts stress the importance of planning ahead and involving the older person in the decision-making process. They also highlight the need for ongoing communication and maintaining relationships with aging parents, even as their needs change.
Hosted by: Nicole Lessio
Produced by: MSQUARE Productions
Episode 1 Transcript
Nicole:
Welcome to Navigating Aged Care, a five-part series from St. Vincent's Care aimed at exploring the complex world of aged care. I'm your host, Nicole eo, and over these five episodes, we're going to talk about gaining a better understanding of our aging parents, how we navigate some pretty emotional transitions, how to integrate into aged care communities, ensuring our loved ones flourish, and how we can compassionately approach end of life care. We'll be joined by true experts in the field, the residents and their families, as well as aged care staff, a geriatrician and a psychologist. In episode one of Navigating Aged Care, we'll be focusing on how to deepen connections with our aging parents. And I'm delighted to be joined by Grace and her daughter Sheridan. Welcome to you both.
Sheridan:
Thanks so much for having us.
Nicole:
I'm really excited to have you here. Grace, you are a resident in St. Vincent's care Aged Care facility. I'm really excited to find out from you. What about choosing to go into aged care was the scariest thing for you?
Grace:
Starting a new chapter in my life was the scariest part. What was going to happen? Would I adapt and what was going to happen?
Nicole:
What was your relationship like with Sheridan before you went into aged care?
Grace:
It was good. It was terrific.
Nicole:
But she was caring for you at
Grace:
The time? Yeah, she was caring for me at the time. Yeah.
Nicole:
What made you decide that it was the right time then to move into aged care?
Grace:
I went into age care for respite for a couple of weeks to see if I was going to like it or not. A try
Nicole:
Before your bike?
Grace:
I tried, yes. And if I didn't like it, I was still welcome to go back to my daughter's, but after two weeks I thought, it's really not enough time. And I said to she, and I think I'd like to stay here a little bit longer, test the waters. And I did. And I'm still here. Yeah.
Nicole:
You liked it so much you stayed. I
Grace:
Stayed,
Nicole:
Yes. She. What about your relationship with your mom before she went into aged care?
Sheridan:
When she was living with me or, yeah, when she was living with me. So it all happened quite suddenly. So it was quite a bit of a whirlwind, to be honest. It was a big adjustment for myself and my son. It wasn't always an easy adjustment because it is a big life change, but we had a good relationship, which I think helped. We were able to have conversations about things that weren't working, things that were working, and I think that put us in good step for where we are now.
Nicole:
How's it improved since mom moved into Aged Care?
Sheridan:
Oh, massively. Yeah. Yeah. Yeah. I think our whole relationship has changed. I think we're closer than we ever were before. The dialogue is now much easier. Conversations are easier, but I think our relationship has just shifted in a really positive way.
Nicole:
So do you feel like before you were carer and parent and now you can be back to parent and adult child or adult to adult these days?
Sheridan:
Yeah, yeah, yeah, absolutely. I think it's more adult to adult. We still have definitely Mother-daughter, definitely moments.
Nicole:
We all have those.
Sheridan:
Yeah, she still worries about me and things and vice versa. But yeah, there's definitely still a healthy respect for the parent-child relationship. But I think for the most part we're more like friends now or more adult. Adult. Yeah.
Nicole:
How did you broach the subject? Who started that conversation about, I think it might be time. Was that you Grace, or was that Sheridan?
Grace:
I think we both realized at the time that it was time for me to sort of see how I was going to fit into aged care, and I knew him myself. It was just taking that first step, and I think once I took that step and got used to the idea that, hey, it's not so bad, and you slowly merge into these things and I think that's what I did. Sorry. That's okay.
Nicole:
I was going to ask you, it's not that bad, you said, and I'm really keen to explore that because we have a lot of preconceived notions about what aged care is. What were your thoughts beforehand?
Grace:
I didn't think I'd have as much freedom as I've got, and I thought it would be so more strict than what it was. And I'm particularly lucky because of where I am. I've felt a comfort that I didn't think I would feel.
Nicole:
We have that notion that it might be a bit more boarding school and less horrible.
Grace:
That was the word I was looking for, more like that. And it wasn't, it was more caring that I took for strict supervision at the time, but when in retrospect they were just looking after me,
Nicole:
It's nice to feel looked after, isn't
Grace:
It? Yeah. And that's what they were doing. Yeah. But you move into these facilities, it's a bit overwhelming of course. So you've just sort of got to settle in to say, Hey, no one's picking on me. They're looking after me. Yeah,
Nicole:
That mindset. Mindset,
Grace:
Yeah. It's a mindset. Yeah,
Nicole:
Absolutely. It is. Sheridan, your relationship with your mum, you clearly have a very open conversation, open dialogue with each other. Not many people have that. How do you foster that? What kind of advice might you give to people to foster that?
Sheridan:
Yeah, okay. I don't think we were always that way. I think that's evolved over time.
Grace:
Definitely.
Sheridan:
And I think the best way to foster that, well, what worked for us anyway, was that had to be given an open forum like my house for, I've tried to create an environment for my friends and my family and my children of a place where it's safe to be you. Whatever you define that to be is entirely up to you. But it's a space for where you can exist and be yourself. So when mom came to live with me and whatever I told her, that was kind of the rule of the house, that this is how we work here, that we do talk. We do talk about things that maybe mothers and children shouldn't talk about. I dunno, but this is how we roll. This is our system and it works for us. And so it was about us both giving each other permission to speak openly and honestly, even if that meant that it may not be always nice, but you can be honest and be kind at the same time, I think was really important for us. I think that's what started the ball rolling of us, really establishing of what has become a very close relationship was just this open communication and that safe space to say whatever you're thinking and feeling and without judgment,
Nicole:
That's a really important space to get to, but it's hard to get to that, isn't it Grace?
Grace:
Yeah, it is.
Nicole:
You had a parent child relationship and it's hard
Sheridan:
To
Nicole:
Move on. How do you change that?
Grace:
It's a reverse thing. Yeah. I don't know how you change it. There's an old saying, be nice to your children when they're little, because they're the ones that are going to look after you when you're old.
Nicole:
Yeah, that's true. Okay.
Grace:
So yeah.
Nicole:
So that's the tip start. That's the tip. Be really
Sheridan:
Nice to them
Grace:
Where they're going to put
Sheridan:
You. She's only being nice to me, so I did put her in a bad home.
Nicole:
It's a good tip. I'm going to write this down. Wait a minute. But that is really hard because you've had this parent child situation where mom told you what to do and then all of a sudden you are telling mom what to do almost. It's quite a weird thing, isn't it?
Sheridan:
I think the change in that is not so much me telling her what to do, because I don't want to take away her autonomy. I still have to respect that she is still my parent, she's still my mother, and she's still older than me, and that deserves a level of respect. But at the same time, I'm not telling her what to do, but we can have decisions made together and if she wants to do something and she just says this what I do, okay, that's fine. At the end of the day, it is still her life as it is mine. I think being a parent myself and as you, you know that you have to sometimes step back and hopefully she trusts me enough by now, after all these years today, that she can trust some of my decision making ability. I do sometimes make good decisions,
Grace:
Sometimes. Sometimes,
Sheridan:
Sometimes.
Nicole:
Was choosing to be in aged care, one of the decisions you made together?
Grace:
Yeah, it was.
Nicole:
How do people do that, do you think? What advice would
Grace:
You give? Communication. Yeah, communication. Being honest with each other.
Nicole:
Is it just simply, like I said, I want to write this stuff down. We're all learning. We all want to know.
Grace:
I think you've got to be honest with each other and say, Hey, I'm scared if I need to come over, can I come over when I want to? Which was open to me. And I think that communication, if you can't get to someone's place, pick up the phone, ring someone, but have that open to you. At least have someone to talk to.
Nicole:
Yeah,
Grace:
It's really important. I think that is really, really important.
Nicole:
It's really important also to live across the road from age care
Sheridan:
Facility.
Grace:
Well, I advise it for everybody.
Sheridan:
Yeah, I totally did that on purpose.
Grace:
Buy up your plots of land. Now
Nicole:
We're all wishing we'd done it before. Yeah. Many people are terrified of having that initial conversation. You guys have a great relationship where you can have those open, honest conversations. That is not the way a lot of parents and kids roll.
Grace:
They don't.
Nicole:
So what do you think they can do to broach it if their relationship isn't quite as strong, do you think?
Sheridan:
Sheridan? Well, based on the fact that I would say that ours probably wasn't actually in that place back then. I found it a very difficult, I did broach it and it was a very difficult conversation to have because you are fearful of their reaction. And as the child, no matter how old you are, you still want your approval from your parents. You still want their acceptance and their validation. So to get anything other than that is very confronting. But it's a conversation that has to be had, so you kind of have to just sort of suck it up, I guess. But essentially for me, I think the way I approached it was I anticipated that there might be a negative reaction and I allowed that to exist. I didn't get defensive with her. I didn't get angry or I didn't get anything like that. You understand that this is going to be a difficult conversation and it's going to be difficult for her and all that sort of stuff. And if you approach it with empathy and a bit of understanding and patience, I suppose as well, being incredibly patient and being mindful of where she's at in her life. It was only a few months before that my father had passed, so there's a lot of big changes going on. Mom's life had changed very dramatically in a very short period of time. So approaching it, like I said, with empathy and understanding that this is a lot for her and not thinking about myself and my own needs, what's important here is her.
Nicole:
But as a mom, grace, you also want your child to still think about herself. Of
Grace:
Course, of course. Of course you do.
Nicole:
Of course you do. How do you navigate that
Grace:
Again? Communication. Yeah, it just all comes
Nicole:
Down to it. It
Grace:
It really comes back to that and steps.
Nicole:
Yes.
Grace:
Yeah. That's what us as the older generation have got to remember is just baby steps. Because every day does get better, but it takes time.
Nicole:
But what you said about the timing for you moving into aged care with your husband, passing away and then making these big life decisions to move into Sheridan's house and then again making another big life decision to move into aged care. It's a lot going on. How did you go with that?
Grace:
I don't know. I just coped. I just kept myself busy and I was lucky because the lifestyle girls used to load me up with plenty of things to do, and I think it was keeping busy. If they wanted something cut out, I did it. They were marvelous. And when I didn't feel or I felt that I needed something to do, I could wander down there at any time. The door was always open. And I think just having that freedom to say, even in yourself, I'm just not feeling myself today. I could wander down there and say, have you got something you want cut out or something you want done? And I think that played a big part. And I think, yeah.
Nicole:
Yeah, being open to it.
Grace:
Yeah, being open to something.
Nicole:
But the fear that you had beforehand, Sheridan, what level of fear are we talking?
Sheridan:
Oh God. I think that's relative to anyone. My scale of fear is probably very warped compared to other people. I'm not afraid her much. The fear that I think I had predominantly was one, I don't want to upset my mom. I don't want to upset her and hurt her. But yeah, again, a fear of her being unhappy with me, being angry at me. No kid, no matter how old you are wants that.
Nicole:
You don't want your mom to say, I'm disappointed. Oh my
Sheridan:
God, that's the worst.
Nicole:
It's terrible.
Sheridan:
But yeah, again, it's that thing where you have to overcome the fear because at the end of the day you have to think about her needs, my needs and the needs of my family, like my child and things like that as well. Everything has to be factored in. Yeah. So yeah,
Nicole:
Because not just one person, of course, the person who's going into age care is the center of those decisions, but it is counted by a whole lot of things that circle around it, isn't
Sheridan:
It? Yeah.
Nicole:
What about guilt?
Sheridan:
Guilt?
Nicole:
I think that's one of the things that I'm afraid of is I'm afraid of how much guilt I'm going to feel. How have you navigated that?
Sheridan:
The way I navigate most things, which is you just sit in it, you just have to accept it. It's too easy to feel a negative emotion and to push it aside and try to avoid it or find some way to distract yourself. And that's where poor behaviors can come from. Trying to avoid bad feelings. I acknowledge that I don't want to feel this way. I know no one wants to, but you just have to sit in it. You have to explore why do I feel this and understand why you do and work through it the best that you can. And if you can't, then I would highly encourage someone to seek assistance from somewhere else, which I did as well. I mean, yeah, I'm a huge advocate for therapy, and I mean, you're going to have a psychologist on it hurts, so I'm sure she'd be happy to hear someone advocating.
I'm sure she would for therapy, but yeah, that's what you do. If you don't know an answer to something, you seek the advice from somebody who does the analogy of if my tooth hurts, I don't fix it myself. I go to a dentist if my brain hurts and I can't figure out why you go to a psychologist. And that's kind of what I did. So the guilt, it's there, it's real, and I think it's a normal part of the process as is. There's a grief component to it as well. There's a resentment. There's a whole bunch of different negative emotions attached to it, and you just have to ride 'em out. The
Nicole:
Only way around is through
Sheridan:
Pretty much the buffalo run into the store. Got away from it. Yeah.
Nicole:
What about the relationship now as you are moving into both of, you're getting older, obviously all of us are getting older. It doesn't change when you're in aged care, it keeps happening. What about the relationship now between the two of you? Are you as solid as you were when you made that first decision?
Sheridan:
More solid, I
Grace:
Think. Yeah. More solid.
Sheridan:
Yeah. Substantially. Yeah. It's vastly
Grace:
Different. We're more open with each other and we just tell it how it is. Oh
Sheridan:
Yeah,
Grace:
Yeah. Even if we don't like it, we just say it.
Nicole:
How do we avoid those hurt feelings though?
Grace:
Well, we really we're past that stage. Yeah, I
Sheridan:
Think so. I mean, you can caveat a lot of stuff. You can say, Hey, you put a caveat at the beginning, but I mean really you're just prolonging the inevitable, aren't you? No, I mean, but I don't think there is a lot that really needs to be said now between us or that is said that has any sort of hurt feeling sort of attached to it. I think there is this understanding now between the both of us that nothing's ever done with malice. There's no harm meant
Nicole:
Good place to start with that intention of knowing the other person's heart and they're wanting the best for you.
Sheridan:
Yeah, absolutely.
Nicole:
The grief part though, I think is really interesting because often what precipitates a decision to go into aged care is exactly what happened to you. Grace is that your partner passed away. How do you manage that grief in the midst of all of that other stuff, grace,
Grace:
You really dunno how to handle it. That is the problem. So it manifests itself in different ways and it comes out in different ways. And I don't think it doesn't really hit you till a long time after the event, you don't really, it's happened, but part of you thinks that person's still going to walk through the door. It doesn't happen.
Nicole:
Yeah. And you've got a different door now, so it's all kind of intertwined, isn't it? What about you Sheridan, that guilt piece and understanding mom's feelings? Sorry, the grief piece. Understanding mom's feelings.
Sheridan:
For me, I think actually speaking of my therapist, I think he put it really well. We were talking about people transitioning into age care, particularly if anyone, they have dementia or anything along those lines. And he said, it's like the longer goodbye, it's like this prolong goodbye. And he said, it can be agonizing to watch, he said, but all you've got to remember is that it's not necessarily the case. There is still life to be had and to be found if you look hard enough for it kind of thing. And it was that realization that the grief for me, not even just losing dad, but in understanding, accepting mom as she's right now, not the person that I know from my childhood, not any of that, but where we are right now. And that grief then was mitigated by understanding that I could have potentially another, hopefully 20 odd years of a relationship with this person, and suddenly that longer goodbye doesn't feel like such a big deal because you realize, oh, that's ages away. That's not that big of a deal. So you start living in the moment a little bit more and that mitigates the grief, or for me it did anyway.
Nicole:
But then you make that decision to move forward and enjoy those times rather than,
Sheridan:
Yeah, exactly. Yeah. It's valuing the moment what you have right now. Yeah.
Nicole:
Is your mom the same person you think that she's always been? No,
Sheridan:
So much better. Tell us all the, she was always great. She was always great. She was a great mom. She always was, but she's a totally a new person. Maybe you were like it. I just didn't know. I had know your perception of your parents is always whatever, but no, she's an amazing human being. All the core parts of her are exactly the same. That has not changed at all, thank God. But no, the person she is now is vastly different to who she was before, and I absolutely love the person that she is now on a totally different level than I thought was possible.
Nicole:
And that relationship's obviously just deepened and will continue to do so.
Sheridan:
I hope so. Yeah,
Grace:
Certainly you do hope. So
Nicole:
When you've got visitors and grandkids and that kind of thing, grace coming in and visiting you in your home, your new home, what does that feel like now that you've made that decision? It feels great. Yeah.
Grace:
Yeah. You welcome them with open arms. It's my home, and luckily I do feel that. So they come in and we go up to my room or we have a cup of tea or whatever. It's great.
Nicole:
So you still get to have all those relationships that you've had.
Grace:
Of course you do. Yeah. You
Nicole:
Just have to foster
Grace:
Them. There's nothing to stop you doing that.
Nicole:
Yeah. And that's a choice that you make though, isn't it? That's
Grace:
A choice you make. Yeah.
Nicole:
Which you clearly make to do every single day, don't you, grace? Yeah. When we're talking about parents and children, there's often a bit of animosity to start with because that relationship is that parent child relationship getting to that friend part. How does that feel for you Sheridan?
Sheridan:
It's very healing. There was a bit of resistance from me, I think at first. I dunno if it was conscious, but in hindsight now, it was there. And I think that it becomes this part of growth for me, but healing because then having children myself, you start to view things differently where you look at and you realize, oh, she didn't know everything.
Nicole:
Yes, she did great.
Sheridan:
She was working through her own emotions, her own growth as well, her own trauma, her own everything, and trying to do that while also trying to raise a family and all of the issues and all of the great parts that come along with that and wait, oh wait, that's exactly what I've done. And then you start to then not see them so much as these people that are flawed or they didn't do everything and you forgot something, something or whatever your grievance, what grievance might be with your parent. You start to say, oh, okay, well actually you did a pretty good job considering what skills you had, what knowledge you had, and then you can grow from that as well. You can change the way you parent, which I have, and then hopefully your kids, and that's the whole thing. It just sort of cycles on, doesn't it? It does. And that for me was just huge to really realize that, oh wait, she's a person.
Speaker 4:
She's like, I'm not a yoga. She's
Sheridan:
Flawed just like the rest of
Speaker 4:
Us.
Nicole:
No, no, that's really true because we do see our parents, we put them on a pedestal, we see them as this authority figure and to then be able to get to the place where we're friends. I know that people listening will be very excited about the possibility of that, but they have to communicate, done, they grace, communicate, forgive. That's the big tip,
Sheridan:
Isn't it? That's a big tip.
Nicole:
Well, we appreciate so much the amazing tips and ideas that you've given us, as well as just seeing a little peek into the relationship that you have. I agree. I think your mom's done a great job, Shane. Oh,
Speaker 4:
Thank you. So we've got these two. It was hard work. Of course, of course
Sheridan:
Mean
Nicole:
We've got these two experts with us, but we've got more experts joining us in just a moment, so thanks so much, Sheridan. Thanks so much, grace. Thank you. Thank you. And we'll be back in just a second. We're joined by three more experts. We've got Brian, Dalton, Zoe Folster, and Dr. Richard Kain. Thank you so much for joining us today. I'm really excited to have a chat about the medical part of deciding to be part of aged care. Richard, I wanted to go to you first. What are some of the things that adult children loved ones will see that will necessitate that conversation around maybe it's time to go into aged care?
Richard:
Yeah, it's a great question. It's something that comes up almost every day in my practice. There are often a lot of things coming together that influence the decision, but common things are falls and frailty physically, and then cognitive impairment, which might be severe enough to be characterized as dementia, where someone isn't as independent as they used to be because the memory and other impairment of cognition is creeping in. The other thing that often happens is that people have recurrent presentations to hospitals, so they're coming in on a number of occasions suggesting that their health needs are catching up with them, and they need to make that move to an environment that has that extra level of support.
Nicole:
Yeah, they're good things for us to watch out for. Brian, what were some of the things that you saw in your mum, Gwen, that you thought maybe it's time
Brian:
Sort of following on? It was about Mum was becoming, she wasn't eating properly. The apartment that she was living in was getting beyond her capability to manage. She did have a TIA and as a result of that, we had some home care packages wrapped around, but it wasn't long term, and that was enough for mom and our family to start having that conversation. She also had a change in her social environment where her best friend who and mum never drove, so this lady drove, she passed away, and that was also another catalyst for looking at mum, starting to be a little bit isolated. So there were a number of things which really alerted fortunately to mom as well, but also to us to really start thinking about, well, what is the next step?
Nicole:
Yeah, and what was your relationship with your mom before having to have those conversations? Brian?
Brian:
Because mom was at that time, very vibrant and independent. It was still a mother son relationship, and I'd still listen to what mom had to say, and it was always taken at face value. Then we started this progress and it started me thinking about, oh, I'm hit with maturity. It's now started a little bit of a reverse. I now need to be more of a counselor, more of a catalyst to help mom through this next phase of her life, but also through the phase of our life, because as we've found out moving into an aged care residence is just another phase, and it was preparing us to adapt to that.
Nicole:
That's a really great piece of information for us. I think Brian know that it's not just about the resident, it's about our relationships with them and about our adjustments as well, Zoe with parents in particular, I mean loved ones. Obviously a lot of us are responsible for loved ones, but with parents in particular, we have this sense that we know our parents, we know these people. Do we really know our parents though?
Zoe:
Oh, that is a great one because I think our parents mean different things to us at different stages of our life. Obviously the parents that we grow up with are idols. Usually we look up to them. They are all knowing, all seeing, and then that changes during our teenage adult years. They merge more into peers and equals, and often many of us are lucky enough to have relationships with our parents where we can actually have a really equal relationship and equal discourse around different things that are happening in our life. For many people, parents become their friends, and then later in life there can be shifts as well where our parents might need us to help them a bit more. And there is maybe a shift in the dependence. I wouldn't so much call it as a reversal, and I think as we've heard earlier, it's certainly not like we become their parent, but it's more like they do look to us for some reassurance, some guidance, support.
Nicole:
We make those assumptions based on the relationship we've had with them previously, but there's a new relationship as we're changing and shifting, aren't we?
Zoe:
Yeah. Yeah. I would say in adult years, we do get to know our parents a lot better
Nicole:
To the medical professionals in the room. There are courses for us on how to have better relationships with our kids. There are courses for us on how to have better relationships with our partners. There are even courses for us and workshops about how to have better relationships with work colleagues, but I don't know of any that give us the idea of how to deal with that changing relationship. How do we navigate it, Zoe?
Zoe:
That's such a good point. And actually one of my old colleagues has now written a book on exactly this because she made that same observation that there's no guidebook that we can carry around in these later years. We learn by trial and error. Often we learn by talking with our friends who've gone through similar things. We learn by reading blogs and talking to professionals.
Nicole:
So it's all about learning. Richard, when you see people coming into your practice as a geriatrician, you'll often see a parent and an adult child. What do you see those relationships look like?
Richard:
Yeah, often I do see them as together rather than separate, but sometimes it's appropriate to have those conversations separately too. A lot of the things that have been described already resonate with me. One observation I have, which I talk a lot when I'm educating younger medical and other staff about decision making and older people is that, and it sounds really simple, but older people in many ways are just like us, but older. So they have the same want for self-determination. They have the same want for independence. They have the same capacity to make bad decisions like we do as younger adults and as children. And so imagining yourself in that older person situation is often a really good way of looking at the situation. Just because something feels safer and makes us feel more comfortable as the children of an older person doesn't necessarily mean that's the best thing or the safest thing for them in their eyes. And balancing that sometimes as cognitive impairment can come into play with that need sometimes to guide decision making in the way that my colleagues have described already.
Nicole:
Yeah. Is there an ideal time to have the conversations that we're talking about Richard?
Richard:
Look, I think often there are two ways this comes about. One is the situation that was described earlier where there's an accumulation of different small things that lead families and a person to start thinking that residential care might be sometime closer than they had imagined into the future. The other situation that I often come across is where there's been a crisis of some kind, either a significant medical event like a fractured hip or a stroke, or someone's developed malnutrition or other issues in relation to their health. Often that forces a decision to be made really quickly and often at a time where the older person themself might be unwell and less able to participate as much in the decision as they may have liked. And so I often counsel people that if you can plan as much as you possibly are comfortable doing prior to a crisis unfolding, and then you can be much more involved in the decision making and the choices then you might otherwise be.
Nicole:
I like that tip that we need to be planning this kind of thing. Brian, was there a plan in place for mom that all of those things and accumulating made that decision easier or was it that crisis that led to the change?
Brian:
There wasn't a plan per se. We were fortunate that the crisis wasn't significant, but enough, and we had to plan then on the hop. But again, the advantage was that mom, because she was independent and cognitively quite good, she was involved in the process. So it was a family unit who was deciding what the next steps. The only part of the plan that was fixed was mom had always stated that she never wanted to burden her children with living with them. So we knew that that was off the table and that narrowed down what the options were.
Nicole:
How did you have that conversation then? What did it feel like? Because we're all thinking about the times that it's going to be for us when we need to have those conversations. What does it feel like as an adult child having that conversation with your parent who's aging?
Brian:
Look, I won't say it wasn't difficult and it needed a lot of thought about how to approach it and how we would collectively actually identify what we were going to do. And so there's a lot of a duck. There's a lot of paddling underneath amongst the siblings about how to approach this. And then it's sitting down with mom. And I tried to approach it in a methodical way away knowing that living with one of us wasn't on the table. So what were the age care options? And of course, we all had preconceived ideas having experienced our grandmother and what the age care environment and options were then. And they've moved so significantly. And so that was another thing that we had to look at. Well, how do we engage mom so that she also comes to that realization, and that meant something as simple as making a short list of options and actually physically driving mom out to the facilities, making appointments and viewing them. So mom actually got a feel for the environment where it was what it looked like, what the resident's makeup was like, and that actually done between, split between my sister and I actually worked out quite well because we were really able to narrow it down. But it did mean from us as children perspective, having to allocate quite a bit of time and juggling to make sure that that was available. So it is a time consuming process and not something to be fast tracked, but something to evolve when there is a real significant crisis.
Nicole:
But it's just driving around for a new neighborhood. You're looking around to see whether you want to live there.
Brian:
Exactly.
Nicole:
You did the same
Brian:
Thing. Exactly. And part of the outcome was, and one thing we learned that there is a benefit if it's available to actually try and remain in a district that is familiar to you. Mom was fortunate in choosing the residents that she went into and being able to get in that there were people there who she didn't know were there, who she'd grown up with. Oh, wow. So there were little things like that. It was walking distance to a church that she was familiar with, and again, in a community which she had some knowledge and an area which she had some knowledge about, and that really helped in the next phase, which was the settling in process
Nicole:
And all those conversations in the car. I know from driving your kids around the conversations you can have in the car, it's the same for everyone, isn't it? When you're side by side, you can have lots of conversations like
Brian:
That. You can, and it's probably easy because concentrating on the road, so you can raise things and Yes, but you're absolutely right. It's a bit like when you're bringing your kids home from school, have a lot of conversations you don't have otherwise.
Nicole:
Exactly. Zoe, how do we prepare ourselves? I'm selfishly asking you going to take notes. How do we prepare ourselves to have those conversations with our parents? Because that idea of you're getting older, we might need to make decisions, or as you're getting older, we might need to make decisions. How do we start
Zoe:
That? I think there's a great time to have these conversations, and that's now, right? There's no such thing as too early. Even if aged care or aging is not necessarily happening right now, you can always start to explore some of the values that underlying the decision making. So even from what you've mentioned about your mom, just knowing that about her that she didn't want the kind of psychological burden that she would feel being cared for by you, knowing about that well ahead of time just helps you plan those next steps. So yeah, I'd say you can have that conversation today in terms of how to prepare yourself for it. So I think ultimately it's accepting that there is going to be a level of discomfort, approaching it with a curiosity, just a sense of openness, a sense of, Hey, look, I was wondering about this. It seems like something that might be important to talk about. How would you feel about talking about it? And then you have to gauge very quickly how receptive your person is to having that conversation. For many older adults, they might just shut it down. They're not ready yet to talk about it, and you might need to go away and think about another way to attack that, but for many people, they might be waiting for you to ask.
Nicole:
Yeah. Richard, I'm going to put you on the spot. Have you had this conversation with your parents?
Richard:
I've got to be totally honest not to the level of detail we're describing, and that's going to be my first job when I get home.
It's amazing. I work in this space and I have a really good feel, I think from my mom and dad's values in many ways about the things that are important to 'em. But I probably haven't had that level of specific detail. And I would feel even though it's something that I do, a degree of trepidation entering into it. And so I think acknowledging that discomfort, as Zoe described, it's a really important thing. And even overt it. Look, I feel a bit uncomfortable bringing this up, mum, but I'm starting to wonder whether maybe and asking a question rather than making a statement, I think is a really nice way of starting that conversation. I agree.
Nicole:
Excellent. So we'll be your accountability partners then, Richard. We'll call you next week and make sure you've started these conversations.
Richard:
Please do. Please do.
Zoe:
I'll be honest, Richard, I haven't had the conversation either. We've skirted around it, but I think there's more for me to do as well.
Nicole:
We're all on the text chain now. Brian, your relationship with your mom now, is it better? Is it worse? Is it changing? Is she the same person? What is it like for you at the moment?
Brian:
I certainly don't think it's changed as far as for better or for worse, I think it's pretty consistent. I still mentally approach it as I am her son, even though I've taken on some of the responsibilities that mum used to do for me, and that would be her financial affairs or sometimes questions around her care needs and how she'd like that to happen and facilitating that. But it's still, if I'm sitting in the room with mom and we are having a conversation, I suppose I revert to being the child again. But if there's something important that we've got to discuss, I think a bit like you've said, I'll raise it as a question. Have you thought about this? Or for instance, things around leaving something for the children is still very important to mom, so it's often just reassuring her that her financial status is still sufficient.
Yes, you can still survive and remain in the aged care facility. And yes, mom, you have looked after us. So it's little things like that that come up. And the other one, which I think is big is for all our siblings is encouraging our children to visit mom or contact her. That was very important over Covid, and you don't want to fall in if that to fall off. So it's still just a matter of saying, have you spoken to your grandmother? She'd love to hear from you. That sort of thing. I think we also take on responsibility for keeping that happening.
Nicole:
Yeah, that contact is really important, isn't
Brian:
It? Vital,
Nicole:
Richard, for those who are at that crisis point of cognition, perhaps not necessarily the physical elements, how important is maintaining that relationship then?
Richard:
Look, I think it becomes even more important in many ways because sometimes the person with cognitive impairment, by virtue of that has issues or some deficits emerging in their memory or their ability to retain information and make reasonable decisions about things. But at the same time, they may still have a very firm view about certain things and be very able to express those views. So it's about navigating what can be a really nuanced, complex set of circumstances there. I saw a patient this morning and her daughter was saying that the personality of her mother had changed quite significantly over the last year or two to the point now where she was much more agreeable and affable and able to be encouraged to do things that the family felt were the right things for her and less disagreeable than perhaps she'd expected She might be in the situation. So it can make it harder, and sometimes it can make it easier too,
Nicole:
But they're still our parents, aren't they, Zoe? And we still want to maintain that relationship, don't we?
Zoe:
Yeah. I think we'll always have that difference to our parents, and we'll always feel somewhat uncomfortable making decisions for them. I think at the end of the day, we often come to that point of making a call about residential care or care at home when the risk is high. And that risk might be a physical risk. It might be a risk that they might harm someone else, someone else in the household, or might forget to take in the medications or leave the burner on or something like that. And so it's almost like that risk pushes us into this uncomfortable place of feeling responsible for their safety.
Nicole:
And those risks are also something we feel in having those conversations. We feel a bit apprehensive about that a little bit, like there's a bit of element of risk to it. So I think having this conversation today might've helped all of us to think that that's something we can do. So I really appreciate your time, Richard, and to you Zoe, and to you, Brian, for being so open and helping us hopefully, and having those great relationships with our parents. Thanks so much to Grace Sheridan, Dr. Richard, Zoe, and Brian for joining us. We really appreciate the advice as we start our journey into the landscape of aged care. I think we all know now that focusing on strengthening our bonds with our aging parents is a great first step. So thank you for tuning in. If you enjoyed today's episode, be sure to hit the follow button and share it with your friends and family. Don't forget to visit our website, www.svcs.org au to watch the videos from our latest campaign, which inspired this podcast. You can also stay connected with us on Facebook, Instagram, or LinkedIn by searching St. Vincent's Care. And if you've enjoyed this podcast, leaving a rating or review would mean the world to us. It really helps other people find this content. Stay tuned for our next episode where we're going to be exploring the emotional transitions in aged care. Bye for now.
Welcome to Navigating Aged Care, a five-part series from St. Vincent's Care aimed at exploring the complex world of aged care. I'm your host, Nicole eo, and over these five episodes, we're going to talk about gaining a better understanding of our aging parents, how we navigate some pretty emotional transitions, how to integrate into aged care communities, ensuring our loved ones flourish, and how we can compassionately approach end of life care. We'll be joined by true experts in the field, the residents and their families, as well as aged care staff, a geriatrician and a psychologist. In episode one of Navigating Aged Care, we'll be focusing on how to deepen connections with our aging parents. And I'm delighted to be joined by Grace and her daughter Sheridan. Welcome to you both.
Sheridan:
Thanks so much for having us.
Nicole:
I'm really excited to have you here. Grace, you are a resident in St. Vincent's care Aged Care facility. I'm really excited to find out from you. What about choosing to go into aged care was the scariest thing for you?
Grace:
Starting a new chapter in my life was the scariest part. What was going to happen? Would I adapt and what was going to happen?
Nicole:
What was your relationship like with Sheridan before you went into aged care?
Grace:
It was good. It was terrific.
Nicole:
But she was caring for you at
Grace:
The time? Yeah, she was caring for me at the time. Yeah.
Nicole:
What made you decide that it was the right time then to move into aged care?
Grace:
I went into age care for respite for a couple of weeks to see if I was going to like it or not. A try
Nicole:
Before your bike?
Grace:
I tried, yes. And if I didn't like it, I was still welcome to go back to my daughter's, but after two weeks I thought, it's really not enough time. And I said to she, and I think I'd like to stay here a little bit longer, test the waters. And I did. And I'm still here. Yeah.
Nicole:
You liked it so much you stayed. I
Grace:
Stayed,
Nicole:
Yes. She. What about your relationship with your mom before she went into aged care?
Sheridan:
When she was living with me or, yeah, when she was living with me. So it all happened quite suddenly. So it was quite a bit of a whirlwind, to be honest. It was a big adjustment for myself and my son. It wasn't always an easy adjustment because it is a big life change, but we had a good relationship, which I think helped. We were able to have conversations about things that weren't working, things that were working, and I think that put us in good step for where we are now.
Nicole:
How's it improved since mom moved into Aged Care?
Sheridan:
Oh, massively. Yeah. Yeah. Yeah. I think our whole relationship has changed. I think we're closer than we ever were before. The dialogue is now much easier. Conversations are easier, but I think our relationship has just shifted in a really positive way.
Nicole:
So do you feel like before you were carer and parent and now you can be back to parent and adult child or adult to adult these days?
Sheridan:
Yeah, yeah, yeah, absolutely. I think it's more adult to adult. We still have definitely Mother-daughter, definitely moments.
Nicole:
We all have those.
Sheridan:
Yeah, she still worries about me and things and vice versa. But yeah, there's definitely still a healthy respect for the parent-child relationship. But I think for the most part we're more like friends now or more adult. Adult. Yeah.
Nicole:
How did you broach the subject? Who started that conversation about, I think it might be time. Was that you Grace, or was that Sheridan?
Grace:
I think we both realized at the time that it was time for me to sort of see how I was going to fit into aged care, and I knew him myself. It was just taking that first step, and I think once I took that step and got used to the idea that, hey, it's not so bad, and you slowly merge into these things and I think that's what I did. Sorry. That's okay.
Nicole:
I was going to ask you, it's not that bad, you said, and I'm really keen to explore that because we have a lot of preconceived notions about what aged care is. What were your thoughts beforehand?
Grace:
I didn't think I'd have as much freedom as I've got, and I thought it would be so more strict than what it was. And I'm particularly lucky because of where I am. I've felt a comfort that I didn't think I would feel.
Nicole:
We have that notion that it might be a bit more boarding school and less horrible.
Grace:
That was the word I was looking for, more like that. And it wasn't, it was more caring that I took for strict supervision at the time, but when in retrospect they were just looking after me,
Nicole:
It's nice to feel looked after, isn't
Grace:
It? Yeah. And that's what they were doing. Yeah. But you move into these facilities, it's a bit overwhelming of course. So you've just sort of got to settle in to say, Hey, no one's picking on me. They're looking after me. Yeah,
Nicole:
That mindset. Mindset,
Grace:
Yeah. It's a mindset. Yeah,
Nicole:
Absolutely. It is. Sheridan, your relationship with your mum, you clearly have a very open conversation, open dialogue with each other. Not many people have that. How do you foster that? What kind of advice might you give to people to foster that?
Sheridan:
Yeah, okay. I don't think we were always that way. I think that's evolved over time.
Grace:
Definitely.
Sheridan:
And I think the best way to foster that, well, what worked for us anyway, was that had to be given an open forum like my house for, I've tried to create an environment for my friends and my family and my children of a place where it's safe to be you. Whatever you define that to be is entirely up to you. But it's a space for where you can exist and be yourself. So when mom came to live with me and whatever I told her, that was kind of the rule of the house, that this is how we work here, that we do talk. We do talk about things that maybe mothers and children shouldn't talk about. I dunno, but this is how we roll. This is our system and it works for us. And so it was about us both giving each other permission to speak openly and honestly, even if that meant that it may not be always nice, but you can be honest and be kind at the same time, I think was really important for us. I think that's what started the ball rolling of us, really establishing of what has become a very close relationship was just this open communication and that safe space to say whatever you're thinking and feeling and without judgment,
Nicole:
That's a really important space to get to, but it's hard to get to that, isn't it Grace?
Grace:
Yeah, it is.
Nicole:
You had a parent child relationship and it's hard
Sheridan:
To
Nicole:
Move on. How do you change that?
Grace:
It's a reverse thing. Yeah. I don't know how you change it. There's an old saying, be nice to your children when they're little, because they're the ones that are going to look after you when you're old.
Nicole:
Yeah, that's true. Okay.
Grace:
So yeah.
Nicole:
So that's the tip start. That's the tip. Be really
Sheridan:
Nice to them
Grace:
Where they're going to put
Sheridan:
You. She's only being nice to me, so I did put her in a bad home.
Nicole:
It's a good tip. I'm going to write this down. Wait a minute. But that is really hard because you've had this parent child situation where mom told you what to do and then all of a sudden you are telling mom what to do almost. It's quite a weird thing, isn't it?
Sheridan:
I think the change in that is not so much me telling her what to do, because I don't want to take away her autonomy. I still have to respect that she is still my parent, she's still my mother, and she's still older than me, and that deserves a level of respect. But at the same time, I'm not telling her what to do, but we can have decisions made together and if she wants to do something and she just says this what I do, okay, that's fine. At the end of the day, it is still her life as it is mine. I think being a parent myself and as you, you know that you have to sometimes step back and hopefully she trusts me enough by now, after all these years today, that she can trust some of my decision making ability. I do sometimes make good decisions,
Grace:
Sometimes. Sometimes,
Sheridan:
Sometimes.
Nicole:
Was choosing to be in aged care, one of the decisions you made together?
Grace:
Yeah, it was.
Nicole:
How do people do that, do you think? What advice would
Grace:
You give? Communication. Yeah, communication. Being honest with each other.
Nicole:
Is it just simply, like I said, I want to write this stuff down. We're all learning. We all want to know.
Grace:
I think you've got to be honest with each other and say, Hey, I'm scared if I need to come over, can I come over when I want to? Which was open to me. And I think that communication, if you can't get to someone's place, pick up the phone, ring someone, but have that open to you. At least have someone to talk to.
Nicole:
Yeah,
Grace:
It's really important. I think that is really, really important.
Nicole:
It's really important also to live across the road from age care
Sheridan:
Facility.
Grace:
Well, I advise it for everybody.
Sheridan:
Yeah, I totally did that on purpose.
Grace:
Buy up your plots of land. Now
Nicole:
We're all wishing we'd done it before. Yeah. Many people are terrified of having that initial conversation. You guys have a great relationship where you can have those open, honest conversations. That is not the way a lot of parents and kids roll.
Grace:
They don't.
Nicole:
So what do you think they can do to broach it if their relationship isn't quite as strong, do you think?
Sheridan:
Sheridan? Well, based on the fact that I would say that ours probably wasn't actually in that place back then. I found it a very difficult, I did broach it and it was a very difficult conversation to have because you are fearful of their reaction. And as the child, no matter how old you are, you still want your approval from your parents. You still want their acceptance and their validation. So to get anything other than that is very confronting. But it's a conversation that has to be had, so you kind of have to just sort of suck it up, I guess. But essentially for me, I think the way I approached it was I anticipated that there might be a negative reaction and I allowed that to exist. I didn't get defensive with her. I didn't get angry or I didn't get anything like that. You understand that this is going to be a difficult conversation and it's going to be difficult for her and all that sort of stuff. And if you approach it with empathy and a bit of understanding and patience, I suppose as well, being incredibly patient and being mindful of where she's at in her life. It was only a few months before that my father had passed, so there's a lot of big changes going on. Mom's life had changed very dramatically in a very short period of time. So approaching it, like I said, with empathy and understanding that this is a lot for her and not thinking about myself and my own needs, what's important here is her.
Nicole:
But as a mom, grace, you also want your child to still think about herself. Of
Grace:
Course, of course. Of course you do.
Nicole:
Of course you do. How do you navigate that
Grace:
Again? Communication. Yeah, it just all comes
Nicole:
Down to it. It
Grace:
It really comes back to that and steps.
Nicole:
Yes.
Grace:
Yeah. That's what us as the older generation have got to remember is just baby steps. Because every day does get better, but it takes time.
Nicole:
But what you said about the timing for you moving into aged care with your husband, passing away and then making these big life decisions to move into Sheridan's house and then again making another big life decision to move into aged care. It's a lot going on. How did you go with that?
Grace:
I don't know. I just coped. I just kept myself busy and I was lucky because the lifestyle girls used to load me up with plenty of things to do, and I think it was keeping busy. If they wanted something cut out, I did it. They were marvelous. And when I didn't feel or I felt that I needed something to do, I could wander down there at any time. The door was always open. And I think just having that freedom to say, even in yourself, I'm just not feeling myself today. I could wander down there and say, have you got something you want cut out or something you want done? And I think that played a big part. And I think, yeah.
Nicole:
Yeah, being open to it.
Grace:
Yeah, being open to something.
Nicole:
But the fear that you had beforehand, Sheridan, what level of fear are we talking?
Sheridan:
Oh God. I think that's relative to anyone. My scale of fear is probably very warped compared to other people. I'm not afraid her much. The fear that I think I had predominantly was one, I don't want to upset my mom. I don't want to upset her and hurt her. But yeah, again, a fear of her being unhappy with me, being angry at me. No kid, no matter how old you are wants that.
Nicole:
You don't want your mom to say, I'm disappointed. Oh my
Sheridan:
God, that's the worst.
Nicole:
It's terrible.
Sheridan:
But yeah, again, it's that thing where you have to overcome the fear because at the end of the day you have to think about her needs, my needs and the needs of my family, like my child and things like that as well. Everything has to be factored in. Yeah. So yeah,
Nicole:
Because not just one person, of course, the person who's going into age care is the center of those decisions, but it is counted by a whole lot of things that circle around it, isn't
Sheridan:
It? Yeah.
Nicole:
What about guilt?
Sheridan:
Guilt?
Nicole:
I think that's one of the things that I'm afraid of is I'm afraid of how much guilt I'm going to feel. How have you navigated that?
Sheridan:
The way I navigate most things, which is you just sit in it, you just have to accept it. It's too easy to feel a negative emotion and to push it aside and try to avoid it or find some way to distract yourself. And that's where poor behaviors can come from. Trying to avoid bad feelings. I acknowledge that I don't want to feel this way. I know no one wants to, but you just have to sit in it. You have to explore why do I feel this and understand why you do and work through it the best that you can. And if you can't, then I would highly encourage someone to seek assistance from somewhere else, which I did as well. I mean, yeah, I'm a huge advocate for therapy, and I mean, you're going to have a psychologist on it hurts, so I'm sure she'd be happy to hear someone advocating.
I'm sure she would for therapy, but yeah, that's what you do. If you don't know an answer to something, you seek the advice from somebody who does the analogy of if my tooth hurts, I don't fix it myself. I go to a dentist if my brain hurts and I can't figure out why you go to a psychologist. And that's kind of what I did. So the guilt, it's there, it's real, and I think it's a normal part of the process as is. There's a grief component to it as well. There's a resentment. There's a whole bunch of different negative emotions attached to it, and you just have to ride 'em out. The
Nicole:
Only way around is through
Sheridan:
Pretty much the buffalo run into the store. Got away from it. Yeah.
Nicole:
What about the relationship now as you are moving into both of, you're getting older, obviously all of us are getting older. It doesn't change when you're in aged care, it keeps happening. What about the relationship now between the two of you? Are you as solid as you were when you made that first decision?
Sheridan:
More solid, I
Grace:
Think. Yeah. More solid.
Sheridan:
Yeah. Substantially. Yeah. It's vastly
Grace:
Different. We're more open with each other and we just tell it how it is. Oh
Sheridan:
Yeah,
Grace:
Yeah. Even if we don't like it, we just say it.
Nicole:
How do we avoid those hurt feelings though?
Grace:
Well, we really we're past that stage. Yeah, I
Sheridan:
Think so. I mean, you can caveat a lot of stuff. You can say, Hey, you put a caveat at the beginning, but I mean really you're just prolonging the inevitable, aren't you? No, I mean, but I don't think there is a lot that really needs to be said now between us or that is said that has any sort of hurt feeling sort of attached to it. I think there is this understanding now between the both of us that nothing's ever done with malice. There's no harm meant
Nicole:
Good place to start with that intention of knowing the other person's heart and they're wanting the best for you.
Sheridan:
Yeah, absolutely.
Nicole:
The grief part though, I think is really interesting because often what precipitates a decision to go into aged care is exactly what happened to you. Grace is that your partner passed away. How do you manage that grief in the midst of all of that other stuff, grace,
Grace:
You really dunno how to handle it. That is the problem. So it manifests itself in different ways and it comes out in different ways. And I don't think it doesn't really hit you till a long time after the event, you don't really, it's happened, but part of you thinks that person's still going to walk through the door. It doesn't happen.
Nicole:
Yeah. And you've got a different door now, so it's all kind of intertwined, isn't it? What about you Sheridan, that guilt piece and understanding mom's feelings? Sorry, the grief piece. Understanding mom's feelings.
Sheridan:
For me, I think actually speaking of my therapist, I think he put it really well. We were talking about people transitioning into age care, particularly if anyone, they have dementia or anything along those lines. And he said, it's like the longer goodbye, it's like this prolong goodbye. And he said, it can be agonizing to watch, he said, but all you've got to remember is that it's not necessarily the case. There is still life to be had and to be found if you look hard enough for it kind of thing. And it was that realization that the grief for me, not even just losing dad, but in understanding, accepting mom as she's right now, not the person that I know from my childhood, not any of that, but where we are right now. And that grief then was mitigated by understanding that I could have potentially another, hopefully 20 odd years of a relationship with this person, and suddenly that longer goodbye doesn't feel like such a big deal because you realize, oh, that's ages away. That's not that big of a deal. So you start living in the moment a little bit more and that mitigates the grief, or for me it did anyway.
Nicole:
But then you make that decision to move forward and enjoy those times rather than,
Sheridan:
Yeah, exactly. Yeah. It's valuing the moment what you have right now. Yeah.
Nicole:
Is your mom the same person you think that she's always been? No,
Sheridan:
So much better. Tell us all the, she was always great. She was always great. She was a great mom. She always was, but she's a totally a new person. Maybe you were like it. I just didn't know. I had know your perception of your parents is always whatever, but no, she's an amazing human being. All the core parts of her are exactly the same. That has not changed at all, thank God. But no, the person she is now is vastly different to who she was before, and I absolutely love the person that she is now on a totally different level than I thought was possible.
Nicole:
And that relationship's obviously just deepened and will continue to do so.
Sheridan:
I hope so. Yeah,
Grace:
Certainly you do hope. So
Nicole:
When you've got visitors and grandkids and that kind of thing, grace coming in and visiting you in your home, your new home, what does that feel like now that you've made that decision? It feels great. Yeah.
Grace:
Yeah. You welcome them with open arms. It's my home, and luckily I do feel that. So they come in and we go up to my room or we have a cup of tea or whatever. It's great.
Nicole:
So you still get to have all those relationships that you've had.
Grace:
Of course you do. Yeah. You
Nicole:
Just have to foster
Grace:
Them. There's nothing to stop you doing that.
Nicole:
Yeah. And that's a choice that you make though, isn't it? That's
Grace:
A choice you make. Yeah.
Nicole:
Which you clearly make to do every single day, don't you, grace? Yeah. When we're talking about parents and children, there's often a bit of animosity to start with because that relationship is that parent child relationship getting to that friend part. How does that feel for you Sheridan?
Sheridan:
It's very healing. There was a bit of resistance from me, I think at first. I dunno if it was conscious, but in hindsight now, it was there. And I think that it becomes this part of growth for me, but healing because then having children myself, you start to view things differently where you look at and you realize, oh, she didn't know everything.
Nicole:
Yes, she did great.
Sheridan:
She was working through her own emotions, her own growth as well, her own trauma, her own everything, and trying to do that while also trying to raise a family and all of the issues and all of the great parts that come along with that and wait, oh wait, that's exactly what I've done. And then you start to then not see them so much as these people that are flawed or they didn't do everything and you forgot something, something or whatever your grievance, what grievance might be with your parent. You start to say, oh, okay, well actually you did a pretty good job considering what skills you had, what knowledge you had, and then you can grow from that as well. You can change the way you parent, which I have, and then hopefully your kids, and that's the whole thing. It just sort of cycles on, doesn't it? It does. And that for me was just huge to really realize that, oh wait, she's a person.
Speaker 4:
She's like, I'm not a yoga. She's
Sheridan:
Flawed just like the rest of
Speaker 4:
Us.
Nicole:
No, no, that's really true because we do see our parents, we put them on a pedestal, we see them as this authority figure and to then be able to get to the place where we're friends. I know that people listening will be very excited about the possibility of that, but they have to communicate, done, they grace, communicate, forgive. That's the big tip,
Sheridan:
Isn't it? That's a big tip.
Nicole:
Well, we appreciate so much the amazing tips and ideas that you've given us, as well as just seeing a little peek into the relationship that you have. I agree. I think your mom's done a great job, Shane. Oh,
Speaker 4:
Thank you. So we've got these two. It was hard work. Of course, of course
Sheridan:
Mean
Nicole:
We've got these two experts with us, but we've got more experts joining us in just a moment, so thanks so much, Sheridan. Thanks so much, grace. Thank you. Thank you. And we'll be back in just a second. We're joined by three more experts. We've got Brian, Dalton, Zoe Folster, and Dr. Richard Kain. Thank you so much for joining us today. I'm really excited to have a chat about the medical part of deciding to be part of aged care. Richard, I wanted to go to you first. What are some of the things that adult children loved ones will see that will necessitate that conversation around maybe it's time to go into aged care?
Richard:
Yeah, it's a great question. It's something that comes up almost every day in my practice. There are often a lot of things coming together that influence the decision, but common things are falls and frailty physically, and then cognitive impairment, which might be severe enough to be characterized as dementia, where someone isn't as independent as they used to be because the memory and other impairment of cognition is creeping in. The other thing that often happens is that people have recurrent presentations to hospitals, so they're coming in on a number of occasions suggesting that their health needs are catching up with them, and they need to make that move to an environment that has that extra level of support.
Nicole:
Yeah, they're good things for us to watch out for. Brian, what were some of the things that you saw in your mum, Gwen, that you thought maybe it's time
Brian:
Sort of following on? It was about Mum was becoming, she wasn't eating properly. The apartment that she was living in was getting beyond her capability to manage. She did have a TIA and as a result of that, we had some home care packages wrapped around, but it wasn't long term, and that was enough for mom and our family to start having that conversation. She also had a change in her social environment where her best friend who and mum never drove, so this lady drove, she passed away, and that was also another catalyst for looking at mum, starting to be a little bit isolated. So there were a number of things which really alerted fortunately to mom as well, but also to us to really start thinking about, well, what is the next step?
Nicole:
Yeah, and what was your relationship with your mom before having to have those conversations? Brian?
Brian:
Because mom was at that time, very vibrant and independent. It was still a mother son relationship, and I'd still listen to what mom had to say, and it was always taken at face value. Then we started this progress and it started me thinking about, oh, I'm hit with maturity. It's now started a little bit of a reverse. I now need to be more of a counselor, more of a catalyst to help mom through this next phase of her life, but also through the phase of our life, because as we've found out moving into an aged care residence is just another phase, and it was preparing us to adapt to that.
Nicole:
That's a really great piece of information for us. I think Brian know that it's not just about the resident, it's about our relationships with them and about our adjustments as well, Zoe with parents in particular, I mean loved ones. Obviously a lot of us are responsible for loved ones, but with parents in particular, we have this sense that we know our parents, we know these people. Do we really know our parents though?
Zoe:
Oh, that is a great one because I think our parents mean different things to us at different stages of our life. Obviously the parents that we grow up with are idols. Usually we look up to them. They are all knowing, all seeing, and then that changes during our teenage adult years. They merge more into peers and equals, and often many of us are lucky enough to have relationships with our parents where we can actually have a really equal relationship and equal discourse around different things that are happening in our life. For many people, parents become their friends, and then later in life there can be shifts as well where our parents might need us to help them a bit more. And there is maybe a shift in the dependence. I wouldn't so much call it as a reversal, and I think as we've heard earlier, it's certainly not like we become their parent, but it's more like they do look to us for some reassurance, some guidance, support.
Nicole:
We make those assumptions based on the relationship we've had with them previously, but there's a new relationship as we're changing and shifting, aren't we?
Zoe:
Yeah. Yeah. I would say in adult years, we do get to know our parents a lot better
Nicole:
To the medical professionals in the room. There are courses for us on how to have better relationships with our kids. There are courses for us on how to have better relationships with our partners. There are even courses for us and workshops about how to have better relationships with work colleagues, but I don't know of any that give us the idea of how to deal with that changing relationship. How do we navigate it, Zoe?
Zoe:
That's such a good point. And actually one of my old colleagues has now written a book on exactly this because she made that same observation that there's no guidebook that we can carry around in these later years. We learn by trial and error. Often we learn by talking with our friends who've gone through similar things. We learn by reading blogs and talking to professionals.
Nicole:
So it's all about learning. Richard, when you see people coming into your practice as a geriatrician, you'll often see a parent and an adult child. What do you see those relationships look like?
Richard:
Yeah, often I do see them as together rather than separate, but sometimes it's appropriate to have those conversations separately too. A lot of the things that have been described already resonate with me. One observation I have, which I talk a lot when I'm educating younger medical and other staff about decision making and older people is that, and it sounds really simple, but older people in many ways are just like us, but older. So they have the same want for self-determination. They have the same want for independence. They have the same capacity to make bad decisions like we do as younger adults and as children. And so imagining yourself in that older person situation is often a really good way of looking at the situation. Just because something feels safer and makes us feel more comfortable as the children of an older person doesn't necessarily mean that's the best thing or the safest thing for them in their eyes. And balancing that sometimes as cognitive impairment can come into play with that need sometimes to guide decision making in the way that my colleagues have described already.
Nicole:
Yeah. Is there an ideal time to have the conversations that we're talking about Richard?
Richard:
Look, I think often there are two ways this comes about. One is the situation that was described earlier where there's an accumulation of different small things that lead families and a person to start thinking that residential care might be sometime closer than they had imagined into the future. The other situation that I often come across is where there's been a crisis of some kind, either a significant medical event like a fractured hip or a stroke, or someone's developed malnutrition or other issues in relation to their health. Often that forces a decision to be made really quickly and often at a time where the older person themself might be unwell and less able to participate as much in the decision as they may have liked. And so I often counsel people that if you can plan as much as you possibly are comfortable doing prior to a crisis unfolding, and then you can be much more involved in the decision making and the choices then you might otherwise be.
Nicole:
I like that tip that we need to be planning this kind of thing. Brian, was there a plan in place for mom that all of those things and accumulating made that decision easier or was it that crisis that led to the change?
Brian:
There wasn't a plan per se. We were fortunate that the crisis wasn't significant, but enough, and we had to plan then on the hop. But again, the advantage was that mom, because she was independent and cognitively quite good, she was involved in the process. So it was a family unit who was deciding what the next steps. The only part of the plan that was fixed was mom had always stated that she never wanted to burden her children with living with them. So we knew that that was off the table and that narrowed down what the options were.
Nicole:
How did you have that conversation then? What did it feel like? Because we're all thinking about the times that it's going to be for us when we need to have those conversations. What does it feel like as an adult child having that conversation with your parent who's aging?
Brian:
Look, I won't say it wasn't difficult and it needed a lot of thought about how to approach it and how we would collectively actually identify what we were going to do. And so there's a lot of a duck. There's a lot of paddling underneath amongst the siblings about how to approach this. And then it's sitting down with mom. And I tried to approach it in a methodical way away knowing that living with one of us wasn't on the table. So what were the age care options? And of course, we all had preconceived ideas having experienced our grandmother and what the age care environment and options were then. And they've moved so significantly. And so that was another thing that we had to look at. Well, how do we engage mom so that she also comes to that realization, and that meant something as simple as making a short list of options and actually physically driving mom out to the facilities, making appointments and viewing them. So mom actually got a feel for the environment where it was what it looked like, what the resident's makeup was like, and that actually done between, split between my sister and I actually worked out quite well because we were really able to narrow it down. But it did mean from us as children perspective, having to allocate quite a bit of time and juggling to make sure that that was available. So it is a time consuming process and not something to be fast tracked, but something to evolve when there is a real significant crisis.
Nicole:
But it's just driving around for a new neighborhood. You're looking around to see whether you want to live there.
Brian:
Exactly.
Nicole:
You did the same
Brian:
Thing. Exactly. And part of the outcome was, and one thing we learned that there is a benefit if it's available to actually try and remain in a district that is familiar to you. Mom was fortunate in choosing the residents that she went into and being able to get in that there were people there who she didn't know were there, who she'd grown up with. Oh, wow. So there were little things like that. It was walking distance to a church that she was familiar with, and again, in a community which she had some knowledge and an area which she had some knowledge about, and that really helped in the next phase, which was the settling in process
Nicole:
And all those conversations in the car. I know from driving your kids around the conversations you can have in the car, it's the same for everyone, isn't it? When you're side by side, you can have lots of conversations like
Brian:
That. You can, and it's probably easy because concentrating on the road, so you can raise things and Yes, but you're absolutely right. It's a bit like when you're bringing your kids home from school, have a lot of conversations you don't have otherwise.
Nicole:
Exactly. Zoe, how do we prepare ourselves? I'm selfishly asking you going to take notes. How do we prepare ourselves to have those conversations with our parents? Because that idea of you're getting older, we might need to make decisions, or as you're getting older, we might need to make decisions. How do we start
Zoe:
That? I think there's a great time to have these conversations, and that's now, right? There's no such thing as too early. Even if aged care or aging is not necessarily happening right now, you can always start to explore some of the values that underlying the decision making. So even from what you've mentioned about your mom, just knowing that about her that she didn't want the kind of psychological burden that she would feel being cared for by you, knowing about that well ahead of time just helps you plan those next steps. So yeah, I'd say you can have that conversation today in terms of how to prepare yourself for it. So I think ultimately it's accepting that there is going to be a level of discomfort, approaching it with a curiosity, just a sense of openness, a sense of, Hey, look, I was wondering about this. It seems like something that might be important to talk about. How would you feel about talking about it? And then you have to gauge very quickly how receptive your person is to having that conversation. For many older adults, they might just shut it down. They're not ready yet to talk about it, and you might need to go away and think about another way to attack that, but for many people, they might be waiting for you to ask.
Nicole:
Yeah. Richard, I'm going to put you on the spot. Have you had this conversation with your parents?
Richard:
I've got to be totally honest not to the level of detail we're describing, and that's going to be my first job when I get home.
It's amazing. I work in this space and I have a really good feel, I think from my mom and dad's values in many ways about the things that are important to 'em. But I probably haven't had that level of specific detail. And I would feel even though it's something that I do, a degree of trepidation entering into it. And so I think acknowledging that discomfort, as Zoe described, it's a really important thing. And even overt it. Look, I feel a bit uncomfortable bringing this up, mum, but I'm starting to wonder whether maybe and asking a question rather than making a statement, I think is a really nice way of starting that conversation. I agree.
Nicole:
Excellent. So we'll be your accountability partners then, Richard. We'll call you next week and make sure you've started these conversations.
Richard:
Please do. Please do.
Zoe:
I'll be honest, Richard, I haven't had the conversation either. We've skirted around it, but I think there's more for me to do as well.
Nicole:
We're all on the text chain now. Brian, your relationship with your mom now, is it better? Is it worse? Is it changing? Is she the same person? What is it like for you at the moment?
Brian:
I certainly don't think it's changed as far as for better or for worse, I think it's pretty consistent. I still mentally approach it as I am her son, even though I've taken on some of the responsibilities that mum used to do for me, and that would be her financial affairs or sometimes questions around her care needs and how she'd like that to happen and facilitating that. But it's still, if I'm sitting in the room with mom and we are having a conversation, I suppose I revert to being the child again. But if there's something important that we've got to discuss, I think a bit like you've said, I'll raise it as a question. Have you thought about this? Or for instance, things around leaving something for the children is still very important to mom, so it's often just reassuring her that her financial status is still sufficient.
Yes, you can still survive and remain in the aged care facility. And yes, mom, you have looked after us. So it's little things like that that come up. And the other one, which I think is big is for all our siblings is encouraging our children to visit mom or contact her. That was very important over Covid, and you don't want to fall in if that to fall off. So it's still just a matter of saying, have you spoken to your grandmother? She'd love to hear from you. That sort of thing. I think we also take on responsibility for keeping that happening.
Nicole:
Yeah, that contact is really important, isn't
Brian:
It? Vital,
Nicole:
Richard, for those who are at that crisis point of cognition, perhaps not necessarily the physical elements, how important is maintaining that relationship then?
Richard:
Look, I think it becomes even more important in many ways because sometimes the person with cognitive impairment, by virtue of that has issues or some deficits emerging in their memory or their ability to retain information and make reasonable decisions about things. But at the same time, they may still have a very firm view about certain things and be very able to express those views. So it's about navigating what can be a really nuanced, complex set of circumstances there. I saw a patient this morning and her daughter was saying that the personality of her mother had changed quite significantly over the last year or two to the point now where she was much more agreeable and affable and able to be encouraged to do things that the family felt were the right things for her and less disagreeable than perhaps she'd expected She might be in the situation. So it can make it harder, and sometimes it can make it easier too,
Nicole:
But they're still our parents, aren't they, Zoe? And we still want to maintain that relationship, don't we?
Zoe:
Yeah. I think we'll always have that difference to our parents, and we'll always feel somewhat uncomfortable making decisions for them. I think at the end of the day, we often come to that point of making a call about residential care or care at home when the risk is high. And that risk might be a physical risk. It might be a risk that they might harm someone else, someone else in the household, or might forget to take in the medications or leave the burner on or something like that. And so it's almost like that risk pushes us into this uncomfortable place of feeling responsible for their safety.
Nicole:
And those risks are also something we feel in having those conversations. We feel a bit apprehensive about that a little bit, like there's a bit of element of risk to it. So I think having this conversation today might've helped all of us to think that that's something we can do. So I really appreciate your time, Richard, and to you Zoe, and to you, Brian, for being so open and helping us hopefully, and having those great relationships with our parents. Thanks so much to Grace Sheridan, Dr. Richard, Zoe, and Brian for joining us. We really appreciate the advice as we start our journey into the landscape of aged care. I think we all know now that focusing on strengthening our bonds with our aging parents is a great first step. So thank you for tuning in. If you enjoyed today's episode, be sure to hit the follow button and share it with your friends and family. Don't forget to visit our website, www.svcs.org au to watch the videos from our latest campaign, which inspired this podcast. You can also stay connected with us on Facebook, Instagram, or LinkedIn by searching St. Vincent's Care. And if you've enjoyed this podcast, leaving a rating or review would mean the world to us. It really helps other people find this content. Stay tuned for our next episode where we're going to be exploring the emotional transitions in aged care. Bye for now.
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