A mother-daughter conversation about aging, care support, and end-of-life.
Rebecca Crichton’s life stage and encore career align with her volunteer interests in aging and the field of hospice and end-of-life care. As Executive Director of Northwest Center for Creative Aging (NWCCA) in Seattle, she designs programs and presentations that incorporate information and practices related to successful aging and its inevitable endpoint.
At 82, Crichton understands how important it is for her peer group to consider and discuss care needs as they age and get closer to end-of-life. A surprise is how much ambivalence or discomfort people feel about this issue. This can mean they avoid talking about their changing needs with families and friends.
Crichton’s 50-year-old daughter Erika has worked in the fields of aging, caregiver support and training, and hospice and palliative care for the last 18 years. Because Erika’s career mirrors Crichton’s own interests and expertise, mother and daughter now work together to facilitate important discussions between older adults and those who care about, and for, them.
Rebecca and Erika sat down for a conversation about this topic and how it relates to them and their own family.
Rebecca: Erika, I’m delighted we have this opportunity to talk about this topic!
Erika: Me too. And this is not the first time we have talked about aging and someone’s changing needs for support. We seem to talk about these topics often.
Rebecca: I was thinking recently about what’s referred to as the ‘safety vs. autonomy spectrum.’ Some people value personal safety more than a sense of independence so will readily accept caregiving support. And some people value their independence over their safety and are OK with the risks that come from living with an illness or disability. What are your thoughts about this idea?
Erika: Family members can find it hard to support how an older person chooses to live if they are worried about the person’s safety. That’s why conversations between older family members and those who care about them are so important. Open communication related to someone’s changing health or care needs means that when something significant happens there will already be a basis of understanding about what is most important to the older person. Ideally, the appropriate caregiving support can be provided to them in alignment with what they want.
Rebecca: We know that most caregiving for older people is provided by family members. We also know that many families juggle child-rearing, jobs, and other demands that make it hard to provide the amount of care that an older family member might need.
Erika: I had a client recently who shared he wanted his family to hire in-home caregiving so that they were not overburdened. I thought it was a beautiful lens to have as an older person—that his care for his family meant he wanted people outside the family to take part in supporting him.
Rebecca: In the decade since I started working in this field, I have seen some new options for support for people as they age. Often a caregiving agency is hired to help someone, but other times families create a community of support that includes volunteers from their faith community, or a local civic organization. I am on the board of an Aging in Place village in Seattle. We have volunteers who offer everything from gardening and transportation to appointments and companionship. There are also organizations that hire retired people to provide non-medical support to older people.
Erika: Each person’s living situation has unique factors that will influence planning for support. Just as we talk about how raising a child ‘takes a village’ so does supporting an older person as their care needs change. You and I did that for our friend, Ruth, who lived to be 100 and lived independently up until she died.
Rebecca: Ruth is a good example of someone who valued independence over personal safety. Since she did not have any family locally, many of her friends came together to ensure she could remain at home. I was honored to be part of her support.
I want to share two important ideas that relate to both caregiving and end-of-life planning. The first is that thinking carefully about what we want as we get older or become ill can help ensure we live well to the end. The more we share about what we want at the end of our lives means we can be in the present without feeling burdened by thinking about our future needs. And, as we both know, many people don’t know all the aspects of end-of-life planning.
The second idea is that people generally ‘die the way they live.’ When we make a conscious effort to review our lives before we die—clearing troubled relationships, clarifying our wishes, sharing our values with others who might not know them—we can change default approaches to living that may not have served us well.
That is why talking about this feels so important.
Erika: I really like that you are thinking about what’s important to you and that we can talk openly about your life and goals. And I want to say that if your goals change that’s OK, too. Just keep me updated.
For me, honoring your choices as you get older, even if they aren’t choices I fully agree with, is something I think about quite a bit. I also want to ensure your goals and desires are known to your doctors and other care providers so they can best support you over time. Knowing you have an up-to-date Healthcare Directive, a Power of Attorney for Healthcare, and a will gives me peace of mind around supporting you in the ways you want.
Another element of our personal situation is that we live in different cities, so I am not immediately available if something happens to you.
Rebecca: That’s not uncommon. Your father lives in Canada and I know you’ve also talked with him about what he needs as he ages. I also know he has many people around him who are providing a range of support. It’s important to me that you don’t totally give up your life to take care of me in the coming years.
In your professional experience helping older people, how do you suggest starting a conversation about what someone needs and wants as they age?
Erika: I had a friend whose mother had a diagnosis of early-stage dementia. They did not live in the same city and her mother did not want to talk about her diagnosis or plan for what should happen as her illness changed. Her daughter felt frustrated. She told me she wanted her mother to have some hired caregiving support, but knew this would make her mom feel she was losing her independence. I suggested she use words that expressed her feelings about her mom’s situation. Something like, ‘Mom, I worry that at some point you might need more help related to your situation, and I am sad we haven’t talked about it. How do you feel about what’s happening?’ This way of acknowledging the emotional elements of the situation allowed them to talk about what her mother’s diagnosis meant to each of them and how the daughter could best support her mother from afar.
Rebecca: That’s a good example of a ‘proactive discussion’ instead of a ‘reactive discussion’. I’ve seen friends and their families trying to talk through caregiving issues during a crisis of some sort, often health related. It is more stressful to talk about these things during a crisis. We should also mention again that a discussion about aging and care support is not a one-time event. And as we both know, it’s common for families to completely avoid these discussions.
Erika: These conversations become easier the more we have them. And if there are particularly challenging dynamics in a family related to aging or illness, finding a neutral person to facilitate the discussion can be helpful, which is what I do. In my experience, when the discussion gets started from a place of positive intent, it leads to the right dialogue and people feel better about the overall situation they are experiencing.
Rebecca: As my daughter do you think we are having the right conversations?
Erika: I do! And we’re not done. I feel lucky that you are still in good health and that you have a strong community of friends and extended family around you. And I also know that might change over time. I want to keep talking about this topic so I can help you in the right ways as things change.
Rebecca: I’m glad we can talk about these issues and that we are working together to get other people talking, too!
The following suggestions can be a good starting point for anyone who has not yet talked about aging with their family.
- Parent/Elder: “I want to share with you what is most important to me as I get older and what support I might need as I age. Can we talk about this soon?
- Parent/Elder: “As I see my friends getting older, I’m thinking about my own situation and I want to talk about how you can best support me.”
- Adult Child: “I hope we can talk about what your needs for the future might be and how I will be involved.”
- Adult Child: “I want to talk about what I can do to best support you if your need for support starts to change.”
Rebecca Crichton is Executive Director of Northwest Center for Creative Aging (NWCCA) and brings wisdom and purpose to her work with the aging community in the Puget Sound area.
Trained as a hospice volunteer, Rebecca continues to teach and facilitate grief and resilience support groups for several organizations. Rebecca has master’s degrees in child development and organizational development and is a certified coach.
Erika Crichton completed her Master of Social Work degree at Columbia University in 2006. She has worked in the fields of aging, disability and dementia services, caregiver support and training, and hospice and palliative care. Erika has extensive experience as a medical social worker and has also held leadership roles in large health care systems. She recently started offering personalized health and care planning support through her business, Open Ended Support (www.openendedsupport.com.)
Erika is a Washington state licensed advanced social worker and trained Dignity Therapy© practitioner. She holds advance certifications from the National Association of Social Work and the Center to Advance Palliative Care.
This story was made possible by funding support from AARP Washington and BECU. For more information, tips and resources for family caregivers in Washington state, visit www.aarp.org/caregiverswa.