James D. Huysman Psy.D., LCSW

Life in the Recovery Room


Necessary Conversations in Caregiving - Part 1

Initiate discussions about long-term care

Posted Aug 17, 2013

How do you, as a caregiver, begin to talk to your loved one about the need for more or different care?

This is a difficult question and a difficult point to reach on your caregiving journey. The specific answer depends on your loved one’s mental and emotional state, as well as on your relationship history. You’ll need to consider these things before you raise the topic. But many people face this same situation every day, and there are some general tips that may help make the sometimes challenging conversation easier.

Care for Yourself First

In caregiving, as in all areas of life, we can only give our best when we are at our best. So the first conversation you need to have is with yourself.

It’s natural to have mixed feelings about your loved one’s current and future care. On one hand, you want to make sure your loved one gets the care they need to be comfortable and content. On the other, you may feel you should be able to meet all of these needs yourself. Feelings of guilt or failure may come up when you are faced with the fact that you may need help.

It’s helpful to remember that true caregiving takes a village, because caregivers need to be taken care of, too. Your loved one will benefit, and so will you, when you ensure your own health and wellbeing first. Part of this is accepting that your loved one may need more care or supervision than you are able to provide.

Prepare Ahead

It’s best to talk with your loved one about their wishes well before the need for long-term care arises. It can still be a difficult subject, but planning ahead may help ease the transition when the time comes to take action. Many important decisions will have already been made or at least discussed. Planning ahead also allows you and your loved one to consider the financial aspects of long-term care and what is possible in your situation. Remember, Medicare does not cover long-term care.

Be sure to do your homework before opening the conversation with your loved one. You can only take someone as far as you have taken yourself. You may have emotions to work through as well as information to gather. Take the time you need to feel prepared.

It’s a good idea to learn about long-term care and the options in your community before approaching the subject with your loved one. When you feel confident and can answer questions that may come up, it may help your loved feel more comfortable with the discussion.

Respect Your Loved One’s Readiness

There is an adage in the clinical world that also applies to caregiving: Always start where the other person is rather than where you believe they should be.

As difficult as it is to be a caregiver, it is arguably more difficult to be the one needing care. It’s important to introduce the topic of long-term care gently. You may want to start with a request. For example, “I would like to talk with you about your long-term care wishes. It’s important to me that your needs are met. We may need help at some point. Can we talk about this?”

Remember that your choice of words has the power to make or break the lines of communication. For instance, using the term “rightsizing” as opposed to “downsizing” might make all the difference in the world. Approaching the conversation in this way can help assure your loved one of your respect and of your intention to honor their wishes.

Tap Into Available Resources

Losing one’s independence is a hard pill to swallow. Your loved one may resist talking about long-term care needs and decisions. Some people need time to think and reflect. Often you can come back to the discussion at a later time—perhaps several times. Other people may simply refuse to cooperate.

An objective third party, such as a geriatric social worker or care manager, may be able to help you move the conversation along. These professionals can provide important information about options. Their involvement also may help lessen some of the emotion around the conversation so that both you and your loved one can listen and understand what needs to be done. In addition, it allows you to remain in a supportive and proactive role with your loved one. This can help you both feel safe and able to reach a solution.

It may be helpful to think of this: “TRUST” is To Reach Ultimate Success Together. Fostering trust with your loved one can help conversations about long-term care end with you both feeling safe, heard and at peace with your decisions.


Get the Right Care for Your Loved One: Watch this video for more help talking about long-term care.

Medicare versus Medicaid: Learn how these two programs compare.

Medicare.gov: Visit the official U.S. government site for Medicare.

Medicare Helpline  24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.

Medicare Made Clear, call 1-877-619-5582, TTY 711, 8 a.m. - 8 p.m. local time, seven days a week.