Adult children whose parents appear to be affected by dementia face a challenging future. Once they’ve decided to have the hard conversations, what happens next? The previous article in this series set the stage for initial discussions once family members sense something’s amiss. This article explores the issue in more depth.

Once there’s basic alignment, have that talk. Choose an in-person moment – perhaps when everyone is already gathered for a family event – so seriousness, tone and empathy aren’t lost. If one parent is declining, and the other is not, begin with the parent who is of better mental health. They often see more than they realise or admit and can hopefully assist you time and frame this important conversation.

Regardless, expect resistance, either from family members or your affected parent. Your mentally healthy parent may not agree with your assessment. Even with all family members aligned, the seemingly ailing parent may hear your concerns and infer, “You’re wrong,” or “you’re trying to take away my independence and my money.” This can especially be the case when suggesting they give up driving, bring in aides or move them out of their home .

Maybe reframe the conversation:  “This is about you maintaining control. We’re providing you choices so others aren’t forced on you later.”

Be honest about the physical realities the family is facing. In many families, one elderly spouse cannot safely care for the other; think of a 200-pound partner needing help from someone a third their size or with their own health issues. Even with hired help, not every arrangement works; some elders fire well-intended and qualified aides who don’t meet their expectations, sometimes due to a misunderstanding of their role and responsibilities.

Discuss the continuum that various options may bring. That could be staying at home and aging in place, with appropriate support and care. Maybe, moving to an assisted living facility near home will help them maintain connections with longtime friends. Geography matters, sometimes more than costs and services.

Talk about money. Face it, a family’s financial means can determine their ability to better care for an ailing member. Long-term care insurance may help, but many families won’t have robust coverage, and benefits-rich plans are becoming unaffordable, if available at all. Map out what’s affordable, who can contribute money and time, and what trade-offs are realistic.

The presence of apparent dementia raises unsettling, even scary questions for many families. Heredity plays an undeniable role. If dementia runs in the family, planning isn’t just for mom and dad. Whether in the face of an ailing parent, or after reading an article like this, use this moment to adopt healthy habits; organise your own documents, including advance directives; and normalise hard conversations across generations.

Finally, accept that any conversation isn’t a one-off talk. The first chat will be the start of a number of conversations to create a long-term plan. The first step may simply be getting the siblings’ thoughts aligned, followed by gaining a parent’s agreement to keep talking. That’s progress. Hard conversations don’t get easier by waiting. Start now – gently, clearly, and together.

If you need help addressing the family, financial and health care concerns brought on with aging parents – or at any stage of life, let’s talk. I’ve faced this in my life and have helped other families bring clarity to confusing – even scary – situations.