Most people avoid such conversations about dependent care, instead making such decisions in the face of a crisis - such as a stroke or broken hip or change in the health-care needs of an individual with a chronic debilitating disease, McGrew says.
"Families are more likely to have burial plans than long-term care plans, and this is a reflection of the more-feared-than-death dread we have about becoming dependent on others," she says. "But the lack of planning and prior discussion means that when long-term care is needed, families have fewer choices and more confusion and conflict."
Though difficult, planning for long-term residential care makes the transition easier for elderly relatives and their families, experts say.
"It's hard. This is not like planning a vacation. It's not something you look forward to. But I think it's never really too early to start planning for future needs," says Tracy Moser, marketing and admissions director at Reeders Memorial Home in Boonsboro. "Make decisions yourself, while you're able to, so you can help avoid a lot of guilt on family members. And put it in writing if you can. The family will feel more comfortable with placement if you've discussed it. When they can say, 'I know I'm doing what Mom wants,' that's a big deal."
An easy way to open up the subject is for family members of all ages to talk about the possibility of needing long-term care, because disability and dependence upon others can happen at any age, McGrew says. Moser suggests initiating the conversation about dependent care when the issue arises with another family or another family member. But even then, and especially when long-term care is a must, the conversation could be tough.
"It requires a great deal of understanding, and you need to convey that to the person who needs to be placed in long-term care," says Fred Otto, executive director of the Washington County Commission on Aging.
Ask an elderly person to gauge his own health needs. The dependent care decision will be easier if the elderly loved one acknowledges a need for help, says Dana G. Cable, psychology and thanatology professor at Hood College in Frederick, Md., and board chairman of Hospice of Frederick County.
It's also wise to use concrete examples - such as advice from doctors and gentle observations of the loved one's difficulty in caring for themselves at home - to help him or her determine that self-care is no longer possible, Otto says. Express empathy for the fear and other emotions that the elderly person likely will feel about nursing home placement, he says.
Let relatives know that you want the best possible care for their future, and give them a variety of choices, Moser says. Visit nursing homes, assisted living centers and other facilities, and evaluate costs and services. Ask staff members and residents plenty of questions, experts say.
Elderly relatives often feel more comfortable about long-term care living after they see firsthand the wide variety of social activities and other services available at different facilities, Cable says.
"Find out as much as you can about the environment," Otto adds. "Try to accommodate (the loved one) to the utmost with regard to their current living style."
Assure elderly relatives with pets that the animals will be cared for in their absence. If possible, let them decide who will take care of their pets, he says.
Counselors and support groups are available nationwide to help families prepare for making dependent care decisions. For more information in Washington County, call the Commission on Aging at 301-790-0275.