Caring for an elderly loved one facing declining health is one of the most complex – and sensitive – of family issues.But The Scarborough Hospital took steps recently to open up the topic in “It’s Time to Talk,” the first of a series of forums on difficult-to-talk-about health issues. Among the standing-room-only audience was Christine Azeez whose heart-wrenching battle is typical of those faced by an increasing number of Canadian families. “My mother has recently been diagnosed with early stages of Alzheimer’s,” Azeez says softly. “Some moments (she is) so lucid and so with it, and she gets angry and fighting it the whole way. It’s been very difficult on the family. I’m trying to learn more about that so I can help her.” The problem is bound to get bigger. Statistics Canada figures suggest people over 65 years of age will outnumber those under 18 within seven years. Debbie Driver, a Scarborough Hospital nurse practitioner specializing in geriatric care, says planning for future care is essential. “(You have to discuss) what’s important to you in life and how to communicate that to people who might ultimately end up making decisions for you,” Driver says. Like Azeez, Barb Anderson also came in search of help with those tough decisions. “My husband is going through a bad time and I’m debating about a nursing home,” Anderson explains. “He just became a paraplegic.” Experts say there are keys to addressing the emotionally-fraught issue: Talk with your loved ones, with family, primary health-care providers, faith leader and even friends. Identify the values you want reflected in your care. Communicate that to caregivers. Plan how care will be implemented. A meaningful plan tells caregivers how assertively you want to be cajoled into treatment. It will broach the sensitive issue of a substitute decision maker – a spouse, child or even a trusted friend who can advocate for a loved one who no longer understands information or the impact of a medical choice. A guiding question, says Scarborough Hospital ethicist Moji Adurogbangba, is: “What would my loved one have wanted if he or she were able to tell the health care team?” But even the experts can stumble putting advice into action. Scott Wisner, a social worker at The Scarborough Hospital, failed in his first attempt to talk with his mom about long-term care. “It just hit me how uncomfortable I am with the idea of discussing my parents passing on,” he said. “I froze and didn’t know where to start.” Instead, Wisner will have preliminary discussions with his siblings. Meanwhile, the experience helps him understand families coping with major life decisions while a loved one is in hospital. “Hospital is a hard place to make these decisions,” Wisner observes. Adurogbangba suggests using an everyday family event or non-threatening topic to start the conversation. Avoiding the issue is not an option. “If you ignore it, it is definitely going to come back on the family _ either the kids or the spouse or any other loved one,” she says. “We want you to be able to say, ‘When she was able to make her decisions, this is the sense of what I got from her.’ It makes it fulfilling for you that you are fulfilling the wishes of your loved one.” Cultural diversity adds another dimension to the dynamics of care for aging loved ones. Driver says hospital staff is sensitive to the issues, and keeps an underlying principle in mind. “You want the best for your loved one,” she says. “You want them to be independent and have a say in their care because that is their right.” Question period heard criticism levelled at Community Care Access Centres (CCAC). Several audience members described an alarming shortage of home care or difficulty finding long-term care homes. Wisner says CCAC has a “tough job” parceling out limited resources. “Everyone recognizes there needs to be more (home care-service),” Wisner says. “If we have a growing elderly population that we want to stay home longer, the services need to be stronger to support them in their homes.” The Scarborough Hospital plans to tackle other difficult-to-talk about subjects in May and October. Men’s health is on the list of topics, along with mental health and weight management. It’s part of a shift to position hospitals as resources for preventative health as well as acute care. “It’s really important to The Scarborough Hospital that we are seen as experts in care,” says spokesperson Kerry McLeish.