Aging Parents Resist Help

Aging parents using help post hip fractureAn example of aging parents refusing help: “Thanks for the follow-up. Mom’s in charge. Not always making good decisions, but she has to make her own mistakes. It’s sad to watch but it is what it is. Will reach out as events warrant.”

This text comes from a daughter who had arranged for an aide to walk with her father on weekends when he was in a Rehab Center so he wouldn’t lose any momentum on days when there was no Physical Therapy. Once home, her aging parents refuse any in-home care or needed assistance as the wife feels she can adequately take care of her husband, to the dismay of their daughter.

Her father is in his nineties and frail, while her mother is also elderly with medical conditions of her own. This is a common snapshot of American families today when the adult sons and daughters recognize the need for some care for their aging parents but such recommendations and offers are rebuffed.

Reasons of Refusal

Most people recognize when things become more difficult to do or that their body and/or mind (Dementia) aren’t performing routine tasks as easily as before. However, emotionally and psychologically it is difficult to come to terms with many aspects of aging and illness. The “Big Three” are Denial, Fear and Impairment.  Many older adults deny the normal aspects of aging and how it can affect safety (fall prevention) and personal care (ADLs). Hearing or Vision loss makes walking or driving more difficult. It is natural to fear the loss of independence and the ramifications of aging and disease.  While denial and fear are fierce adversaries for a well-meaning son or daughter who see that their aging parent needs help, it is still up to the parent to decide whether they will accept help or not. When impairment, particularly cognitive impairment is the issue, the very inability to use good judgement and make sound decisions is affected and therefore, family members need to be more proactive in arranging for some degree of care or assistance and begin planning ahead. There is a difference between being stubborn and being intellectually impaired.

Strategies for Accepting Help

While a legally competent adult cannot be forced to do anything, with continued urging and pragmatism some aging parents will get beyond their denial and fear of accepting some degree of in-home assistance. It is important to recognize and acknowledge their feelings and voice your own. After all, your concerns for their safety and well-being are most likely based on what you are seeing in their inability to do everything the way they used to with regard to either personal care (bathing, dressing walking), home management ( shopping, cooking, laundry, driving) or a bit of both. Be patient; be kind and persistent with the following:

~ Ideally some conversations will have been started before a crisis; such as a fall or illness occurs so no one is reacting to an emergency. Conversations include how your parents are experiencing their own aging process, what they envision for themselves in the future and sharing your own observations, feelings and concerns.

~ Be aware how your parents may trigger some intense feelings in you. They may be passive or quite angry at their situation and it may result in unkind words behaviors towards you. We often rage against a loved one about our own fears and anger. Remaining calm and offering reassurance can help a loved one cope with their functional loss and emotional responses to them.

~ Ask open ended questions aimed at how they feel about their situation. Address the parent who is experiencing the loss or impairment and the parent who has become the primary caregiver. With illness, whether cognitive like Alzheimer’s disease or physical like Cancer, Heart Disease or Parkinson Disease, both parents are going through it, but have their own, individual experience.

~ Validate the reasons they give you for not wanting help. They may say they “don’t want a stranger in the house”, “it is too expensive” or that they are “just fine and don’t need any help”.

~ Have options to offer which address their concerns. The “stranger” has been vetted and is experienced when hired through a licensed Home Care company. They can afford it or have Long Term Care insurance or there may be Government benefits, Veteran’s benefits or other methods of payment (including family paying but not necessarily telling the parent that they are).  Share your concerns about their safety and how their condition may affect their ability to do everything they used to… such as driving, mowing the lawn, carrying groceries or laundry. Redirect the changes caused by the disease or fall, or whatever has caused the need for assistance.

~ Some aging parents will only listen to their sons and daughters or will listen better to anyone but their grown children. Enlist the help of an Elder professional to meet with them or the family unit. Geriatric Care Managers, Social Workers, Elder Law Attorneys and Primary Care Physicians.

~ Prioritize a Care or Action Plan. If they will accept grab bars in the shower and wearing an Emergency Response Button (especially if they live alone) that is a good start. If they will accept meeting with a Home Care representative or starting with a few hours of help a week for driving, shopping and laundry, that is a good way to ease into more care. Some parents who ought not to drive may accept a taxi service or use UBER. Start with what they will accept and which will have a positive impact on their safety.

~ When your parent is has some degree of Dementia or Cognitive impairment, less is more when it comes to the amount of information given. If they cannot absorb the information it is useless and leads to frustration and maybe anger.  You may also employ “Therapeutic Fibbing” with regard to calling an aide, an old friend rather than a caregiver from a company.

~ Accept that it is ultimately their decision and we are all entitled to make our own mistakes. Even when those mistakes can lead to a lot of heartache for the whole family.  Only if your aging parent is cognitively impaired (PD, Alzheimer’s, Dementia, Brain Injury etc.) is it imperative for you to arrange for more support and care. The roadblock in that case is usually the well parent. They may feel threatened by a hired helper or are in denial of their spouse’s condition and so forth. Keep in mind, spousal or other family primary caregivers are about 6.7% (almost 7 in 10) more likely to become gravely ill themselves and tend to die before the person they are caring for. This is reason alone to bring in help or consider Day Care or even future placement.

Some aging parents you can prevent from falling and others you can only pick back up.