Raise your hand if you’d like to go back to being a toddler—a time when every part of your life was dictated by someone else. You couldn’t choose what to do, when to eat, or where you’d go. No takers? Certainly not an older adult who has lived a long time making his or her own decisions.
An older adult’s resistance to care is about fear, and specifically about fear of losing control. Their fear often has its foundation in truth. Perhaps they’ve lost some or all vision, hearing, mobility, and maybe thinking ability, too. They are in fact, losing control. The idea of accepting help from a caregiver is another confirmation of loss.
Strategy is critical to overcoming resistance.
- Assess needs. An honest, rational approach is key. Call a social worker at your local Area Agency on Aging, such as Aging Partners (Lincoln) or Eastern Nebraska Office on Aging (Omaha) or a professional care manager for help evaluating needs.
- Be a good listener. Talk with your loved one about her fears and be prepared to listen. Show you are paying attention to her concerns with reflection and reframing. Assure her you are not abandoning her, but getting the help you need. Express concerns in terms of “I” statements, such as, “I know you’re concerned about being a burden to me. I am worried because you’ve fallen. I worry I won’t be available when you need me.”
- Use persuasion and positive language. What does your loved one enjoy? Gardening? Baking? Make a date to do these things together and have your talk while you’re repotting a fern or baking a cake. What’s her favorite music? Use it to put her in a good mood. Address emotion, not logic. “I want to keep you safe and independent here in your own home, vs. “You fell 3 times; you need to move to an assisted living place as soon as possible.” If you’re discussing types of care, don’t assume your loved one is ignorant, but tread carefully. Call caregivers “assistants” and use “Adult Day Services” instead of “Adult Day Care.”
- Stay patient and calm, and be clear about the risks of continuing on the same path. Ignore petty differences. If your loved one refuses to discuss options, ask her how she will handle an accidental hit on the head that knocks her out. Your goal is to motivate your loved one to exercise autonomy and control of his/her own well-being and eventually accept help.
- Regroup and evaluate urgency. If you see a few of the signs of need, take small steps. Offer medication boxes which alert the caregiver if not opened in a timely fashion. Bring in a cleaning service and order prepared meals. Suggest a trial of adult day services or home care. A two-week trial of home care worked for my family. We had adjustments to make, but after a few days, my dad was enormously relieved to have help caring for my mom. Instead of giving up, be unavailable for a day to help your loved one understand her need for care.
Action is necessary if you see frequent falls, dangerous driving, getting lost, an inability to take medication properly, or suspect dementia. Be firm, assure your loved one you will continue to help and be involved, but either full-time help must be brought in or she must move to assisted living, because you cannot continue to be the sole caregiver. If you don’t have legal Power of Attorney, bring in a trusted attorney, doctor, or care manager to speak to your loved one.
I’d love to give you a magic phrase to say to make this situation right, but there isn’t one. Fear is powerful and motivates many older adults to refuse help, especially when they desperately need it. Do your best to see past resistance and keep trying until your loved one is safe.
Call me or one of our care managers; we’re here to help, 402-261-5158, in either Lincoln or Omaha.
Lee Nyberg, a partner at Home Care Assistance of Nebraska, focuses on education and aging issues, co-leads a Parkinson’s support group, and is a Legislative Advocate for the Alzheimer’s Association.