Your older adult family member living “independently” at home could benefit from some assistance such as companionship, housekeeping services, meal preparation or personal care; but absolutely refuses to consider the idea.
This scenario plagues many families with aging loved ones. Concerns about the physical safety and emotional well-being of the older adult are present, as well as questions about the legal liability of family members who may be perceived by others as being neglectful of their loved one.
One of the first steps to dealing with an individual who is demonstrating this behavior is to determine the individual’s perceptions of the situation. Thoughts of changing one’s lifestyle may lead to feelings of anger at oneself or others at not being able to manage daily tasks any longer, fear of losing independence or guilt about being perceived as a burden.
Denial may occur as a method of coping with this potentially threatening situation. Feelings of pride may lead the individual to view the need for assistance as a sign of weakness. Concerns about the cost of care, receiving help from strangers and loss of privacy may also exist.
If someone’s perception is that help is unnecessary, it will be very difficult to convince him/her otherwise. A lack of insight into the need for assistance could be due to cognitive deficits resulting from Alzheimer’s disease or another dementia. In this case, the use of logic as a tool to try to change this perception is pointless since the older person’s brain cannot effectively process a logical explanation. Even for people without dementia who are capable of understanding complex situations, logic is not the most effective tool to use.
Clifton Mitchell, of the East Tennessee State University Department of Counseling and Human Services, talked to Lynne Shallcross in 2010 for an article in Counseling Today, called “Managing Resistant Clients.” “If people changed because of logic, nobody would smoke or drink and everyone would have an exercise program and get eight hours of sleep. When people make major changes in their life, they don’t do it because of logic. They do it because they have an emotionally compelling reason.”
Although Dr. Mitchell was referring to a counselor/client relationship, the same concept is applicable to an older adult who is resisting assistance.
So how do we help our loved ones develop an “emotionally compelling reason” to accept care?
Have general conversations about “what ifs” early, before a need arises, so that some background information can be gathered before a “threat” exists. This information can become a starting point for conversations later on; “You once told me that …”
Use your understanding of your loved one’s perceptions to guide conversations about goals and the realities of the present situation.
Choose a time when a relaxed conversation is possible.
Take a casual and slow approach that initially focuses on the individual’s strengths to set a positive tone for discussions.
Play dumb, and allow the individual to think and develop realizations about their situation that may seem obvious to you.
Avoid asking too many questions since they may be perceived as confrontational, and use “I” statements to make a point without placing blame. Instead of beginning with “Do you want help with your bills?” or “You aren’t paying your bills”; try “I notice there is a pile of bills on the table.”
Consider who the best person is to have these conversations with your loved one. Sometimes, older adults are more open to suggestions made by close, trusted individuals who aren’t family members, such as a physician or pastor.
If multiple people are involved in conversations, make sure that everyone generally agrees on the issue(s) of concern and possible solutions. If not, additional discussion is needed before approaching your loved one.