For a long time, my sister, brother, and I chose to ignore signs that our mother needed assistance with daily living. At first, there were lapses in personal care—buttons missing from her favorite jacket, a hem undone—and her housekeeping skills were slipping, too.
We proposed hiring someone to come once a week to help with chores. After all, mom was in her 80s; it wasn’t an outlandish idea.
“No!” shouted our normally soft-spoken mother. And she stood firm.
We didn’t want to threaten our mother’s self-esteem or her right to make decisions about how she lives her life, yet we were uneasy.
We backed off, not knowing what else to do. We didn’t want to threaten our mother’s self-esteem or her right to make decisions about how she lives her life, yet we were uneasy. What do you do when a parent says no?
The answers vary, of course, based on the problem’s severity and on the individual personalities involved—both of caregivers and of those being cared for.
So why would an elder refuse care or companionship?
“Getting to the underlying issue is important,” says Steven Barlam, a licensed clinical social worker in Los Angeles and a past president of the National Association of Professional Geriatric Care Managers. “Perhaps the parent is thinking, 'If I accept somebody into my home, then my daughter will no longer come by twice a week. So I’m going to say no to a home care worker.' You need to reassure the parent: ‘Mom, I need some help. If we have someone here to take care of the chores, we can spend better time together when I do come.’”
More success is found if the issue is framed around the needs of the adult child than the requirements of the parent. “How you phrase it is important,” says Fran Hankin, director of program services for the Greater Illinois chapter of the Alzheimer’s Association. “Adult children might tell the parent, ‘We know you can still take care of your own home, but it would make us feel better to have somebody help you with the chores.’ If the response is ‘Well, why aren’t you doing it?’, you can be honest. Say ‘I really need some rest.’ To aid in the transition of having someone come into the home, a family member should be present for the first few visits.”
That’s how we handled the situation with my mother. As mom grew more frail and forgetful, her doctor advised that the time had come when we could no longer take no for an answer. A professional’s perspective is often helpful in assessing when the risk requires action. He said, “Just make sure that one of you is there when the homemaker arrives to reassure your mother and to help her adjust to the new situation.” We followed his instructions, and they worked. Although mom protested at first, over time she began to appreciate the look and feel of a clean apartment. She accepted the presence in her home of a kind and helpful new friend. Had we not been guided in breaking the “No” barrier, how would mom ever have accepted full-time in-home assistance when that became necessary years later?
“NO, I WON'T GO TO THE SENIOR CENTER. THERE ARE TOO MANY OLD PEOPLE.”
“My father-in-law, a widower, sits in front of the TV day in and day out, except for those times when I plan excursions,” says Sarah*, a part-time consultant who gave up her work when her father-in-law moved in. “For one thing, I’m worn out by having to be his full-time company-keeper. For another, I’d like Pop to enjoy a better quality of life. But whenever I mention a senior program where he might find appropriate companionship, enjoy a nutritious lunch and engage in an activity, he says, ‘Not for me.’ And that’s the end of it.”
“Sometimes, when parents age, the adult child thinks this is the time to fix the parent up and make him a different kind of person,” says Helene Ebenstein, MSW, coordinator of the Caregiver Resource Center at New York’s Mt. Sinai Hospital. “So, let’s say the parent refuses to go to the senior center. Is he sociable or has he always been a loner? If he has generally kept to himself, then the senior center might not be something he would enjoy.”
But if the parent has been active and engaged with others yet now refuses to venture outside the house, Barlam suggests that “this may be an issue to raise with his or her physician. There may be an underlying depression that should be treated.”
If you still think or hope that joining a center or day-support program would benefit your parent, doing your homework might bring about the desired result, advises Constance Todd, director of the National Institute of Senior Centers in Washington, D.C. “Senior centers vary in the kinds and quality of services they deliver,” Todd says, “so visit the center first. Make sure it is right for your parent. If you’re enthusiastic, it is often easier to sell the older person on the idea.”
A helpful strategy, she suggests, is to promote a program or activity on the center’s calendar—a reading-and-discussion club for someone who wants intellectual stimulation or some kind of aerobic class for a person interested in remaining active. A group outing to the theater or a casino may spark a positive response. “Figure out what might be of interest,” says Todd. “Bring parents in for a particular event, let them engage in that activity and make some friends. It should be easier to get them back on the next occasion.”
And go slow, say the experts. Adult children often think they know what has to be done in a given situation. What’s more, they feel everything has to be done quickly. But that’s not always the right pace for the older adult. Be patient and tolerant of the elder’s decisions. “We all do things in our lives that may not be smart,” says Barlam. “As a caregiver, you have to be at peace with some decisions parents make even if you don’t agree with them.”
“NO, I WILL NOT GO TO THE DOCTOR.”
One reason the parent refuses to go to the doctor may be that she, too, is concerned that something is the matter and doesn’t want her fears confirmed. Still, a diagnosis is important to determine possible treatment. “If you’re concerned about mom’s memory,” says Barlam, “or you’re worried about mom’s heart condition, you may have to figure out some less-threatening reason for her to see a doctor—perhaps to seek treatment for the ache in her knees or to get a flu shot. Express your real concerns to the doctor ahead of time. But the flu shot—that’s the ticket in the door.”
“A positive way to approach the matter is to have some sense of the target problem,” suggests Gary J. Kennedy, a geriatric psychiatrist and chairman of the Geriatric Mental Health Foundation. “The older adult might protest, but the concerned family member can say, ‘You know there’s a problem. You left the kettle on and forgot to turn the stove off.’ Or, ‘Do you realize that your blood pressure medicine ran out two weeks ago?’ Or, ‘You’ve been complaining about your teeth.’
“The point,” Dr. Kennedy concludes, “is the caregiver has identified a concern that the older person will acknowledge. The next step is to say, ‘Perhaps this is something where we can get you some help. You deserve the help. Medicare will pay for this.’ And then say, ‘I’ll come with you to the doctor.’ That makes the older person feel a little less alone, a little less frightened.”
Another way to proceed, says Dr. Kennedy, is to negotiate with the parent. He offers an example: “‘You want me to help you with these checks, dad? I’m happy to do it, but you have to do your part. Let’s see a doctor and find out why you can no longer manage this. Or let’s see if there’s a problem with your eyesight.’ That’s negotiation,” Dr. Kennedy explains, “and it’s justified when the older adult is relying on someone else to maintain his or her autonomy.”
Is it ethical to be a bit manipulative where the parent’s health is concerned? “If the stakes are high enough,” says Dr. Kennedy, “it’s ethical and it’s certainly warranted.”
“NO, I WILL NOT STOP DRIVING! IF I COULDN'T DRIVE SAFELY, I WOULDN'T DRIVE.”
The facts underscore the dangers in this area. According to the National Highway Traffic Safety Administration, older drivers are more likely to be involved in traffic crashes—and they are more likely to be killed in traffic accidents—than drivers in their 30s, 40s or 50s. Nevertheless, says Elinor Ginzler, co-author of Caring for Your Parents: The Complete AARP Guide (AARP Books/Sterling Publishing Co., Inc., 2005), “the inability to continue driving represents one of the greatest losses to an older person, so don’t be surprised if the parent says no.”
First off, asks Ginzler, how did the conversation go? Was it confrontational or, as in Karen’s case, did you come at it from the vantage point of concern for the parent? Do you have concrete, reliable information that makes you pursue this issue? For example, have you driven with the older person and noticed that he has difficulty staying in lane? Do other drivers keep honking because the parent is driving too slowly? Is she on medication that might affect the ability to handle the car? Have there been more traffic tickets or warnings in the last year or two?
In short, if you’ve reason for concern about your parent’s driving, this is not a time to shy from confrontation. If your parent rejects your suggestion, there are options. “Bring in other family members,” suggests Ginzler. “Who does your parent listen to?” Sometimes a loving grandchild is better able than the adult child to get across concern for the older person’s safety. Sometimes the family doctor, alerted to the situation, can prescribe a halt to getting behind the wheel.
You might also raise the financial advantage. Suppose your parent protests, “I can’t afford to hire a car service every time I want to go somewhere.”
“Yes, you can,” you might answer. Point out that such expense is actually less than the cost of owning, insuring and maintaining a car.
Before you confront your parent, however, be ready to offer other means of getting around. Learn about supplemental transportation programs in their area. Locate a student or retired person who might be available to drive your parent on errands. Be resourceful.
“It’s not about reducing the quality of life, but extending the quality of life,” says Ginzler. “That’s the message to get across.”