You’re sitting next to your dad at the kitchen table, and yet there’s a gulf between you that you’re not sure how to navigate. You’ve noticed signs that he seems to be struggling a bit—his house is unusually messy for one thing, and he isn’t cooking the way he used to—and you think he might benefit from home care. But he is resistant, insisting he’s fine and doesn’t need help. “We’re not there yet,” he tells you. The more you talk to him about it, the more heated the discussion becomes, turning into an argument. You’re not getting anywhere, and you’re both upset and frustrated. Where do you go from here?
What’s Really Going On?
First, know this: The majority of adults 65 or older prefer to grow old at home, and this is especially true of the 79 percent of people in this age group who are homeowners. However, it’s common for older adults to resist any care that doesn’t come from a spouse or other family member, according to a 2018 report published in CSA Journal. When older adults ultimately need extra support, this hesitation can be a tension point.
The research also shows that even minor changes at home, like eliminating throw rugs or installing grab bars in a shower to reduce fall risk, are often upsetting to older adults. Understandably, accepting the idea of outside caregiving after decades of living independently is an even bigger challenge.
“For many people, living at home is key to their independence,” says Linda Ercoli, PhD, the director of geriatric psychology at UCLA, who serves on TheKey’s Scientific Advisory Board. “They have to take a leap of [faith] to allow strangers to come into their home and care for them, and that can be difficult.”
The possible reasons for resistance to home care presented by the researchers make a lot of sense when you put yourself in the shoes of your loved one. For example, bringing in help in the form of a caregiver might make Mom feel helpless or dependent. It could also trigger certain emotions, such as frustration over admitting that she needs help or fears that she can’t take care of herself anymore. The potential loss of dignity from relying on someone for help can also come into play.
3 Ways to Approach the “Home Care” Conversation
Instead of trying to talk your mom into something she doesn‘t want to do, and both of you end up angry and upset, consider tackling the topic from another angle, Dr. Ercoli suggests. (Another idea that can be helpful: Avoid using the terms “home care” or “caregiver.”) Here are some other techniques that Dr. Ercoli has found often work:
1. Reframe the Issue
Using an “I statement” is a better approach than telling your loved one what to do, Dr. Ercoli says. Explain what you’ve noticed and why you’re concerned, and be as specific as possible. For example:
Instead of: “You need help around here. You don’t seem to be taking care of yourself, and you’re not eating enough.”
Try: “Over the past two weeks, I’ve noticed you’re eating less and less and that makes me worried for your health. I think if someone could help with meals, it would be a big relief since you wouldn’t have to deal with it.”
From there, Dr. Ercoli suggests asking questions so that the conversation becomes a discussion rather than a one-way interaction. For instance, ask: “How would you feel if someone made meals for you a few times a week?”
2. Emphasize How Home Care Can Help Mom Remain Independent
Often, resistance stems from a concern over loss of independence, which is understandable. But Dr. Ercoli says that you can help your loved one see how home care can actually help them meet that goal. “Having home care usually expands the person’s autonomy because it allows them to stay at home in a safer environment,” she explains. “The whole idea of home care is to keep people home longer and have a better quality of life.” By choosing the right words, you can help her see that.
Instead of: “You don’t seem able to keep up with tasks here. Maybe the house is getting to be too much for you.”
Try: “I know how much you love being in this house, and having someone come in to assist can go a long way toward helping you stay here,” or “Let’s talk about what can be done to make sure you stay in this house as long as you want.”
Approaching the conversation that way may help your parent see it from that perspective, especially if he or she has started to feel overwhelmed by daily tasks.
3. Involve Mom in the Process
When you’re setting up home care, it’s essential for your parent to be included, Dr. Ercoli says. For example, your mom could interview home care professionals with you, choose the days and times for home care to come in, and select the tasks to be done. That will help her maintain a sense of control, which is extremely important. Tell her that the two of you will be working on this together.
Instead of: “The person I chose for home care is coming over this afternoon to help you.”
Try: “How do you feel about someone coming over to evaluate what kind of help you might need? Which days this week work for you?” or “What things do you need the most help with? What’s most important to you? Let’s focus on those first.”
If she is still resistant, say: “Let’s give it a try for a month. If you don’t like it after that time, we don’t have to continue with it.” By putting your loved one more in charge, it gives them a feeling of control, Dr. Ercoli says. Plus, you’ll be able to hear more about their goals and concerns, which is essential information for finding the right fit.
When Dementia Is a Factor
The approaches above can be helpful for someone who doesn’t have dementia or cognitive issues or is in the early stages of the disease. However, in the later stages of dementia and especially when accompanied by anosognosia—which is when the person is unaware of their condition or can’t perceive it accurately—a different strategy is often required, says Paula Marks, vice president of care partnerships at Tender Rose Dementia Care Specialists, now part of TheKey.
“Refusal of care by people who have dementia is a huge issue,” Marks says. And it’s extremely difficult: “At the same time family members are grieving about the way the family dynamic is changing, the loved one is scared and experiencing a complex disease process.”
In this situation, Marks suggests you seek assistance from a professional. You can work with someone who has extensive knowledge about and experience with people living with dementia and their care. This type of expert can help evaluate the situation and tailor an approach that will work best for your family and your loved one.
Family Caregivers Need Care, Too
As you work toward helping your loved one get the help they need to continue living a high-quality, independent life, take a moment to focus on yourself. Family caregivers can experience a mix of emotions about bringing in home care, including feeling guilty that they can’t do everything themselves. It can feel like you’re “failing.” But the truth is, most family caregivers can’t and shouldn’t try to do everything, especially over a long period of time. That’s when frustration builds and often escalates into feelings of anger toward the loved one you’re caring for. [RELATED: What Is Caregiver Anger and How Can You Work Through It?]
The important thing to keep in mind is that home care means you’ll do less of the everyday tasks and chores—get the support you need to stay strong and healthy—and be able to spend more meaningful time with your loved one. Home care benefits everyone in the family, and that can bring you all closer together.
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