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What if Your Elderly Client Refuses Help?

By February 7, 2018Professional Tips
Senior doesn't want help and resists care

Sometimes elderly clients resist help because aspects of the problem suit their needs. Here’s how to deal with that.

It happens all the time: a client does something that leaves you bewildered and wondering: “why?”

I’ve been there, too. A widower in his late 80s I once worked with knowingly put himself in grave financial danger by funding a failing business. In essence, he gambled away his hard-won financial security. There was also an elderly client who had considerable assets but lived in a dirty, run-down home she was filling up with junk. Another confessed that she’d started giving away large sums of money to somebody she had just met.

These are obvious red flags. So it would seem only natural to try to intervene and help. Despite your best intentions, chances are your client will refuse help with something to the tune of: “Thank you very much. I’m just fine.”

Control and autonomy are essential elements of a happy life for older adults. But there’s a fine line between a fear of losing autonomy and control and issues that are far more complex.

How can you help your clients when they don’t want to be helped?

How can you know if your clients are shrugging you off for more complicated reasons? And what can you do if a senior refuses care?

Early in my 30-plus year career, I was working as a social worker and care manager with an elderly client I’ll call Stella. She lived in an apartment in need of repair, and her refrigerator hadn’t worked for over a year. Three times each week, her daughter had to bring her a cooler of food. Her situation struck me as unsustainable, unhealthy, and potentially dangerous.

So I was excited to discover a grant that would help her buy a new, working refrigerator. When I told her the news, I thought she’d be ecstatic. Instead, I was met with anger. “No!” she said. “Absolutely not!”

I backed down quickly, feeling baffled and defeated.

I discussed this with my clinical supervisor, who gave me advice I’ve never forgotten. “Steve,” she said, “think about this from a functional approach.”

In psychology, the “functional” school of thought considers the mind as an organism that adapts to its environment by keeping what it needs and what is useful. Thanks to my supervisor’s comment, Stella’s behavior became crystal clear. As long as Stella’s refrigerator was broken, her daughter visited her three times each week. This probably seemed like an excellent trade-off to Stella. I could see that the broken refrigerator stressed her family relationships and put her at risk for poor nutrition and illnesses from spoiled food. But it worked for her, it was useful, because it satisfied a much larger goal, which was to get visits from her daughter. She was afraid that if I brought her a working refrigerator, she would suffer the loss of her child.

I have since realized that when trying to understand somebody’s behavior, it can be beneficial to consider what a person stands to gain from staying stuck.

Armed with this insight, you can help them get past the most significant obstacles to health and happiness.

How can you create meaningful solutions for your elderly clients?

As I’ve pointed out before, when an aging client says they’re “fine,” they may not mean they’re “good.” So how do we get them from fine to good? How, for instance, could I ensure that Stella got regular visits from her daughter, but also had a working refrigerator and a healthy life? How can we bring a new vision to our clients — to help them see win-win opportunities and let go of destructive behaviors?

Over the years I’ve found that these four steps usually lead to positive outcomes for elderly clients:

  1. Figure out what makes your client want to hold on to the problem. When you see a “red flag” situation, ask yourself: What about it “works” in the eyes of your client? What benefits do they draw from the problem going unsolved?
  2. Confirm your assumption with the client. Be careful not to rush to conclusions or assumptions. It’s always best to discuss what you’ve gleaned with your client. In Stella’s case, I merely asked if the inconveniences of having a broken refrigerator were offset by the chance to see her daughter three times each week. She confirmed that it was.
  3. Create a plan to keep the benefits and nix the problems. Try to find a way to maintain the benefit that the elderly client so badly wants while also removing the problem. I asked Stella’s daughter if she would still visit three times each week if the refrigerator worked and she said, “Of course!”
  4. Propose the solution to your client. Explain how the solution will maintain the benefit she cares about, but will also remove the danger. Stella was delighted to have a working refrigerator once she knew that she’d still get regular visits from her daughter. It didn’t have to be a one-or-the-other situation. She could have both.

As professionals, we must always find out what is important to each client. From a professional perspective, providing solutions to your clients that improve quality of life helps to build trust. This extra step may take more time up front, but it will help you create solutions that are more likely to be implemented and sustained, and are therefore better for your client.

What if asking these questions seems inappropriate or awkward?

There may be times when this kind of discussion doesn’t feel appropriate to you, either because of the scope of your practice or your relationship with your client. Or maybe you’re just not comfortable asking these kinds of questions. That’s okay.

If you do have concerns about a client holding on to an unhealthy or dysfunctional situation that puts them at risk, there are other options. You can partner with an Aging Life Care Professional™ such as a geriatric care manager. They can visit your client at home and provide a robust bio-psycho-social assessment. They can get to know your elderly client’s needs and wishes, what is important to the client, what they need, and what risk factors are at play. This will lead to solutions for the client that genuinely are win-win.

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Steven Barlam

Author Steven Barlam

Steven Barlam, MSW, LCSW, CMC is the Chief Professional Officer and Co-Founder of LivHOME. Since 1985, Steve has worked exclusively in the field of geriatrics, working directly with clients and their families, and developing innovative service delivery models. He has served as President of the National Association of Professional Geriatric Care Managers. Steve is a regular lecturer at local universities and national conferences on topics relating to care management, technology, and patient/client care.

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