Dirty dishes piled on the counter. A skipped bath here, a few skipped meals there. Maybe your elderly parent is rapidly losing weight, has stopped going to their monthly bridge club, or their laundry hamper is stuffed to the brim. Signs an aging loved one is struggling to take care of their health and environment on a daily basis can range from glaring to nearly-imperceptible.
Marianne could easily see that her stubborn elderly mother wasn’t keeping up with the housework, but whenever she tried to broach the subject of hiring a caregiver, her mother responded with an adamant “no” and refused help. Don was in a similar predicament. His stubborn elderly father flatly refused to accept home care—even though he was having so much trouble with mobility issues that he rarely left the house.
Elderly parents have the right to refuse help. But there are times when it’s undeniably clear that a senior would benefit from caregiving assistance. What should you do if you mention elder care services to your parent, and they respond with a resounding “NO?” Is there a way to help them accept the assistance they need?
How Families Approach Resistance to Elder Care Services
Over my thirty-plus years of working with families and their aging parents, I’ve noticed that when family caregivers encounter resistance over the issue of elder care, they typically take one of these four approaches:
- The Blue in the Face Approach. For some families, talking about elder care can become confrontational. If neither side is willing to compromise, the situation can spiral into a full-blown argument, with no resolution in sight.
- The Steamroller Approach. Families can simply ignore their loved one’s protests and proceed ahead, whether the elderly parent wants to accept elder care services—or not. Granted, a “steamroller” may be required in genuinely critical situations and/or when the senior lacks the capacity for rational participation; however, I generally discourage this approach because it is disrespectful and can lead to strained relations for days, weeks, or even longer.
- The Backing-Off Approach. Some family caregivers choose to back off as soon as they encounter resistance from a demanding parent. Initially, acquiescing like this may seem like a way to honor and respect the rights of an elderly loved one; however, backing off is not effective, primarily if the senior could benefit from services that would positively impact their quality of life and sense of well-being.
- The Understanding Approach. To have the best outcome, you need to understand why your elderly parent is refusing help. Put another way; you need to find the underlying reason for the “no.” Once you have a better understanding of what your parent is facing, you can develop a plan that aligns with, not against, them. Continually trying to convince your parent to take action can be perceived as adversarial (it pits you against them). But if you work to understand truly, you’ll become an ally, not an adversary.
How to Respond to Your Elderly Parent’s Fears
When your elderly parent says an unequivocal “no” to elder care, they are usually reacting to some basic fear or apprehension. There are four of the most common fears among the elderly.
Fear of Loss of Control
How it sounds: Your elderly parent might tell you, “I’ll let you know when I need help.” Or they might say something like, “I don’t need you pushing me, thank you very much!”
Suggested response: The aging process can feel overwhelming and uncontrollable, so it is common to see demanding parents dig in their heels to exert control in other areas of their lives. You can relax some of this resistance by asking your parent questions that allow them a measure of control, letting them make some choices, etc. Try saying something like: “I get it—you don’t feel that you need help now. But if you should in the future, what would that look like? Having someone come in just a few days? What kind of things might they help you with? What days and hours might work best for you? What if we tried this out just for a couple of days for a few hours? You could be in control to let us know if it worked well or not and give us feedback so we could fine-tune the plan specifically to what you want and need.”
Fear of Change
How it sounds: As I mentioned above, aging is complicated and unpredictable, and it’s not surprising that many people fear the changes it brings. Your parent may say, “I hate the idea of having to talk about getting sick and frail. I’m OK now, and I’ll be fine in the future” or “Why do you want to talk about this stuff anyway?”
Suggested response: Be accepting and empathetic but stress the advantages of acting proactively. Your answer could go something like this: “Sandy and I just met with an attorney ourselves, and I have to tell you, it was a bit weird talking about health care decisions and what we did and didn’t want, but, wow, does it feel great now! Nobody likes change or thinking about needing help, but if we do it now, we will know what you precisely want and get it down in writing. That way, in the future, when you may need some help, we will know how to honor your preferences and not make decisions based on assumptions. And if you do need help, I want you to know that Sandy and I will be there so you won’t have to do this alone.”
Fear of Impoverishment
How it sounds: For many older adults, money issues are tied to strength and vulnerability. As a result, the more they spend, the more helpless they feel. Your parent might say, “I’m not made of money!” or “I don’t want to talk about getting help. Home care sounds too expensive.”
Suggested response: Financial security is subjective and depends on someone’s values, needs, and preferences. For instance, there are people with $7 million in assets who would feel impoverished if the stock market went down and they were worth “only” 6 million this week. That’s why when you respond to fear of impoverishment, you need to discern between real affordability and value. In other words, if what you spend money on can make you feel secure, resolute, and whole, then the cost is worth it.
Does your elderly parent have ample funds accessible to them, yet they do not want to spend their money unless it is necessary? If this is the case, try breaking the decision into manageable pieces. Your part of the conversation might go like this: “Let’s try hiring home care help for 2-3 weeks. In the end, we can regroup, and you can let me know if the services put in place are helpful and make a difference. If they’re not, we’ll adjust the plan. If you’re happy the way things are going, we can continue for a little while.”
You may find it beneficial for your parent’s financial planner to reassure them about the affordability of the plan and to perhaps create a simple graphic to demonstrate that they have the resources to continue with home care for “x” years without significantly impacting their assets.
Fear of Being Perceived as “Less Than” or “Incapable”
How it sounds: This is a huge issue, and often denial kicks in to protect the self from the discomfort of having to accept that on some level you cannot do for yourself. Your parent might say, “I am very capable of managing my affairs! And thank goodness I don’t have memory problems like your Uncle Leon. I have a good pension, and I am just doing fine, I don’t need any help, and did I tell you, how your Uncle Leon is losing it?” or “I still drive, and even with my eye condition, I can see everything. I don’t have to worry, because I can handle everything myself.”
Suggested response #1: One way to deal with a fear of being perceived as incapable is to take the spotlight off your elderly parent and put it on yourself. You could respond with something like: “Dad, I hear you loud and clear that you don’t feel that you need any additional help right now. But I also know that I am not sleeping well, because I worry about you, given how Macular Degeneration is affecting your vision. I was wondering, would you be willing to have a little help for my sake? I could use that reassurance.”
Suggested response #2: Another way to deal with a fear of being perceived as incapable is to align with your elderly parent against whatever it is that’s challenging them. You could say, “Dad, I hate that you have had to live with Macular Degeneration for the last five years. Besides you, I have had many close friends who have lived with serious eye conditions, and I know how frustrating it can be not to see things as well as you once did – that darned disease. I’d like to help you get a little help around the house to do those things requiring clear vision. Let’s work on this together. I know it can allow you to stay on top of things—having someone who could read to you your mail, help you with laundry, etc. The kind of things I would do if I lived closer.”
What to Do If Your Elderly Parent Refuses Help
Once you start to appreciate your elderly parent’s resistance, you can leverage the trust they have in you to help them step out of their usual comfort zone and eventually accept help. Remember: The two of you have developed trust built on
- past interactions and behaviors
- history and consistency
- your ability to understand
Use this trust to reinforce to your parent that they are not going through this alone, but rather with your support as a family member who’s focused on helping them to feel safe throughout the process.
If your relationship with your parent is strained at the moment, enlist the help of someone they do trust—perhaps another family member, clergy, a doctor, neighbor, or friend. You could also consider a credentialed geriatric care manager or Aging Life Care Professional™. With their specialized training, skills, and experience, geriatric care managers prove invaluable in multiple ways and will work with you to get your parent the help they need to live to their fullest potential at home.