Convincing an Elderly Parent to Accept In-Home Care Assistance

When an elderly person begins to show signs of requiring in-home assistance, it is usually an adult son or daughter who first recognizes the need. However, quite often it turns out that the parent does not feel that he or she needs help in the first place. Sometimes no amount of reasoning or persuasion can overcome the disagreement. What to do?

The reason this issue can become such a point of contention across generations has to do in part with a difference in perspectives. A son or daughter may notice a parent exhibiting gait unsteadiness, missing medications or showing impaired ability to perform self-care or household tasks. This naturally leads to concerns about safety and well-being. Arranging for help in the home is an obvious solution that can allow a parent to live comfortably and safely.

The parent's perspective, of course, may be quite different. His or her focus may be on privacy and independence. To accept the need for an aide or companion may seem like surrendering one's dignity and control. Cost may also be a concern. Reconciling these different perspectives can be difficult if not impossible. Here are some suggestions from our experience that may be of help to the children of elderly parents:

Try to Avoid No-Win Arguments

We see lots of families locking horns over whether the parents are really slipping or not. A typical discussion goes this way:

You:"Mom, I've been noticing you haven't been eating as well lately, and when I look in your refrigerator it seems like you have barely touched food that I bought for you days earlier."

Mom:"I'm eating perfectly well, dear. You know I'm not as active as I used to be, and I don't need as much. I'm certainly not going hungry."

You: "But wouldn't it be easier if we had someone come in and cook for you?"

Mom:"No, I don't want that and I don't need that. I cook for myself just fine."

You:"Another thing, we've noticed that you aren't as steady on your feet as you used to be. We're worried that you could fall."

Mom:"I'm very careful. Don't worry about me."

You:"But you fell last month getting out of the tub. It was lucky you didn't hurt yourself."

Mom:"That was just a fluke accident because the vanity light wasn't working. I'm really fine. I don't need any help."

You: "John and I think you do, Mom."

Mom: "Well, I don't."

These kinds of arguments usually don't accomplish much. They can lead to anger and can just harden resistance.

Emphasize Your Needs, Not Theirs

A parent may be a little more accepting of home caregiver services if you emphasize that it's for your benefit. Point out that you would feel more comfortable knowing someone was helping with the meals, laundry and household chores. Pose it as a favor for you. Explain that it would give you peace of mind as you attend to your own personal or job priorities.

Accept that Safety Doesn't Trump Everything Else

One important lesson we've learned over the years is that compromise is almost always necessary on the issue of safety. An elderly person with functional impairment and/or chronic illness is at increased risk of mishaps, injuries and adverse events. To make safety the overriding issue seems like the compassionate, ethical thing to do. But if it comes at the expense of dignity and quality of life, it may not be.

Better to accommodate a parent's values and preferences while practicing the art of the possible. If your parent refuses your entreaties to get live-in care or move to assisted living, set up more limited home care visits and arrange for an emergency alert system. If imbalance is a problem, make sure a medical evaluation is done, and then learn about the many ways a home can be modified to protect against falls (e.g., installing grab bars and rails; using no-slip mats; assuring good lighting; removing trip hazards and clutter.) If medication errors are a concern, make sure that a physician reviews all prescriptions to keep the regimens as simple as possible, then at least buy a medication dispenser. There are even a variety of electronic dispensers that will automatically dial a programmed telephone number if doses are skipped.

Don't ignore the many possible ways in which technology can allow adult children to monitor the safety of aging parents. Remote monitoring of vital signs like blood pressure, tracking movement throughout the home with motion detectors or cameras, confirming compliance with medications-all of these and more are possible nowadays.

A great deal can be done to improve safety for an elderly person living alone. But at the end of the day, no combination of strategies will eliminate all risk. The challenge is to maximize safety while not ignoring important values like self-esteem, dignity and reasonable independence.

Focus on Help with Household Tasks

One way to persuade an elderly loved one to accept in home assistance is to present it as help with household chores, laundry and meals rather than personal care. Many people of all ages use housekeepers, and this doesn't entail the perceived stigma that a personal care aide may represent. Once the "foot is in the door," the elder can develop a relationship with the caregiver and then become less resistant to personal care.

Enlist the Help of a Trusted Professional

Whereas an elderly individual may resist the pleas of concerned family members, the advice of a trusted personal physician, lawyer or clergyman may be more persuasive. Meeting with such an individual is almost always a good idea. But be careful about appearing as if you have enlisted the professional to press your point of view. If the elder feels he or she is being "ganged up on," this approach may backfire.

Don't Ignore Signs of Dementia

Behaviors such as repeating the same story over and over, forgetting appointments, becoming lost in previously familiar surroundings or losing the ability to perform tasks that were once routine, are signs of dementia. Too many people ascribe such behaviors to normal aging.

When a parent has dementia, persuading him or her to accept help becomes much more complicated, because judgment may be seriously impaired. How assertive should you be? What are your filial and ethical obligations? At what point do you insist upon taking control, and at what cost to your relationship?

The first critical priority is to arrange a medical evaluation to assess the cause and extent of dementia and to initiate treatment, if possible. Find out from the physician how much cognitive impairment exists, and what kinds of decision-making responsibilities you should be taking over for your parent. Educate yourself about the problem by contacting the Alzheimer's Association or the NIH's Alzheimer's Disease Education and Referral Center.