Overcoming Resistance
in Elders to In Home Care

For adult children of aging parents, balancing the responsibility for increasing levels of care with respect for their parent’s independence can be a difficult task.  Helping an elder who may need assistance to continue to live independently requires in most cases, the consent of that elder.  These children have noted that their parent is having some difficulty keeping the house in order, doing laundry, or preparing adequate meals.  They may be concerned that medications are being skipped or not taken properly.  They may live far away and be concerned about the possibility of their parent falling, wandering or driving safely.  Elders living alone can become isolated being at an age where they may have lost spouses and friends.  Such isolation can lead to decreased cognitive functioning, depression, poor hygiene and poor self-care.

Private in home care provides services that can range from minimal assistance to full time custodial care.  It allows elders to continue to live at safely home where research proves that they stay healthier longer and are happier.  By bringing in services such as light housekeeping, meal preparation, medication reminders, hygiene assistance and escort for shopping or appointments, elders and their families can feel confident that they are able to live safely and with dignity while maintaining independence.

Often though, when the idea of in home assistance is presented to an elder, the well intentioned family is met with resistance, resentment and open hostility.  Many elders genuinely do not feel they need help.  Others may resent what they feel is an intrusion into their private business.  Still others may have lost some capacity for making good judgment.  In these situations families feel powerless to intervene.  They feel frustrated and can get angry at their parent.  This usually leads to the elder becoming even more oppositional to the idea of help.  Family members may threaten that if help is not accepted the elder will be sent to a nursing home. The whole effort to assist the elder in remaining independent but safe may fall apart.

Understanding Resistance – Aging is not for sissies

Resistance to change is a nearly universal human trait.  Few of us like unexpected changes or changes in our routines.  We like our homes just the way they are.  We cling to our favorite chair even after it’s faded and worn through.  That old flannel shirt feels so comfortable even though our kids say they are embarrassed too be seen with us wearing it.  We know just where our tweezers are kept and the salt and pepper are always right there to the left of the spice rack.  We like the smell of our spouse’s hair or the way they wear it.  And haven’t we all experienced the mild annoyance after company stays in our home for a week of having things put back in the wrong place?

For elders change is much harder.  They continually experience loss – of people and capacity.  Spouses and friends pass away.  Their children and grandchildren may live far away or just be busy with their own lives.  Lifelong relationships are broken by friends moving to Florida, into their children’s home or being placed in a nursing home in another town.  It’s harder to stay active at church or in a social club because they may not drive as well or at all anymore.  Their eyesight is going, their body aches and is falling apart.  They may think about end of life issues - regrets that can never be rectified; things they never did that now will never be done; dreams they had that never came true.  Quite frankly they can be angry about it all.

Resistance is one way we cope with change.  We resist.  We say no to the world that forces these changes upon us.  We say no to our children, no to the doctors, no to our spouses.  Some resistance is healthy.  It allows us to maintain our sense of independence, dignity, self-sufficiency and defines in some measure who we are. It can prevent people from taking advantage of us or exploiting our good nature. 

Resistance though becomes stubbornness when it clouds our judgment and gets in the way of one’s health and safety.  It is unhealthy when it interferes with people who care about an elders’ welfare and who truly see what assistance is needed.  Resistance is expressed related to certain objections that elders raise when their family members present the need for some help at home.

Common Objections

There are several common objections that elders pose to families wishing to arrange in home care.   Let’s look at these and first understand the experience of the elder.  We will then discuss strategies for successfully countering these objections.

10 Tips on Handling Resistance to Home Health Care

When the time comes for you to realistically consider home health care for loved ones who can no longer safely live on their own, nine times out of ten you will meet with their strong resistance. The people who very much need the care are generally adamantly against giving up their independence and autonomy, and that is understandable. But, rather than coming up against their resistance with your own arguments, stand back and try to offer appropriate responses that acknowledge their feelings and provide suggestions to alleviate their fears.

 
Consultation, Advocacy and Resources for Elders

 

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  1. When your parent says, "I don't need any help," they are expressing their need to believe in their own ability to carry on as they always have. They may be in honest denial of their limitations.  To counter this, point out how overwhelmed she gets doing normal household chores; or how she forgets to renew important prescriptions, or how she has set off the smoke alarm several times in a month, or any other specific examples. Then tell her how much more comfortable and less confusing her life would be with help. Show her that home care would enable her to stay in her home as long as possible.
  2. When your parent says, "I like things done my way. I'm the only one who knows what to give your father to eat," she is expressing her fears that se will no longer be needed and respected.  She may also fear that things will not be handled properly leading to illness or accidents.  In this case you may tell her she will be actively involved in supervising and instructing the care giver in her duties.
  3. When your parent says, "I don't want a stranger in my house," she will be clearly expressing fear about intrusiveness into her private space.  She may be embarrased or resent the loss of privacy.  She may be concerned that the caregiver will steal.  Allay her fears by staying over one or two days and by popping in to see how things are at different hours of the day and night.  Additionally make sure the agency performs extensive background checks and let her k all about the process.
  4. .When your parent says, “I can’t afford it!”  it is probably the most frequent objection voiced by elders.  Why is this so common? There are several factors that are at work when finances are raised as an objection.  First, elders are acutely aware of their financial situation though they often grossly underestimate their assets.  They often are deeply committed to “passing something on” even if it means they go without.  They are concerned that if they spend down their savings and assets they will have their independence taken away.  Having grown up when bread was 10 cents a loaf and gasoline 21 cents a gallon, they cannot believe that things really cost so much today.  They may resent that family members seem so keen on spending their money.  If the elder suffers from Alzheimer’s disease, they may experience paranoia and accuse family of trying to steal their money.  When they weigh the cost of in home care against their need they may simply feel it’s not worth the expenditure.  Lastly, they may not feel they are worth it. Contact her accountant or financial planner to assure her that she can afford help. Also discuss the fact that it is not practical to worry about savings at this time in her life. Assure her that you want her to use her assets for herself and that you do not need her to save them for you.
  5. When your parent says, "I won't have any of those people in my house," discuss the matter of prejudice and urge her simply to give the home health care giver a try.
  6. When your parent says, "Absolutely no," contact the home care agency and arrange a home visit with another senior who is happy with her care giver. Seeing a positive situation is always good motivation.
  7. Encourage your parent to express her fears and concerns about what is happening to her.
  8. Discuss what would happen if she won't let people help her. Let her experience a day without your help -- no meals, soiled clothing -- so that she sees that she needs regular assistance.
  9. Start small.  Often having a caregiver in a few hours a day twice a week can give her the comfort level she needs.  Slowly introduce your parent to outside services. For example, arrange to have someone deliver her meals or do her shopping. A kind, compassionate person coming into her home may earn her trust and prepare her to be open to further assistance as it becomes more necessary.
  10. If the situation requires immediate attention, consider hiring a geriatric care manager who has the expertise to help your parent accept assistance.

Caring for our parents is a responsibility that allows us to give back for the years of love and help they have given us.  Even when the relationship with a parent has been strained over the years, the later years offer a chance for reconciliation and healing. 
Caring for a parent can be draining on us physically and emotionally.  Often, we are so busy in our own lives that when we care for our elderly parent all we have time for is chores and errands.  We lose the ability to make time just to have a relationship.  Obtaining the right caregiver can help us return to having a relationship again - Time to chat and listen to stories.  Time even to have lunch or just visit.  The elderly years bring home to us all that time is limited.  The days do, eventually, run out.  The quality of the relationships we have and the time to enjoy them becomes so important.  Helping elders accept care aids in ensuring we have the time to be together while they remain safe at home, with dignity.