Q & A Table of Contents
Convincing Elders To Accept Care
From: Naomi, Philadelphia, Pennsylvania
Question: As a hospital/geriatric social worker, both in my personal and work life I am frequently asked the following question: My elderly [parent, aunt, neighbor...] clearly needs some help at home, but refuses this help [even if free, or done by a family member, a church...]. How can I convince this person to accept help?
After I've determined that the issue isn't financial (usually a solvable problem), then I am frequently at a loss. The situations I've seen like this seem to only resolve after a crisis occurs, and the person has no choice.
How would you approach a situation like this? The issues seem to revolve around pride, retaining control, denial of illness, aging or disability... Any thoughts?
Response: In his 'Notes From The Underground', Dostoevsky wrote "Human behavior is motivated by the craving for absolute freedom and self-assertion in defiance of all dictates of reason." As decrepitude takes its toll on our bodies -- and minds -- often pride is the only thing we have left.
Waiting for a crisis is excruciating for folks who think of themselves as caregivers when it comes to organizing care for people who have less and less capacity to take care of themselves or their personal surroundings.
Probably the wisest thing to do is ask a whole lot of questions. Using the example of children of an elderly parent, first the concerned children need to ask themselves what are their own interests. Do they want to assuage guilt? Do they fear that harm will come to their parent? Are they concerned that a crisis will interrupt the normal course of their own lives?
Questions also need to be asked of the parent: What most concerns you about your situation -- health, comfortable surroundings, companionship, your capacity to hold your head up and say, "Daughter please! I can do it myself!" One can also ask, "What do you think are the standards that determine one's capacity to live an independent life?"
This questioning approach brings the parties into fuller participation in the decision-making process. When I ask you a question it means I am taking you seriously; the reverse is equally true. Of course the crucial element is listening closely to all the elements of the responses to those questions, both the questions one asks oneself and the questions asked of other people.
Clinging on to the indicia of independence is a critical vital sign. The fear of loving relatives that something bad can happen has to be balanced against the knowledge that if you kick someone in their self-esteem, you are attacking a most vulnerable part of their anatomy. You cannot negotiate away a person's self-esteem, but you can destroy it through frontal and flanking attacks.
The frustration faced by folks who see loved ones failing to take proper care of themselves is phenomenal. Very often the folks who have advocated professional care must utter the ultimate, but unsatisfying statement statement, "I told you so."
In your question you indicate that crisis forces choice. Perhaps the best approach is to prepare a safety net that is ready when the crisis occurs. It cannot prevent a crisis from happening, and it is crucial to make sure that a crisis is not worsened by forcing the 'victim' of it to lose face. But having that safety net ready can at least reduce the force of the fall.
Relationship is one of the seven most significant issues to consider in negotiation. Focusing on the relationship with an elderly parent or friend, not letting decrepitude get in the way of love and caring can make it much easier when someone's self-esteem is attacked by a crisis. Looking at oneself and saying, "It's not my fault," is not a way of avoiding blame, but rather giving a loved one the freedom to make their own mistakes -- just as they did so the first time we were given the keys to the car.
Good luck with a tough job.
Steve
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