Your mother resists in-home helpers, insisting you can wait on her. Your frail father won't stop driving. Your aunt denies the need for a personal care aide, in spite of her unwashed hair and soiled clothes. Your grandmother refuses to move to an assisted living facility "because it's full of old people."
Sound familiar? Nothing is harder for a family caregiver than an elder loved one who refuses needed help. "This is one of the most common and difficult caregiving challenges that adult kids face," says Donna Cohen, Ph.D. a clinical psychologist and author of "The Loss of Self: A Family Resource for the Care of Alzheimer's Disease and Related Disorders."
Before pushing your mother too hard to accept help, try to understand her fears about aging, says Cohen: "Many older people see themselves as proud survivors. They think 'I've been through good times and bad, so I'll be fine on my own.' Plus, they don't believe their children understand the physical and emotional toll of age-related declines."
A senior in the early stages of cognitive impairment may be the most difficult to deal with. "Your angry father or agitated mother is aware of this miserable change in their brain they don't quite understand," Cohen adds. Calm reassurance will help them cope with a frightening loss of function.
It's normal for family caregivers to experience rage, helplessness, frustration and guilt while trying to help an intransigent older loved one, says Barbara Kane, co-author of "Coping with Your Difficult Older Parent: A Guide for Stressed-Out Children." "You may revert to the same coping mechanisms you had during adolescent power struggles with your parent -- screaming, yelling or running out of the room," she says. "You need to understand what parental behaviors trigger your emotional response and realize you have other choices." (And Kane advises considering seeing a therapist yourself if necessary to deal with a difficult parent.)
Here are nine strategies to help you overcome the objections of a recalcitrant loved one:
Ideally, families have relaxed conversations about caregiving long before a health crisis. Look for opportunities to ask questions like, "Mom, where do you see yourself getting older?" or "How would you feel about hiring a housekeeper or driver so you could stay home?"
Ask open-ended questions and give your loved one time to answer, says Care.com Senior Care advisor Mary Stehle, LCSW. "You can say, 'Dad, what's it like to take care of Mom 24 hours a day?'." But be warned: Conversations may be repetitive and tangential, veering off-topic. It may take several talks to discover the reason your mother, a meticulous housekeeper, has fired five aides in a row is simply that they neglected to vacuum under the dining room table.
Ask questions to determine why an elder refuses help -- then you can tailor a solution, says Kane. "Is it about a lack of privacy, fears about the cost of care, losing independence or having a stranger in the house?" says Kane. To build trust, listen with empathy and validate rather than deny your loved one's feelings. (Learn more about starting a conversation about care with your parent)
If possible, include your parent in interviews or in setting schedules, says Stehle. Let them choose certain days of the week or times of day to have a home health aide come. Emphasize an aide will be a companion for walks, concerts, museum visits and other favorite activities. (Find a senior care aide.)
Recruit Outsiders Early
"Sometimes it's easier for a parent to talk to a professional rather than a family member," says Cohen. Don't hesitate to ask a social worker, a doctor or nurse, a priest or minister -- even an old poker buddy -- to suggest your parent needs help.
Make two lists, says Cohen, one for your loved one's problems and another for the steps you've already taken -- and where to get more help. "If you don't categorize your efforts, caregiving becomes this huge weight," says Cohen. Writing it down and numbering by priority can relieve a lot of stress.
Use Indirect Approaches
If your father has dementia, offering less information may be more effective at times, suggests Stehle. "You could let your parent know the aide is someone very helpful who can take your father on walks, fix him meals, and help him throughout the day. You don't need to explain every aspect of care the aide will provide before the relationship has been formed. This may make your loved one feel less threatened."
Take it Slow
Weave a new aide in gradually, says Kane. Start with short home visits or meet for coffee, then bring the aide along to the doctor's a few weeks later. "You leave early on some pretext, letting the aide accompany your parent home."
Accept Your Limits
As long as seniors are not endangering themselves or others, let them make their own choices, says Cohen. "You can't be at your parent's side all the time. Bad things can happen, and you can't prevent them," she says. "You need to accept limits on what you can accomplish and not feel guilty." It may sound unfeeling, but maybe going a day or two without meals is just the reality check an elder needs to welcome a badly needed helping hand.