“I don’t want anyone but family in the house.“ “I see just fine to drive myself to my doctor’s appointments.” “I don’t need to hire someone to walk the dog — she’s OK without walks.” Sound familiar — and frustrating? It’s all too common for aging or ailing parents and other care recipients to resist accepting help — and to add to the challenge for family caregivers, seniors’ reasons for refusing assistance are frequently irrational.
They may be confused, dealing with cognitive decline, or struggling with anxiety as a result of aging-related changes, says Donna Rasin-Waters, a clinical neuropsychologist who has specialized in working with older adults for more than 35 years. “The longer someone has led an independent life, the harder it is often for them to accept care,” she says. “If they’ve always been independent and capable, it’s much harder to accept that perhaps they need help with tasks such as bathing or can no longer be a safe driver.”
That lack of acceptance often leads to family conflict. Although this dynamic can be difficult and upsetting for both caregivers and their loved ones, there are many strategies for defusing tensions and convincing seniors to accept help and changes. Wondering how to deal with irrational elderly parents? Read on for the reasons aging loved ones may resist the care they need, the most common scenarios that provoke resistance and the best practices for dealing with objections to care.
Why elderly parents may push back on care
The reasons older adults may resist care are as varied as the reasons they need it, from the lack of awareness that comes with dementia or other cognitive conditions to fears of change and decline, says Kristin J. Addison-Brown, a clinical neuropsychologist who specializes in geriatrics and has also cared for both her parents.
“There’s the sort of existential fear of getting older and not being able to take care of basic, fundamental aspects of daily life,” says Addison-Brown. “The thought, ‘I can’t take my own medicines. I can’t bathe myself. I can’t ambulate properly through my home.’ That terrifies people. And with people with dementia, there’s just a total lack of insight.” (In other words, dementia patients can’t recognize the changes in their own thoughts or behaviors.)
Some resistance, such as refusing to accept care from someone who’s not a family member, may be based on more specific anxieties. “With a stranger coming to the home, there’s that component of being vulnerable,” Addison-Brown. “[A senior may worry,] ‘Are they going to steal from me? Are they going to mistreat me?’ That’s a very real, understandable fear, because that does happen.”
Although pushback on needed care is frustrating, it’s important to remember that such resistance is common and normal for this stage of life. “It’s a funny cycle of life, a lot like a toddler’s willfulness,” says Vanessa Bradden, a licensed marriage and family therapist and the owner and director of Lakeview Family Therapy Group who has led support groups for caregivers. “The older adult feels things slipping, but they still want to be able to do all the things. It has to do with pride and identity and life coming to the end of its cycle, which creates a normal resistance.” That often leads to a power struggle for control between caregivers and older adults, explains Bradden.
Situations in which elderly parents often push back
Although conflicts can arise related to any aspect of care, there are some common trigger points for which family caregivers may want to be prepared, according to the experts we spoke to. These may include:
- Accepting help from family
- Accepting in-home care from someone who isn’t family
- Getting assistance with acts of daily living, especially private matters such as bathing or toileting
- Hiring a house cleaner or other household help such as a dog walker, lawn care or the like
- Ceasing to drive
- Moving into a full-time care facility
As Addison-Brown points out, many of these activities are more emotionally and physically complex for older adults than their caregivers might realize.
“Things like bathing or going out to a doctor’s appointment can become a huge endeavors,” she says. “There are so many steps, literal and figurative, involved. With bathing, that’s often when caregivers are called in, and there’s a dignity component.” And while seniors may not want a stranger bathing them, they may also feel awkward having a family member do it.
Fear-based objections can become even more acute for major life transitions like moving to a care facility. “If you just think about the whole physical and cognitive process of moving — that’s hard for anybody,” Addison-Brown says. “And then, you add age and any kind of cognitive decline or physical conditions on top of that, and it becomes quickly overwhelming.”
Understanding those underlying factors is critical to helping older adults overcome their fears, says Tena Scallan, a longtime family and professional caregiver, caregiving consultant and the author of “The Ultimate Compassionate Guide to Caregiving.” “You just have to ease their insecurities [and] their fears, and once you figure out why they are so fearful of change or someone coming in, then you can fix the problem,” she says. Even if family caregivers may feel like they’re at an impasse with their loved one, she emphasizes, “There’s always a solution.”
“You just have to ease their insecurities [and] their fears, and once you figure out why they are so fearful of change or someone coming in, then you can fix the problem.”
— Tena Scallan, author of “The Ultimate Compassionate Guide to Caregiving”
Key strategies for helping elderly parents accept help
Although the reasons and types of scenarios older adults are pushing back vary widely, experts say that the best strategies for dealing with any kind of irrational resistance tend to be similar. Here are their top tips:
Lay the groundwork with conversations before there’s a crisis
When possible, have difficult conversations about loved ones’ wishes and the possibility of future changes, before dementia or decline sets in. You might also talk about hiring help sooner versus later.
Seniors can more fully contribute to conversations about change that take place when they’re 75 and vital, says Bradden. It may be tough to break the ice but it’ll still be easier to touch on these topics than when a parent is already scared and vulnerable.
Introduce changes slowly or over several conversations
If your loved one brings up many irrational objections to a needed change or simply refuses to talk, try bringing up a change more than once, choosing in low-pressure moments. “If you bring a subject up and they say, ‘No, no, no, no, it’s not going to happen,’ check back with them in about a week or two,” says Scallan. “I promise you things can change.” The next time you raise a subject, consider framing it as a question.
Be aware, also, if your own frustration or anxiety is driving the pace of the conversation. “Often if there’s burnout and frustration, you may be rushing, and it’s going to come across in the interaction,” says Rasin-Waters.
Enlist professional help to deliver tough news
The top tip from all our experts? Get a doctor or other professional (like a neuropsychologist or care consultant) to lay down the law, especially with safety concerns like taking away a loved one’s car keys. As the neuropsychologist families were consulting, Addison-Brown has often played the part of “the bad guy.” “If family members didn’t think someone should be driving, and in most cases I agreed, I would tell them, ‘You can’t drive anymore,’” she explains.
Instead of arguing, be patient, calm and matter-of-fact
Arguing with irrational objections is unlikely to be productive, experts say. Whatever the change is, Rasin-Waters says, “it’s helpful not to get into a battle over it, but to really present things in a calm, more playful style — not as ‘I’m the authority over you.’” Ways to do this include:
- Using a calm and kind tone
- Preparing your loved one for both major and minor transitions (by saying something like “today, we’ll be going to the doctor”)
- Offering them choices that give a degree of control but still lead to the needed outcome (such as asking if they’d prefer help with bathing in the morning or the evening).
If they object, gently but clearly reiterate what needs to happen, rather than engaging with their reasons — especially if they’re irrational.
That may be easier said than done, however, especially if a senior is dealing with dementia, as Addison-Brown acknowledges from her own experience. Her number one rule for patients was to steer clear of arguing with family members with dementia. But when her own mother had dementia, she acknowledges, “Even knowing why that was happening, I still argued.” If that happens, forgive yourself, take a break (more on that in a moment) and move on.
Involve care recipients in decisions where possible
Nobody likes being told what to do, says Rasin-Waters,so try to remember that discussions are a two-way street. In other words, it’s best to avoid language like, “You have to do XYZ.”
“Oftentimes, when an older adult is pushing up against a recommendation from a caregiver, it’s helpful to really make it more of a collaborative discussion and ease your way into [the] direction you want [to go in],” she says.
One example is in dietary choices: “If I say, ‘You have to eat more vegetables,’ [a senior will] probably react by saying, ‘I’m going to eat whatever the heck I want,’” notes Rasin-Waters. “But if [I] say, ‘Hey, I know that you like mashed potatoes. What other kinds of vegetables do you like?’ that’s a different approach” — and one that effectively includes your loved one.
“Some of our elders’ fears may be irrationally-based, but you can go in with that idea that your mom or dad is changing and losing abilities that they really prided themselves on, and that’s very hard and frustrating. Try to develop that compassionate lens.”
— Vanessa Bradden, a licensed marriage and family therapist
If conflict arises in the moment, take a break and find resources to help
If an older loved one’s stubbornness or irrationality continues and you get frustrated, take a breather. “Step back and think about how you can get a break,” says Rasin-Waters. “There are lots of caregiver services, including hotlines, for outreach to get the help you need when things are really difficult.” Examples include the Caregiver Action Network hotline or Crisis Text Support for general support.
If you’re taking a break, make sure it’s long enough to calm down; Bradden says it takes at least half an hour, for emotions to return to baseline. But if you’re able to step away for even more time — an hour for a walk to clear your head or by getting respite care for a day — everyone will benefit from the additional space.
Use gentle touch or pleasant sensations to soothe fears, when appropriate
Seniors may also respond well to calm touch, a suggestion that you fix them a favorite snack, or other simple acts of kindness, says Scallan. “I’ve had some ornery clients who’ve said I couldn’t come in the house, but if I offered a snack, they’d let me in,” she says. “Then, I might say something like ‘Your skin looks so dry, can I put a little lotion on it?’ Or give them a warm washcloth. The power of touch was really important.”
Rasin-Waters notes that for older people who resist help with showers, a sponge bath in bed can be both hygienic and calming. It’s also a way to meet resistance from a senior who is dealing with confusion or dementia and doesn’t like all the sensations of getting undressed and schlepping into the shower, she says.
When safety is at stake, don’t compromise
If a loved one simply isn’t safe alone at home or behind the wheel, it’s time to be firm, says Rasin-Waters. “When it’s a safety issue, at some point you really have to have clarity and say, ‘No, we’re taking the keys now,’ or get rid of the car,” she says. “Safety is number one, and you’re going to pick that battle.”
Even then approach loved ones gently, she recommends: “The message doesn’t have to be delivered as, ‘We know better,’” she says. Instead, convey the message kindly: Say, “We love you, and we’re guided by caring about you” and your safety, she suggests.
The bottom line on dealing with irrational elderly parents’ pushback
Caring for loved ones who are irrational or even combative can trigger your own anxieties and anger, but listening to fears and introducing changes in care with empathy can go a long way toward a smoother, more productive relationship.
Compassion — for both your loved one and yourself — is key, says Bradden. “Part of this is really educating ourselves,” she says. “Some of our elders’ fears may be irrationally-based, but you can go in with that idea that your mom or dad is changing and losing abilities that they really prided themselves on, and that’s very hard and frustrating. Try to develop that compassionate lens.”
