Rolling with Resistance... Part 3 of 3
This is the final part of the three-part series. The series topic is about what you can do when an aging parent needs help, but refuses it. Specifically, in this installment I will present some ideas on what you can do when your loved one refuses the help they need.
But first let's do a quick review of the first two parts. The first part discussed how to objectively assess whether your loved one needs help, what kind of help you are willing or able to give, how to discuss this with your family as well as the different roles each person can play.
The second part talked about why your loved one may be refusing help. Understanding some of the roadblocks can be helpful in removing them.
So now that you understand whether the situation warrants outside help, what you and your family are willing to do and where the resistance from your loved one may be coming from; the question now becomes what do you do about it?
Of course there is no one-size-fits-all suggestion and nor is there a single silver bullet. You may have to try some and fail and/or you may have to incorporate several of these approaches. Also, be persistent. This is your loved one’s health we are talking about and you may have to try many times before you get through to them. Understand that this is not only for their benefit, but also your benefit because the longer they go without the proper care the more stress you'll be put under and the deeper the hole will be to get out of.
When we talk about your loved one needing care, primarily we are talking about medical care and outside care-giving.
Each has its own suggestions, so let’s look at each separately (although there can be some overlap in approaches).
We are assuming here that the direct approach hasn't worked and that your request for them to see a doctor has been met with a firm “no”. In this case, continuing to repeat this approach may make them dig in their heels even more. And if they are having memory or cognitive issues they may be past the point of responding to reason on this. I have seen some families who have tried to give very sound and detailed reasons, hoping that they can have this person participate in the decision to receive care, but this person is no longer able to do so. Obviously this is a judgement call you will have to make for yourself.
However, some of these other suggestions may help move them forward so that they will at least go to a doctor's appointment. These ideas employ more of an indirect approach.
Third-party influences: The reason that health coaches can’t coach their family and friends is because you have so much history together (as well as baggage) that your family or friends don't tend to listen to you. You can have the best advice and knowledge in the world, but that may mean absolutely nothing to your family and friends. But if a doctor or a trusted friend gives the same advice it's as if they've heard it for the first time. The same applies here. If your loved one has a trusted friend or family member then have that person reach out and approach them about going to see a doctor. And if they can specifically name a doctor and share what good things they've heard about the doctor that will help even more. It may be enough to move the needle and make an appointment.
On their own terms: This can be used with the third-party influence approach. If your loved one can be suitably persuaded by a third-party then they might think they came up with the idea to go to the doctor on their own. A slight twist on this is presenting a "problem" that they can help solve by going to the doctor. For instance, if there is a medical insurance reimbursement for something that they want, but need to get a doctor's note for – then that could be a good excuse for them to make the appointment.
Partner-up: Unpleasant tasks like going to the doctor can be made more palatable if you do it with somebody else. So you may want to tell them that you need to go to the doctor to get your check-up and that you would find it easier to go if they went with you and they got theirs done at the same time. If they think they are supporting you and the attention is not squarely on them they may be persuaded to go along with that.
Combine it with an activity: You might be able to persuade your loved one by a little "bribe" of taking them somewhere after the appointment that they like to go, such as the movies, their favorite restaurant, a baseball game, etc. Instead of making the doctor's appointment the "main entree" - it can be a "side dish" that you just so happen to be doing on your way to doing something exciting.
Tip: Prior to the appointment with the doctor you may want to call the office and privately share your concerns with them. Even if the appointment is with a specialist of some sort, if you can get it into the record - it may be shared back with the PCP.
Enlisting their primary care doctor: If they refuse to go, you may be able to speak with their primary care doctor who then may call your loved one and ask them to come in.
As with medical care, a direct approach may not work. However, if some of the resistance is due to feeling a lack of control or if they have trouble adjusting to change, you may want to try the following techniques:
Participate in selection: If it has been determined that your loved one does need some form of in-home care, it may be helpful if your loved one is able to participate in the interview process or participate in deciding what the schedule will be. They may know what days of the week or times of the day would be best for them to have an aid come in to help.
Marketed as a companion: It may be easier for your loved one to accept help if it comes in the form of a “companion”. Shift the importance of this being a home health aide and instead emphasize that this person will be a companion that they can go food shopping with, or someone to get them to their activities or someone that will go for a walk with them. Looking at it as a friendly helper may help them get over their initial resistance.
Gradual acceptance: This technique involves getting your loved one to slowly accept a new visiting aide, by introducing them as your friend. So as you go and visit your loved one you can take along the home health aide and introduce them as an acquaintance. That way your loved one can get to know this person without feeling pressure that someone is being pushed on them. As time goes by and they get to know and trust the person, it will be easier for them to go to the house alone. Also, this gives the home health worker a chance to see what your routine is with your loved one and what things they like and don't like and what approaches work and don't work.
Simple explanations: When people have dementia or cognitive decline there is a point where they really can't take in too much detailed information. In this case, less is more. Keep your explanation simple. If you provide too much information and make the relationship with the healthcare worker seem formal this could be construed as threatening to your loved one. Instead, you can just say that this new person will help them fix dinner and get the mail from the mailbox. If it seems simple, then it will feel less threatening and you will have potentially a better outcome.
Tough love: This has to be used in the right situation in that your loved one has to have enough cognition in order for this to make an impression. If your loved one will not accept help and they expect you to provide 100% of the help then a little tough love may move the needle. For instance, if you are the person that does all the food shopping and all of the meal preparation then maybe you go a couple of days without fixing them a meal. At the same time you make the point that you cannot come over there all of the time and that you need help. And wouldn't it be nice to have someone come over and fix them dinner? Sometimes if they experience some of the consequences that could be enough for them to accept help. Again this is not used in all cases and you have to pick your battles on this one carefully. Some seniors can be extremely stubborn and we don't want anyone to be hurt in the process. But at the same time there is a point where you are enabling them so they don’t have to accept the outside help either.
At the end of the day, these approaches and techniques may not work and so you also have to accept the situation for what it is. Unless your loved one is in an unsafe situation, you can't force care on them. There is only so much you can do. And unfortunately you may have to wait for a crisis to develop in order to make any additional changes. Of course, we want to avoid this, but sometimes it is necessary for the person to get the help they need help.
And keep trying. You never know when you will get that opening that you've been waiting for or they are in a more receptive mood than they've been in the past. Remember, your loved one is not thinking as rationally as they used to and can become incapable of making the best decisions or using good judgement. As you keep trying, you will also have to watch for the moment that you really do have to take control for their safety and for yours. This can be guilt inducing for the caregiver, but know that as the disease progresses you can’t provide all the care that they need.
In fact, many times caregivers wait too long to get the help that both the loved one and they themselves need and in the process they both suffer. Don't wait for that point.
In the meantime – if you are a caregiver and need some support, please consider trying one of my caregiver groups. They are held virtually so you can get help and support from the comfort of your own home. These are starting soon so don’t delay!
6 week Caregiver Self-Care Support Group - For Caregivers who want to focus on their self care
6 week Dementia/ Alzheimer's Support Group - For caregivers who want to share their issues and wisdom with others