| Home & Family

San Francisco (Catholic San Francisco) - If you have an elderly parent or other loved one who lives alone, at some point you may become worried that he or she is not managing well.

Typically, concerns center around one or more of the following issues: mobility, nutrition, housekeeping, grooming, financial management, medication use, safety, energy level, mood and mental status.

No matter how difficult it may to be to look after their day-to-day needs, some older adults are reluctant to ask for help or accept it when offered. The most common reasons are highlighted below.

Denial: Seniors may have difficulty accepting the reality of aging and the prospect of increased dependence on others.

Pride: Often, seniors don't want to appear weak or incompetent.

Discomfort: They don't like the idea of strangers coming into their home, or the role reversal involved in accepting help from younger generations, particularly their children.

Guilt: Seniors don't want to worry or inconvenience their family.

Anxiety: They fear they will be pressured into leaving the comfort of their home, end up in a care facility and generally lose control over their life.

Resentment: Seniors may perceive concerned family members as overly critical or intrusive.

Personality: They may have always found change difficult or have been fiercely independent, stubborn or private.

Finances: They are concerned about the cost of recommended equipment and services, due to limited means or frugality.

Cognition: Some may be in the early stages of dementia and lack insight into their needs and capabilities.

While a certain degree of reluctance is to be expected, if your relative continues to resist offers to help, they may experience a crisis that lands them in hospital.

Preventing a crisis - The approach with your relative depends to some extent on their personality and the nature of your relationship, but here are some general guidelines.

Before talking with your relative, research resources in their community that may be of help. This way you'll be prepared with solutions. Information can be obtained from the local office on aging.

Raise concerns gently and gradually. Use "I" statements, for example, "I notice that..." or "I'm worried that...." Provide concrete examples.

Emphasize your relative's abilities and how these can be supported. A strengths approach helps preserve their self-esteem. Stress that your aim is to help them remain at home and maximize their independence.

Organize a family meeting if your relative denies problems or resists suggestions. Consider including someone from outside the family, such as a trusted physician or a good friend of theirs who shares your concerns. Your relative may perceive them as more objective and consequently take their concerns to heart.

If your relative objects to help, gently probe to learn their reasoning. Listen and respect their point of view. Be attuned to underlying feelings (such as sadness or fear), acknowledge them and demonstrate empathy.

Share brochures or information from the Internet about medical equipment or community services that may be of help. Highlight any that are free or subsidized.

Focus initially on the least intrusive options, such as setting up an emergency response system or obtaining medical equipment.

Acknowledge how uncomfortable it may initially be to change their habits, alter their environment or allow strangers into their home. Remind them of their resilience, drawing on past life experiences.

Offer to pay, or contribute to, the cost of medical equipment, day programs or home services if your relative has limited income.

If your relative appears physically unwell or cognitively impaired, arrange a check-up with their primary physician. If your relative refuses to go or accessibility is an issue, find out if there's a geriatric outreach program that performs in-home assessments.

Bear in mind that choosing not to follow the recommendations of healthcare professionals or family members does not mean a senior is mentally incompetent.

Recognize, too, that opinions about what constitutes an acceptable standard of living and quality of life can vary considerably, and that frail seniors - struggling to maintain control in the face of declining health, relationship losses or other difficulties - often have a different perspective than family members.

Since mentally capable seniors have the right to put themselves at risk, at some point you may need to agree to disagree with your relative about what's best for them, in order to preserve the relationship.

But even if your relative continually refuses help, there are some things you can do.

Stay in close contact and make regular visits to monitor their safety and well-being. And keep collecting information about community resources so you're ready to jump in and assist your relative in making informed decisions and necessary arrangements should they have a change of mind or a crisis occurs.


Lisa M. Petsche is a medical social worker and a freelance writer specializing in family life and elder care issues.