How to manage when your loved one resists help

Caring for an older loved one can be difficult, especially when that loved one resists our help. How do you help someone who doesn’t want help, or downplays the need for help? As caregivers, we walk a fine line between making sure our loved one is safe and taken care of without restricting their independence. But there may come a time when they are no longer able to care for themselves or make good life choices. At that point, we have to step in. It becomes our job to protect them; that can become a struggle of wills, creating both emotional and logistical challenges.

It’s hard to understand someone’s resistance when the need is so clear to everyone else. But for many older people who have lived independently their whole lives, accepting any intrusions can be seen as humiliating and unnecessary.

Reasons for resistance
From a caregiver’s perspective, everything would be much better if only your loved one stopped being unreasonable and started cooperating, right? But their behavior might be their way of maintaining their sense of autonomy. They may feel frightened, vulnerable, incompetent or guilty that they are no longer able to care for themselves. And if their mental and physical abilities diminish and their dependence increases, frustration can grow.

These are common reasons for resistance:

• Desire for independence
• Fear of becoming a burden on their loved ones
• Fear of appearing weak or frail
• Fear of losing their privacy
• Concerns about finances and the cost of care
• Memory loss and dementia can often lead to feelings of vulnerability and helplessness
• PTSD can make someone feel exposed, threatened or at risk

It’s hard not to take it personally when our loved one pushes us away, says hurtful or inappropriate things, ignores medical advice, and continues to do things that are no longer safe such as driving, operating heavy farm equipment or even using the stove. Trying to understand what your loved one is dealing with may help you better understand where their resistance is coming from.

What can you do?

• Keep in mind that this most likely will be a process
  It may take several conversations to learn your loved one’s concerns, wants and needs. Once you sense they are getting defensive, back off and steer the conversation to more common ground. Then try again in a week or two.

• Do your homework
  Determine realistically what type of care they will need. Take time to observe how they are doing, what they are capable of and what they struggle with. Focus only on what they are having difficulties with – meal preparation, housekeeping, medication adherence, transportation. Everyone needs a purpose, and the more they can contribute to their own well-being the less resistant they might be in accepting help for the things they are no longer able to do.

• Ask them about their preferences and what would make life easier for them
  It’s important to get their input and make every effort to incorporate those preferences into the care plan. They will be less likely to reject your effort if they do not feel like you are simply taking control of the situation, but rather listening to them and allowing them to voice their opinions.

• Approach the need for care conversation carefully
  Choose a time when both of you are relaxed and are not feeling rushed. Be honest and open when explaining what type of care or help is needed. Talk about the fact that you both are dealing with changes. Let them know that you are trying to help them retain as much independence as possible, with as little upset to their routine as possible, all while keeping their safety a priority.

• Enlist help
  Enlist the involvement of a trusted family member, friend, clergy or doctor who can act as a buffer as you explain why they need to make changes in their life. It may make a larger impact on them hearing the same concerns from more than just one person. It may make the point that your concerns are valid and their well-being matters.
   
• Suggest a trial arrangement highlighting the positives
  This will give your loved one a chance to "test the waters" and experience the benefits of assistance. Ask them to try it for a limited amount of time. If they don’t like it, see if they would be willing to try something else – another home care service, another "heat and eat" meal program, etc.
            
• Tough love
  Tough love requires your loved one to be responsible for themselves and face the consequences of their actions. Tough love may be necessary, but not in all circumstances.
       If your loved one is still capable — physically, cognitively and emotionally — of doing things for themselves, it is appropriate to act on tough love.
       It is not appropriate to use tough love when your loved one is no longer physically, cognitively or emotionally competent, when they lack the capacity to make responsible decisions.
       At this point you should consult an elder law attorney for information on guardianship/conservatorship.
  Examples when appropriate to use:
       Driving — safety for themselves and others
       Financial matters — if susceptible to scams or financial exploitation
       Fall risks — insisting they use a walker or other device to steady themselves
  Tough love is not an open play; it should be used only when resistance and non-compliance close off all other solutions.
   
• Pick your battles
  Look at what tasks need to be handled first. Some arguments are more important than others. If something that they are resisting isn’t essential, let it go...for now. They may eventually come around.
   
• Ask for help
  If you feel overwhelmed, talk with a friend or family member. Join a support group or chat on a community board – such as AlzConnected. They may be able to offer you guidance and help you prepare a care plan for your loved one.

Here at UK you can reach out to:
UK Elder Care  
or
UK Work-Life and Well-Being, Mental Health Therapists
 
If your loved one is physically, mentally and emotionally competent, a sad and frightening truth is that it might take a major setback (aka a crisis) to help your loved one see the reality of their situation. There is no fool-proof way, no ultimate strategy, to get your resistant loved one to change. If it gets to this point, the only thing you can do is be prepared with emergency plans which include medical and legal papers, contact numbers and resources.
 
At the end of the day, just pushing through will eventually wear you out, impacting not only your ability to cope and provide care but harming your health and well-being. It is important to learn to ask for help and take breaks from your caregiving routine.
 
Stay well, stay healthy, stay connected,
Terri