This is the eighth in a series of articles about the issues that arise over time for older people who experience mental declines - and how you, as a family member or friend, can help.
Your father got lost walking home from the corner store around the block. Your mother has forgotten how to turn the television on, although she had watched the news every night for the previous 40 years.
They may have forgotten a lot of things -- the names of their grandchildren, for instance -- but they haven't forgotten how to say, "No!" And that's their answer when you suggest that they consider moving to assisted living.
You got their doctor to talk with them. You took them to tour two or three great assisted living communities nearby. However, they are still incensed that you would suggest such a thing. Now what?
Jennifer FitzPatrick, a licensed certified social worker and adjunct instructor in the gerontology program at Johns Hopkins University, offered some advice:
"The first thing that adult children need to remember is that unless their parent has advanced dementia or some other cognitive problem and is truly not able to make decisions properly -- and I'm not talking about decisions that they agree with -- they're still a grown-up and they get to make the decision. . .These are not kids. They get to choose. They can choose to make bad decisions."
FitzPatrick advises, "Explain how taking care of the elderly relative affects you: 'Mom, I've been late to work seven times in the last two weeks because you've needed something in the middle of the night and then I had to rush back to my house first thing in the morning.' In addition, give dates and times. If you have a parent who does not want to be a burden, that can be really impactful."
FitzPatrick continued, "In one couple, the daughter-in-law and the son were taking turns spending the night at the parent's house. They were never spending the night at home at the same time. They weren't seeing their kids. And this went on for years."
FitzPatrick explained a "tough love" approach.
"You have got to set some boundaries. Unfortunately, you may have to let them feel the consequences of not getting help. They may be saying 'No, I'm not going to allow home care in this house. No, I will not go to adult day care. No, I will not go to assisted living.'"
She continued, "Then you might say, 'Okay, Mom, that's fine. I understand your choice. It's your decision. However, this is the amount that I can do. I can come twice a week for two hours.' It is really hard for families to set that boundary. A lot of times the adult children are propping up the elderly person. Pulling back support is very hard, but it can be very effective. The senior - if they're still in the very early stages of cognitive impairment - might be able to say, 'You know, I do need some help.'" However, they may never reach that point if the adult child is constantly jumping in to fix all the problems.
And, if that approach is not successful?
While most of us hesitate to use scare tactics, in some cases they can help prevent problems that are more serious.
Many elderly people know someone who vowed that she would stay in her own house until the day she died - and then ended up in a nursing home after breaking a hip. She had no choice about where she lived the rest of her life, because a harried spouse or child had her moved to the first nursing home they could find that had an open bed on the day that the hospital discharged her.
Reminding your parents that such heart-wrenching situations are common might lead them to rethink their refusal.
But suppose that your aging relative has passed the point where rational conversation is possible. For example, suppose that you put both coffee and orange juice in front of them at breakfast and they look confused and ask fearfully, "Which one [am I supposed to drink] first?"
Next week's column will discuss how to arrange a move for a relative with advanced dementia.