This blog is the second of a two-part series addressing the challenge of caring for an elderly parent who is resistant to assistance. Part one of the series discussed our philosophy on how to approach the challenge in a way that facilitates success. Part two, below, shares anecdotes that highlight how we put our philosophy into action with our clients every day.
On your last trip home to see your dad, you were alarmed to find his once spotless kitchen cluttered with dirty dishes and his clothes desperately in need of laundering. He had lost weight and he seemed distracted.
You tried to convince him to get some help around the house. “Do it for ME,” you said. “I’m really worried about you.” He waved you off, assuring you that he was FINE.
Between the kids, your job and a determination to go to the gym once a week, you do your best to call to check in every day, feeling helpless, and a little guilty about living so far away. You implore him to get some assistance while trying to hide your exasperation. He snaps at you to stop nagging. You raise your voice, and you hear yourself scolding him in the same tone he had used on you when you were a teenager with questionable judgement. You’re not getting anywhere. In fact, you’re pretty sure he is screening your calls.
In our last post, we discussed the fine line between caring for your parents and trying to control them, and the complexities of helping your parents when they really need care, but refuse. We discussed the importance of respecting your parents’ need for autonomy and dignity, actively communicating your respect for your parent as an adult, despite the changes they are going through, and facilitating independence as much as possible.
Looking Outside the Parent-Child Relationship
But sometimes (and for a variety of reasons) it’s hard for a parent to accept the idea of care when it comes from a child. At these times, someone from the outside may be able to help – a friend, relative, doctor, clergyman or geriatric professional.
At B’Lev Shalem, one of the most common calls we receive is from adult children who are unable to convince their parents to get the help they feel their parents need. We have the advantage of being perceived as objective; a peer. But we also have a challenge: developing a relationship based on earned trust.
Sometimes, it can take us weeks, even months, of relationship-building before we feel it’s appropriate to start talking to our senior client about making significant changes in his or her life. But those weeks are the necessary foundation not only to manage whatever immediate crisis is taking place, but also to improve the life of our client in the years to follow.
Building Trust
Rachel, one of our Care Managers, tells about her experience making inroads with a client who was initially very resistant to getting any help. “She’s a retired surgeon, used to being very competent and independent, and she thought it was ridiculous to have anyone checking up on her.”
What did Rachel do? “I reached out as a friend. I would come to visit, bringing cake. We’d sit and have coffee and cake, and chat. We’d go out to a café and have conversations. Nothing deep, or sensitive, or in any way related to her current state of affairs. I’d share stories about my life, my kids, and enable her to get to know me. I’d ask about her life, and family, and focus on getting to really know her. It took months of small talk, of reaching out and being there, before the next step: actually offering help.”
Avigail, another of our Care Managers with 30 years of experience in social work under her belt, says that she’ll often call her clients and ask if she can just stop by to visit. These aren’t meetings with agendas. They are simply for the purpose of getting to know her client better, and letting her client get to know her and feel comfortable with her.
In order to build trust, it’s important to find common ground. To try and foster a bond on a human level. Avigail tells the story of a client whose dedicated son moved her to Israel at the age of 92 so that she could be with her children and grandchildren. She found her Aliyah transition challenging, but was traumatized by a missing pair of Ralph Lauren boots. They had gotten lost on the way to Israel. It was a small-but-large thing that accentuated everything in her life she had given up in the move. After the client’s grandson went on a trip to the United States and brought her back a new pair, Avigail came to the next visit wearing HER pair of identical Ralph Lauren boots! “I told her, ‘I heard you got your boots – and I entirely get it, because I love mine, too!’ and it was a real point of connection. That’s one of the reasons I chose this profession: because building bonds comes naturally for me.”
Avigail emphasizes, “You must build trust first – before you can do anything else. We are accompanying people to very sensitive, confidential, emotional and potentially scary situations. We are responsible for facilitating healthy communication in the family. It’s not going to work unless you’ve proven yourself worthy of trust.”
The Next Step: Offering Help
When you feel you have built trust, how do you move on to offering help? Is there a lot of opposition?
Avigail explains, “I usually start with black-and-white, technical issues, like helping clients get what they’re owed by Bituach Leumi. That’s not an emotionally-laden situation, so there’s usually no opposition. However, it enables me to become an active, positive presence in my client’s life. When they see that I’m working on their behalf and there are improvements and accomplishments, they’re able to let me in a little more on the emotional side.”
Rachel adds that she met little opposition with her client due to two factors, “One, I had put in the months of just being there for my client as a friend, so she felt comfortable with me. And two, because I started with offering help for the things she KNEW she needed help with, as opposed to the things she didn’t think she needed help with (but her children did).” Rachel accompanied her to doctors’ appointments when she couldn’t make it there on her own and there was no one else to take her. Rachel took her to an MRI at 3AM (!) because that was when the clinic could fit her in. “She came to regard me as someone she could trust to be there for her and look out for her best interests, even when it was inconvenient or uncomfortable,” remarks Rachel. Only after that came the stage of broaching sensitive topics about her life situation and the need for help.
Knowing Our Clients
What happens when you broach those topics? How do you do so without causing backlash?
“It’s always going to be somewhat of a challenge,” says Rachel. “Admitting you need help is a very sensitive and potentially uncomfortable situation.” But Rachel invested in their relationship initially, proved she was present emotionally, and projected the ability to relate to the client as an independent adult at every step of the way, so it flowed relatively smoothly.
Last year, when Rachel came round to visit this same client for a quick check-in, she found an absolutely egregious hygiene situation in her home. Informing the client that the situation was intolerable and she needed to get help to make sure it didn’t happen again would not have gone over well at all. Rachel would have met resistance if she ordered, threatened or dictated. Instead, she sat down and had an adult, level-headed discussion with the client about the health issues and dangers inherent in situations like this. After that discussion, the client realized it was not a manageable environment and was open to discussing possibilities to avoid these types of situations in the future. “Once you’ve invested the time getting to know your client well on a personal level, you have a good feel for which strategy will work best,” explains Avigail.
One of Avigail’s clients used to be very social, but was in the early stages of memory decline and, as a result, was scared of getting into awkward social situations. She hadn’t left the house in a year! We knew a day care facility would be the best thing for her, but we also knew she would refuse because of her fear of embarrassment. So, Avigail and the client went together to the hospital to have her medically assessed. Avigail sat in on the summary of the diagnosis, together with the family, where the doctor stressed that she needed to be in a day care facility out of the house, exercising, socializing, doing mental exercises to retain her memory. She needed to hear it from the doctor – not from her children, and not from us.
“Now, whenever we talk and she says she doesn’t really need to go to the day care program, I can bring in the doctor’s opinion. For her, that authority is much more powerful than any arguments I (or her children!) could make. If I didn’t realize that or I couldn’t accept that, I’d run into dead ends again and again. But now I’m able to speak to my client in a way that really gets through to her.”
Enabling Life
“Today, my client is at home with full time help,” shares Rachel. “It obviously has not been an easy transition for such a fiercely independent woman, but it is one that has gone relatively smoothly, all things considered. She is at peace with her situation and with her family, who she views as giving her the ability to remain as independent as possible. I’m happy we’ve been able to facilitate that view.”
“I chose this profession because I believe in warmth, in smiling, in embracing other people,” shares Avigail. “We love our clients; we want the best life for them – and we’re privileged to have the tools and understanding with which to help them attain that.”