Elder Care: Key Strategies

Caring for an aging parent can be challenging, rewarding, frustrating, gratifying—or just plain overwhelming. My own mother, Rebecca, had Alzheimer’s disease, and in the course of taking care of her, I experienced all of the above emotions. I checked in every day (if only by phone), visited to see that Mom’s refrigerator was filled, found the right professionals and programs to keep her safe and occupied, and worried about the next stage. Would Mom be able to cope? Would I?

All of this, however, was manageable. Only two things really made me lose my cool: one was Mom’s insistence on wearing the same red jacket, torn and stained, everywhere we went. The other was her adamant refusal to allow a stranger (a home health aide prescribed by her doctor) into her apartment. We fought about that for many months, until I arrived with the aide early one morning and told Mom: “If she goes, I go, too.” It was a matter of safety, and I couldn’t back down.

Lou-Ellen Barkan was similarly worried when her mother, a widow in her eighties, began showing signs of decline. “Whenever I visited her in Florida, I’d find something else to be concerned about,” says Barkan, president of the Alzheimer’s Association, New York City Chapter. “Take paying the bills as an example. Mom was insistent on doing that herself. Though there were problems (I wasn’t thrilled to see all this money going out the door), it wasn’t the end of the world. There has always been a tremendous amount of tension between my mother and me, so I decided to pick my battles.

“Driving was a different matter. I would tell her, ‘Mom, you really shouldn’t be driving,’ and she would be furious with me. But this was a question of safety—hers and others’. My brother and I are supporting our mother, so when she called to tell me she was going to lease a new car I refused to pay for it, and that was it. It was the first time I became specific about what I would and would not do.”

Complex and often subtle changes take place in relationships as parents age. When for years your parent has been responsible for you, roles often change in midlife. So what do you do when you’re trying to be helpful and your parent says no?

Understand Why Your Parent Is Saying ‘No’

“The first thing is to understand what the parent is saying ‘no’ to,” says Claudia Fine, executive vice president of SeniorBridge, a health care management company. “When they’re saying ‘I won’t stop driving,’ for example, what they’re really saying is, ‘No, I’m not going to lose control; I won’t be able to do the things I want to do.’ That’s what they’re saying no to. So you have to listen: What is the concern, and how do you address it?”

Many times, for example, a mother won’t allow an aide into her home because she’s fearful of having a stranger in her space; since this is often the case, offer to accompany the aide until your mother becomes comfortable with her. If Mom continues to be obstinate, ask a doctor, relative, or good friend to talk with her. Mother/daughter relationships are often so fraught with conflict that the last person a mother will listen to is you. An older grandchild may also be more successful in pleading your case.

Another typical challenge is trying to persuade your mother or father to attend an appropriate senior day care program. As you see it, that’s much better than sitting at home in front of the TV, plus a nutritious lunch is served. Alas, she or he refuses to go.

Edwin Boyer, president of the National Academy of Elder Law Attorneys, ran into this problem when his own widowed mother came to live with him.

“Since both my wife and I work, it was important that my mother have something to do during the day,” Boyer says. “We found a very nice senior day care program nearby, but my mother flatly refused to go. I remember her standing at the top of the stairs, using language that she would not familiarly use, and insisting, ‘I will not go there with those old folks.’ She was 89 at the time. Finally, my wife talked her into getting into the car. (After all, I was her son and she wasn’t about to let me tell her what to do.) Once we walked through the front door of the day care, all was fine. Mother was a very social person.”

Boyer speaks from both personal and professional experience: “When you are trying to get your parent to do something they absolutely refuse to do, whether it’s allowing a stranger to come into the home, letting others take over the bill paying, or moving to an assisted living community, there are three things you need to think about,” he says. “You’ve got to be patient; you’ve got to be loving; you’ve got to have help.” You’ve also got to be lucky. Sometimes, none of these work, and (depending upon the degree of danger) an ultimatum may be necessary.

Money Matters

Money is both a practical and an emotional issue in families, particularly when a daughter decides to take charge of her father’s finances—a son often has an easier time—yet as parents age, their mental ability often deteriorates and many are unable to handle the newest forms of technology; even when true dementia does not set in, memory lapses can occur. “My father was paying the same bills three times,” says writer Ruth Katz. “He couldn’t read the bills, didn’t know the amounts due, his checkbook was a mess. Finally, I told him to put all the bills in a pile until I came by. Once a month I would write out the checks and leave them for him to sign. It allowed him to ‘save face’…until he got to the point where that no longer mattered. He was relieved when I took over, but he never would have said it.”

Driving, of course, is one of the toughest activities for parents to give up because it curtails their independence; for men, it also threatens their masculinity. “My mother was in her late seventies and having memory problems, but she refused to stop driving,” says Julia Campbell. “I live in New York, she lived in Cleveland, and finally she promised to stop driving at night. But one evening she went out to get cigarettes, got lost in a bad neighborhood, and called the police to escort her home. After this, my siblings and I adopted a tactic called ‘therapeutic fibbing’ that I learned about in an Alzheimer’s support group. We came up with the story that the car was being recalled for service and that we took it ‘into the dealership’ (really, we took it elsewhere). After a while, we told her, ‘They found something else wrong.’ We finally said, ‘The car is totaled. And it really doesn’t make sense for you to spend money to buy a new one at this point.’ So it was the story of the recall that we kept reinforcing. While initially that didn’t feel comfortable (if you’re raised properly, you’re told you don’t lie to your parents), I finally realized that it was the necessary thing to do.”