The original article can be found on Caring.com here: "What to Do When Your Elderly Parent Refuses Home Care."
The author, Madeline Vann, has written a very good article that offers good advice on a subject we hear most from the sons, daughters, and friends of loved ones whom they feel need help to live safely at home.
We hear the following all the time:
- “My parents say they are fine.”
- “My parents said they never needed help before and they’re not going to change now.”
- “My parents simply will not pay for help in the home THEY feel they should still be doing on their own.”
- “I can’t talk to my parents about getting help on the phone. We just start fighting with each other.”
- “I know they need help, but I just don’t know how to convince them.”
And many more like them. Understandably, our parents have grown up in an era where they got everything done themselves. They feel admitting they need help may be a weakness. They may be embarrassed after all these years of independence. Or they simply can’t afford the help.
After reading through Madeline’s “What to Do When Your Elderly Parent Refuses Home Care” I wanted to make sure we passed this advice on to our followers along with some additional points to help further support and clarify what Madeline has published.
First, the point about empathy is in our minds at Aware the number one goal in any home care conversation. As part of our employee training, we emphasize the primary objective with a client service inquiry is not getting the contact information from them, but to establish rapport. To gain their trust by being a good listener and asking questions to better understand their concerns. Without establishing trust, it’s likely the conversation is going to go nowhere and leave both parties frustrated.
Second, educating them about home health care is a good one and I think needs further clarification. In general, the push back on accepting help IS NOT about accepting home health, rather it’s accepting home care. The distinction is pretty important because home health is doctor-ordered and is going be covered by medical insurance. If home health is being ordered as part of their discharge from the hospital, it’s going to be covered by Medicare Part A. Since it’s covered by insurance and doctor-ordered, you’re not likely going to see push back from Mom or Dad on this. However, Home Care is a completely different issue because:
- It is not doctor-ordered, nor is it covered by health insurance. Unless there’s money paid for it through Medicaid (rare), Veterans Assistance Aid and Attendance (only for qualified Vets) or long term care insurance (only if the client paid for a policy), people will push back on home care simply because it’s out of pocket. I can speak from personal experience with my Stepdad and Mom on this. Mom felt bad because she felt she shouldn’t need the help and she doesn’t have a lot of money.
- You have to do the work to determine the level of help and then hire help. With Home Health, this care is completely managed. On the other hand, with home care you either will hire an agency to work with you on your loved one’s needs and schedule care for you, or you have to do it all on your own hiring a private caregiver.
Informing our loved ones about the differences between home health and home care would greatly help make these difficult conversations easier. We see this education issue all the time, so we created a simple two-sided postcard explaining the difference between the two that we distribute to doctors offices, our partners, and at events.
The third point about costs is typically where we see push back from loved ones about taking on home care. Our advice on this point is to not avoid this conversation but to embrace it. Be up front on the costs of home care. It can be expensive. As I explain, it’s our world. There’s cost with care. A better way to look at it is what if care is refused and your loved one has a fall? The fall could result in a fracture of some type that after a hospital stay, you no longer can live at home. If a move out of the home into assisted living (starting cost in North Carolina is around $4000 a month) or skilled nursing (average cost NC $9000 a month), the cost of $21/hr. for companion care is a lot more digestible and financially feasible for most people.
The fourth point discussing “Focus on how it will help others, too”, in my experience, is the lynchpin. It can be the point where you can turn the conversation towards considering help because typically your loved ones don’t want to be a burden on you or friends. The turning point with my Mom when she finally accepted help was when I asked her to consider how her actions affect me and my family? She had not really considered this. It was all about her.
When I explained the stress and extra hours involved to care for her and/or manage her care and how it negatively was impacting both my work life and family life, the conversation changed. Additionally, she now felt like she had a mission. If she accepted help, it was helping her son. It gave her purpose. Once she saw how planning for home care and accepting assistance was helping her loved ones, it was an easy choice for her to make.
The last point seven about accepting their refusal is good advice. Nothing is usually gained when both sides are not connecting. Pushing further can result in a complete shutdown or worse, hurt your relationship in the long-term. My advice based on my own experience is to manage your expectations. It’s likely going to take multiple conversations before a loved one becomes comfortable with the idea of accepting care. The key to the process is to somehow give your loved one the sense of CONTROL. Present things as options. Give them alternatives. Discuss the alternatives and the outcomes. Put a stake in the ground and pick one of the alternatives as your preferred solution and why it’s beneficial to your loved one and you.
Remember, have empathy, listen, present alternatives and explain that no decision is not a solution nor a good thing. People should know help is out there if they need it: geriatric care managers, caregiving advocates and social workers are all great options when putting together a quality care plan.
I’d also like them to know that they’re not alone; I and many others have been there and the resources are available when things get difficult. For anyone currently navigating such a situation with their loved ones, I wish them the best of luck and we’re always here to help.