July 29, 2020

conversations to help resistance

Change the dialogue and facilitate action

Often, when I’m discussing with a family member of an ageing parent, the reasons why they haven’t considered accessing formal community support, the response is “Mum/Dad's not ready yet”.

This response makes me a little wary.

Especially if the older person is relying on the family member to do things for them that they are unable to do any more.

It’s a big thing for someone to acknowledge that they aren’t as capable as they previously were.

And in my experience, older people are stoic and proud and unlikely to comfortably admit they need help.

And they are very resistant to hearing this from their family, as they take this kind of discussion as criticism.

During an assessment, many older people tell me they don’t need help because their son, daughter, husband, wife or significant other takes care of their needs.

Then I’ll cast my eyes over to the significant other and see the exhaustion and despair on their face and I know that this assessment will need more compassion and courage than usual.

I’ve found myself in many assessments where the older person will tell me they manage their day-to-day activities themselves or that their family helps them and makes light of the amount of assistance that their family is offering. It's often a lot more than they are willing to disclose.

The older person will usually describe assistance being mowing the yard and doing odd maintenance jobs around the house. This kind of assistance is seen as being acceptable by the older person.

But assistance with paying bills, grocery shopping, cooking, cleaning or personal care is less acceptable to the older person and they will doggedly cling to the belief they can manage this themselves, even if the family has been supporting the older person with this for some time.

This is where a skilled and compassionate facilitator is required to open the dialogue.

A facilitator is someone who recognises the situation, is experienced in managing this kind of discussion and skilled in addressing the concerns of the older person, gently introducing alternative options that won’t appear to be diminishing the perceived independence of the older person.

I recently assessed an older lady who was resistant to accepting support from anyone other than her family. She felt her daughters were 'ganging up on her' and trying to take over.

She sat rigid in her chair and would barely look at me during the initial phase of my assessment.
The conversation was tense and emotional.

Her daughters refuted her description of her ability to manage her daily activities as she was describing them. The older lady began to disengage from the assessment.

I asked her daughters if they would allow their Mum and I a few moments alone to complete some documents.

While the daughters went and made coffee, I was able to reassure the older lady by acknowledging her tidy and well maintained garden and house (the daughters managed this, but the older lady took credit for it), that her good health was attributed to her good nutrition (her daughters cooked her meals and stacked the freezer with them so she had an ongoing supply) and reassured her that no one who came into her home was going to tell her what to do (yes, she was fiercely independent).

We discussed someone doing the mowing for her, a carer coming to take her to the shops each week to assist with shopping (and have a coffee while they were there) and someone assisting with the bigger cleaning tasks.

By presenting the options to this lady in a way that was not challenging her independence but enhancing the ‘quality’ time her daughters could spend with her was very appealing to this lady.

She felt that by accepting the support, she was doing her daughters a favour. And this made her feel good!

She agreed to progress the assessment and was willing to accept the services that would be approved for her.

She hugged me at the end of the assessment and thanked me for coming to see her.

Her daughters were grateful that they could take a step back from what were challenging conversations with their Mum. Equipped with a different way of approaching the dialogue these daughters regained the trust of their Mum and were able to progress this discussion from a less emotionally charged perspective.

Don't delay in accessing community services and support for your ageing loved one.

Recognise there may be a hurdle or a few to overcome, but don't give up.

And trust that sometimes the courageous conversations are the breakthrough that needs to occur.

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