- Before you approach your loved one, try to understand what may be contributing to their resistance
- There are many reasons why someone won’t accept help, including those that are medical, emotional, and practical
- Once you’re ready to approach your loved one, the two most important considerations around the conversation are timing and tone
OK: your loved one has reached the point that complete independence is no longer possible. Despite this, they’ve refused to accept support, and you’re stressed and worried about what to do.
Don’t give up: In the same way geriatricians start medications (start low, go slow), there are ways to optimize success by suggesting and adding help incrementally. Below are key tips for anyone hoping to get a loved one to accept assistance they’ve been refusing, blending experience and advice from physicians, families, social workers, and professional care managers.
Go in With an Understanding of What’s Happening
Before you approach your loved one, try to understand what may be contributing to their resistance. There are many reasons why someone won’t accept help, including those that are medical (impaired decision making from dementia), emotional/psychological (the need for privacy), and practical (money).
Our guide on why a loved one won’t accept help provides insight on what might be happening. Based on what you discover, you can bring empathy and understanding into your conversation.
>> READ: Why won't my loved one accept help?
Prepare Prior to the Conversation
Get Everybody on the Same Page
It’s important to get the full “care team” — children, spouses, and everyone else involved — aligned and in the loop from the get-go. Just one person out of sync can undermine all efforts. One of the most frustrating situations is when you’ve made progress and a family member suddenly insists on a completely different course. Avoid this by keeping everyone in the loop to the greatest extent possible so that there are no last-minute surprises. Having everything written down via email (or elsewhere) is also helpful to ensure alignment and minimize confusion.
Take Inventory of the Resources at Your Fingertips
It’s helpful to create a series of potential solutions prior to approaching your loved one. Explore everything: In the case of needing additional companionship and assistance, see if family, friends, and neighbors can jump in, speak to local agencies that serve older people in the community, and look into religious institutions like churches or synagogues that can serve as an important social network for older adults.
Social workers associated with geriatric medicine programs or area agencies on aging can be found via the government’s Eldercare Locator. In many communities, they’re able to come to your home and explain what resources are available. Based on where an older adult lives, their income level, and their veteran status, they may be entitled to additional benefits above and beyond what’s typically offered.
In general, gerontologists love teamwork. If there are trusted people in your loved one’s orbit that share your concerns, see if they can help. Peers, neighbors, and distant family already known to your loved one can be especially helpful here; they are more likely to be accepted, and can be combined with formal (paid) caregivers.
Start Small, and Then Get Progressively Bigger
With someone who is resistant to accepting care, you should propose minimally invasive interventions to start, remaining mindful of preserving dignity to the greatest extent possible. What might this look like? Let’s consider some examples:
- If they just need help with basic housekeeping assistance a few hours a week, don’t immediately jump to hiring a full-time home attendant.
- If someone trusted is already in the home (a housekeeper, maintenance person, a formal personal assistant from work), see if you can expand their role slightly to help keep an eye on things (like asking a housekeeper to shop or make meals that can be frozen and eaten later).
- If financial decision making is the concern, rather than taking away someone’s checkbook, consider bringing in a daily money manager (different from a financial advisor). They can make sure bills are being paid, monitor cash flow, and ensure that your loved one is not being financially exploited. The American Association of Daily Money Managers can help you find one in your area.
Pay Attention to Your Own Needs
It’s important to note that this process can be emotional and highly-charged, and the toll it takes on one’s own mental health should not be understated. The effects of what researchers call “caregiver burden” are striking, and we’re just beginning to understand the enormity of the impact of taking care of a loved one. Don’t minimize how stressful this can be, and lean on your own network for support: family who are in it with you, friends who have gone through similar experiences, or professional therapists or counselors. It can also help to role play the conversation or write down everything you’re planning to convey in advance.
How to Approach the Conversation
How you broach the subject often determines whether or not you make headway. And even if you make some progress, it’s normal to have multiple conversations before substantial change happens. Rome was not built in a day, as the saying goes.
Once you’re ready to approach your loved one, the two most important considerations around the conversation are timing and tone. As it relates to timing, don’t have the conversation amidst a time of crisis, like bereavement or a recent hospitalization. Pick a time that suits your loved one: breakfast, a vacation, a quiet walk. Gerontologists often use the expression “in the quiet light of day, rather than during a hurricane.”
No matter how frustrated or concerned you are, coming in with a kind, warm, empathetic tone is critical, and helps set for the kind of conversation that you’re hoping to have. As you approach it, it’s important to also think about your loved one’s values and what kind of overtures they typically respond well to.
Based on those elements, here is some framing to consider:
- Express your legitimate worries: “Dad, I’m so worried about your health. I need you around for a long time for your grandchildren. How can I get you to be more interested and involved in getting your diabetes under control?”
- Provide reassurance: “By accepting a little bit of help, I think you could actually stay in your house longer, which I know is important to both of us.”
- Use sensitivity and flattery: “Mom, you are still one of the most beautiful women I know, and with some assistance and a few new dresses, you’d look and feel better. I know how much you like to dress up. How about getting someone in periodically to help with your hair and wardrobe?”
- Express your own needs and how you’re impacted: “Mom, I love coming to see you, but I can’t be productive at work if I need to come over for emergencies at a moment’s notice, especially if I’m traveling. How about we get someone ‘on call’ should something come up?”
- Create a common bond: “We’ve been using Uber Eats to order dinner a few nights a week because it’s so much easier than cooking, and they have all of our favorite restaurants. Can I show you how it works?”
- Highlight potential financial benefits: “Can I help you take a look at the finances of all this? There may be insurance benefits from the local government or the VA that could do this in a less costly way than you think.”
When Is It Okay to Tell a “White Lie?”
For patients who are refusing help on the basis of cognitive and behavioral impairment from diseases like Alzheimer’s, a white lie can be permissible to ensure health and safety (experts sometimes call this “ethical deception”). When a person lacks capacity and can’t understand their need for assistance — and how quickly they’ll wind up leaving the environment they’re trying to protect — helping them by nearly any means necessary is often justifiable, as long as it aligns with the wishes they articulated before they became impaired.
Only Play the “Guilt Card” if You Have To
If you’re out of options to get a loved one to accept support, the last resort would be the “guilt card.” If caregiving and trying to keep a loved one safe is becoming overwhelming, then it’s okay to find a kind way of telling them that.
It’s important to adjust the message based on their particular sensitivities: “I’m going to lose my job because of your refusal to accept services” might better be brokered as “my co-workers are upset that I’m out so frequently.” Your goal is to get your message across, not to make them feel like a burden.
As Best as Possible, Ensure the First Intervention Is a Success
If you’ve gotten a loved one to accept assistance, it’s helpful to make the first intervention one that brings an immediate, tangible benefit. Some examples: If mom needs supervision at home while dad is in the hospital, how about bringing help in and equipping them with all of her favorite recipes to make for meals? If there are changes that need to be made for mom to remain safely in her home, how about integrating some fashionable new improvements that fit the style she likes?
What To Do When It Just Doesn’t Work
If you’ve tried everything and are still unable to make any headway, you’re far from alone — these are common challenges that many spouses and adult children deal with.
In this situation, it’s important to ask yourself two questions: (1) Does the behavior actually pose a danger to the person or others, and if so, what exactly is that danger? (2) Does the person actually understand the poor choice that they are making?
These questions are complex, and often require a physician for a formal evaluation. Read our guide on how to evaluate whether or not a loved one is able to make their own decisions to learn more.
If one does have the ability to make the decision themselves, they have the right to make a choice you disagree with, as difficult as that can be to accept. In this case, all you can do is continue to voice your concern, try as many of the strategies above as you can to help them hear you, and monitor the situation closely. You can also reach out to their physician to see if they’d be willing to discuss it directly with the older adult. When done appropriately, sometimes suggestions can be easier to accept coming from a doctor.