Mind your own Business!
When do you tell your older family member what to do and when do you bite your tongue? If you ask your older relative they would respond that you should have no decision making authority because they are adults and can make their own decisions. However, older adults cannot always make competent decisions based on either dementia or lack of clarity to see that their situation or abilities have changed. I have a friend whose 92 year old mother insists she is a good driver, yet he has seen her drive through stop signs.
When to force change and when you can’t
Obviously if a family member has dementia and is doing something that is a safety risk you need to act. Even if the person does not have a dementia, consistent medication administration errors, dangerous driving and other risky behaviors demand change. Unfortunately, many states do not help by issuing ten year driver’s licenses to 85 year old’s with only a vision test.
Some behaviors are potential hazards and it is difficult to insist on change. Some examples are living in homes with lots of steps or homes that are not kept clean, or have a lot of clutter and are unpleasant but not a danger. Quality of life issues could be watching too much T.V. or eating too much fast food.
Sometimes, if you are facing a potential hazard, and the person is resistant to change, you may need to wait until things get worse. Sometime you may need to wait until things get really bad, unfortunately. Unless you are the person’s legal guardian (power of attorney doesn’t count) there isn’t too much you can do.
How to make changes
If your relative is in real, immediate danger and is incompetent, you will want to consider guardianship. Be warned – guardianship is a legal process and the courts do not grant it easily. You have to be truly unable to make your own decisions, not just make ones your family feels are not right, to be appointed a guardian.
So what if your relative is not eligible for guardianship but you feel strongly they need to change something in their life to prevent disaster and they refuse? The best way to accomplish this is to have someone other than you say what needs to be said.
If the issue is unsafe driving, doctors have the ability to take away a driver’s license. They can also talk to a patient about getting more help at home or moving to a safer living situation. I was with a client when an ophthalmologist asked her how she would feel if she killed a child while driving. It was very effective. There are companies that will do driving assessment for older adults. A trusted friend may also be able to talk to your relative in a way they will listen.
If there is a medicine administration problem, such as missing doses or mis-dosing, speak to a pharmacist about options. There are pill packs and even devices that alert you that it is time to take medicine.
Because of HIPA laws, it may be difficult to talk to a health care provider or even know who they are. My husband came up with a great way to find a doctor or nurse practitioner’s name – look on a medication bottle. Because of privacy laws, a medical practice may not be able to acknowledge that your relative is a patient if they did not give permission for you to discuss their medical care. However, you can leave a message for that practitioner explaining your concerns.
Issues not involving medical care or driving
For issues that do not involve medical care or driving, such as a messy house, a different approach is needed. The person needs to be part of the decision making and you need to start slow. If clutter is an issue, ask if you can go through one basket with them and purge unneeded items. For people not eating properly you can work with them to make a few healthy meals and freeze them or ‘make too much dinner’ and bring it over.
Make the initial decision low commitment. I have clients that are resistant to services from The Extra Daughter. Since we only have a two hour minimum the commitment is very low. Almost every client enjoys their first two hours and they become regular clients. You can try the same thing with someone to clean their residence. Only a one time visit to see if they like it.
I constantly hear from adult children about the struggle with their parent to make change. It is not easy and can damage a relationship. The balance between wanting what is best for your relative and what they think is best can be very difficult. Hopefully these strategies will help.