How and when to intervene with an aging parent

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By Liz Taylor

Special to The Seattle Times
Last week, I responded to a letter that disagreed with my advice to a reader who was struggling to protect her 96-year-old father by moving him from his home of 56 years first to a mobile-home park, then to a retirement community “” all, it appeared, against his wishes.

Although the reader meant well, I said she needed to involve her dad in the decision-making. He had the right to say no, as do we all, even if it put him in danger. The woman who wrote in response has parents in their 90s who live far away. She implored me to change my advice and give adult children the right to assert better control over their stubborn, aging parents when they resist.

“Parents who need care and refuse it aren’t just cute, independent and feisty (as far too many will tell you),” she wrote. “They are in some sort of very bad psychological space of unhealthy denial. These parents come across as no longer caring a smidgen for their children, especially when they themselves are getting older and are exhausted from trying “” and feel guilty for not understanding.”

If anything captures the angst and anger of adult children going up against the brick wall of a parent’s obstinate resistance to change, it’s this single paragraph. I’ve long been amazed at the adult children who pay no attention to their parents, despite obvious impairments “” and have none of these worries. For the many others who do, however, some older parents react with a swift kick to the shins.

“Leave me alone,” they demand. “I’m fine!” Often, they’re not “” sometimes they’re in horrible shape, and it’s obvious to everyone but themselves.

So what to do?

The first rule: Don’t allow harm to others. If your parents’ behavior puts others at risk “” driving being the most obvious example “” adult children (and neighbors, friends and doctors) must step in by contacting the authorities.

Otherwise, says Virginia Morris, author of the eldercare classic, “How to Care For Aging Parents,” if your parent has a mentally competent spouse, it’s largely the spouses’ job to decide when and how to intervene. You can offer information, advice, and resources, but the spouse is in charge.

If you have a lone parent or two disabled parents who appear to be mentally incapacitated, have them evaluated for depression or dementia (both causes of poor judgment). If a physician determines your mom has a dementing illness, you “” or the person named in her durable power of attorney for health and finances “” can begin making decisions about her life.

But when the parent’s daily existence begins to crumble and he’s still lucid, the situation gets markedly more difficult. “Your duty to protect your parent is superseded by his right to make his own decisions,” writes Morris.

You can step in to make sure he’s paying his bills, turning off the stove or taking his pills if he’ll let you, but there are limits to what you can do to force the changes you believe are necessary. A competent parent has the right to say no, no matter how crazy it makes his kids.

The primary tool, as inadequate as it sounds, is communication. Talk about these issues early, while your parents are healthy. If you didn’t when you should have, start now: slowly, gently, carefully, calmly. Tell your mom that the changes you think she needs are in her best interest, and that’s your goal. Don’t issue orders and “shoulds,” but rather, “Have you thought about this?”

Raise issues by discussing someone else “” what happened to a neighbor who had a stroke and her kids didn’t know what to do. Clip something out of the newspaper or a magazine and show it to your mom; tell her you’d like to talk about it. By taking the focus off your parent, she may learn from what others have done.

Hold a family conference, inviting all critical people (including siblings you don’t like). Invite your parent to attend (if she’s not demented) to voice her opinions and preferences, as well as to hear the concerns of others. Sometimes she’ll be shocked by what they say, but when she hears it from several people at once, it’s more likely to register.

Then listen. You may discover your mom has different priorities than you do. Living independently may be more important to her than being safe. Or her idea of a retirement community may stem from long-ago visits to her grandmother in a horrible nursing home. Or she may not want a certain surgery, being more interested in living fully than in living longer.

“Understanding her point of view will help you let go of futile battles,” writes Morris. It might also spark some efforts at compromise.

Sometimes the best influence is going through someone else “” an in-law; a sibling; a trusted neighbor; or someone in authority, such as the parent’s physician, pastor or lawyer.

All of this takes time; it rarely happens overnight, which is why you have to start this conversation early, before a crisis “” and why it’s extra difficult if your parents live far away.

Next week: What happens if nothing you do works?

Liz Taylor, a specialist in aging and long-term care, counsels individuals and teaches workshops on how to plan for one’s aging “” and aging parents. You can e-mail her with questions at [email protected] or write to Liz Taylor, The Seattle Times, P.O. Box 70, Seattle, WA 98111.

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