Every time you visit your parents, you notice that they are having more and more difficulty keeping the house clean.
They seem to be losing weight, and when you look in the refrigerator, you can see why. Clearly their nutritional needs are not being met. You suggest they bring in private help a few days a week to help with the shopping, cooking and cleaning, but they will not even consider it.
Does this sound like your parents?
As a geriatric social worker, the question I get asked most often is, “Do you have any suggestions of how I can get someone in the home to help my parents? They just won’t agree to help.” Boy! Do I wish I had a cookie cutter answer!
In reality, there are so many different personality characteristics and past experiences that impact one’s openness and willingness to acknowledge deficits and accept help. I cannot give you the guaranteed solution.
Below are some basic suggestions to assist you in introducing home care assistance:
1. Lower your own expectations. It is not realistic to expect that individuals who have been managing their own life from A to Z are going to welcome others taking over. Understand that things will not change overnight.
2. Acknowledge their fear. Most seniors feel that once they accept help, even in the most minimal way, it is the “beginning of the end” for them. This is scary and they want to prolong this first step for as long as possible.
3. Introduce the topic slowly. Start by asking your parents some open ended questions, such as, “Tell me how you’re managing the housekeeping?” Not, “Can you do the housekeeping?” – which will draw a quick “yes” and an abrupt end to the discussion.
4. Start with housekeeping. This is usually the least threatening type of help and the one most appreciated. If your parent already has a housekeeper, how about suggesting that “large” chores are done by someone else, i.e., washing windows, and that you know of someone who is available and good.
5. Give the gift of help. Instead of presenting help as a “need”, give your parent a gift for the holidays, a birthday or anniversary. You can frame it that your spouse/friend gave you the same thing (i.e., housekeeper for 3 months), and you found it so incredible, you wanted to share the joy. You may find that they are relieved once the assistance begins.
6. Qualifications. Make sure that the housekeeper is a qualified nurse’s aide (attendant, caregiver) and able to assist with personal care (bathing, dressing, etc.), even though this service will not be introduced at this time. Professionals will understand and expect that their introduction into the home may be about “housekeeping” for a period of time. At least you know that this person has additional skills if needed in the future.
7. Introducing housecleaning. Ask your parent what tasks in which they could use help. DO NOT decide for them. Suggest large tasks such as window washing, floors, toilets…this may feel less threatening than imaging a stranger washing their clothes. Once the housekeeper is there, she can offer additional tasks gently and at your parents’ pace.
8. Building on existing housekeeping. When there is already a housekeeper in the home, ask if this person is available and willing to provide more help. If they are, perhaps they could take some basic nurse’s aide courses to learn about assistance with transfers and bathing.
9. Introducing groceries and cooking. Suggest the housekeeper start to phone your parents prior to her visit to state that she is running to the grocery store on the way to their house and would your parents like her to pick up a few things (milk, coffee, bread). Presented in this fashion, it will not feel like your parents are in “need”, but are benefitting from a convenience.
a. Slowly, this person can ask if they would like her to “run to the store” quickly at the end of her day. Soon, she can suggest she bring them along to do the shopping themselves.
b. One day, this person can show up with a bag of groceries, stating they have a “surprise” and cook a meal WITH your parents (if they want). By this time, there should be a nice rapport and relationship, so this would be a fun activity to do as “friends.” Again, this is not a “need”.
c. Over time, this could build into a weekly/daily activity.
10. Introducing medication assistance. Once this person is in the home, they can ask to assist your parents with minor organization, such as placing their medication and other supplies in one location. Then, this person will have access to their medication and can slowly begin to monitor the medication to ensure it is being taken properly.
11. “It costs too much!” When/if your parents resist due to finances, there are a few ways to proceed.
a. You can pay yourself, if you have the money.
b. You can sit down with your parents and review their finances to reassure them that they have the funds. Look into tax write off’s for home health support.
c. If you have a banking power of attorney, you can make the payments directly so your parents do not have to see the bill.
d. You can find low cost support through a community agency.
e. You can arrange with the provider/aide that services rendered more often are at a reduced rate, making it more affordable to your parents.
f. IF you have discussed “assisted living” environments in the past, you can compare costs.
g. Be honest! You can talk about the risks that are currently in the home. Are your parents willing to end up hospitalized and then placed in a facility? Or, would they rather spend some money up front? Not eating well is a risk that can lead to hospitalization and subsequently a medical evaluation that finds the person incapable of living autonomously.
h. You can look at existing insurance policies to assess if there are funds available, or if the policy can be “cashed out” and used towards help.
12. Following up. When you ask your parents how this “housekeeping” is going, again, use open ended questions to encourage their verbalization of the benefits. For example, “What did she do today?” (“Oh, how nice!”) “Are there ways she’s helping you that you didn’t expect?” (“Oh, how nice”). If your parents do not want to “fess up” to all the things this person is doing, do not push it. Does it really matter? As long as they are getting what they need, you can find out from the aide/caregiver what she is doing straight from her!
13. Discuss your concerns lovingly. When you were a child, your parents encouraged you to make healthy and appropriate decisions. You are honoring them by behaving in the same way, making good decisions for their health and safety. Share this with them.
14. Be honest. Your parents will know if you are trying to “trick” them and this never works. If you’re introducing someone through the existing housekeeper, make sure that the new person and the existing housekeeper meet ahead of time so when she is introduced to your parents, you can honestly say they know each other. Or, if you give the gift of help, make sure you DO use it prior to honestly share what your experience was like. Dishonesty will always backfire.
15. Letting go. In the end, as hard as it may be, if your parents have the cognitive awareness as to the risks and benefits of their decisions, you cannot force, demand or bully your opinion into the situation. You may have to take a step back and wait for the “crisis” to hit. I know. Not what you wanted to read.
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