Eldercare: Choices and Dilemmas

At some point, most people are called upon to assist an aging parent or other close relative who has become less able to manage on their own. Fortunately, caregiving options for older adults have expanded so that it is no longer just a choice of living with relatives or going to a nursing home. Many seniors are keeping a high level of independence and good quality of life through home-based healthcare services, rehabilitation centers focused on restoring adaptive functioning after an illness or injury, and assisted living facilities that might have a “step-up” option for residents who end up needing nursing home care. But being able to choose among several options can add another layer of confusion to what can be a difficult, emotionally-loaded situation for all concerned.

It is always painful to acknowledge that a frail or debilitated loved one will probably never get “better” enough to be completely independent again. The prospect of moving to a setting that offers more medical and/or practical support brings with it many losses – one’s home and neighborhood, nearby friends and activities, even the grocery story that one has visited regularly for so long…. When all family members including the senior are in agreement about how to proceed, they can at least provide each other with emotional support and do their grieving together. Unfortunately however, many families have trouble facing the reality of an elderly person’s declining health or accepting the fact that (major or minor) adjustments will have to be made to ensure their care.

Sometimes there is a well-entrenched denial system that has propagated dysfunctional family dynamics (usually involving untreated addictions or mental illness) for many years. These psychological defenses can obscure what should be obvious: that the elderly person’s health and safety might be at risk without additional support and monitoring. Or, the denial system can just keep everyone too paralyzed to take decisive action. The effect is that some relatives might avoid the senior altogether…or fail to recognize their poor functioning…or react only in a crisis…or leave one person to do all of the caretaking (emotional, practical, financial)…or get so mired in conflict that nothing can be decided or resolved.

Often, it is the aging person who resists any attempt to intervene on their behalf. No one wants to become dependent, but there is a point beyond which fierce determination to stay well becomes maladaptive stubbornness and denial. This can be related to various factors including fear of change, shame over admitting the need for help, or poor judgment due to decreased cognitive functioning. Rigid personality characteristics can also play a role. Some people spend their entire lives refusing to let others help them, holding on to a fantasy of strength and invincibility despite any evidence of declining (physical and/or mental) health. Others have an unconscious wish to become increasingly dependent on loved ones – so it is more gratifying to have their adult children scrambling around to take care of them vs. being assisted by a hired companion or nursing aide.

Adult children and other relatives can be left wringing their hands over seniors who insist on living alone despite some of the following issues:

  • increased risk of falls and other accidents in the home;
  • being unable to maintain good nutrition or hygiene;
  • inability to manage medication or other aspects of one’s health condition(s);
  • social isolation that degrades quality of life and increases vulnerability to depression;
  • being unable to maintain the home and living environment at an acceptable level;
  • making poor financial decisions and possibly being subject to fraud or exploitation; or
  • driving when poor general health or cognitive/motor/sensory deficits make it unsafe.

While the elderly person might agree in theory that it would be helpful to get more structure and support, it can seem that there is “no good time” to go forward with making such arrangements. Often no action is taken until there is some precipitating crisis (e.g., being hospitalized after a fall), which makes the process that much more stressful and chaotic. Meanwhile, many frail seniors try to get by with a bare minimum level of support, leaving worried loved ones to anxiously hover and “put out fires” as problems arise. Sometimes arrangements are made for the aging relative to get extra help, only to be sabotaged when they keep firing home health aides or acting so disagreeable that no one will stay.

Anyone who is trying to assist an aging parent or other relative should consider getting professional consultation, either from a government or non-profit agency focused on elder care, or a mental health professional who specializes in geriatrics. Such consultation can provide: evaluative feedback regarding the elderly person’s needs and functioning; recommendations on care-giving services (including living options) that take into account the person’s financial situation; and help with addressing any family dynamics that might be keeping everyone “stuck.” While working to ensure the best possible care for aging parents and other loved ones, adult children must maintain some balance so that their own needs do not get completely obscured. Even with hired assistance up to and including nursing home care, assisting a frail or debilitated elderly person is a relentless demand. Many caregivers get burned out physically and emotionally because they don’t “calibrate their efforts” in relation to other responsibilities (e.g., job, spouse & children) and their own health/ wellness concerns.

One must take into account emotional and psychological issues that could be exacerbated by too much caregiving responsibility. Those struggling with depression, severe anxiety, or addictive/compulsive behaviors should make it a priority to address these issues, even if it means being less available to an aging relative. Some of the toughest dilemmas arise when mental health problems are partly attributable to childhood abuse, neglect or abandonment – and now the adult child is being called upon to take care of the parent/relative who inflicted the harm. If there is a desire to help despite any past hurts, it is reasonable to maintain more limited involvement (e.g., managing finances or administrative affairs rather than having frequent social visits) to allow continued focus on one’s own recovery process.

Generally, networking with others who are caring for elderly relatives can provide invaluable information and support. Eldercare support groups are offered through community agencies, nursing homes and assisted living facilities, and some workplace employee assistance programs. As the population ages, eldercare issues are drawing increased attention, challenging families and communities to develop creative solutions that keep vulnerable elderly people both safe and connected.

Aging and Elderly Resources

Alzheimer’s Association800-272-3900
American Association of Retired Persons (AARP)202-434-2277
Maryland Department of Aging800-243-3425
National Family Caregivers Association

301-942-6430 or

800-896-3650

National Association of Area Agencies on Aging -Eldercare Locator Service800-677-1116
National Institute on Aging (NIA) Information Center800-222-2225
Office on Aging – Information and Referral Services

Alexandria

703-838-0920

Fairfax

703-324-5411

Montgomery County

240-777-3000

Prince George’s County

301-699-2696

District of Columbia

202-724-5626
United Seniors Consumer Cooperative202-479-6973