"My 86 yr old father in law has been suffering from dementia for the past 6 yrs. My mother in law (79) has been taking care of him. He has been in rapid decline lately. We want to help her make a tough decision to either get home care or put him in a nursing home. She doesn’t want to let go of control. What’s the best way to approach this decision with her? An intervention? Offer up the options? What about having his geriatric physician make a recommendation? Any suggestions?"

Answer:  I think it is important to address the issue with her, and hopefully therefore avoid a crisis or worsening of the situation.  The specific approach very much depends on the personalities involved.  I think in all cases approaching it from a concerned and loving perspective, with thankfulness for all she does as a caregiver, and an offer that you wish to help.  An example of a statement that might be appropriate would be “Mom, you are doing such a great job caring for Dad.  However, because you’re doing such a great job, we don’t want to be neglectful in helping either and want to make sure we’re doing what we can to support you and Dad.  We thought it would be helpful to sit down and talk about how things are going, anything we might do for you and plan a bit for the future.”

Ask what her goals, fears, needs and concerns are.  Address some specific concerns you have.  You may have a lot of ideas and know some serious help is needed, but don’t bombard her with ideas/overwhelm her.  Plan a time and setting (and participants) to talk that will be least threatening (and perhaps plan for a loved one to take Dad on an outing or spend time with him while you have the initial conversation with her).  Reassure her that the control remains in her hands, and by perhaps getting a little bit of help, it will offer them the most/best choices.  For example, the idea of a nursing home may be very frightening to her, but perhaps someone coming in to help one day/week to start would be helpful.  You can offer to do leg work for her, but she can make the choices.  For example, if she agrees to getting a caregiver in to help—she can interview the caregivers (confirm this with any agency you contact, they should be able to make arrangement to let you meet potential caregivers—or help match based on criteria you set forth such as experience with dementia, strong housekeeping skills/cooking).  If she is open to looking at facility options or adult day care, for example, arrange tours so she can review.  She may have unfounded fears about some of these things, which you can help allay by sharing the realities.

If you feel you are going to “hit a brick wall”, you may also consider whether an outside party can help you in the discussions.  Who this is depends on her—who’s opinion would she listen to and respect?  The family doctor, clergy, a nurse that has been involved, someone within the family?  Another option is for your family to consult with a geriatric care manager.  He/she can help you strategize, but also explain what the possible options are and be available to answer any questions or concerns anyone has.  Geriatric care managers deal with a lot of reluctant clients and families and have the professional skills to counsel families through these issues.

I would also highly recommend the book, How to Say it to Seniors by David Solie.  It is a great resource and gives some specific examples and approaches to different situations with aging parents.

Shannon Martin, M.S.W., CMC
Aging Wisely, LLC
Clearwater, Florida
727-447-5845
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