When Extra Help is Needed:
Raising a Sensitive Issue With Someone You Love

Robert F. Bornstein, PhD & Mary A. Languirand, PhD

We live in a culture that values autonomy and self-reliance-it's part of the fabric of America. This is one of the main reasons why growing old in our society can be especially difficult: Successful aging requires us to rely on others for help with the little things (like driving to the grocery store), and sometimes with the bigger things as well (like getting to and from the bathroom). But most of us are not that good at asking for help-we don't want to appear needy, helpless, or weak.

How to Raise the Idea of Extra Help and Care

Discussing the prospect of in-home care with an aging partner, sibling, or parent is never easy or pleasant, and there's nothing we can do to change that. Raising the idea of assisted living or nursing home care is even worse, and quite likely to elicit a negative-even hostile-response. This conversation will never be easy, but by following a few guidelines, you can make the discussion go as smoothly as possible

Who should participate?

To answer this question, you need to think about how the person in need of extra care reacts to unpleasant news. If you know from experience that this person is likely to be persuaded by a united front of family members, then raise the issue as a group. If you think the person would be most receptive to one or two people, then those people should meet with the person privately.

Where should you meet?

Choose a meeting place where you'll have privacy and no interruptions. It should be a place where the person feels safe and comfortable, such as her home. Avoid intimidating settings like a doctor's office, and definitely do not raise the issue in a public place like a restaurant. That's just asking for trouble.

When should you do it?

You might not have a lot of leeway here, particularly if the problems are pressing. If a group or large family meeting is needed, it's likely that no time will be convenient for everyone; just do the best you can, and fill in the no-shows later. Whatever time you choose, make sure everyone clears his or her schedule. This is not an appropriate setting for people to take phone calls, check in with the kids, and so forth.

Common Objections to Receiving Extra Help

Chances are, your loved one will be scared and angry when you raise the prospect of extra help and care. Can you blame her? Put yourself in the care receiver's place-you'd probably respond the exact same way. Here are the kinds of objections you're likely to hear at this point, along with some suggestions for dealing with them:

I don't need help.

"I was just having a bad day." "I had the flu." The possibilities are endless. To counter these, let your loved one know that your concerns didn't arise from a single incident, but from a sustained pattern of behavior. Use specific examples to illustrate your concerns. Be ready to show that you're not overreacting to a single event, but to a series of problems that indicate a clear need for help.

My brother needs me

This might be true, but it doesn't change the fact that your partner or parent now needs help as well. If your loved one has been the primary caregiver for an ailing spouse, or a handicapped sibling or child, you're facing an especially thorny predicament. You might have to seek services for two people instead of one, and they might not be eligible for the same type of care.

You wouldn't do this if your father were alive.

This statement will tug at your heartstrings, but it is an easy objection to counter if you recognize what she's really saying. The implication, of course, is that you're taking advantage of a helpless person. Explain to your loved one that you're not trying to get away with something-you simply want her to have the best possible care. And point out that she is hardly helpless. The fact that she's fighting with you over this is proof of her independence.

After all I've done for you.

The implication here is, it's payback time: She took care of you, now you do the same for her. Your best strategy is to reframe the situation so the person can see things differently. You are paying her back-not by caring for her yourself 24/7, but by doing whatever is needed to ensure that her needs will be met as fully and safely as possible.

Developing a Partnership With the Care Receiver

Understanding the care receiver's fears and concerns will help you develop a partnership-a "working relationship" that is invaluable when difficult decisions must be made. Several strategies are useful here:

Reaffirm the value of the care receiver.

Don't assume the care receiver understands your motivations. In fact, she may be assuming the worst-that you're just trying to get rid of her, or get her out of your hair. Tell her why you're doing this: Because you love her, you're concerned about her, and you want her to be safe, comfortable, and happy. You might need to provide this reassurance many times-perhaps every time the care receiver feels threatened or frightened-but that's OK. If it makes the person feel better, say it again.

Put the care receiver in charge.

To help the care receiver feel that she still has control, let her know that the family is her caregiving team, and she's the CEO. Her needs and desires are central to the decision-making process-they will never be ignored. She might not be able to have everything just the way she'd like it, but the primary goal of the team is to preserve her vision of the future-whatever it may be-in the context of current realities.

Clarify everyone's role.

Once you've put your loved one in charge of the operation, clarify everyone's role within the organization-who'll do what, who answers to whom, and so forth. Draw an organizational chart if you have to, with the care receiver at the top. Put everyone's name where it belongs on the chart, with their telephone number and email address alongside. When something goes wrong, she'll know who to contact.

Put it in writing.

If the care receiver continues to express concerns about loss of freedom and autonomy, she might appreciate a written "contract" with the family, indicating who's responsible for what tasks (driving her to church, feeding the cat, etc.). Don't make promises you can't keep (even an informal contract may be legally binding), but everyone can benefit from a written agreement. Everyone (including the care receiver) should sign the contract, and everyone should get a copy.


Robert F. Bornstein and Mary A. Languirand are the authors of When Someone You Love Needs Nursing Home, Assisted Living, or In Home Care, published by Newmarket Press. The first edition, released in 2002, received the 2003 Caregiver Friendly Award from the National Association of Caregivers. The second edition, completely revised and updated to incorporate cutting-edge trends in late-life health care, was published in 2009.
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