By Robert F. Bornstein, PhD and Mary A. Languirand, PhD

The caller was clearly upset. "I went to visit my sister at the nursing home the other day," she said. "I got so mad, I had to leave."
     "What happened?"
     "Well, you know she broke her leg last winter, and went through all that physical therapy. She was such a stubborn mule I felt bad for the therapist. 'Get up, Jenny! Hold on to the walker with both hands, Jenny! Look up, Jenny!' The guy had amazing patience….without him she'd just sit there like a lump on a log."
     "Uh-huh. So what's the problem?"
     "Well, now that therapy's done, that's exactly what she's become-a lump. She can walk, and she knows it, but she chooses to just sit there in that stupid wheelchair, and scoot around with her feet. She won't even use her arms to run the chair-it's ridiculous!"
     There was a long pause. Then: "I've told her that if she doesn't start using the walker and getting her butt out of that chair I'm not going to bring her home for Christmas dinner. Even that didn't motivate her! I could just strangle her….I really could."

Yep, it's frustrating…but really, really common. Fall and break something and most of us develop a powerful-and not entirely irrational-fear of further injury. It gets worse once we realize just how much effort, discomfort, and frustration is associated with getting back to normal functioning. After a lifetime of trusting that your body does what you tell it to do, it can be humbling-and a bit unnerving-to know that it doesn't always obey you, no matter how much you beg, or will it to be so.

Even worse, that basic, bedrock confidence that "I can do this"-be it standing, walking, or going to the bathroom unassisted-takes a nasty hit following an injury. You start to doubt that you can do anything you used to be able to do. Once you start getting some of your functioning back, you may embrace the notion that what you have is precious indeed, and realize that a whole lot of details, random events, and things you used to ignore could steal it all away again. A wet floor, ice, pets, a loose rug can all begin to seem rather like minefields.

What should you do? Ideally, you grit your teeth, gather your courage, buy shoes with good support, and get back on the proverbial horse (or walker, as the case may be). However, some people just find the threats too impossibly scary, and they surrender to inactivity.

So how can you help when your loved one stubbornly chooses not to do the things they need to do to maintain good health and independent functioning? There are four things you can do:

  • Acknowledge the fear It's really frightening to find yourself at the mercy of your body, and dependent upon other people for help. Empathize with the person's fears and concerns. If you've been injured, it's not silly or childish to fear further injury-it's natural. However, it isn't wise to let the fear take over.

  • Reinforce the goals When something is taken away, some people cope by minimizing the importance of the lost skill (saying, in effect, "I really didn't need it"). This can be adaptive for a brief period of time when there's no other alternative-such as during the initial phase of recovery when immobilization is essential for healing. However, as soon as it's safe, it's time to remind the patient how important that skill is to their enjoyment of life. "Use it or lose it" isn't quite the tone you want to take-you're not a drill instructor, and they didn't sign on for this mission. Rather, stress the things you know they really love, and how much they're going to enjoy getting back to them. ("Sure will be nice to get back to that golf course/shopping center/garden, won't it?")

  • Celebrate successes (even tiny ones) Recovery is neither quick nor smooth. 'One step forward, two steps back' is an apt description, and it can be very discouraging. So make a fuss over all successes, however small. While failure shouldn't be minimized or denied, accentuate the positive. It's possible that your loved one won't ever resume full pre-injury functional capacity, but if she can walk with a walker or a cane, it's something. Further, not everyone improves at the same pace, and your loved one may be a late bloomer.

  • Avoid the temptation to 'awfulize' While realistic acknowledgement of the negative consequences of missing their rehab goals may seem helpful, you can be sure the patient is keenly aware of these consequences, and doesn't need reminding. Let's be realistic: They won't be thrown out into the snow to die unassisted if they can't walk. They may wind up in a less-than-ideal situation or setting, relying on others for help with an awful lot of 'simple' things, but that's the worst that will happen. This outcome would be frustrating and unpleasant, but it isn't the end of the world.


Robert Bornstein and Mary Languirand are the authors of When Someone You Love Needs Nursing Home, Assisted Living, or In Home Care, published by Newmarket Press. The second edition, revised and updated, was recently released. Here's the link: