Navigating Tough Decisions in Elderly Care: Balancing Safety and Independence

Navigating Tough Decisions in Elderly Care: Balancing Safety and Independence

Podcast Transcription

[Harrison] Alright, good morning, Ms. Joan.

[Ms. Joan] Good morning, Harrison.

[Harrison] Hey, so I had a really interesting situation pop up and I wanted to run it past you. But the other day I was invited to a client’s home for a consultation by the son of a potential client and the situation kind of unfolded such that it presented a unique question in my mind that I was curious how you would think about it.

But essentially what happened was the son was looking into potential solutions for his mom as an interim step before considering memory care or assisted living. And in the course of the consultation, it became obvious that the client was going to be very apprehensive to care, having a caregiver coming into her home. It just wouldn’t work. She had some memory issues and was in a mental state where she just wasn’t interested in having anybody in the home setting with her. And so while we were talking together with the son, it became obvious that she was agitated at my presence and ended up kicking both me and the son out of her house. And so I had the opportunity to talk with the son in the garage just going over his journey and looking at potential care options for his mom. And one of the things he said was, you know, we went and looked at different facilities, Harrison, and on our way back from viewing some of the assisted living properties, mom said, I want to age at home, but if you guys consider putting me in a memory care facility or in an assisted living facility and take me away from home, I would rather die. I’d rather kill myself than leave home.

And so, obviously that’s a shocking statement coming from their mother, but it presents the family with a really tough decision. If she’s going to deny home care services at home, and she’s not going to move into a facility, She is at risk of falls and being in a bad position at home. How do you approach what the family should do or how the family should make a decision in the midst of a tough situation like that?

[Ms. Joan] That is a tough one. It’s not unusual, but it is tough. How big is the family? Is it just the son? Are there siblings, do you know?

[Harrison] Yeah. In this case, there were two other siblings and there was obviously disagreement about the state of their mom’s needs. And they feel like she’s more independent than she really is, right?

The son that I was talking with was really concerned about her safety, right?

So, you know, there was disagreement amongst themselves, but in the case that she’s home alone without assistance, falls, and really isn’t safe at home anymore, yet she’s denying the opportunity to go to a facility, you know, it presents a challenge.

[Ms. Joan] Was, what was your observation of her ability? Was she very frail?

[Harrison] I can absolutely see her being a potential fall risk. And if she has nobody there to help her with her ADLs and her everyday life, it might be a position where the family can’t check in very often, and therefore, because there’s no one else around, she might be alone for a while.

[Ms. Joan] Couple things. One is the family really does need to sit down together as a family and talk honestly about what they think could and should happen and possibly involving a doctor, cuz sometimes a doctor can tell a client, this is what you need, and they’ll listen to the doctor, but they won’t listen to their son or their daughter. But, you know, so that’s, you know, that’s some of the things, but if they can kind of talk through, and also talk through the what ifs, if in fact mom refuses, I mean you can’t. put her in handcuffs and drag her there, and she falls and, and dies or something, you know, what are, this is what she has decided to do.

But, so anyway, talking, having the family really sit down together, and then talking once they can, if they can come to some agreement. Then sitting down as a family with mom and talking very honestly about what they’re seeing and what their concerns are. And if mom still says, I don’t care what you say, this is what I’m doing. Then maybe, can you put in some safety things? If she’s, you know, are there neighbors that you can inform that, you know, she’s there? The police, is she apt to wander where you can give a picture of her and say, this woman has some dementia, we’re concerned about her. Does she drive, do you know, or does she?

[Harrison] No, they were able to take her keys away from her and ultimately sell the vehicle, but…

[Ms. Joan] So how does she get groceries and stuff? They bring them?

[Harrison] Yeah, the family’s bringing them once a week.

[Ms. Joan] Once a week. Okay. So, one, I had a neighbor who went through this with her mom for many, many months and the kids, she was the, as often as the case, the… Sister is the it, and one brother was just adamant mom was okay, the other brother was, you know, like this. And mom actually signed up finally in one place and backed out, and they went through just a lot of back and forth and back and forth and talking. And finally, the doctor got involved, and mama agreed finally to go, and I actually was doing some work at the community that she went to.

And she was as happy as a lark. I love it here. I’ve made friends. So, you know, if you can get through that. But she went kicking and screaming almost to it. So, it’s really being honest if they have… I mean, we’ve talked in past sessions about family dynamics. And you can’t change mama at this age. And if the relationship has always been a little strained, it’s not going to change. But just talking together with her what your concerns are. What do you want to do mom if you, if you fall, do you want to be resuscitated? I mean, if she has the ability to make some of those decisions, then you talk to her doctor and you agree on what is the short term plan. And then in the event she falls and hurts herself, where’s she going to go? And you kind of set in place those things.

Sometimes someone has to just go through some scary situations, you know, like lying on the floor for a while because nobody’s there. If she has the wherewithal to press a button to get her a pendant. Where if she does in fact fall she can notify somebody so you put in place some security things But just talking and continually talk to the point where if she gets to a place where she’s scared, had a close call she agrees. But I’ve seen situations where they just refuse to the very end and you can’t don’t do anything about it, you know, you really can’t change them.

If she’s gone to some places, sometimes most people don’t know the difference between assisted living, memory care, and a nursing home. And so if they have an ability to see what a nursing home, or what an assisted living community is really like in terms of things going on and you’re not like, locked in a room kind of thing, that can also open eyes. Another option maybe they could look into is if there’s an adult day program where she could go for a couple hours a day and be with other people if she’s willing to do that. Some of those places have transportation, and she could possibly have some quality of life issues if there’s a good adult day program nearby. But the only thing I have seen that works is just constant open communication, realistic, you know, mama, this is what you did. You left the burner on yesterday. You did this. If mother doesn’t remember, you just say, I’m sorry, you don’t remember this, but this is what happened. Because even if people have dementia, they are able to comprehend some stuff and learn. And so, you know, what are some things that they can do, you know, we’ve talked about safety in the home. What are some things they can do to make sure mama is safe? And then, you know, keep trying, you know, we’re concerned, you had this happen, you left the stove on, you did this, can we try once again to invite Harrison to come back and talk and see if just having a little bit of help makes it easier for you. But just continually talking and, you know, beating the drum to see if she will get realistic about what she can and can’t do.

[Harrison] Yeah, it was, it was an interesting meeting for sure. And it made me think about another situation where a client of ours was refusing to go to an assisted living facility and they couldn’t afford 24-hour home care, obviously. And the client lived on a lake and he would constantly want to go repair the dock and there were a couple of times where the neighbor witnessed him fall in. And it was one of those situations where there’s not a clear right answer because somebody can’t be offering him 24/7 oversight, yet the dock is unsafe, right? But you can’t prevent him from going to the dock, right? And so it’s one of those tough balances of safety versus allowing them to live life on their terms, even in the midst of cognitive decline. Right. And it’s a, it seems like a really hard line to balance, with families.

[Ms. Joan] It is a very hard line to balance. And, in the streak of independence for many older people, you know, the fear of becoming dependent is, you know, sometimes overrides their own sense of what they can and can’t do and should and shouldn’t do. But, you know, as I said, you can’t really, you really can’t force them. First of all, no community is going to accept them if they are forced to go. Because the next thing you know, they’re running out of the building. And even if you’re on a locked unit, they, I’ve seen people on locked memory care who just watch and they look just like you and I. And so, somebody, a family member comes in to visit and they say, Oh, hi, I’m just leaving. And they go out the door. You know? So, it’s sort of like you have to just, deal with where they are and, and I guess knowing what she’s always been like. I mean, is this new behavior or has she always been, you know, fiercely independent? And in which case, you know, if, if she falls and breaks a hip or something, you know, she knows that she made this decision against her family’s wishes. And, you know, you have to kind of, you don’t want to say, I told you so, but you have to just kind of say, sorry this happened, mom, but, you know, we tried to convince you to take some precautions. But again, you can’t force, but it just takes a while.

It took my neighbor, oh, probably six or seven or eight months before her mom went from that place, I mean, from absolutely denying, you know, wouldn’t let it, wouldn’t go any place, signed a contract and then broke the contract, to finally moving in and then becoming very happy. So, you know, it, it just was something that just took them a long, long time. And again, encouraging the son if she has a doctor that she feels confident in. Sometimes the doctor can really say to her, you know, you really need to, it’s my advice that you do this. And sometimes that will, that can make a difference sometimes if, if in fact they have that kind of relationship.

[Harrison] Yeah. So, takeaways I’m hearing is continue the conversation, right? Keep the line of communication open, talk about it, and especially in the case of cognitive decline, it’s possible that she may change her mindset at some point.

[ Ms. Joan] She might get scared, she might realize, you know, I, I did this, or I, I didn’t do this. And then again, she might not, you know, sometimes there’s a lot of denial, people are scared if they know they have dementia. They don’t quite know what to do with it, and so it frightens them, and so they’ll sometimes overreact in the wrong way. But sometimes they also have to just realize, or oftentimes some situation will arise in which they come face to face with what they realize is a poor decision.

[Harrison] Yeah, it’s a tough decision, but thank you for helping us think through the possibilities.

[Ms. Joan] I mean, there’s no, you wish you could just say, all you have to do is say this, this, and this, and it’ll happen. But, you just don’t know. But the threat to kill yourself, you do have to take it seriously. But it is also, you know, another thing that rightfully scares people and they back off. So, that’s why it’s not taking that into account, but just pointing out. I mean, if they bring the groceries and they can see that she hasn’t eaten all week, or hasn’t eaten much, you know, to say, Mom, I’m, you know, I, this is what we brought and you haven’t eaten and I’m concerned. And just, again, say, I’m concerned and let her go. And then, you know, just bring up the reality of what you’re seeing and then keep trying.

[Harrison] It seems like in senior care there are obvious do’s and don’ts and obvious things that are helpful and, and things to avoid. And then there’s situations like this that are just absolutely gray areas and there just doesn’t seem to be a right, you know, a perfect answer.

[Ms. Joan] And not an easy thing because when some older person digs his or her heels in, you know, you really have to, you have to try to honor it. And, you know, we often say, you and I don’t always make wise decisions, and when you get to be 90, you don’t always make wise decisions. And we have to face the consequences of the decisions we make.

[Harrison] Hmm. Well, that’s helpful. Thanks so much, Ms. Joan.

[Ms. Joan] Okay, I wish I could give you an easy out.

[Harrison] Yeah, I know, I know. Yeah, there’s no easy out.

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