If you are concerned about your loved one being resistant to having crucial conversations with you about end-of-life issues, you might hesitate to bring up the subject.
Talking about aging and end-of-life issues with an ailing loved one is not easy for most of us. Many of us avoid this conversation altogether until we actually face difficult end-of-life issues and decisions for a loved one need to be made. Having crucial conversations now, while your loved one is relatively healthy, will make it easier if and when you or your loved one is faced with a sudden and unexpected health emergency. The way in which you approach having these conversations is crucial to creating a plan that spells out clearly how matters will be handled in the future. Such a plan is empowering for all involved.
In many aspects of caregiving, resistance often comes into play, and you will need to address this resistance when fulfilling the role of a caregiver. When I cared for my dad, one of the toughest challenges I faced was his resistance to care. How do you help a loved one who doesn’t want or resists your help? I had to learn and understand why my dad was resistant and develop new strategies to gain his cooperation.
This article will provide you with the necessary tools to have crucial conversations with a resistant loved one, and it will also provide tips to help you deal with resistance that comes from either your loved one or other family members.
When Your Loved One Is Resistant
Have you ever thought about why your loved one is resistant to receiving care or having crucial conversations with you and other family members? It could be due to the fact that he or she may be dealing with a personal loss, such as a spouse, physical loss, mental loss and/or the fear of losing his or her independence. It could be that your loved one may feel that having a crucial conversation about end-of-life with you might signal he or she has to relinquish their privacy and adjust to new routines. Or it could be that your loved one doesn’t have a solid relationship with you and/or other family members. Or maybe it’s connected in some way to the fact that your loved one’s friends have all passed away. Or your loved one could be in the early stages of dementia. Or perhaps your loved one doesn’t want you to know about a chronic condition he or she is suffering from. And it could very well be because he or she is afraid of:
- You taking away his or her car keys
- Losing his or her way of life
- Getting old
- Not having any financial assets to help you
- Being a burden on you
- You taking all his or her financial assets
- Having you as a caregiver
- Being thrown into a nursing home
How to Help Your Loved One Overcome Resistance
To help your loved one overcome his or her resistance to engaging in crucial conversations about aging and end-of-life issues, illustrate for him or her the importance of planning ahead by asking these questions:
- If you suddenly and unexpectedly get ill, who is going to take you to the hospital?
- What kind of care do you want in the future?
- Where is the money for hospital care and long-term care going to come from?
- And finally, what are your desires regarding your funeral?
- Who is going to pay for it?
Aging loved ones should be reminded that if they don’t have these crucial conversations with adult family members while they are still well, all hell can break loose when they are too ill to intervene, as family members may express different desires and stress each other out. As a concerned family member, keep in mind that you must be very patient and gentle with your loved one in the early stages of discussion, when they need your help the most. Trust is a major factor for your loved one—after all, your loved one is putting his or her life in your hands—and so his or her resistance may very well dissolve as trust in you grows.
Another strategy for bringing your loved one on board is to share with him or her what your wishes are for your own end of life, and to explain that you have started thinking about how your own final wishes can be realized when the time comes. After all, you should not expect your loved one to do something you have not done for yourself. You will find that the crucial conversations are much easier when you have actually contemplated your own end-of-life stage and described it to someone else.
Strategies for Effective Crucial Conversations With a Resistant Loved One
The following strategies will help you enter into that first conversation about aging and end-of-life matters with a resistant loved one and make it productive. First, tell your loved one that you would like to set a time for the two of you, plus other members of your family, to have a crucial conversation about how you are all going to prepare yourselves emotionally, financially and legally to avoid sticky end-of-life issues. Once you have agreed upon a time for the conversation, schedule a family meeting.
Remember never to hold this type of meeting on or around a holiday. This subject is too heavy for a holiday. Next, select two or three family members who are confident and qualified to lead the conversation. (Remember, this is not an easy conversation, and not everyone is equipped to do this.) Remind family members beforehand that they must have only your loved one’s best interests at heart.
Once the meeting gets under way, ask your loved one this question: “If I had to handle a sudden and unexpected health emergency for you, what is the most important concern you would have?” Allow your loved one to articulate his or her biggest concern, and then ask why this concern in particular is so important. Next, ask your loved one to relate his or her wishes for end-of-life care. Then share what your wishes are for your loved one’s end-of-life care, and allow your family members to air their wishes for your loved one, as well. The point is to allow everyone to feel that they have a say-so regarding the issues that might arise during end of life. This approach will help your loved one feel that he or she is not being pushed around by family members, and that he or she has a say regarding the care received. Making this initial crucial conversation a family affair will foster greater participation in future and will set the stage for a better outcome. And it will steer your aging loved one away from the notion that “it’s all about him or her” and toward the realization that “it’s a family affair.”
Before the meeting ends, be sure to share with your loved one and other family members what might happen if you do not come together and preplan. Share only facts, and don’t resort to scare tactics. (Do not ever threaten or use scare tactics when talking with a loved one about end-of-life issues or decisions.) These are some potential pitfalls of a lack of preplanning:
- Family rivalries and dissension could reach an all-time high as each person tries to have his or her wishes for the loved one carried out. If problems between family members exist, those relationships could go from bad to horrid.
- If you or your family members are uncomfortable about having this crucial conversation, an alternative is to enlist the aid of a geriatric mediator or a geriatric attorney. Have them come to your home, meet with your family and provide everyone with the necessary tools and resources to help in the decision-making process. A geriatric attorney can also ensure that you have the necessary legal documents in place to protect both you and your loved one.
Keep the following points in mind:
- If there are family members who are unsupportive and who will not cooperate, definitely seek legal counsel.
- Hire only professionals who are experts in geriatric care to assist with the emotional, financial and legal matters surrounding your loved one’s end of life.
- Caregiving Empowerment Strategy Training Courses are available online. You can get the help you need at CaregiverStory.com.
Other Strategies for Effective Crucial Conversations With a Resistant Loved One
If your loved one refuses to accept that he or she is in poor health, and thus sees no need for crucial conversations, make a dramatic case. When approaching your loved one, it is best practice to have some proof substantiating your concerns, such as pictures, letters or other documents, for your loved one to review. An example would be showing your loved one a photograph of himself or herself taken a month earlier, and then showing him or her a photograph that was taken that week or that day. Your loved one will clearly see how much thinner or unhealthy he or she appears to be in the recently taken photograph. Remember, a picture is worth a thousand words. When you use show-and-tell to convey your concerns, your loved will eventually trust you, knowing you have his or her best interests at heart.
Describe “caring” in a positive way. You may consider describing respite care as an activity your loved one likes. Talk about a home-care provider as a good friend. Also you might describe elder care as a seniors’ country club, or refer to your loved one as a volunteer or helper at the country club. Never give up on your loved one. If he or she doesn’t want to discuss the topic the first time you bring it up, try again later.
When your loved one acknowledges his or her medical conditions but still refuses to tell you about them, be patient. Voice your concern and offer your help. Know that your loved one will eventually come around.
Enlist the help of family members. Family and friends might be able to help you persuade your loved one to accept help. What should you do if your loved one refuses to tell you if he or she is being abused or if he or she refuses to tell you if he or she does not like his or her doctor, assisted living or long-term care facility?
Listen, listen and listen to your loved one. When your loved one tells you that he or she does not like a particular doctor or a staff member at a long-term care residence, make certain to ask him or her why, as abuse could be the root cause. Also, make sure you are aware of any bruises or cuts on your loved one for which there is no explanation. These could very well be telltale signs of abuse. If you believe that a doctor has abused your loved one, contact your state medical board. If you believe your loved one has encountered abuse at a long-term care facility, report, report, report your findings and concerns to the facility’s higher-ups, your state’s long-term care ombudsman and/or adult protective services. They will conduct an investigation to get to the bottom of your concerns.
Reasons for your loved one’s resistance Is your loved one resistant because:
- Your loved one is dealing with a personal loss, such as a spouse, physical loss, mental loss and/or fear of losing his or her independence?
- He or she does not want to relinquish his or her privacy?
- Your loved one does not want to adjust to new routines?
- Is your loved one in the early stages of dementia?
- Your loved one wants to keep his or her chronic condition a secret?
- Is your loved one afraid of you taking away his or her car keys, losing his or her way of life, getting old, not having any financial assets to help you, being a burden on you, you taking all his financial assets, being thrown into a nursing home, dying?
Strategies to Overcome Resistance
- Have you scheduled a family meeting?
- Has your loved one been included in the family meeting?
- Are you holding the meeting during a neutral time of the year (not around the holidays)?
- Have you given your loved one an opportunity to voice what he or she believes is his or her biggest health concern?
- Have you made your loved feel like his or her opinions matter?
- Are you honest with your loved one?
- Have you refused to use scare tactics to facilitate your loved one’s cooperation?
Strategies to Overcome a Refusal to Communicate
- Have you made a dramatic case to your loved for why he or she should communicate his or her health concerns?
- Have you described the idea of “caring” to your loved one in a positive way?
- Have you made it clear to your loved one that you will not give up on him or her?
- Are you patient with your loved one?
- Have you enlisted the help of family members to persuade your loved one to accept help?
- Have you listened to your loved one’s concerns?
By Carolyn A. Brent, MBA
Author of The Caregiver’s Companion
Excerpt. © Reprinted with permission. All rights reserved