Caregiver Connection
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What to do when your loved one resists plans and help

Posted 11/13/2018 by Fallon Health

By Emily Lemire, M.S.W.

It’s not easy to take care of another adult, especially while managing other responsibilities and, ideally, taking good care of yourself, too. Stress comes at you from many directions.

There’s one source of stress that often takes caregivers by surprise—a loved one’s resistance to help and suggestions.

Although noncompliance and active defiance probably aren’t reactions you expect, they’re not unusual at all. A person who’s having a physical or cognitive decline may:

  • Push away their family and friends
  • Ignore medical advice
  • Continue to do things that are no longer safe
  • Say hurtful or inappropriate things

Your loved one’s responses may make it more difficult for you to provide necessary care or safety measures. The resistance and negativity your loved one expresses may also bring up feelings you wish you weren’t having: anger, impatience, guilt, confusion, frustration, depression.

Try to see their side

From your perspective as a caregiver, it may seem that everything would be much better if only your loved one would stop being unreasonable and start cooperating. But the difficult behavior you see may actually be your loved one’s attempt to keep control and maintain a sense of autonomy.

Look at the situation from your loved one’s perspective. Whether physical or cognitive, decline can be accompanied by a strong sense of loss for the person experiencing it. As the ability to do things independently declines and dependence increases, frustration can grow.

Driving is a common pain point. If you haven’t dealt with a loved one who continues to drive long after it’s advisable, then you probably know someone who has. The tangible and symbolic loss of independence that goes with giving up driving can be difficult to accept. Many refuse to look objectively at their driving, because they fear that they’ll have to admit it’s time to stop. And they recognize that, when they turn over the keys, their dependence on others will grow.

Don’t dote too much

Sometimes when your loved one is coming across as resistant, it may be an effort not to be a “burden.” For example, one woman I worked with has cognitive loss but knows how the situation is affecting those around her. Her anger and frustration come from the fact that she can’t escape being reliant on them. 

Her family’s response is to dote on her, and the woman takes that as a confirmation that she is a burden. In that situation, it can help to pull back a little and let other family, friends or professionals do some of the work of caregiving, so you can work at other parts of relationship and keep it healthier.

Make decisions together

Even if you’re not able to strike a perfect balance, trying to understand the emotional conflict your loved one is experiencing—while also being practical and effective in managing their care—can go a long way toward calming the situation.

I regularly encounter families who say, “We want mom to go to an adult day health center five days a week.” Yet when I ask whether their mom also wants that, I often learn that no one has asked her. When she finds out that they haven’t consulted her on this important decision, she becomes resistant to the idea of going to a center at all.

They’re not necessarily leaving mom out of the decision process intentionally. They’re trying to find efficient and effective solutions for the situation they’re in. That alone can be consuming.

While there are some decisions, of course, that need to be made quickly, I believe the person receiving care should still have a voice—even if their thinking is not as ordered, and even if their desire is unrealistic. The more decisions you take away from them, the more things they have to acquiesce to, the more they’re going to feel resistant. They’ll feel like they’re losing control and no longer being treated as an adult.

And whether or not they are able to articulate their feelings, sometimes they will have the upsetting and uncomfortable feeling of being a burden for you.

Enlist the help of friends and family

If your attempts at discussion are resulting in your loved one feeling angry or resistant, it may be time to look at the situation from a different angle.

Sometimes a person rejects his or her caregiver’s advice, but will accept that same advice from a different source. Is there someone else your loved one may listen to? A friend? Neighbor? Relative? Enlist that person’s help and support with the conversation.

Maybe you have a friend without a driver’s license who uses taxis or other ride services to keep some independence. Or maybe a relative has a calming demeanor that can help set and maintain the tone for an important conversation between you and your loved one.

You may also want to invite others to become more involved in helping with your loved one’s care—that’s another way to ease the stress on you and on your relationship.

Talk to health care providers

You can also ask a doctor, physical therapist, pharmacist or other health care professional to speak to your loved one or recommend an approach for managing your particular situation.

Health issues and medical treatments may also affect behavior and attitude. Check with your loved one’s health care providers to see if that could be the case. If your loved one is displaying aggression or physically abusive, contact his or her provider immediately.

Remember you’re not alone

Although it doesn’t always feel like it, there is a village of people around you who can help you care for your loved one. Reach out to them for help.

Emily Lemire, M.S.W., is Manager of Social Work for Fallon Health’s Summit ElderCare program in Lowell, Massachusetts.

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