Caregiver Connection

What to do when your loved one needs additional care

Posted 04/10/2019 by Fallon Health

By Diane Paseos, M.S.W., LICSW, CDP

A pot left too long on a hot stove. A slippery rug in the bedroom. A door left unlocked overnight. What consequences could these types of hazards have for the older adult in your life?

Perhaps it’s time to increase their level of care and maybe even hire professional caregiving help. But how do you bring up the subject? What can you do to minimize your loved one’s fear of having to move, lose more independence or increase financial obligations?

Here are some recommendations to consider:

Start early. Don’t wait for a crisis. Talk about the possibility of increased care before your loved one needs it. In an urgent situation, you may need to make decisions quickly with limited choices, causing you more stress.

Ideally, you’d want to have these discussions when all decision-making parties are calm—not under emotional distress. And you can think more clearly and make better decisions when you don’t have time pressure. It‘s important to keep other family members informed of your discussions, and involved as much as possible, so everyone is aware of how future needs will be met. As your loved one may need more care, the plan will be clear. 

Get other family members involved. If you have siblings or other relatives who are involved, ask for their advice and support. Getting others involved can decrease the burden on you, reduce stress and eliminate some surprises. As a caregiver, it’s important to reflect on how much you can realistically do—and to ask for help when you need it. It can be helpful to ask others to become involved so they develop a sense of your loved one’s care needs.

Write down your thoughts. Organizing your thoughts before speaking with your loved one can help you be clear and succinct when the time comes to have this conversation. Consider sharing your thoughts with a trusted relative or friend beforehand to get their input. You could even practice the conversation with them first.

Enter the conversation with options, not with decisions that have already been made. Involve your loved one in the process. Empowering your loved one can soften the blow if there will be a loss of some independence.

Be empathetic. If your loved one feels sad or frustrated about the situation, let them know you care about how they feel. You may not be able to put yourself in their shoes, but you can tell your loved one you know it’s hard for them, and that their feelings are important.

Be inquisitive. If your loved one resists help and doesn’t want more care, ask questions to find out why. Let your loved one have time and space to talk about their emotional response to this change. Acknowledge their feelings. Let them know what additional support is available for them to maintain the most independence possible. 

Let them know your first priority is their safety. Safety is paramount. Being in a safe environment helps your loved one avoid hospital or skilled nursing facility admission as a result of injury. Take a look at your loved one’s home and see what changes you can make to prevent falls. Staying as healthy and mobile as possible will help your loved one avoid an increased need for care, resulting in an even greater loss of independence.

Emphasize that no decision is permanent. If a new care situation is not working out, the family can discuss it and find alternatives. Let your loved one know that there are other choices, and that your family is willing to consider alternatives to the plan as his or her health improves or declines.

Don’t promise your loved one that nothing will change. It’s impossible to predict what tomorrow will bring. Having to break your promise can easily result in hurt feelings, mistrust and anger if your loved one feels betrayed or let down. And you may feel guilty if you have to go back on your word.

Prioritize what needs to be done. Determine which tasks are urgent and which can wait. Ask family and friends for help with the urgent tasks. Or find outside sources. Then the non-urgent tasks will be easier to manage.

Even though you’re trying to keep your loved one as independent as possible, they may be feeling overwhelmed or frustrated. They may even refuse aspects of important care needs. Have discussions with your loved one, depending on their cognitive ability, about what is important in the moment and what can wait. Encourage them to get through the tasks that need to be done now. Then take a break and go back to the less urgent responsibilities later when the frustration level is lower.   

Let your loved one make their own choices, as much as possible. Allow your loved one to do what they can independently, such as completing a chore, getting ready in the morning or making a sandwich for lunch. Including your loved one in decision-making, depending on cognitive functioning and ability, is empowering.

Diane Paseos, M.S.W., LICSW, CDP, is a Behavioral Health Case Manager for Fallon Health’s NaviCare program.


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