Note: This information is intended for situations where the older adult has the cognitive ability to make clear decisions for themselves.
Depending on the perspective of the adult child or the older adult, a paid in-home caregiver can be a fantastic idea or one to be avoided at all costs. There are legitimate reasons for reluctance and yet practical steps to help introduce a professional in-home caregiver.
Why an older adult may not want an in-home caregiver
Going from being an independent person to one that needs help Is hard. It can bring up complex feelings that touch on the core of one’s identity. In fact, most older adults initially reject the idea of help from a caregiver. Some of the reasons older adults decline in-home help may include:
- A sense of obligation to entertain or host the caregiver
- Hurt that “family doesn’t want to take care of them”
- Distress that accepting care makes them seem vulnerable
- A desire to remain in control, and not wanting someone to come in and “take over”
- Not wanting a “stranger” in the home
- Feelings of shame or embarrassment by the need to rely on someone else
Setting up the conversation
- Start by asking:
- Did you have the responsibility of taking care of your parents?
- If so, what was the experience like for you?
- Did you have to make any difficult decisions?
- Find out what that experience was like for them. This may help them to look a little deeper at your side of things. They may want to try to make it a better experience for you.
- Mention your increasing concern for their safety and well-being at several separate times before bringing up the idea of hiring a professional in-home caregiver.
- If possible, share successful personal stories of those who’ve received in-home help.
Be prepared that this is likely one of several conversations.
Starting the conversation
Pick an optimal time to talk and begin with a partner mindset, seeking to have a genuine conversation about the concept of in-home care. Try not to enter into the conversation with an agenda of convincing them they “should”.
Consider beginning with these points:
- Let them know how much you worry about them, how frustrated you are that you can’t always be there for them, and how much better you’d feel if you knew there was someone who could provide them with support.
- Communicate your stress and the impact that has on you, your family, your work, and your health.
- Describe how an in-home caregiver would assist both of you.
- Assure them that you aren’t abandoning them, but that you need help.
- Emphasize that in-home care will enable them to remain as independent as possible, living safely in their place of choice.
Cast a vision
Choose a few ways a caregiver could support them and highlight those points. Are they tired of dusting? Do they miss the cinnamon rolls at the coffee shop just past where they are comfortable driving? Are they sick of cooking, but miss that one recipe? Would they like someone to listen to them reminisce?
Responding to reservations
- Align with whatever reservations they have.
- State your desire to help them as much as possible.
- Take the conversation about any reservations further by asking a question such as, “Tell me more. What are you concerned about specifically?” Then listen and repeat what they’ve shared so that they know they’ve been heard.
Once the older adult’s concerns are understood, you may be able to help set up a plan that mitigates their specific concerns and provides support.
Easing into in-home caregiver support
- To make it more comfortable, consider having a trusted family member there for the first couple of visits.
- Bringing in a caregiver as a housekeeper, driver or cook and then easing into companionship or personal care can be a “gentler” start.
- If there are any, have them outline any areas of the home they don’t want the caregiver to have access.
- Start with just a handful of hours a week and increase over time as needed
Responding to a hard “no”
Most everyone wants to have as much autonomy as possible, for as long as possible. If the older adult responds to the idea of having in-home help with an adamant “no”, honor their answer and drop the topic. Consider asking if you can check in again about it at another time. Change is hard. They may warm up to the idea after thinking it over for a while.
If over time, the reply remains a hard “no” try to have peace of mind that you’ve done what you could and that you are honoring their desires. As hard as it may be, the consequences that may come from them not having the support at home will be theirs as well. They may still have chosen those consequences over bringing in professional in-home care.
If a doctor says they are not safe without a caregiver
In a situation where the older adult’s doctor is clear that they are unsafe without a caregiver, the one legally responsible for them is required to ensure a safe environment where their needs are being met. If possible, have the doctor communicate this message clearly and directly to the older adult. In a case such as this, in order to keep them safe, the responsible party may be required to make decisions that may not always align with the older adult’s desires. Likely there are many other ways where their wishes can be honored.
