Family members will often assist older relatives, through direct and/or professional care, as their needs become evident. This is a wonderful way to help an individual live at home as long as reasonably possible, while maintaining a sense of independence. Being in the place in which someone has built valuable memories feels comfortable, and is often preferred. As the time and energy spent on keeping a loved one at home gradually increase over time, it sometimes gets to the point that the recipient of this care does not realize just how much is being provided.
I spoke with a woman struggling with a choice her frail mother is making. The 90-plus-year-old woman wants to unnecessarily “house-sit” for a relative who will be away for a month. The house is in a city that is a nine-hour drive from the supportive family members who have been assisting her with all of her daily routines. There is always someone putting out the cans on trash day, taking her to appointments, preparing her meals and spending the night for reassurance. Her driving skills in her small town have substantially decreased, yet she still considers herself able to tackle the freeways of the large city.
Her family has kindly made it so easy for her that she does not have a sense of the assistance she truly needs. Her children have pointed out the reasons they are concerned, and even though they have advised her against going, she insists. I suggested pulling back in all of the ways they have been giving her a false sense of independence, so she can see for herself just how valuable and necessary it is to have family closeby. If it is more obvious to her that she needs assistance, she may be more accepting of her limitations.
When an individual has some type of cognitive impairment, such as dementia, it’s a bit easier for the family to feel validated to step in and make more reasonable choices for their loved one. In a case like this one, in which the older adult’s risky choices stem more from overly optimistic expectations, the lines get blurred. She has the right to make her own choices. Unluckily, the dangers that lurk within this living situation will not be clear until they arise, and at that point it may be too late to protect her.
So, what is her family to do when she has the right to make this potentially dangerous choice for herself? Along with clearly stating their concerns and pulling back on their assistance in her daily routine, they simply may have to let go and let her experience the consequences of her choices. I have no doubt that if an emergency arises, the family will pull together and support her. In the end, she is still in charge of her own choices and is entitled to take her own risks. One thing that I will say absolutely needs to happen is that the car keys are nowhere to be found so she cannot endanger anyone else on those busy city streets.
Karyn Clay is a gerontological specialist who began caring for older adults 23 years ago and earned her B.A. in gerontology from SDSU in 1998. She founded HooNani Day Center in 2002 and Ho’oNani Care Home in 2015, which are located on the same property in Waimea. She invites readers to join her Caregiver Conversations gatherings at Tutu’s House the first Wednesday of each month.