How can we convince her it's for her independence?

Sandyb asked...

My Mother-in-law broke her hip and is in a rehab center. Her house was in terrible condition and we have been using the time that she is gone to fix up her room, Shower etc. to make it safer for her and to allow her independence.the problem is she does not want help or any improvements to be done and is acting very angry. Are there any suggestions how to break the news that we are doing it to give her independence not to take it away.

Expert Answer

Kay Paggi, GCM, LPC, CGC, MA, is in private practice as a geriatric care manager and is on the advisory board for the Emeritus Program at Richland College. She has worked with seniors for nearly 20 years as a licensed professional counselor, certified gerontological counselor, and certified geriatric care manager.

When an elderly person resents safety modifications made without her permission in her own home, I have two reactions. The first is indignant. She should be grateful that her children care about her enough to ensure that her home is safe.

My second reaction is suspicion. I imagine a mentally alert, older adult living independently in her home. She has an incident and breaks her hip, spends time in the hospital getting it repaired, and goes to rehab. If this person is alert and able to manage her life without assistance, why would she not welcome modifications made to her environment to prevent another incidence?

It's possible that she is a difficult person and resents anything anyone does for her. But, if she is mentally alert and oriented to reality, she must secretly realize that safety modifications are necessary to maintain her independence. If this is the case, she may complain about you interferring but secretly be pleased. My suspicion is that she may not be as cognitively intact as she appears. Beneath all anger is fear. She may be expressing resentment and anger but reacting to her fear that her environment has changed. People in early stages of dementia depend on the environment to provide sameness and structure. When that changes and things are no longer in their familiar places, it is threatening.

I suggest that you tell her what changes you have made before she goes home to find them. She may be angry. Accept that as justifiable. I'd be upset, too, if you remodeled my kitchen while I was away and din't consult me about the color scheme. Do not apologize. You can say that it is too bad that she is not pleased. Explain (only once) that you want her to remain in her home, and a second broken hip could cause her to lose her independence. Don't explain more than once because this means you are on the defensive and feeling guilty, and there is no reason for you to be. If she yells and become unreasonable, leave. If she is still angry, you may need to hire a taxi to take her home, rather than allowing her the opportunity to yell at you during the trip from rehab to home.

What I'm recommending is to allow her a reasonable response to having changes made without her knowledge and participation but not an unreasonable one. If she is verbally offensive, do not be there as a target.

To answer your question plainly, tell her what you have accomplished in her home in a loving way and allow her to be angry but not offensive. Be alert that there may be more going on than a broken hip, that her refusal to admit that modifications need to be done for her own protection may be warning signs that she is losing her ability to make good decisions. Do not accuse her or assume that she is senile - just be alert, and continue to be loving and supportive, to the extent that she will allow.