How can I get my mother an in home aide without offending her?

4 answers | Last updated: Oct 11, 2012
Sarao asked...

My mom has dementia, and is headed towards Alzheimer's. She is getting less and less lucid each day, but is still functioning well (driving, some cooking) although she can't keep her own schedule and has forgotten how to do many basic things. She also falls -- a lot. She has also picked up smoking again. We feel an in-home care person is going to be important soon, but she is still too aware for her not to notice and be offended by this. How should I handle this sort of transition to getting daily care for her without offending her?

Expert Answers

As Founder and Director of Circles of Care, Ann Cason provides caregiving, consulting, and training services to individuals and public and private organizations involved in eldercare. She is the author of Circles of Care: How to Set Up Quality Home Care for Our Elders.

Thank you for asking this question. Many adult children fear offending their parents. I picture your mother standing on the edge of a cliff,  shaking her fist..  She is shouting, I will drive, I will smoke, I won't go to the doctor. She struggles to maintain independence while you struggle for her safety.

The time is approaching when you must say to your mother,  "Mother, I love you.  I have to keep to safe."  Then you have to tell her that it is not safe to drive anymore.  " We have to get someone to drive for you and cook a meal." 

But don't go alone to tell your mother.  Do you have a sibling?  Do you have a partner?  Do you have a friend that your mother trusts. Or do you have a minister?    With this other person, create a supportive environment.   Sit, drink tea, relax, then speak directly.  "Mother your memory is not so good."  When she gets angry, sit quietly.  Don't lose your temper or get into a shouting match.  Let her anger rise and fall.   Be warm and relentless in your insistence.   "Mother, you are falling down. I am afraid you will break a hip.  I don't want you to suffer"

You will have to do this more than once. She has to get used to the idea.  With dementia in home aides may need to be taken to meet your mother more than once. You may have to go with the caregiver several times as she begins to work with your mother. She has to gradually see the value for her. I suggest you watch the old movie, Driving Miss Daisy.  Also, my book, Circles of Care, has many examples of how others worked with dementia.

  It does sound as if your mother needs more medical attention.  Dementia going into Alzheimer's does not sound like a medical diagnosis. Also, why is she falling? After a complete check-up, it might also be decided that she needs a geriatric psychiatrist. 

Sometimes people who suffer from dementia may take up smoking as a comfort. Your mother may feel terribly lonely.  Take her to lunch or shopping or to an art showl. Maybe you could go out for coffee.  Spend time with her without an agenda so that she can enjoy your company. 

Also, I would suggest a Professional Geriatric Care Manager who has experience with dementia and  knows the services in your part of the country. If you can't find a care manager, go to your Area Agency on Aging or the Visting Nurse.  You will need quite alot of support during the last years of your dear mother's life. 



Community Answers

Frena answered...

i really also encourage you to get a full alzheimer's workup for your Mom. all alzheimer's is dementia but not all dementias are alzheimer's. beside which, lots of other things look like what people think of as alzheimer's. the work-up helps to identify some of those other things. falling is not a usual part of alzheimer's, so she is very likely to have other important health issues to account for that and possibly even to account for the appearance of dementia. Medicare pays the whole cost of the work-up.

i must say, i hate to hear she's driving still. i have a useful motto for that: "families don't let family members drive demented". The accident rate is huge, about 6 in ten in the months before finally a family intervenes, including death-causing accidents. and, i hate to add this, but it's a liability issue for the family.

no-one wants to think they aren't managing their life, especially if they aren't. i've found that it may work better if you take it on yourself, as in, "Mom, I know you don't feel you want extra help, but i love you a lot and i worry about you so much. i know i shouldn't, but i do and that's why...blah blah blah." There's no accusation in that and you own your feelings and it's hard for a person with dementia to argue their way round it.

i also suggest the family conference -- a sort of care intervention. and since your Mom is both falling and smoking (though presumably not at the same time), that the danger elemtn in her house is pretty high. i endorse ann's suggestion that you bring in a helper, hang out together with your Mom and the helper until some bonding is happening and then let it be. it'll probably work quite well after that.

nothing is perfect, but planning helps. and i respectfully suggest to you that your mother needs help now. if you're waiting for the time she says, "Oh honey, you're right, it's time for me to have help. please find me someone..." that's likely to be the 12th of never, to be honest. if you see something wrong now, then now is when your intervention is needed.

Go for doing the right thing for her needs, not the right thing for her to be pleased with you. I know that you'll feel better when you know she's being helped as much she needs, even if she complains to you about it. that's when you just say, "Uh-huh, I know, Mom" and you'll know you took care of what was needed. she'll probably come around on it when she likes her helper.

go to a local caregiver support group -- you'll learn lots and you'll get the support for doing the right thing. you may possibly even find a good help person through that.

From Frena Gray-Davidson" author of "The Alzheimer's Sourcebook" and "Alzheimer's 911."

Jenny seymour answered...

Hi Sarao, I am not a professional, but have been taking care of my father (along with my Mother) for the last few years, who suffers from dementia (as well as other medical issues). In my exprience I have found that asking your loved one to do something for you helps, for instance when my Dad does not want to use his walker we will ask that he does it to help us incase he falls, or if he doesn't want to put on his oxygen, I ask that he just tries it for me, and it typically works. You could also present it as offering someone just to pitch in and help out, and as she needs more help increase the amount of time the aide is there. I am not sure if you are working with medicare, or private insurance, doesn't sound like you have hospice involved but with each of these you usually have a social worker or a case manager who can help ease into things of this nature, with my Dad who is with hospice now we have a social worker that has helped with tough choices as well as financial issues, and other miscellanious concerns. I know that this is so difficult, but I have found that following your first instincts is usually the correct answer.

Good luck, I will definitely say a prayer for you and your family.

Annedonneundone answered...

As we're still going through this conflict with both parents (Mom has Alz; Dad has had a series of small strokes and is beginning to fail), I can empathize.

Along with the suggestions above, martial as much "official" support as you can. In January, both Mom and Dad were hospitalized, which gave us the opportunity to move on in-home care, which we'd wanted to do for months. We were able to say -- truthfully -- that in-home care was a condition of both their discharges from hospital. That way, we are able to keep the lines of communications open with both parents (ie. we're not the "baddies," we're simply complying with their doctors) while still assuring their safety at home.

Keep yourself sane through this!