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Making hard decisions: Listen to the emotions behind their words

"If adult children understand that it’s human to need time and space to process life-altering changes, they can approach the process with more patience and compassion," Minding our Elders columnist Carol Bradley Bursack explains.

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Dear Carol: I’m struggling to understand how to help my dad who has dementia. I can be with him for part of each day which has worked out all right until now, but recently his memory has taken a big tumble. I work full time so I can’t extend my hours with him, which leads me to think our next step is to arrange in-home care or a care home. He’s aware that he needs help, yet he doesn’t want strangers to do it, so he goes back and forth between the options and ends up confused. Any ideas for how I can move forward with this? – GD

Dear GD: My heart is with you. It’s so difficult to see someone we love loses their capacity for self-care.

Part of the problem is that we as caregivers value our older adults’ safety above almost anything else, yet most older adults value their autonomy above safety. For this reason, many older people will resist both in-home help and moving to a facility. It helps to think deeply and honestly about how you’d feel in their place. If adult children understand that it’s human to need time and space to process life-altering changes, they can approach the process with more patience and compassion.

Even though having strangers come into the home is a disruption, for some, in-home care works as an intermittent step that can help older adults stay in their homes longer. Eventually, though, a move to a care facility could be the best way to both get needed help and increase socialization. This holds true whether dementia is involved or not.

In general, people like your dad who are living with dementia have an even harder time making such a life-altering decision. His failing memory may not be able to retrieve the knowledge that he’d felt frightened and confused an hour earlier. He may also have problems with self-expression due to damage to the language center in the brain which can make finding the precise words needed next to impossible.


Even cognitively sound older adults who are faced with two less-than-perfect life-changing choices often change their minds as they attempt to come to terms with what must be done. As you’re seeing, the process becomes substantially more difficult when the older adult is cognitively impaired.

Think back on discussions you’ve had with your dad throughout the years when he talked about friends who needed care. Did he say one option was better than another? Compassionately watch his face and eyes as he now tries to make a choice so that you can pick up on unvoiced emotions.

Reassure him that while changes are necessary for his safety and welfare, you’ll still be there as his primary support and his advocate. Remind him, too, that having additional people around just might increase the fun factor in his life.

There is no perfect solution, GD. You have the heart to do the right thing so do your best and move forward.

Carol Bradley Bursack is a veteran family caregiver and a nationally-recognized presence in caregiver support. She's the author of “Minding Our Elders: Caregivers Share Their Personal Stories,” a longtime newspaper columnist and host of her blog at mindingoureldersblog.com. Carol's an introverted book nerd, so you won't see her mugging in viral videos, but you can easily reach her using the contact form at mindingourelders.com.
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