Have you noticed worrisome changes in your aging parent?
Maybe they’ve been mostly okay but now you’re seeing problems with memory, such as forgetfulness or asking the same questions repeatedly. Or maybe you’ve noticed trouble with driving, keeping up the house, managing stairs, or paying bills.
Some aging parents simply begin to seem more withdrawn. Others start leveling accusations at others, claiming someone took or moved something, or acting paranoid.
For many adult children, these changes lead to mounting questions. What’s wrong? What’s happening? Is it safe for Mom to keep driving? Should Dad live alone much longer?
I think of this as the “uh-oh” stage. It’s a transition no one looks forward to, and most haven’t prepared for: the time when you might have to start helping your aging parent.
And for many, it comes with an added challenge: Most aging parents don’t welcome much help from their adult children. They may see it as interference, or an invasion of privacy.
Some parents might even refuse to accept that they’re having difficulties, despite issues that feel glaringly obvious—and concerning—to you.
By the time you’re noticing changes and have safety concerns, it’s quite possible that you’re right: that your parent does need help of some kind. So how should you best get involved, especially if your attempts to do so have gone poorly in the past?
Well, it’s certainly not easy. These situations are complicated from a medical and eldercare perspective, plus they tend to bring up difficult emotions for older parents and adult children alike.
But I do believe that it’s crucial for families to get involved. It’s not likely to be easy. But it can be easier, if you’re able to learn the better ways to do so—and also what to stop doing.
The very best way to learn this is to work closely with professionals trained to assist aging adults, such as geriatricians and geriatric care managers (who are also known as aging life care experts).
That said, geriatricians are in short supply and can be hard to find, and geriatric care managers must be paid out of pocket (although it’s often a worthwhile investment). And although local Area on Aging Agencies do exist and can be great resources, they’re also often short-staffed and underfunded.
That’s why I’ve created this article for you, explaining a step-by-step process that anyone in this situation can follow. It’s based on what I help families do, when I advise them on how to step in and assist an aging parent.
Here’s an overview of the steps:
- Collect the facts on the situation, by checking for specific signs an aging parent needs help or is unsafe, and by respectfully gathering information from others.
- Get your parent’s perspective, so you can understand how they see the situation and what’s important to them, before you make any more attempts to get them to make changes. (Don’t even think about getting them to understand, agree, or accept what’s going on during these initial conversations.)
- Find out what an ideal medical and eldercare intervention looks like, to guide plans if there really are signs of memory problems, safety issues, or declines in independence.
- Learn some legal fundamentals about signs that mental “incompetence” or “incapacity” might be an issue, and about legal documents, such as powers of attorney, that can better enable you to assist your aging parent.
- Create an actionable plan that addresses what’s most important, based on what you’ve learned about your parent’s situation and priorities so far. Every family is different, but usually what’s most important might involve:
- Working on getting a medical evaluation, and hopefully a diagnosis
- Addressing the most important safety and care issues
- Connecting with your parent and persuading them to accept at least some changes
- Implement your plan. Be prepared to make several attempts, because that’s usually what it takes.
(Want a much more detailed version with checklists, sample dialogue to say, workarounds for common obstacles, and “what this looks like” examples? That’s all in my book When Your Aging Parent Needs Help, and you can learn more about it here.)
Let me now explain these six steps in a little more detail:
1. Get the facts: Checking for signs your aging parent needs help
You might think you know what’s going on but surprisingly, our starting assumptions can be wrong or incomplete. That’s why it’s important, before you do anything else, to try to gather information that will help you confirm that your worries are justified. I recommend checking on these particular things:
- Signs of problems with memory and thinking
- Signs of problems with life tasks and safety
- What other family members and key people in your parent’s life are noticing
- Any “bright red flags” that indicate you probably should step in sooner, rather than later
To help people check for worrisome signs, I created a free downloadable guide a few years ago, with easy-to-use checklists. You can get it here: Quick Start Guide to Checking for Health & Safety Problems.
Making a systematic effort to gather this information will help your family have a clearer picture of the problems and concerns. Doctors and eldercare experts will also need details about what’s going on, whether to help them make a diagnosis or just figure out what kind of support and safety measures will be needed.
2. Get your parent’s perspective: How to learn what matters to them and how they’re seeing things
Even if you’ve already tried talking to your parent(s)—and if you’re like many of the families who write to me, you have—chances are good that you haven’t yet used the most effective approaches.
Families often talk to a declining older person with the intention of getting them to understand, or accept, that problems have arisen and that certain steps should be taken to keep them safe and well.
This is well-intentioned and understandable. Unfortunately, it tends to be counter-productive and often leads to frustration and conflict.
So you’ll want to take a different approach to these talks. Which is to “talk” with the intention of listening, and helping your parent feel heard.
This is the way a geriatrician approaches a patient, especially one who is reluctant or resistant. You want to listen intently, to learn more about what they’re thinking, feeling, and preferring.
At the same time, you’ll want to avoid arguing, correcting, or attempting any convincing. (Now is not the time.)
When you learn more about how your parent sees a certain situation, and what matters the most to him or her, you’ll end up in a stronger position to invite them to try a change you think will help them.
Taking this important step can help soften resistance and improve the odds of practical success. Many families are relieved to find it also builds “relationship capital”—goodwill you’ll need for the challenging future.
For more on how to talk to a resistant older parent, try this podcast: 028 – When Older Parents Resist Help: 4 Tips for Better Talks.
3. Get informed: What an ideal medical and eldercare assessment and intervention looks like
Let’s face it, what’s “ideal” doesn’t always happen. Still, it’s super useful to know what experts advise should happen, in a perfect world where you could control everything, because this gives you a guide for where to aim your best efforts. That can save you time and trouble later.
Key is getting a medical evaluation. This is because most worrisome “life” problems families notice in an aging parent are actually being caused or worsened by an underlying medical issue. You want to get answers to questions like: What might be causing the symptoms we’re concerned about? Could medications be an issue? (They often are.) What’s the plan for follow-up and what happens next?
If you’ve been worried about memory or other thinking skills, the doctor (and starting with your parent’s primary-care provider is fine) should look for underlying causes of cognitive impairment. For more on what should be checked, see Cognitive Impairment in Aging: 10 Common Causes & 10 Things the Doctor Should Check. If your main concern is paranoia or false accusations, also see 6 Causes of Paranoia in Aging & What to Do.
The ideal approach also involves taking steps to address immediate safety concerns and assist your parent with any daily life tasks they’re currently struggling with.
Working with specially trained social workers or geriatric care managers can be very helpful to assess housing and care needs, and to come up with a plan to meet them. These professionals also usually have ideas on how to manage common safety concerns, such as driving difficulties , or trouble managing finances. Or you can begin to look for resources in the area to help you. I suggest some excellent starting places in this article. The Quick Start Guide also includes ideas on how to get help with any problems you notice.
Last but not least, setting up certain lifestyle changes can help an aging parent maintain the best possible physical health, and can also slow cognitive decline, if any is present. For my top suggestions on maintaining a healthier brain, see here, and for my suggestions on maintaining physical health, see here.
4. Learn about the potential legal angles: Signs of mental “incompetence” or “incapacity” and legal documents to check for
If you’ve noticed any problems with memory, judgment, or other thinking skills, then it’s a good idea to learn more about mental capacity and when an older person might be considered incapacitated or “incompetent.”
This matters for several reasons. One is that if your parent has ever completed a power of attorney for healthcare, or for legal affairs, it may only give you (or someone else) the ability to act if they are “incapacitated.” (This is sometimes called a “springing” power of attorney.)
It also matters because if there are signs that an older person has lost the capacity to mentally understand the risks of a given situation, then it becomes more ethically – and sometimes legally – permissible for you to intervene.
Now, just because your aging parent rebuffs your concerns, ignores safety issues, or refuses to accept help, that doesn’t mean he or she has lost mental capacity. Still, it can be a good idea to learn more about capacity so you’re clearer about whether to look into it more now, and in case the situation changes.
Your understanding of your parent’s mental capacities can and should affect how you approach them when the time does come to take next steps, or try to convince them to make a change.
You can learn more about capacity here: Incompetence & Losing Capacity: Answers to 7 FAQs. For more on powers of attorney, see here.
5. Put it all together: Create a next-steps action plan customized for your family’s situation and parent’s preferences
Now that you’ve laid the important foundation of observing, listening, and learning, it’s time to put it all together and take action.
Obviously, there’s no single “right” way to go about helping an aging parent; what you do will depend on what’s going on with your parent, what matters to them, what’s feasible, and more.
Here’s an A-B-C formula can help you create a plan that works for you:
1. ASSESS: First, you want to review your assessment of the situation right now: your parent’s thinking skills, observed safety issues, life tasks they’re struggling with, and other key issues, as well as your parent’s/family’s priorities. You’ll also want to review how much of the ideal next steps have taken place so far.
2. BRAINSTORM: You’ll then weigh your options for taking next steps. You’ll need to consider things like:
- What seems most urgent/important to address?
- What seems most feasible?
3. CHOOSE AND PLAN: Based on what you’ve brainstormed, pick one to three issues you’re going to focus on. (If you have siblings or other involved family members, it’s best to do this together and coordinate.) For each issue, plan some specific next action steps. These might include:
- Something to research (a health problem, a legal point, a service, an agency, experts, and so on).
- Something to do (make a call or appointment, tour a facility, review medication, hire someone, and so on).
- A conversation to have (with your parent or sometimes someone else, like a consultant, the doctor, a neutral third party, a sibling, your other parent, and so on).
6. Implement your action plan: Be prepared to persist
NOW you’re ready to effectively step in and try to “do something” to help your aging parent. Give it your best go, taking the next steps you’ve planned out.
Be sure to use your best communication skills and consider capacity issues, if appropriate. (They often are.) Failing to focus on good communication and the importance of capacity trip up many families.
Based on how things go, you’ll reassess, adjust your approach, and likely try again. I like to tell people they should plan on “experimenting,” because families almost never get the progress they’re hoping for right away.
In fact, it’s normal for this part to involve a lot of back-and-forth as you try to move past certain roadblocks or figure out the best tack to take with your parent (or with someone else who’s involved, such as another family member or your parent’s doctors).
There’s an art to learning to persist and try a few different approaches as you try to help your aging parent. To get past the most common roadblocks, such as your parent refusing to go to the doctor, I recommend crowdsourcing ideas and advice from others in a support group; there are some good free ones online.
I also have a whole chapter on getting past common roadblocks in my book, “When Your Aging Parent Needs Help: A geriatrician’s step-by-step guide to memory loss, resistance, safety worries, and more.”
No matter what happens next, consider it progress
If you follow the steps outlined above and persist, the odds are very good that you’ll get your parent more of what they need for their care and safety—and you’ll likely get them to come to better acceptance of the changes.
Now, it’s definitely possible to do all the “right things” but still end up feeling stuck. That’s not unusual. There are, in fact, additional options to consider, if you’ve made multiple well-thought-out attempts to help yet feel your efforts are going nowhere.
For instance, it may be appropriate to consider “watchful waiting,” or even looking into last-resort measures such as petitioning for guardianship. (These are beyond the scope of this article; my new book includes a separate chapter on these scenarios.)
Even if things stabilize, you’ll probably have a sense that something has changed since your initial “uh-oh” moments. And it has. Your family has shifted to a new stage of life.
The “new normal” might wind up feeling familiar (if seldom exactly the same as before), allowing you to step back awhile. Or you may be in active “help mode” for a long time. That’s pretty common.
Whatever this ongoing journey through this stage of life is like for you and your parent, simply by approaching your aging parent using this thoughtful and caring process, you will be making a needed difference.
That’s because what your parent needs most of all, during this time of change for them, is your presence and your connecting with them. You won’t be able to control everything and you probably won’t be able to get all the safer outcomes you want for them.
But that’s ok. You’re showing up to help, you’re learning to do it in better ways, and you’ll be doing the best you can to accompany them on their aging journey. And that will make a huge difference for your aging parent.
I hope this article and my step-by-step process will be helpful to you. If you have questions or comments, please post them below.
You might also find my free online training for families helpful (see below), in which I teach families how to better communicate with an aging parent who may have memory loss.
Marge White says
How can I print this?
Nicole Didyk, MD says
I’m glad you enjoyed the article! At the very bottom, underneath the advertisement for Dr. K’s new book, on the left, is a little icon of a printer. Clicking on that will lead you to a printable version.
Evelyn A Eickmeyer-Quinones says
Excellent article. I’m reading it at just the right time for my family.
Nicole Didyk, MD says
I’m so glad! If you’re starting to help your aging parents, you will probably be interested in Dr. Kernisan’s new book: When Your Aging Parent Starts Needing Help. It’s a very practical step-by-step guide about how to communicate with your parents and other family members, and figure out the best way forward. I’ve recommended it to patients and have even used it myself with my own aging parents.
You can hear more about the book in this interview, here:
Dawn Kinsella says
Your article was very helpful. My father lives in Maine and I live in St. Louis and am his only family. I feel based on your article that it is no loner safe for him to be alone 24/7. I’d like to start by having someone come in several times a week so that we can figure out a long term solution without jumping the gun too quickly and making expensive mistakes.
How do I go about finding suitable in home care for my father?
Nicole Didyk, MD says
It’s always hard to provide care from a distance, Dawn.
This article about finding in home care might be helpful: https://betterhealthwhileaging.net/hiring-home-care-for-aging-in-place/.
Dr. K’s new book When Your Aging Parent Needs Help: a geriatrician’s step-by-step guide to memory loss, resistance, safety worries, and more has a wealth of practical information about how to help your parent, including how to help when you don’t live nearby. You can learn more here: https://betterhealthwhileaging.net/education-and-support/when-your-aging-parent-needs-help/
My son and daughter-in-law are experiencing difficulty with elderly grandparents. The grandfather has MS, and his wife has dementia. The grandfather flatly refuses any help, and is extremely noncompliant in cases where he’s been in the hospital or under doctors care. They are at a point in their lives where they cannot seem to make rational decisions, but rebuke anyone who tries to make any decisions for them, and refuse simple suggestions that would make taken care of them easier, such as using incontinence products. The grandfather even discourages having someone help with his wife, even if it means that she may be at risk of such things as falling, etc. I have suggested that perhaps they may want to speak to some sort of professional, who can assess the situation, and by chance with their professional advice, inspire them to begin to accept reality and the fact that there are others that are trying to help them. Right now, the stubborn and prideful grandparents are making it impossible. Do you have any advice on this scenario, Who they could speak to to get help, or does your book cover this?.
Nicole Didyk, MD says
This sounds like a tough situation but not an uncommon one.
Dr. K’s new book When Your Aging Parent Needs Help: a geriatrician’s step-by-step guide to memory loss, resistance, safety worries, and more has a wealth of practical information that covers such a scenario. You can learn more here: https://betterhealthwhileaging.net/education-and-support/when-your-aging-parent-needs-help/
It’s usually a slow process, full of compromise and gradual change, and unfortunately sometimes a crisis is inevitable. Good for you for trying to help your son and his wife. The more supportive family members, the better.