Chapter 8
Making the Right Decision
Facing the challenge of handling your loved one’s future can bring up emotions like guilt, fear, or anger—even in the strongest of personalities. The individual who has taken the initiative in addressing care issues and encouraging the decision to make changes is usually the one closest emotionally to her senior. She has been the person who has been checking in regularly, on-call for emergencies, or providing care herself, and it can feel as if she is giving up and letting her elder down when it’s suggested that it’s time for another form of assistance.
Asking loved ones to welcome change or move to a new environment can be uncomfortable or even distressing. It’s likely they have developed schedules, routines, and habits that aren’t easily altered; and when they are most vulnerable, you are insisting they must listen to you and perhaps go against their own wishes. Suddenly they are expected to allow strangers in to their home, honor someone else’s timetable, and follow instructions that may be confusing or that they don’t agree with. Or they must adjust to a new home setting where they will have to make different friends, trust unknown caregivers, and learn the community rules.
It’s been said by eldercare professionals that when you disrupt a senior’s life—especially if you relocate her—and even if she is receptive to the idea of change, she will decline physically and mentally, even if it’s just a small degree. You have to hold your breath and hope she will rebound quickly and start to flourish under the new conditions. Don’t worry; a decline is almost always a temporary condition. But the last thing you want is to realize that you’ve made a mistake and have to start all over again.
Approaching Your Decision
In any situation, there are factors you can control and others you cannot. It’s understandable that, when making important care decisions, you want to cover every possible need and do your best to prevent anything bad from happening. The following suggestions can help you decide whether you are heading down the right path or need to reconsider your choices.
• Don’t be afraid to ask yourself the hard questions. Decide whether you are making accurate judgments about your loved one’s condition and what he or she requires. Sometimes you need an unbiased set of eyes to help you see clearly. Don’t be afraid to ask for others’ opinions.
• Take into consideration your own needs and those of other family members besides your loved one. Focusing only on your senior, other relationships can suffer. It can also lead to the deterioration of your mental or physical health to the point where you need care yourself and you focus less on your loved one. There’s a reason caregivers often pass away before their loved ones do. Consider that, when healthy and independent, your senior would never want to put you through this.
• The earlier you put support services in place, the more likely you can extend your loved one’s independence and overall well-being. Waiting until a problem occurs or until your senior is unable to welcome changes can make things more difficult. View care as a means of protecting your loved one’s lifestyle rather than damaging it.
• Listen to your heart. Caregivers often say they knew immediately when they were making the right choice. If a resource or community feels wrong or uncertain to you, pay attention, and continue investigating additional possibilities until you find one you feel comfortable with.
• Accept that your relationship with your senior may be altered, at least for a while. It’s not uncommon for loved ones to project their fear, anxiety, or anger onto the person trying to help them. Often this is only temporary, but you have to stay strong.
• Consider some decisions to be temporary solutions. While it’s reasonable to want to make one decision and have it be the solution for the remainder of your elder’s life, that may not be feasible. It’s more likely that from time to time you will have to reassess and make adjustments as your loved one continues to decline and his or her needs change. This doesn’t mean that you have made any mistakes, but only that some things are beyond your control.
Knowing When to Compromise
Knowing when to compromise, finding the common middle ground between opposing points of view, and hoping that both parties will find the solution acceptable can be the key to resolving an issue and preserving relationships. In eldercare, there can be instances when you may have to make a concession with your loved one in order to move forward. Otherwise, the entire objective of seeking care can come to an abrupt halt. It is better to concede on smaller, less important matters in order to succeed on critical issues.
It can be a double-edged sword when your loved ones are still highly functioning and involved in the decision-making process regarding their care. While you may be pleased they are relatively independent and can voice their desires, it can be frustrating when those desires don’t match what you feel needs to happen. Out of respect, you may even ask yourself what right you have to impose your will on them. The following questions can help you identify how much and when you should compromise.
• Have you had a discussion with your loved one about his or her vision of the future? If you have made decisions without involving your loved one, and the decisions are not in accordance with his or her wishes, you may need to alter them and compromise to reach a common ground.
• Is your senior willing to compromise on that vision to give you more peace of mind that he or she is being taken care of? You may be surprised to learn that if your senior feels listened to and not in danger of losing control over his or her life, your loved one may be more willing to accept your recommendations. If you ask him or her to compromise, however, you must be willing to do the same.
• Are your suggestions reasonable? Have you done your research and feel confident your proposals are realistic? If, for instance, you are insisting that your parents hire a live-in caregiver, is there a private room where the caregiver can sleep and keep his or her personal property? When flaws in your thinking are pointed out, you might need to rethink your plan.
• If your loved one is resistant, do the objections make sense? Consider your senior’s opinions and decide whether you may be overreacting to them. Are you making fear-based decisions? Could there be other solutions? If your senior is being reasonable in his or her protests, try to reach a compromise.
• Can you take baby steps toward higher levels of care, or do you need to make immediate and significant changes right now? This consideration depends on your loved one’s condition and what he or she is capable of handling. If your mother simply needs help with household chores and you are suggesting she move to an assisted living community, chances are she will be resistant. Agreeing to a cleaning service instead may be a good compromise. But if your father has had a massive stroke and can no longer function without significant assistance, you are being reasonable in suggesting he move to an assisted living facility, a compromise may not be possible or desirable.
• Has your loved one continually reneged on solutions he or she approved after you reached agreement? If there is a pattern of agreeing to certain actions and then refusing or attempting to renegotiate, recognize that your senior is stalling or sabotaging your efforts, and let him or her know that you will no longer compromise.
• Is the situation yes or no? If you can honestly say there are no other choices available, such as your father requiring constant supervision and support but you and your family cannot afford 24-hour care, there is no room for compromise. In this case, the answer is no, you can’t afford private care, and yes, you need to move him to a less expensive assisted living group home.
• Is your loved one a danger to himself or herself or to others? You cannot compromise when there is a concern that someone might be in danger.
Deciding Who Makes the Final Decision
There can be tremendous pressure and responsibility in making the final decision on eldercare. Ideally, our loved ones would be in a position to make these choices for themselves, but often they are too unsure, in denial, or mentally unable to do so. In these cases, someone else needs to step in and take charge. To determine who will be the most appropriate selection to make these ultimate conclusions, start with the following considerations.
• Has my loved one expressed his wishes in the past and are they still feasible? If he is capable of making sound decisions and his desires are reasonable and can be carried out, your senior should have the last word on what eldercare choices are made.
• Is my loved one too ill to make the decision for himself? If his health has prevented him from participating in his care, whoever has the legal right to act on his behalf must do so.
• Is my loved one capable of making rational and sound judgments? If he suffers from a mental illness or dementia and cannot decide what is in his best interest, his opinion can be requested, but ultimately you, as the representative, must step in and make the decision.
• How do we decide what to do if the family is not in agreement? If there is a legal representative, such as a power of attorney or guardian, and he wishes to force that power over the decision-making process, he has the right to do so. However, if family members want to reach an amiable conclusion, enlist the services of a family mediator to assist you in coming to the best resolution possible.
• What do we do if no one has legal authority, and our loved one is incapable of making decisions? You will most likely have to seek guardianship or conservatorship to make decisions on his behalf. A judge will appoint someone on the senior’s behalf to make choices for him.
In making eldercare decisions, your first choice should be to include your loved one in the process. If that is not a viable option, then ask whoever has the legal authority to make decisions on your senior’s behalf to work through the preceding questions. Sometimes the answer is made clear for you through that process alone.
When making decisions for your loved one is so overwhelming that you don’t know where to begin, it can be helpful to identify specific steps and create a system to guide you through the process. Here is a model for systematically making informed decisions.
Identify the issue. Define the problem using specific details, such as “Dad has left the stove on three times in the last month.” By isolating individual issues, it will allow you to focus more clearly.
Gather information. By getting all the data you can, you will be making decisions based on facts and not on assumptions, emotions, or opinions.
Ascertain and assess your options. Brainstorm and identify as many options as possible. Then consider the short-term and long-term consequences of each and compare them.
Develop a strategy. Speak with anyone involved in the care of your loved one and create a step-by-step blueprint for initiating and carrying out the plan.
Take action. Determine which option is best, and do what is necessary to put it in place.
Evaluate the results. Give the plan a reasonable period of time and then assess the outcome. Keep an open mind about altering the strategy, if necessary. Try another option if your plan is not working as anticipated.