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When do elders lose the right to make their own decisions?

by Carol Bradley Bursack, Editor-in-Chief

Most of us want to have as much say in our futures as we can, for as long as we can. As caregivers, we recognize this desire in our aging loved ones, but we also worry abut their safety. When do we bite our tongues and let them decide how much help they want, and when do we need to interfere? The timing is different for everyone, but respect lies at the base of this question. Our elders deserve respect and that often means letting them make decisions we disagree with.

Many elders want to remain in their own homes for as long as they can. Sometimes this is a viable decision and sometimes it's not. Often, with help from family, friends and perhaps a good in-home health agency, the elder can remain at home for months or even years longer than he or she could, alone.

However, for many, the time to move out of the home comes sooner rather than later. A stroke or a type of dementia can alter plans for the elder to remain on their own. This is when many adult children start to push. They want their loved ones safe, and safe to most of us means someone is looking after our loved ones all of the time. Safe also means physical surroundings designed to prevent accidents or health emergencies that can cause further deterioration of health, or even death.

Put Yourself in Your Elder's Place

Looking at it from the outside, a decision to move the elder to assisted living, or even a nursing home, can seem like a no-brainer. However, as caregivers we must put ourselves in our elder's place. How would you like someone who had always reported to you at work to turn around and suddenly start giving you orders? Perhaps this person would even try to re-arrange your office and put a tracer on your phone calls. You'd be, um, rather upset, right?

This scenario is just a glimpse of what many elders must endure. Only it's worse for them. The person giving them orders was once the infant who was totally dependent on them. This person is the same person who they taught to drive. Why, suddenly, is this person taking over their life for their own good?

For who's good, they'd like to know. And they have a point. Most of us love our parents. We want them to be safe and cared for as they age and their needs increase. We help as much as we can, but we often can't be there as much as we'd like. So, we push and push to get them to move to that nice assisted living facility on the edge of town.

For Many Elders a Move to Assisted Living Is a Good Idea, But Go Slow

For many elders, this is a good idea. They've lost many of their friends to death and the neighborhood has changed so much that they don't even know who lives next door. They are isolated and alone. Assisted living could be a wonderful option. The new social life they could have, once they've adjusted, could extend their mental and physical life significantly. But, even in this case, adult children who are wise move slowly.

Unless aging parents are deep into dementia or other mental illness, or are in grave physical danger, they have rights. Their desires and personalities need to be the focus of the decision making process that determines their future. Go slowly. Perhaps, for awhile, you can suggest some in-home care that would offer some light housekeeping and perhaps help with bathing and grooming. Along with this assistance, the elder can have some companionship. For many this is a good start.

Yes, you may run into a road block even with this small change. You may have to back off and see if an old friend could start visiting your folks regularly, or get someone from your parent's faith community to stop in. After they've gotten used to someone outside of the family being around, then you could try once more to hire some in-home care. Stay with in-home care for awhile, if it seems to be working.

When Possible, Tour Facilities and Give Elders Choices

Eventually, start looking at assisted living facilities. Find the best ones around and then suggest that you and your parents tour them for future reference. Do so, if they allow it, and then drop the subject for awhile. As you see your parents get more frail, you can tactfully bring up the centers you toured and ask them if they'd like to go see them again. If you are lucky, they may even have friends already living in a center. That could make moving an easier decision.

Whatever choices you and your elders make, unless there is a true emergency, try to work with them. Remember to respect the fact that they are your elders. They've lived full, independent lives. They are now suffering the losses and indignities that the aging process forces on most of us. Go slow. Ask what they think. Back off if you must. Then bring up help from a different angle.

What if someone falls because you didn't get them into a home soon enough? That's tough on everyone, but is it tougher than taking away their power of making their own decisions too early? Remember that you, too, could fall and break a bone. Would it have been better if you had been forced into a care center, even though you don't need one? Life happens.

Work with your loved ones, not against them. Unless circumstances give you no choice, go slowly and offer help as they need it, but do so in a way that leaves them some dignity. This kind of care takes longer, but in the end it's probable that you should all be happier with the choices.