Caregivers Shouldn't Be Dictators

I was sitting on the sofa in my 89-year-old mother’s new home, cleaning out her purse while she napped after lunch. As her recently self-appointed elder-care manager, I felt it was my duty to simplify everything in her life, and that included purging her pocketbook of expired medical identification cards and dusty cough drops.
 
“I’m going to throw out the keys to your old place,” I told Mom after she woke up. A few weeks earlier, she’d moved from a large one-bedroom apartment in New York to this small studio in an assisted-living center near my home in New Jersey.
 
"No," she said, sharply. "I want them.”
 
“Why? You don’t live there anymore,” I reminded her. But she insisted that I put the keys back in her purse. I rolled my eyes and muttered, “You’re being ridiculous.” When she wasn't looking, I put the keys in my pocket instead.

Turns out, I was the one being ridiculous.
 
When people go through a major transition, like moving into a long-term care center, "It's not the setting, but the losses" that can cause the most stress, says Barbara Resnick, a geriatric nurse practitioner and professor at the University of Maryland School of Nursing. “It’s not, 'This building is awful,' as much as, 'I’m losing my home, my independence, my car, my life as it was.'”
 
I know now that my mother was feeling those losses, but at the time, I was so caught up in getting her settled in, I didn’t notice.

Understand Where They're Coming From

For several years, my brother and I had talked to Mom about moving out of her old apartment. (Our father died many years ago.) She always resisted, insisting she was fine on her own.
 
But she wasn’t. Mom had fallen several times, and fainted twice (once at a bus stop). She didn't eat or drink enough, or take her medications regularly. And she rarely left her home except for doctors' appointments — she had stopped socializing with friends. To persuade her to move, we had tried logic (“This is a normal step for someone with your health issues”), scare tactics (“The next time you fall, you may crack your head open!”) and even temptation (“It’ll be like living in a hotel”). The conversations always ended with nothing resolved and all of us feeling badly.
 
It wasn't until the day Mom fractured her pelvis after yet another fall that I started seriously researching assisted-living centers. My brother and I agreed it would be best if she lived near me. While she was in rehab recovering from her injury, I visited five facilities and ultimately chose one — without her input. Given her past reluctance, we didn’t want to burden her with making a life-changing decision and perhaps compromising her recovery.
 
About three weeks before Mom was due to be released from rehab, the facility's head of nursing spoke frankly to her and my brother. This administrator told Mom what we already knew — she could no longer live alone safely. (Aside from the falls, she had also developed memory problems around this time.) When Mom resisted, she asked her: "Do you realize how stressed your family is over this? Your children are terrified that you’ll fall and get hurt again."

The head of nursing's approach was on target, Resnick says. When parents must be told that their declining health requires them to leave their home, it's important to emphasize safety concerns, and to be honest about how the situation is affecting the family. "Let them know if you’re losing sleep because you’re worried about them, or if you’re having a hard time taking care of their house along with your own," Resnick says. "Many parents will respond to that because they don’t want to make life harder for their children."

The next time Mom and I spoke, she told me that she had decided she was ready to move.

Later, I asked Mom what she wanted me to keep from her old place as I packed it up. Her answer? Everything. Every piece of furniture, all six boxes of Christmas decorations, all four bedspreads, both rugs, the suits from her days as an elementary-school teacher that were three sizes too big now, even the broken VCR that she’d never gotten fixed.
 
I told her no; the new studio was just a quarter the size of her old apartment. She demanded that I take her back to the apartment, for one afternoon, so she could pack up the place herself. But I was worried she would fall — there were boxes everywhere — and I knew she had neither the stamina nor the discipline to do any purging, so I again said no.

In the end, I donated most of her things to charity. And with that decision, I began to feel less like a daughter and more like a dictator.

Find a Way to Offer Sensitivity and Support

There was no disputing that my mother needed to move into assisted living. But I could have been more respectful and patient during the transition. Instead, I demanded that she accept the changes, and losses, immediately, without remorse or reflection.
 
“You can’t make the situation better for the parent,” Resnick says, "but you can acknowledge that it’s a hard thing and that it will take time to adjust. Every individual has to make a life for themselves, but let them know that you’ll be there to help them get acclimated and for emotional support.”
 
To start her new life, my mother needed to say goodbye to her old one, on her own schedule. The next time I visited, I slipped the old apartment keys back into her purse. She can throw them out when she’s ready.