My nursing home patient was fuming as she pointed at a beautiful ceramic planter, filled with colorful flowers and festooned with a "Happy Birthday" balloon.

"My sister is a fool! That stupid thing must have cost at least $50—of my money! What a waste….I called her and told her never to do that again!"

There was more—much more—all in the same vein. My patient's sister lives about a two hours' drive from the nursing home, and suffers from chronic illnesses that make traveling difficult. In spite of this, she visits at least twice a month, usually toting bags of candy, clothes, and toiletries for my patient (who complains bitterly if her sister dares bring the ‘wrong' brand).

Inevitably, they argue about the offerings, and the sister leaves in tears. On the other hand, if she dares to arrive empty-handed, a meticulously detailed shopping list appears. Talk about your lose-lose situations….

Now, my patient is an intelligent person, and she knows this kind of interaction isn't healthy. We work in therapy on trying to develop healthier, more constructive ways of relating to the sibling she really does love, but progress is hard won. Time after time, well-intentioned visits end in arguments, and hurt feelings.

When dealing with people raised in the shadow of the Great Depression (or other economic hardship conditions), any interaction involving money is likely to be fraught with tension and anger. Often, people raised in impoverished circumstances have spent a lifetime depriving themselves of necessities in order to build a nest egg they hope will protect them from future catastrophe.

When they were young and healthy, striving to keep the metaphoric wolf from the door was a challenge, and wresting success from the jaws of possible ruin becomes the stuff of proud legend. My patient loves to tell the story of how she walked 30 blocks to work to save the carfare, and once calculated how many lunches she'd skipped to fund a semester of her sister's college education. Some of her life's greatest triumphs were built on iron-willed self-denial.

Unfortunately, the focus shifts over time, and as people age they fixate more and more on the habit of privation—the ritual of self-denial—rather than the security they built or the happiness of the people for whom they deprived themselves. Once a means to an end, saving (or more accurately, hoarding) money becomes a goal unto itself.

Happiness takes a back seat to the self-worth derived from the struggle: The more you do without, the better a person you are. However, life goes on, needs continue, and prices go up. There's no way around it: All of us must part with money to live. But to my patient, and many other people of her generation, every penny spent feels like a failure.

If your loved one fits this pattern, you probably know well how hard it can be to do anything nice for her. Instead of being touched by your thoughtfulness or wowed by your taste, she'll lecture you on your spendthrift habits or refuse to accept (or use) your offerings. "Nothing I do is ever right" is an oft-heard refrain from caregivers in this situation, and it's no wonder that many are tempted to just stop trying, and walk away. Few experiences are more frustrating than the sense that your well-meaning efforts are doomed to failure. Common responses are to stop trying or to stop loving, neither of which is particularly positive. In such situations, a few things can be helpful:

  • First, try to be empathic. Remind yourself that people do not choose the conditions under which they were raised, and formative experiences and beliefs can be very, very difficult to change.
  • Second, when you buy things for your loved one, try to get her to be a partner in the decision-making process. This lets you factor in current real-world conditions, and allows her to experience them first-hand. She may have been able to buy the perfect wool sweater for $5.00 in 1950, but prices are now higher. Wool may no longer be the best option--a $20 fleece made of recycled plastic bottles may provide more warmth, and appeal to her sense of thrift and need to save the universe.
  • Third, let her vent. Listen to the story about the perfect sweater she found at the now-defunct department store in 1953, praise her thrift and industry and great bargain-hunting skills, mourn the passing of the good old days, then help her to choose from among the clearly-priced sale options in a catalog. She may choose the cheapest, and later berate you for ‘letting her buy that junk,' but it's also possible that she'll wear it until it falls apart, proud to continue her tradition of ‘making do.'

Of note: When I returned to see my patient the following week, the planter was gone, having been given to an aide. The balloon remained, carefully tied to her bookshelf. She caught my glance, and noted, "Well, it is kind of cute…"