Coping with Elders Who Won’t Accept In-Home Caregivers

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Hiring in-home care for my neighbor, Joe, was quite an ordeal. The company we chose and their caregivers were great, but the quality of care wasn't the issue. The problem was that Joe resented anyone but me helping him.

He locked one caregiver out of his home, let another in but was rude to her, and thoroughly enjoyed one young man, but only because they could discuss golf together.

Families hire home care to provide respite and quality care for seniors, but what is a caregiver to do when their loved one refuses to cooperate with this new addition to their care plan?

Fear of Outside Caregivers

Many times in-home caregivers’ best efforts are met with anger or even abuse dished out by the elder they are intended to care for. It is crucial for the family and hired caregiver(s) to determine the underlying reason for a senior’s lack of cooperation and find ways to remedy the situation.

I believe that fear is the foundation of much of a senior’s reluctance and even disrespect for non-family caregivers. The presence of an outsider may suggest to them that their family can't (or doesn't want to) take care of their needs. It also magnifies the extent of the elder’s care needs, making them feel especially vulnerable. This combination of concerns can create the perfect storm, especially if they are prone to lashing out when angry. Of course, the family members who arrange these services get an earful, but the professional caregiver becomes the primary target for sending the message that outside help is neither wanted nor needed.

Fearing a Loss of Independence

People of all ages dread the idea of losing their independence, but many seniors are living this reality and trying to come to terms with it. Aging is hardly a graceful process, so who can blame our elders for digging their heels in?

If a senior is still of sound mind, emphasize that home care enables them to continue living safely in their own home. This in itself is an overarching symbol of independence. The right caregiver will pick up on this strong desire to be self-sufficient and provide assistance in ways that allow the senior to retain as much control as possible.

Fear of Strangers

Trust issues can also trigger anxiety in some seniors and their family members. Inviting a professional caregiver into the home to care for someone you love is a very personal decision. The best way to alleviate worries about a new caregiver’s character and trustworthiness is for the family to take an active role in the hiring process. If the senior is capable, they should participate as well. Again, a sense of involvement and the ability to have a say in these decisions can reduce apprehension.

Adapting to in-home care is much smoother when the family is confident in the hire. Know what to look for in a provider and interview caregivers before services begin to determine a good match. With this approach, if something seems off, you have the opportunity to correct your decision before it actually becomes a problem.

Read: How to Select a Home Care Company

Dementia Contributes to Fear

It can be challenging to encourage a mentally healthy senior to accept outside help, but Alzheimer’s disease and other forms of dementia can make this process even more complex.

Depending on the progression of the condition, a senior may not be able to fully participate in the hiring process. Nonetheless, introducing potential caregivers beforehand to see how both parties get along is still a valuable step. Dementia patients’ moods and capabilities fluctuate from day to day, though, so keep this in mind when trying to help a loved one to warm up to someone new.

Paranoia, hallucinations and delusions are common symptoms that a dementia caregiver should know how to handle. Look for someone who is trained in this kind of care and knows how to communicate with and calm their clients. Having a family member present during the first few shifts while everyone gets to know each other can reassure a senior that they are safe and in good company.

Some dementia drugs and psychiatric medications currently in a senior’s regimen could contribute to outbursts and negative reactions. If your loved one is unusually agitated and fearful, talk to their doctor about adjusting medications. While drugs should not be a go-to solution, behavioral symptoms may be managed through a combination of modifying prescriptions and altering the caregiving environment.

A senior with dementia may not ever be comfortable with a particular caregiver, even though the aide is making a considerable effort to do everything right. Regardless of the reason, some matches just do not take, and the care team may have to simply request another caregiver.

Overcoming Resistance

You know your loved one best, so do whatever you can to help make them more comfortable with this new arrangement. Assure them that you are still their primary caregiver, but explain that you need help. Emphasize that the professional caregiver is there to assist both of you and that you are closely monitoring the process and their wellbeing.

Communicate openly with the caregiver and the home care company about any challenges you experience. Understanding the source of the senior’s resistance will help you cope with this problem, and a care team meeting may be instrumental in brainstorming solutions together.

Carol Bradley Bursack

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Over the span of two decades, author, columnist, consultant and speaker Carol Bradley Bursack cared for a neighbor and six elderly family members. Her experiences inspired her to pen, "Minding Our Elders: Caregivers Share Their Personal Stories," a portable support group book for caregivers.

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60 Comments

I have a similiar problem with my elderly mother. She is living independly and is
financially set. Her only health issue is COPD which limits what she can do. The problem is she would rather get help for free than pay someone to come in to help her. She is becoming a burden on her neighbors and family with her mooching off on others for help. There is a reliable neighbor willing to help out for a reasonable fee, but my mother has yet to hire her and at the same time complaining she cannot do this or that. She is competent to make her own decisions, but ignores my advice on getting help. Since she has tied my hands, I have decided she can either get the help she needs or do it herself. I will not allow her to use me as one of her freebies.
Carol, thank you for giving the paid caregivers side of this situation... I work independanlty with Alz. patients, in home.. I recently took a job with the male having Alz, the woman, pre-lukemia... she is unable to do many things... and in some cases simply won't try... but it took awhile for her to accept me being there.. after repeated verbal abuse, I finally sat down with her one day and asked her if she prefered someone else to come in and help... she seemed shocked and said well no she was very pleased with my work... so then I simply tried to reaasure her that it is hard to let a stranger in your home,(they have been married for 63 yrs.) and even harder for her to see someone else taking such an active role with her husband.... to make a long story short, I was ready to quit, but made the one last effort to simply reassure and let her know I did understand... It still took a little while, but the sitution is good now, I have learned to let her say no twenty times to me helping her with something, then when it's her idea everything is ok..
I have read many times on this sight about paid caregivers having'detatchment' , yes to a degree, but we are still human, and being treated like the red headed step child gets old really fast....but have learned thru the years to use my imagination, try different things, ask questions, not too personal, and understand we all have bad days..... she is grumpy by nature... so some of it I take with a grain of salt, but I have also started asking her if she feels bad, ect.... and many times that is it... she just doesn't feel good... no, it's not an excuse, but I then do not take it personally.... but thank you for pointing out we can't help everyone, and sometimes, as much as we may not want to, walking away is the answer... I am happy to say, we are doing great now, even talked her into baking a cake with me the other day..... so, now it is a win-win situation....
Rejection of outside help makes it hard for the whole family. If possible, elderly loved ones should be exposed to a "companion" first to establish trust and a bond when they don't "need" a caregiver, per se. Once the trust is established and the elderly loved one's health declines, the transition from companion to caregiver would be easier for both the care recipient and the care provider.