A recent question on the AgingCare Caregiver Forum brought back memories from my early days of caregiving. The member wrote, “My 81-year-old father still thinks he can do handyman jobs around the house, including climbing ladders, using power tools, etc. How do I convince him that this is dangerous and he must stop?”
This post really struck a chord with me. Most seniors need to feel useful to enjoy a high quality of life. They maintain a sense of purpose by sticking to their everyday routines and engaging in activities and hobbies they enjoy. But if caregivers believe an elder’s actions are risky or downright dangerous, when should they step in?
As caregivers, we walk a thin line between keeping our loved ones safe and helping to preserve their independence. One of my first experiences with this concept occurred with my elderly neighbor and first care recipient. Joe was in his 80s and lived in his own home. He was totally deaf, so to communicate with each other, he would speak and I would write on a large legal pad.
One day, I hurried into his house at my typical visiting time and immediately sensed that something was off. Joe would usually sit at his kitchen table waiting for me arrive, but this time there was no sign of him. I feared the worst and ran down the basement steps since he’d fallen there before. Fortunately, he wasn’t there. I headed back upstairs, where I heard a rustling noise coming from his bedroom. Joe, whose gait was wobbly at best on a flat surface, was perched halfway up a metal ladder. He was using needle-nose pliers to jab into a light fixture in his closet ceiling. There was no bulb in the fixture and the electricity was still on. Joe saw me and gleefully screeched, “Hold the ladder, honey! I’ll be down in a minute.”
I frantically grabbed my legal pad and wrote “GET DOWN!” in big letters. He just chuckled. This scene ended with me turning off the fuses in the fuse box, so he wouldn’t electrocute himself. He eventually tottered down off the ladder and we shared some laughter. Joe couldn’t understand why I was upset. He was simply trying to fix the light and it was his house after all.
The issue at hand is that we want to keep our aging loved ones safe, but we also want them to be able to do for themselves as much as possible. So, at what point does the risk warrant our interference and demands that a loved one refrain from doing something they’ve always done? And, if something is dangerous enough, how do we get our elders to stop doing “handyman” tasks, difficult yard work, extensive cleaning or considerable cooking projects?
Everyone needs a reason to get out of bed in the morning. If a person has no purpose in life, then why go on living? For elders whose bodies (and sometimes minds) seem to betray them more each day, this becomes a very contentious issue.
Some aspects of this dilemma are more black and white than others. For example, if Mom’s eyesight is seriously compromised and she can’t drive without placing herself and others at considerable risk, it’s imperative to stop her from getting behind the wheel. (This is one of a caregiver’s most daunting tasks.) But, if Dad just wants to play handyman, which has been his greatest pastime and purpose since he retired, when do we have the right and/or responsibility to step in and say, “You’ve got to stop that because you may get hurt.” Do we even have that right?
Weighing Risks and Benefits is Highly Individual
It’s very easy to become over protective of our elders. We don’t want them to fall, get injured while trying to fix something, or cut or burn themselves while trying to cook. But, where does their pleasure and their sense of self-worth factor into our desire to protect them? When should we decide to interfere? What happens if we wait until it’s too late?
I believe that every person and situation is different. Caregivers should assess the risks of certain activities on a case by case basis and factor in how participating in a certain action (or preventing them from doing so) would affect their physical and mental health. In many cases the joy that an elder receives from an activity far outweighs the potential dangers. But, if a loved one is cognitively impaired and is incapable of realistically assessing risks and using sound judgement, it is up to you to take over this assessment and decide accordingly.
Let me share another experience with this difficult balancing act. My dad had a botched brain surgery that caused immediate dementia and necessitated his move to a nursing home. In the first years after the surgery, he would go through streaks of wanting to “get in shape.” This was a man who spent his life with his nose buried in books. Suddenly he wanted me to buy him some hand weights, which I did. When he was in one of his more alert moods, he could sometimes be found sitting in his recliner lifting weights. This was great stimulation and exercise for him and the staff was pleased.
However, in the same mood, he would occasionally decide to race his rollator up and down the hall of the nursing home. Rather than wait for an aide to help him stand up, retrieve his wheeled walker and find his balance, he’d get himself up and dash down the hall. While this was irresponsible, he was usually okay. The problem was, he had very poor judgment. There would be days when he was too sleepy or dizzy to get up safely on his own, but he’d try anyway and end up falling.
The staff and I struggled to find a solution to this problem. All kinds of chair alarms and other options were tried and he’d circumvent everything that made basic sense. More restricting strategies would probably have been more effective, but they would have caused such psychological misery that we decided against them. We knew that falls would be unfortunate consequences, but we all agreed that restraints weren’t an option. Dad needed some freedom, or he would feel that his life wasn’t worth living.
My father is an excellent example of the fact that seniors will perk up if they have a routine to follow and set tasks to do. They may be strange and nonsensical, like a one-man footrace in a nursing home, but it helps them feel some sort of agency in their lives. Adult day care centers and long-term care facilities offer a wide variety of activities, events and hobbies for this reason. Staff members can help determine from the person’s past which ones might be a good fit. Some women enjoy folding laundry. That was part of their responsibility to keep their homes running smoothly for all those years and continuing this routine helps them feel useful. Others may like to bake, dust or garden. Good facilities foster a sense of purpose for the people they are caring for and it’s important for family caregivers to strive for the same.
Should the elderly father mentioned previously be made to give up his role as Mr. Fixit around the house? I’m certainly not close enough to the situation to say one way or the other. If the situation is similar to the one I had with Joe, I’d probably try to persuade him to back off slightly and take a few more precautions. For instance, I’d suggest he have another family member present while he’s working on his projects just in case something goes awry or he needs an extra hand.
If things are a little more precarious, you may have to put a few well-intended safety measures in place yourself. For instance, if Dad’s judgement and coordination are questionable, yet he is determined to use power tools for his projects, you may have to keep them under lock and key, so he cannot access them without supervision or claim that the drill or power saw is “broken” and out of commission until it gets fixed (i.e. indefinitely). However, I wouldn’t stop the activity altogether, and I wouldn’t step in too early.
Each person has different wants and needs, but I think nearly all of us need to feel valued and useful. We need a purpose. My personal belief is that people should be able to do as much as they can as long as they aren’t going to hurt someone in the process. If there is some risk involved, then it should be discussed. Maybe some safeguards can be put in place or some adaptations and compromises made. My advice is to be very, very careful about taking away hobbies or tasks that help people remain active and feel a sense of accomplishment.