Challenging Behaviors, Chapter 2 - Understanding the Resistance

For resistant elderly, the more subtle or indirect the assistance is, the more likely you will have success. Please understand that these elderly are, at their core, terrified. They often have always been fiercely independent and prided themselves as not needing anyone. In reality, we are all interdependent but don't try to reason with someone who has lost the ability to reason. You will lose every time. Elderly folk remember nursing homes and other assisted living facilities [even though the concept of assisted living hadn't been thought of yet] as terrible warehouses of miserable humans who are not cared for properly. While nursing homes and other similar facilities still have their problems, they are nothing like they were in the 50's.

Almost every new client I get insists on staying home and I have to accept this and try to make this happen for them while trying to gently educate them by taking them for "tours" and not putting a lot of pressure on them. Also, natural consequences can be a great motivator.

Many times, family and others trying to help a resistant person help too much. Just how much help is too much help? Well, that differs from person-to-person, which makes it difficult to have a one-size-fits-all answer. If the "helpers" quit helping in certain areas and suggesting an alternate, the resistant person will initially try very hard to coerce, guilt trip or whatever has worked in the past to get the "helper" to continue helping. Once the resistant person realizes that the "helper" will no longer step in, he/she will either a) agree to the alternate solution or b) find another "soft-touch" somewhere to help out. There is nothing you can do if the resistant person chooses "b." Again, you just have to sit back until "b" either shows it works out or the "soft-touch" gets tired and beats a hasty retreat. Playing a rendition of "Good Cop/Bad Cop" can sometimes be helpful. If you can have others [Adult Protective Services, the doctor, etc.] be the "Bad Cop" and set yourself up as the "Good Cop" all the better.

Does it look hopeless? It isn't necessarily hopeless but you have to make a plan and be patient. Talk with Adult Protective Services, especially if the resistant person is being financially exploited or abused. Have a consultation with a Geriatric Care Manager with behavioral experience, who can help you make a plan and give some creative suggestions on how to handle the issue. Contact your local Area Agency on Aging for local resources. The key is to pick your battles and get everyone involved with the resistant person to agree to the plan. One weak link will make positive change almost impossible.

Unsafe and Resistant to Help, Chapter 1

What constitutes being unsafe? In our country we value our independence and our laws reflect it. Short of a court order, which is extremely difficult to get, a person can live as they chose. As people age they sometimes lose the ability to meet even basic needs. Of course, this doesn't happen all at once. It is typically a slow process. As a caring person, when this becomes obvious you want to set in and "fix" the situation. There are seniors who will welcome help, seniors who will tolerate help and [my typical client] seniors to steadfastly deny that they need help. Here is a list of some of the problem areas:

Financial Exploitation: This happens far more often and any of us want to admit. Financial exploitation has many "faces."

• A family member always in need of money. Maybe the senior has helped them financially all their lives but there comes a point where the senior my develop dementia and can no longer make a conscious choice.


• "Helpers" or "friends." Too many times a senior in denial looks to a neighbor or "nice" stranger for assistance. At first the "helper" assists for little or no compensation but over time they manipulate or demand more from the senior.


• Solicitation phone calls. Seniors are fodder for a phone solicitor who is friendly and seems to provide a little companionship for those who are lonely and isolated.


• Mail solicitations. Seniors get deluged with mail requesting financial assistance for anything from sick animals to disabled veterans to third world countries.


• Charities: Even religious organizations can be pushy about donations.

Personal Safety: There are many personal safety issues but these are some of the highlights.

• Hoarding. A senior may lose the ability to determine what is trash and what is important so then will not throw anything away. Over time this can build into a health and/or fire hazard. This problem is becoming so prevalent that there are many books written about it.


• Falls. As a person ages, the possibility of falling increases dramatically. Even when a person realizes he/she needs to use a walker when outside the home, that same person will park the walker in a corner of the house and hang onto furniture and whatever else that is in reach. If a person is going to fall, he/she will fall no matter the location [home/assisted living/nursing home] so the question the becomes, "Just how long do you want to be on the floor before help arrives?"


• Allowing anyone who comes to the door into the house. This always strikes a certain amount of terror into my heart. Lonesome seniors who welcome anyone into their home yet refuse appropriate assistance.


• Driving. This is a real hot button for most seniors. When a senior gives up driving, he/she gives up a huge amount of independence and sometimes does not have the ability to problem-solve well enough to figure out alternatives or understand how the alternatives work.

Inability to follow medical instructions

• Because of short-term memory problems or the inability to comprehend, the senior is unable to follow through with instructions. This may mean medical tests, medication changes or as simple as remembering the next appointment.


• Inability to manage medication. I have entered many a home that had medication [old and new] everywhere. Other times a senior had a method of tracking medication but due to illness or dementia that method no longer works and the senior is unwilling to change. I've met other seniors who are so afraid of taking too much medication that they take too little.


• Doctor "hopping." A senior either doesn't like what he/she hears or cannot comprehend the instructions. The senior denies that he/she has a problem, therefore it must be the doctor and changes doctors frequently.

Inability to manage Activities of Daily Living:

• Personal hygiene becomes poor. The senior doesn't pass the "sniff" test. He/she insists that he/she bathes regularly but it's tough on the nose to be in the car with them for any length of time. Clothing is dirty but the senior insists their clothes are just FINE. [We occasionally have a client that necessitates the use of an air freshener after transporting the client to an appointment]


• Unexplained weight loss. The senior is losing weight but there is no medical reason. The senior won't let anyone look in the refrigerator or cupboards insisting that he/she has plenty of food. You take that person out to eat and he/she announces their not hungry but eats most or all that is served. If you can look in the refrigerator, food has spoiled and the boxes and cans in the cupboard are past their pull date.


• Inability to clean house. The house may be fairly tidy but it become increasingly grimy.

What is the answer? There are often no easy answers. What you need is a big bag of "tricks." In the next post I will list some "tricks" that have worked with some of my more challenging clients.