Safety vs. Independence: A Case Study

by Jan Allen, CSW, MSE
More About Jan. . .

When it comes to older adults, they usually value their independence over being "safe." However, the adult children of elders usually want just the opposite - they want their mom or dad to be "safe" - even if it means giving up a home, some independence or both. How do families successfully deal with these warring values?

Here is a case study to illustrate some of the circumstances that families might face and some possible ways of dealing with the situation:


Harry and Frieda were married for 47 years. Frieda was the "typical housewife" and Harry was the "breadwinner." Now, Frieda has passed away (6 months) and Harry is struggling to learn how to take care of himself. Their only child, Anna, has seen her childhood home become very dirty and messy. Her father has lost 25 pounds in the last 6 months because he is not eating those good meals Frieda once prepared. He looks thin and this week, he called Anna to tell her that he is in the hospital with pneumonia. Anna works full time and has three kids of her own. She is very worried about her dad - who lives about 3 hours away in a different city. Anna discusses her dad with her own spouse and they "decide" that Anna's dad will come to live with them so they can feed him properly and keep and eye on him. The family home will be sold. When Anna goes to see her dad in the hospital, she broaches the topic of moving very directly. To her surprise, her father absolutely refuses to consider selling his home or moving in with his daughter. Anna is shocked. Her father has always been a very quiet and gentle man. He has never been assertive. Anna stops short of arguing with her father when he has a big coughing fit. "Dad, we will have to talk about this some more," she states.

Clearly, Harry is having difficulty in taking care of himself; so Anna's concerns are justified. However, are there some things Anna could have done differently?

First, Anna "decided" that her father was going to come live with her. She made the mistake of assuming that whatever she decided for her father was going to be accepted. So, she went to see her father with a prepared agenda that she expected her father to agree to. What if Anna had taken a different approach? What if she had discussed the matter with her spouse; but instead of "deciding" Dad was coming to live to with them, what if she had simply made sure her husband had no objections so she could safely put that on her list of "options of how to help dad."

Second, Anna may not be aware of how powerful the process of grief might be at this time with her father. Frieda has only been gone 6 months. Her father is still in the process of accepting her death and learning to adjust. It is quite possible that he will improve given some additional time. He might learn to cook better. He might begin to assess his own need for that big, old, house he now lives in alone. The simple fact is that Harry is busy doing "grief work" and he isn't ready to confront another major life change right at the moment.

Third, Anna decides she is going to talk to her dad while he is sick in the hospital. Unless it is absolutely necessary, Anna might have chosen to select a different time to speak with her father. Perhaps after he returns home - or is feeling a little better - or even after her initial visit to the hospital. Since his illness is not completely debilitating or imminently life threatening, it is reasonable for him to think about going home from the hospital with a safe discharge plan. Anna has a resource on the hospital staff that she has not even considered using. That resource is the social worker/discharge planner. Even though discharge planners must get permission to discuss discharge planning with family members, most older adults readily agree to that - if the topic is broached in a helpful, problem-solving sort of way. Let's assume that Harry has already told the discharge planner that he is willing to have his return home discussed with his daughter. The discharge planner's expertise is how to get the patient returned safely home. So, the discharge planner can serve as an objective professional in helping Harry see that he has some options to consider that he might not have thought about up to this point. The discharge planner can also be sure that Anna knows the community resources available to her father in his own town:

*Meals on wheels
*In-home support for cleaning, meal preparation, errands, shopping, etc.
*Senior citizens centers
*Parish nurses or other clinical professionals to help him cope with his grief
*Support groups for widows/widowers to help him learn practical skills of coping
*County, City or Not-for-Profit agencies that assist older adults with all sorts of services.

Having a better idea of the services her Dad might be able to access can give Anna some much needed peace of mind. She might not have thought her Dad "had" to come to live with her if she knew all the help he could get - and still stay at home.

What about Harry, though? Is he being realistic? Can he really learn to take care of himself? Or, is he just going to have a series of illnesses and further decline which sap his daughter's energy and take up her time in "rescuing" him? Does he expect his daughter to drop her family responsibilities and run to help him? Is he being selfish in not considering her desire to have him close by where she knows he's safe?

Once again, the discharge planner can play a crucial role here. S/he can help both Anna and Harry understand the resources available and the need to be respectful of each other's opinions and solutions. The discharge planner might realistically suggest that Harry go to stay temporarily with his daughter until they can discuss all their options and perhaps come to a closer agreement on how to proceed. This will help Anna to have immediate peace of mind and will help Harry to get some much needed support. We do not know at this time if Harry will even need that support on an on-going basis; but if it couched in "temporary" terms, he is much more likely to accept the idea. No one likes to be pushed into a decision. Perhaps a few weeks with his daughter and he will begin to consider moving as "his idea." Perhaps Anna will look into options that will keep her dad independent but with some support services.

Either way, both will have learned that there are more options than the only one that was originally presented. If Anna's dad was not hospitalized but they were still facing these issues of decline and need for support, Anna or Harry could access a social worker or case manager with the county aging office or human services agency. There are trained care management professionals who can help family members negotiate and work through some of these difficult matters. There are also professional independent care managers who can be hired for a fee to assist in working out, negotiating and managing the details of these types of transitions.

So, here are some of the things family members can think about when faced with a elderly loved one in declining health:

1. Discuss matters with them open and honestly; but don't tell them, "It has to be thus and so."

2. Affirm your love and support of them; but also be sure they understand that you have limitations in what you can do for them. The old, Biblical ideal of "honoring your father and your mother" does NOT necessarily mean doing every single thing they want the way they want it. Even the elders of the family must sometimes compromise their wishes.

3. Do your homework. Call and find out the resources available in your community to help. Many adult children of elders do not even know that there are now many options between staying at home going to a nursing home. In fact, fewer than 30% of all elders ever go to a nursing home. Find out about retirement centers, communities, assisted living facilities, group homes, in-home services, meal services, government services and other agency services.

4. Pick the right time to call a "family meeting." Be open to everyone's ideas. One very overlooked family group is the grand children. If Harry is coming to live with Anna, how do her three children feel about it? Is one of them going to have to give up a private room and start sharing a bedroom? The family dynamics of how ALL family members will be affected by these decisions needs to be explored. Don’t assume that a teenage son is willing to make the same sacrifice for his grandfather that you are willing to make for your father. The children need to know they are heard - even if the decision is made that they don't agree with. If they are included and asked for their solutions and ideas, accepting the transition may be easier for them.

5. Try to "think outside the box" as well. Is there an adult or young adult family member who is single and who might consider moving in with Harry for an exchange of rent for care giving? Is there a nice widow in the neighborhood who would be willing to come over and show Harry how to cook up simple dishes and freeze them? (That might also help with is grief work). Instead of Harry coming to live with Anna - would Anna consider moving her family in to live in Harry's house? Obviously, there are employment issues and other matters to think of here; but I have actually seen this idea work very, very well.

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Recommended Reading
Coping With Your Difficult Older Parent by Grace LeBow, et. al. (Read our Review)
- Caring for Yourself While Caring for Your Aging Parents by Claire Berman (Read our Review)
- As Parents Age: A Psychological and Practical Guide by Joseph Ilardo
- Additional Books and Reviews are in the ElderCare Bookstore

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