What do you do when you see that your elderly parent needs help at home, but he or she doesn't agree? Perhaps you've noticed that your parent misses medications, walks more unsteadily or eats poorly. Maybe you worry that he or she seems less able to do basic household tasks, or is forgetting things more.

You've been shouldering more of the load, but your own family and work responsibilities are being squeezed. You broach the subject of home care services, so that your parent can get help to continue living safely at home-but he or she doesn't want to consider it. What can you do?

Avoid No-Win Arguments
The first rule is not to make your parent's limitations or disability the central issue. Laying out the evidence of your parent's lapses and limitations might persuade an objective party, but it can just make your parent defensive or resentful.

To our elders, losing the ability to handle daily affairs symbolizes a loss of dignity and control. No one wants to feel dependent. And none of us like to be told that we are no longer capable of managing tasks that once came easily.

Emphasize Your Needs, Not Theirs
A parent may be more accepting of help if you emphasize that it's for your benefit. Point out that you would feel more comfortable knowing someone was helping with the meals, laundry and household chores. Pose it as a favor for you. Explain that it would give you peace of mind as you attend to your own personal or job priorities.

Focus on Household Tasks First
Your parent may be more willing to receive assistance with household chores, laundry and meals rather than personal care like bathing or dressing. Having a "housekeeper" doesn't entail the perceived stigma that a home health aide may represent. Once your parent develops a relationship with a home care worker, he or she may become less resistant to personal care.

Enlist a Trusted Professional
Your parent may be more receptive to the advice of a trusted counselor, clergyman, personal physician or lawyer. Meeting with such an individual is almost always a good idea. But be careful about appearing as if you have enlisted the professional to press your point of view. If your parent feels he or she is being "ganged up on," this approach may backfire.

Plan for Success
If you've gained acceptance for a trial of home care, make sure you choose a home care provider carefully. A bad experience with an agency or caregiver can destroy any progress you've made. At the minimum, have a trained health professional meet with you and your parent to learn your needs and expectations, perform a basic functional assessment, assign an appropriate home care worker and provide ongoing supervision. For more information, see Arranging Home Care Services for a Loved One.

Deal With Dementia
When dementia such as Alzheimer's disease is present, things get more complicated because judgment is impaired. Telltale signs include forgetting recent events, retelling the same story repeatedly, becoming lost in familiar surroundings, losing track of time and place and losing the ability to perform tasks that were once routine.

Such behaviors are not part of normal aging. If you recognize them, a medical evaluation is critical. And, be prepared to take a firmer approach on the issue of arranging help. Your parent's safety may depend on it.

January 2004