Messy
When I get referrals from family members or professionals, I grab the phone to gather a sketch of the situation. Depending on the circumstances, I may or may not make phone contact with additional involved parties — i.e., family members, health professionals, lawyers, and, if he or she is capable, the client. Following the phone contact, I arrange a meeting with the involved parties who are able to attend.
Before the first meeting, I usually believe I have a grasp of the situation. During the meeting I learn that grasp is on a rickety handle. As I listen to the various points of view, the “neat sketch” I compiled earlier transmogrifies into abstract art: facts are disputed, “arguments”:http://en.wikipedia.org/wiki/File:PicassoGuernica.jpg ensue, solutions are found wanting. I’ve learned — finally! — not to develop specific recommendations prior to a meeting. Instead, I carry in a general notion of the options. As the meeting progresses, I hone this general idea into a neat approach to solving the problems for the elder and family.
To my dismay, elder and family rarely jump at my neat package; don’t care that it took great pains to assemble. My ingenuity, insight, and judgment, go unadmired, under-appreciated. Why are my clever solutions rejected? Because, as it turns out, people and their circumstances aren’t neat little packages; they’re messy confusing packages, and, unfortunately, as they age, often become messier and more confusing. For elders, there are many reasons for that mess and confusion. Here are the common ones:
Fear of change : Most of us fear change, i.e., the unknown, and to the best of our ability, try to avoid it. For elders, change is even harder because more often then not, it is thrust upon them: They lose functioning and they lose family and friends. Elders are less likely to make changes voluntarily because they are forced to deal with so many changes that are not voluntary. While, for example, I might think a move from home to an assisted care setting is reasonable, elders may be reluctant to abandon the scene of their history, memories, and youth.
Family dynamics: With sufficient pressure from her children, Grandma may agree to assistance but not be genuinely committed to getting help. If one of her children is shoring up her care, Grandma may not recognize how much aid she needs and may not see a reason to make a change.
Dementia: Bills are being ignored and pots are left heating on the burner. Memory loss sneaks up on Mom but neither she nor her family take notice. Both may refuse to acknowledge that there’s a problem.
Money: Many elders are unwilling to spend much, if any, money on their care. Depression-era seniors have a unique concept of how much things “should” cost, and cannot bear to pay a penny more. They may even think services should be free. Also, they may want to conserve as much as possible to pass to their children.
Fear of losing independence : Grandpa may regard accepting help as the first step towards being seen as completely dependent and on the slippery slope to a nursing home.
Ageism: Many elders do not view themselves as old. If I recommend an adult day health center, retirement or assisted living, they’ll respond: “I don’t want to be with all those old people.”
Who’s the decision maker?: His children may be helping Dad make a change, by scheduling visits to assisted living or by setting up an assessment by a homecare agency, but the change may be thwarted by Dad if he has no intention of either moving or hiring care. While his children may believe change is necessary, Dad makes the decisions as long as he’s competent. Providers may get trapped in the middle.
Each of the above can interfere with elders making those changes that can help them function as independently as possible. In our brief contacts with elders and their families, these issues are not easily seen or readily solved. Lives are messy, cases are messy.
