The care discussion: How to handle an elderly relative refusing care

Assuring your loved one of the positive aspects of receiving care can be tricky if their mind seems made up, so here, we’re tackling the difficult subject of organising home care for an elderly relative if they are refusing help.

At Home Instead, our aim is to help people age positively and in place, which means bringing expert care to them at home. This helps them to live independently and enjoy a stimulating life where they’re most comfortable. We’ve helped thousands of families, so whatever situation you’re facing, or whatever your questions about home care, Home Instead can help.

Some of these reasons may include:

• A belief that home care equals moving to a care home – Remind them home care can be adapted as their needs change, so there is no reason to assume they will end up in a care home. Home care is flexible, so they can remain in their own home as long as they want to. 
• A fear that they will lose their independence – Elderly people’s autonomy is important for their wellbeing, so it is important to respect their needs, wishes and values. Make it clear they will be involved in any decision-making when it comes to the type of care they need and the people coming in and out of their home.  
• A fear that they won’t get a say in their daily activities – As above, remind them their daily routine can be whatever they feel comfortable with, and they will retain control over this.  
• A fear of loss of dignity – Having to accept personal care from a stranger can be a difficult objection to handle, as many people are embarrassed to receive help with intimate things like going to the bathroom and getting washed. Remind them that carers are qualified professionals trained in helping with things like this. They will always respect your wishes, make you feel comfortable and do everything possible to preserve your dignity while helping you feel fresh and clean every day. 
• A feeling of guilt – Studies have found that care receivers often feel guilty and embarrassed by receiving more care than they can give in return. Remind your loved one they may have spent years of their life looking after other people, and now it is their turn to accept help without guilt. Assure them that carers want to help them, and they should never feel like a burden. 
• Worries about paying for treatment – Often elderly people worry they won’t be able to afford the care they need, or that their family members will be out of pocket as a result. Assure them there are options when it comes to financing care, and involve them in discussions about how this works. You may find our guides on The Cost of Home Care and Paying for Care helpful for this discussion. 
• Concerns about stigma – Some elderly people may have concerns about others in their social circle finding out they require care. This comes back to an embarrassment about the need for care, as this can affect their pride. Remind your loved one that if they would prefer, none of their friends or other family members need to know the details of their care, as this can take place at home at times that suit them and is entirely private.
• A fear that you or other loved ones will visit less – This can be a difficult discussion to have, as your elderly relative may worry that – by accepting home care – they will see their loved ones less. It can help to remind them of your commitment to visiting, and assure them that even if they see you less as a result of home care, it can make visits more enjoyable and enriching as you can focus on doing activities together and catching up properly without distractions like housework or cooking. 
• A denial about becoming older – Some elderly people feel they don’t need help, and would rather struggle than accept they are getting older. This can be a difficult conversation if they are refusing something you feel is an obvious need, but try to stay calm and listen to their perspective. The conversation may need to be had a few times for them to accept assistance. Also, if your loved one is refusing safety devices like personal alarms due to their association with becoming older, consider work-arounds that offer similar protection without the perceived stigma, like a voice-activated alarm or hidden emergency button.
• A fear of strangers in their home – Many elderly people worry about being on their own with a stranger, and this is an understandable fear. Assure your loved one that person-centred care is the goal, so they will always be fully involved in decisions about who comes into their home and how often. Also, remind them that initial meetings with carers and trial periods can be arranged, so they will get to decide whether or not they enjoy the company of their carer, and can switch if needed. At Home Instead, we take into account the personalities and likes/dislikes of each individual to ensure they are matched well with the best carer for them.  
• A negative perception of the healthcare system – Some elderly people will refuse things like hospital or care home admission, and this attitude can make them sceptical of home care too. Helping them to better understand home care and what this involves can be useful. You may find our guide on What Is Home Or Domiciliary Care? helpful for this discussion. Remind them they will be heavily involved in their own care planning, and can decide what help they need and when. 

What to do if an elderly person refuses care?

It can be tough if an elderly relative is refusing to discuss their care needs, so if all of the above is not working and they are still saying no to care, you may want to try:

• Ask open-ended questions about how they plan to handle future limitations such as mobility problems or an inability to perform personal care tasks
• Have the discussion several times to allow them time to think about some of your points.
• Ask them what they believe they need – remember, person-centred care is crucial so they should be in charge of the discussion.
• Encourage them to consult a doctor or another healthcare professional who can give their opinion. Sometimes people find it easier to hear suggestions from a professional rather than a family member, and doctors are often experienced in people refusing care so they may have some communication tools up their sleeve. 
• Rather than trying to convince a loved one to implement an entire system of care, start with one thing, and this should be the most urgent need. For example, if you are worried about a loved one falling at home, focus on getting them a wearable alarm that can alert someone if this happens. The next point of call can be grab rails or something similar around the home, but an alarm is a good first step. 
• Take them to visit a friend or relative who may already have home care in place. They may be better placed to discuss the potential benefits, and explain how much easier and safer life feels since getting home care. This is not about getting reinforcements for you, but rather, finding someone with the relevant lived experience of home care who can hopefully offer a new perspective.
• Explain your reasons for wanting to arrange care, which might include things like worrying about them, or feeling overwhelmed with care responsibilities. This shouldn’t be about making them feel guilty, it is about helping them understand why home care could benefit you too.  
• Ultimately, put your loved one in the driving seat so they can choose what they feel would make life easier, what kind of help they would like, and which service they would like to try. It can help to arrange a trial period with a few different carers until they decide the fit is right.