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Posted: February 29, 2008

Sometimes a Referee Can Help

Coping with a Difficult Parent

When it comes to caring for an aging parent, most family caregivers have a story or two to tell about Mom’s reluctance to accept help in her home, Dad’s refusal to move into an assisted living facility, or something similar. But while it’s perfectly normal to expect some degree of resistance or anger from an aging parent facing a life-altering circumstance, there are some whose everyday dealings with a caring adult child can make caregiving a grueling, almost crippling experience.

While they’re simplistically referred to as “difficult parents,” these seniors make persistent unreasonable demands, are openly hostile and hyper-critical, and attempt to control through intimidation, manipulation, threats, tears or even bribes. Ironically, this exasperating behavior is often directed toward the very person the aging parent relies upon most – the adult child who willingly steps into the role of their caregiver.

“In situations like these, the frustrations will come out. And those frustrations lead to a treadmill effect. Everyone is making noise and going nowhere,” says Marion Somers, a Brooklyn-based eldercare expert known professionally as “Doctor Marion.”

So, if this sounds like your parental caregiving relationship, how do you get off the treadmill and begin having positive communication and a healthy relationship with your unruly and unappreciative parent?

First Steps

First, it’s important to assess the situation. If your relationship with your parent has always been a web of tension, anger, and negativity, then it’s likely that the situation is not going to change. But if this challenging behavior has occurred only recently, as in the last months or recent years, underlying health reasons could have triggered the changes in your parent’s behavior.

Certain health conditions such as stroke, heart disease, diabetes, Parkinson’s disease, and dementia are often accompanied by depression. Medications used to treat high blood pressure, arthritis, pain, heart disease, and other ailments can also lead to depression. Given the degree of loss experienced by aging individuals, it’s not uncommon for depression to take its toll on a person’s ability to cope with life stresses. Depression may present itself in a variety of ways, including social isolation, tearfulness, lack of self care, or projection of anger onto others.

For all of these reasons, it’s important to start with a good medical evaluation by a geriatric specialist, if the parent borders on being out of control. Behavioral issues often accompany both dementia and the diagnosis of depression, so a screening for both conditions should be part of the assessment.

Listen and Learn

Next, adult children need to have a “third ear” and an open mind to listen and understand the views of their aging parent. Somers says that adult children too often attempt to “fix problems” for their parents. “Adult children come in with their ideas of what is best,” notes Somers, “and what this says to the aging parent is ‘I’ve got to get you off of my to-do list. You are my problem and I have the solution’.”

She adds: “No matter how much you want to help your parent, you don’t want to ruin a relationship, and you don’t want to make a difficult or strained relationship worse. Speak as one adult to another. Studies show that only 7% of our communication is understood through our words; the rest comes from our body language, tone, volume, and facial expressions so how we communicate with our aging parents is most important.”

Somers feels that an adult child feeling pinned down by an uncooperative parent must look beyond their own feelings to the cause, in order to diffuse the situation. “Adult children need to take the time to explore the feelings of their parents, discuss options, address the fear of the unknown, and negotiate for best solutions. There is no quick fix in this whole thing,” says Somers.

Professionals May Help

An aging parent may be so entrenched or angry that it might help to seek counsel from a variety of sources. For example, a trusted physician, pastor or rabbi may be helpful. Other helpful allies include geriatric care managers (GCM) or elder mediators. GCMs tend to focus on finding available resources or sources of assistance, while elder mediators serve as neutral parties to help families reach consensus on decisions. And while a GCM may be able to conduct some degree of mediation, the mediator’s expertise is in helping families resolve conflicts by finding acceptable solutions.

“Unlike counseling, mediation’s purpose is not to address family dynamics or to heal or change the family system. Sometimes a side benefit of mediation is that family members improve their relationships and heal some wounds, but that is not the purpose of mediation,” says Dana Curtis, a California elder mediator.

Tips for Reaching Solution

Curtis offers these tips in finding mutually acceptable solutions between crotchety aging parents and their caregiving adult children:

1. Create the opportunity for all interested family members, as well as the aging parent, if possible, to come to understand one another’s perspective on the situation. Spend whatever time is necessary to give everyone a chance to listen and understand each other’s views.

2. Focus on the needs of the various parties, rather than their wants. Needs can be met in a number of ways, sometimes very creatively. “Wants” generally have only one way of being satisfied.

3. Get help from a mediator before you start, if your family has a history of difficulty in communicating and making decisions.

When hiring an elder mediator, be sure to ask about their level of training and experience. Mediators often will provide for a no-cost initial assessment of 45 minutes to an hour to explain their services and identify what they may be able to offer to your specific situation. Mediators may be found by referrals from geriatric care managers, elder law attorneys, or local senior centers.

There Are Boundaries

Still, no matter how much you may want to help an aging parent, your parent is an adult with the right to make their own decisions. As Somers says, “Every competent adult has a right to make decisions on their own behalf. The adult child may feel a social or moral obligation to help, but the parent makes the choices as long as he or she is legally competent.”

If an aging parent is truly not competent or is in a state of self-neglect, it may be possible to receive help from the local Area on Aging, or in more extreme circumstances a call may be made to the state office of Adult Protective Services. To locate these services in your area, phone Eldercare Locator at 1-800-677-1116 or visit their website. In some situations, an incompetent parent may be placed under guardianship or conservatorship if there has been no prior arrangement made to appoint a decision-maker.

Somers says, “Most caregivers are doing the very best they can with the resources they have – time, money, knowle

ge. What they may need to do is accept the fact they will also need to find and accept help in caring for their parents and to preserve their relationships.”

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Paula S. McCarron has more than 20 years of experience in health care, including nursing homes and hospice. She lives in Chelmsford, Massachusetts, and can be reached at paulamccarron@gmail.com.

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