How to Have the ‘You May Need Help’ Conversation

When we don’t live with our elderly loved ones, it can be difficult to know how they’re really doing living independently at home. But if you see physical, emotional or cognitive signs that they’re not able to take care of themselves the way they once were, it’s important to speak up. This could happen while you’re at their home or after you’ve visited them for the holidays.

If you think it will be a difficult conversation, know that you are not alone. When well-meaning children or other relatives bring up their concerns or suggest their older loved ones move somewhere they could have more assistance, they’re often met with pushback, disregard, and hostility. This is understandable, because any changes involved in one’s routine or home environment can feel like a compromise of independence and privacy, especially for seniors who may be experiencing physical and cognitive changes.

Having the “you may need help” conversation can be awkward and uncomfortable. But it’s possible, and you can do it if you approach the topic with patience, kindness, and respect. Based on my experience working in different home environments with older adults and family caregivers through Gary and Mary West PACE, here are some tips for having this important talk with your loved one.

• Use “I” statements and factually observe what has changed. (“I notice there are a lot of past due bills stacked on the table. You were always so good about paying things on time when we were growing up, have you been able to keep up with paying them?”)
• If commenting on their appearance or hygiene, ask open-ended questions. (“I’ve noticed you don’t like to style your hair as much lately, has anything changed?”)

• Try to restate what they are saying to you back to them to make sure you convey that you understand their wants, needs, and fears. (“It sounds like you’re concerned about people not respecting your privacy, is that accurate?”)
• If your loved one acknowledges they need help, don’t tell them what to do. Instead, ask what their priorities are and ask how they might prefer to solve a given problem. (“I can see that it’s hard for you to keep all your medications straight, but it’s really important to stay on top of that. What do you think you need the most help with?”)

• Give your loved one choices when talking about care. (“It sounds like you could either add a chair lift to help you get upstairs, or you could move your bedroom downstairs and have someone come in a few days a week to help you around the house. What sounds more feasible to you?”)
• Do not dismiss it outright if they express that they want to remain in their own home. Most older adults (77%, according to the AARP) would overwhelmingly prefer to stay independent in their own homes as they age. This does put their family members in a difficult spot as they face mounting age-related health challenges, especially if they live out of the area and need to coordinate care from afar. However, in these situations, you have options for affordable in-home care, including PACE (Program of All-inclusive Care for the Elderly) programs.
• Emphasize the idea of “interdependence” to older loved ones afraid of losing their independence, and that you’re on their side. Acknowledge that people need one another from childhood to older age, and encourage your loved one to remember that by accepting help, they are in turn helping the person providing the help.

Above all, be patient, and give your older loved one time to adjust to your opinion and ideas. Try to approach the conversation with a goal and agenda in mind, let your loved one know the importance of several things you would like to discuss before incorporating the above tips. Most likely, this conversation will naturally develop over weeks or months, unless there is a serious emergency or health hazard that has to be addressed right away. In difficult cases where you are not sure where else to turn, contact your local PACE program, which will help provide guidance and support and can send a trained expert to thoroughly assess your loved one’s home and situation.

Know and understand that caregiving is a journey, you are not required to have all of the answers yourself. Oftentimes, there are more resources and support available than you may expect. Reach out to a PACE program near you to discuss ways in which they may be able to help.