Caring for elderly loved ones presents unique challenges. While we often feel honoured to be able to care for and support our parents, as they have done for us, it also comes with a host of challenges that can be hard to navigate.
One such issue is when elderly parents start to show cognitive decline and/or start making decisions that do not have their best interests at heart.
As parents grow older, our foremost concern is making sure that they are comfortable and safe. As long as they can care for themselves and make necessary decisions about their daily and longer-term needs, those concerns are eased.
But what should you do when an ageing parent starts to show signs that they may not be completely capable of taking care of themselves.
Understanding your parent’s needs
Ageing loved ones often do an excellent job of hiding their declining physical or cognitive abilities from their families, especially from those who live far away. They do this for a range of reasons; from not wanting their family “in their business,” or difficulties accepting that there is a decline, or fear that showing signs of needing support will lead to loss of independence. They may even lack the cognitive ability to recognise that they have a problem.
For adult children to understand if they need to make decisions on their parents behalf, a number of factors need to be considered, starting with establishing an accurate picture of their care needs.
Assess the situation
Do you have a crisis on your hands? An urgent situation? Or an ongoing chronic decline? Your answer to these questions will determine how quickly you must act and make decisions, and how much collaboration with other family members you can afford to engage in. The more urgent the situation, the less time you will have to seek input.
If you find yourself in this situation, make sure that you are the person with the legal authority and responsibility to be making decisions. If you do not have general or lasting power of attorney for your parents, then you must get the person who has this authority involved. If the Lasting Power of Attorney (LPA) has not been set up, that should be your priority, if your parent still has the mental capacity to do so. More on LPA’s shortly.
Mental capacity and cognitive decline
It’s important to understand the legal framework around making decisions on behalf of other adults. Just because a person shows signs of cognitive decline that doesn’t necessarily mean they are not capable of making the right decisions for themselves.
In law, this is referred to as ‘mental capacity’. The Mental Capacity Act 2005, covering England and Wales, provides a statutory framework for people who may not be able to make their own decisions. It deals with who can make decisions, in which situations, and how they should go about this.
Five principles are set out at the beginning of the Act:
- A person must be assumed to have capacity unless it is established that he lacks capacity.
- A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success.
- A person is not to be treated as unable to make a decision merely because he makes an unwise decision.
The Mental Capacity Act 2005 is often used for older people with long-term mental health problems, particularly dementia, and their carers. However, for many people with elderly parents, they may recognise that their parents show signs of cognitive decline but do have the mental capacity to make their own decisions.
Be mindful that you distinguish between a true safety issue and a matter of opinion. Simply disagreeing on what is best doesn’t mean your parent isn’t capable of making his/her own decisions. If there is a safety issue, then it may be an issue of mental competence and it is time to step in.
In situations like this, the most important factors are that the elderly person is safe and making decisions that keep them safe and healthy. If your elderly parent fits into this category, the steps set out below in the section called ‘Talking to Elderly Parents About Care & Decision Making’ can help you and your parents identify areas where they need more support.
Memory loss in elderly parents
Almost everyone experiences some degree of memory loss as they age. As long as the loss is minimal and does not interfere with an elder’s ability to carry on a normal daily routine and make decisions, it is not cause for significant concern. However, it is important to understand that significant memory loss is not a normal sign of ageing, and one should consult a doctor as soon as possible.
If the memory loss becomes more noticeable, it can indicate a more serious problem, such as the onset of dementia or Alzheimer’s disease. There are many different types of dementia and early diagnosis and treatment are crucial to a longer quality of life, as well as being able to set up the legal framework in which to care and make decisions on their behalf.
When elderly parents do not realise there is a problem
Sometimes, elders are totally unaware that they are having cognitive difficulty and strongly resist any effort by loved ones to address problems related to their well-being, comfort, and safety. It is not uncommon for an ageing parent to resist losing their independence and/or control and will not listen to family members.
If your elderly parent does not realise that he or she needs help making decisions and all efforts to talk with them have failed, you do have alternatives. The UK Government website sets out the legal options available for making decisions on behalf of someone else. It details Lasting Power of Attorney and Ordinary Power of Attorney procedures, as well as different approaches for setting up decision-making for short-term or long-term help.
Setting up Lasting Power of Attorney now and for the future
Lasting power of attorney (LPA) covers decisions about a person’s financial affairs or health and care. It comes into effect if the person loses mental capacity, or if they no longer want to make decisions for themselves. You would set up an LPA if you want to make sure you’re covered in the future.
It’s a good idea to set up an LPA with your parents early on, way before it is needed. It ensures that your elderly parent understands that there may come a time when you or your siblings can help to make decisions in their best interests, and legally must be set up when the person has full mental capacity in order for the LPA to be legally binding.
Talking with elderly parents about care and decision-making
1. Start talking early
Often, families wait until they’re in the midst of a crisis to make decisions about elderly loved ones’ care and support. This can make conversations more emotionally charged and make the decision-making process feel rushed. Keep in mind that different family members will have had different exposure to the amount of help a parent may need. For those providing less direct care in the family, this can take time to understand.
Instead of waiting until you have to consider other options, initiate regular family meetings as soon as your parent begins to have noticeable changes in health or struggle with activities of daily living. Be sure to include your parents in these talks so you can start to explore their preferences and feelings, and what types of care or support they may be open to now and in the future.
2. Help your parents feel in control
Do your best to make your ageing parent feel they are in control of their life and this decision — because they are. For example, you might say something like: “I want what’s best for you, but I also respect that it’s your decision. Do you mind if I share my thoughts with you and we can talk about possible solutions together?” as opposed to “I did some research and I think this is what’s best for you.”
3. Prioritise your parent’s independence
Involve your parents in discussions and decisions as much as possible and make choices or recommendations that prioritise their independence. The most difficult aspect of ageing for many older adults is the real or perceived loss of independence, so if you can keep your loved one safe and as independent as possible, it is almost always the better choice.
4. Be patient
Give your ageing parent time to reflect on their current situation, how their health or happiness may change in the coming years and the information they’ve received from you. Unless you consider your loved one’s need to be an emergency, try not to push. It’s hard to wait, but you will likely need to take more time to work through the process than you’d like, so being patient is key.
If you want to broach the subject again, try waiting for an opportunity when you can use an example of a current situation and how it could be better for them. For example, you might wait until a day when Mum is complaining that the house chores are difficult due to her arthritis. Offering potential solutions as discussion points will be much better received when your parents can appreciate a particular challenge they have and how it could be better.
5. Start with the quick wins
You may be concerned about your parents’ ability to make the best decisions for themselves around care and housing, for example. These are big topics that take time to work through. In the meantime, find ways where you can assist your parents in small ways that demonstrate to them that you can make decisions on their behalf, while still involving them in the process.
Whether that be grocery shopping, helping to save them money on bills by switching suppliers or tariffs, helping file paperwork, or dealing with the local council. They can all go a long way to proving to your parents that they can trust you to make decisions that benefit them while they still maintain control and are involved in the process. As you move forward it will feel more like an incremental process toward gaining your parents trust and having a bigger involvement in decision-making.
6. Talk with those close to your parents
If you do not see your elderly parents very regularly, maybe due to geographical location, it’s useful to talk with friends and loved ones who are involved in your elderly parents’ day-to-day life. Whether it be a neighbour, close friend or nearby relative, they can offer perspectives and experiences of how your parents are coping and what they might need help with. Getting a wider perspective can be invaluable.
Collaborating with health professionals
Involving care professionals in your parents health and care needs can garner lots of benefits for you and your parents:
- It takes the pressure off the child–parent relationship where the parent often believes they know best.
- Removes the intense personal relationship dynamics from an already emotive situation.
- Health professionals have extensive expertise and knowledge in the area of adult care that they can bring to the situation.
- A health professional’s opinion or recommendations will usually be more respected than those of a family member.
- Can identify areas of care and support which you may not have thought of or identified.
Involving health professionals may take the form of discussions with your parent’s GP, a care needs assessment, or social worker involvement.
Exploring care options
If you are considering what care options are available for your parents, it’s important to know that there are many more choices than simply coming to live with you or moving into a care home. As the UK has an ageing population and more extended families live geographically apart, it has sparked the rise in alternative care options for the elderly.
The vast majority of elders express a desire to stay living in their own homes as they age. This is now a welcome alternative to residential care thanks to home care providers like Country Cousins. Live-in care is one way for your parents to receive round-the-clock support while remaining independent in the home and community they love. And the costs are often comparable to those of a residential care home.
How Country Cousins can help
If you think live-in care could be a good option for your parents do not hesitate to get in touch. Our friendly expert care team is on hand to answer all of your questions, with no obligation.
Get in touch today on 01293 224706. Alternatively, fill in our online enquiry form and we will be in touch soon.