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Self-Determination: Saving Your Loved One From Themselves

Self-Determination: Saving Your Loved One From Themselves
By Kristina James
Published by Ruby

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As caregivers, it can be frustrating and painful to watch a loved one refuse help.

Unless it has been officially stated by a medical professional that a person needs a surrogate decision-maker – that’s someone else to make decisions for them – the right to make any decision remains with the person.

What can you do if your loved one is not able to take out the trash or do their laundry? They understand that they cannot do this alone, and yet they still refuse help.

Or if a loved one lives alone, and they fall a lot? As long as they can make their own decisions, they get to decide whether to stay at home or move into an assisted care facility.

You can’t make them accept help.

So what can you do as a caregiver? Watch them suffer and do nothing? Let their home pile up with trash and dirty laundry? Remain in constant anxiety that today is the day they will accidentally hurt themselves? No.

Although the temptation might be there to swoop in and save them from themselves by forcing them to move or pay for some day-to-day help, here are some Smart Steps to do first.


Donna Cohen, PhD*., is an expert in this area. She says that we should try to understand a person’s fear about getting old instead of insisting they move into an assisted living shelter or hire services from caregivers.

It’s less about living alone and more about their fear of losing control.

Aging is a scary thought when experienced in a culture that values independence above all.


  • Ask your parents what it is they care about most and what they fear most.
  • Then listen.


Older parents tend to believe that their loved ones, even their children, are incapable of understanding their troubles emotionally and physically. Giving them reassurance that you have heard them and understand their perspective, will lessen their fears about function loss.


  • Try using phrases like, “I hear you saying…”
  • “If I were you, I would feel…”


You can empower your loved by and discussing goals and hopes, and if there are any ways to safely accomplish these. Find resources to engage and encourage them about the future.

It is undeniable that some seniors will not believe something unless the explanation comes from a professional. Dr. Cohen advised that getting help from experts such as doctors, social workers, or even priests and ministers can overcome difficulties in convincing an elderly parent to accept the help they need.


Get Back Up

Professionals can provide correct answers to the concerns of seniors about treatment, empowering the patient to make informed choices. Also, a third party like a doctor, counselor, or a priest, can help you avoid the typical patterns and pitfalls that come from trying to communicate with a family member.

If you are still not convinced that your older parent is safe alone, the AMA Journal of Ethics suggests you request an Elder Self-Neglect Assessment (ESNA) be given by a doctor.



Listening, empathizing, and empowering can help your loved one feel heard and supported and can help compromise be an option. Seniors can be encouraged to accept the help that would allow them to stay in their home. For example, doctors could go into patients’ homes for regular follow-ups to help them achieve their goal of aging in place.

Doctors could work with the health care team to recommend modifications at home that might improve patients’ health and safety.


Life Hacks

If your mother insists on doing her own laundry, consider front-loading machines that offer easier access and less stress on the back. Instead of forcing your father to stop driving, suggest he not drive at night or take shorter trips?

Older parents refuse assisted living and caregiving services because they feel like they no longer have freedom, independence, and options. Always remember that giving them options will make them feel like their opinions still matter and that they are still an independent being.



Just like all people, your senior wants respect for their autonomy. They are in charge of themselves. Even if you disagree with their choices, they are their choices to make. And in the unfortunate event that something does happen, caregivers should not blame themselves for not offering more protection.

Independent people are responsible for their decisions. Just be there to support them in whatever their choices are.


“It’s my party, and I’ll cry if I want to.”

It is never easy to watch someone refuse help when you knew their lives would be significantly richer and safer, but demanding someone move out or hire a caregiver isn’t the answer. Listening, showing empathy, arming them with expert knowledge and third party advice, compromising, and finally accepting their self-determination must be the first approach if you want to be really be of help.

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