Beech Lodge private Nursing Home, Ireland

Five Ways to Manage Difficult Elders by Phyllis Staff, Ph.D.

'You are old, Father William', the young man said,
'And your hair has become very white;
And yet you incessantly stand on your head --
Do you think, at your age, it is right?'
Lewis Carroll (1865)
My grandmother was the original matriarch. When she barked "frog," the only acceptable response was "how high?" She was hard to deal with in her last days, surprising no one.
Not being the brightest penny in the family bag, I reacted emotionally to her complaints, judgments, and demands. Rather than leave immediately, I stood my ground, trying to defend my relatives and myself from her relentless attacks. As a result, we were not speaking when she died.
Had I understood what I was facing, had I tried to put myself in her shoes, our story could have had a better ending. In hopes that your story will have a more satisfying ending, I offer a few of the tricks for dealing with difficult elders I've learned since then.
1) Make a plan BEFORE a crisis
The best way to deal with difficult parents is to avoid as many problems as possible by planning how you will handle them before they arise.
Pick a time when ALL family members can meet in person or on a conference call to discuss what you will do when a family member needs help. Take the focus off elderly
Family members by fully including them in the planning and making certain they have a role to play.
Be sure to take notes! Share them with all family members to verify your family agreements. In difficult situations, you might want to ask family members to sign and return a copy of any agreement.
Here are a few of the issues you may want to address:
Physical Location
How will you help a family member when they live in another town?
Can you be an effective long-distance caregiver, and, if so, how?
If not, who will move, and when should that move happen?
Roles
Who will be responsible for what?
Will you share expenses equally, or will you balance money versus time contributions?
What will happen when there are disagreements?
How will you handle changes in individual circumstances?
How will you react to threats to health and safety?
Differentiate preferences and requirements. If it's more than a preference that family members not live together, get it out on the table before a crisis erupts.
Document Planning
Where will you store important documents such as
Wills,
Power of attorney,
Insurance policies, and
Deeds of trust.
Who will have access to these documents? And under what circumstances?
2) Stretch your patience muscle
Remember your excitement when you crossed the threshold of adulthood? When you first got a driver's license? When you got your first job? When you found your first apartment and could decorate it all on your own? Then think about how you would feel if you had to give up adult privileges, one by one. What you're feeling now may closely approximate the feelings of your difficult parent. But your elder's feelings cannot be imagined away.
Your difficult parent may fear
·Becoming invisible;
·Seeing themselves as useless or stupid;
·Losing their friends;
·Losing physical abilities;
·Becoming dependent.
By imagining yourself in their place, you may react more sympathetically and suitably.
3) Forget "Parenting Your Parent"
One of the least helpful ideas in our current culture is the notion that as your parents age, you become their parent. Stuff and Nonsense! You are NOT your parent's parent, nor will you ever be. Your role may be friend, confidant, caregiver, and supporter, but when you take the role of parent, you diminish your elder by reducing them to the position of child. No wonder they react negatively. Wouldn't you?

4) Use behavior modification techniques
Behavior modification has gotten a bad rap of late, probably due to the many ways in which its principles have been misused. However, used properly, behavior modification techniques can remove unpleasant behaviors and return sanity to your family.
If you don't know the basics of behavior modification, here is a site that can bring you up to speed quickly:
http://chiron.valdosta.edu/whuitt/col/behsys/behmod.html
A few tips to help you begin
Before you begin, you must clearly define what outcome you want to achieve. For example, you find that you are spending an increasing amount of time waiting for your elder to get ready for an outing. If you want your elder to be on time, make that the specified outcome.
Identify your elder's positive reinforcers. Clearly they do not respond to your annoyance (or are you even allowing your irritation to show?), but they do enjoy outings.
Tie the outcome to the reinforcer in a clear statement, for example, "If you are ready at 10:15, we will go shopping."
Shape the behavior you want. If your elder is habitually 30 minutes late, it is unlikely that they will suddenly be on time. So, decide in advance to shape their behavior. For example, you may choose to wait 20 minutes. If they are not ready, leave without them. Once that behavior has been established, wait only 10 minutes, then only five. By using this tactic, you will arrive at the outcome you desire with a minimum of pain.
Punishment. Punishers can work - if they are severe and immediate. However, they increase the likelihood that you'll get results you didn't anticipate or want! Locking someone in a room or closet is punishment. Don't go there!
Extinction. Use extinction techniques rather than punishers to get rid of unwanted behaviors. Extinction is simple. Offer no reaction to bad behavior. Don't talk about it. Don't react to it. Leave the room, leave the house if you must. But remove the opportunity for reinforcement of such behaviors.
Be aware that it will take time for extinction techniques to carry out your goal. Also realize that the frequency of the undesirable behavior may actually increase while extinction is occurring. Be patient and resolved. You'll get there if you don't weaken.
5) Identify your own contribution to difficult parents and difficult families

Perhaps the most difficult (and perhaps the most useful) technique is to identify your own contribution to the problem, and stop it!
·Are you taking the course of least resistance and putting up with undesirable behavior because it's too difficult to change it.
·Do you avoid conflict at all costs?
·Could you be afraid to give up your position as "favorite" or "good?"
·Do you feel emotionally superior when you deny your own needs to attend to those of others?
Any of these may lead to more difficulties in the future, so give them up. Decide what you can do within reason, and do that. If you need help, ask for it. You can deal with the problems of difficult parents and difficult families if you are willing.

About the Author
copyright 2003 by Phyllis Staff, Ph.D. - Phyllis Staff is an experimental psychologist and the CEO of The Best Is Yet.Net, an internet company that helps seniors and caregivers find trustworthy residential care. She is the author of How to Find Great Senior Housing: A Roadmap for Elders and Those Who Love Them. She is also the daughter of a victim of Alzheimer's disease. Visit the author's web site at http://www.thebestisyet.net.

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