"People always say they don't need help until it's too late," cautions Barth Holohan, president of Home Helpers. "Unfortunately they wait for that catastrophic event that often forces their family member to bypass the independence phase and move to some kind of assisted living facility. The goal of home care is to allow people to remain in their homes in a safe and healthy way."

It can be difficult to convince a parent they need help. "They'll almost always say, ‘I'm not ready yet.' They often think of needing assistance as being weak," he says. "Our goal is to help them understand that getting help with the activities of daily living will help extend their independence." He suggests beginning in small ways. "You can introduce the idea of someone coming in for only a few hours to help organize bills, do laundry, walk the dog or drive to the grocery store." Help with transportation is a very good beginning, because seniors may have already realized that they can no longer drive.

Holohan recommends a home visit with the client, the adult children and the potential caregiver. "We need to establish exactly what type of care is needed," he says. "Do they simply need a companion or do they need help with cooking and bathing? We want to know their preferences, and we work very hard to find the right match." When the chemistry between client and helper is right, that can ease the transition.

"We're there to help where we're needed and wanted. Our clients have tons of life experience and may resist someone trying to take over and tell them what to do," he says. "Some are very set in their ways and resist change." Older relatives may have come to rely on family members who become drained by jobs and their own families. "Meetings between the parent and child can be pretty tense," he says. "Having a neutral third party there can diffuse the situation. I'm comfortable saying, ‘Your daughter can't be here every day to drive you. Let us help with that.'"

Families dealing with a memory impairment may have to be more forceful. "Becoming forgetful isn't bad; it's just part of aging," Holohan says. "Usually if the choice is accepting help at home or moving into a retirement facility, home care is more palatable. Retirement communities are great and necessary for many people. But a large percentage of people who need help want to stay at home, and there's a lot we can do to facilitate that."

Help at home can actually prevent disintegration. "Staying well fed and hydrated is very important for older people," he says, "as is proper management of medications. When seniors are in better overall health, they function better." Don't wait for disaster, Holohan says. At the very least, a parent may consider a home monitoring device, which can be activated if they need help in an emergency. "Be proactive. Don't ignore the signs. If you need to step in, do it gently and lovingly and be as sensitive as you can."

Maggie Holtman, president of Advanced Nursing Services, has been in the home health care business for 20 years. "In all that time, I've never heard anyone say, ‘I can't wait until I grow up and need nurses.' Making the decision to have someone come into your home is always difficult and it's very emotional," she says. "It's a big decision that almost always involves younger family members."

There are many issues that make it difficult for people to accept help, Holtman says. "The work we do up front can make the transition easier. Often, we're called in an emergency, but in a perfect world, we have time to sit down with clients and their families to assess their needs and to discover a little about their personalities so we can find the right match." The realization that life is never going to be the same is hard to accept. "And then there's the sense that their home is going to be invaded by virtual strangers. If you have the opportunity, you have to go slow and give the client time to get used to a new way of life."

Good communication with the client and family and a great deal of flexibility in planning the type and amount of care needed are the keys to success. "We may begin with lots of care and, after time, be able to cut back. That's especially true with someone coming out of the hospital," Holtman says. "Or we may begin with only a couple of hours a week and gradually increase the number of hours based on the needs that become apparent. You can't go in with a hard and fast plan, because you really can't know until you've spent some time with the client."

Jim Guller's Cooperative Attendant Service deals with resistance all the time. "For the people seeking help, it's all new and can be very upsetting," he says, "but for us, it's something we have a lot of experience with. We can share our expertise and, together with the family members, come up with the right home health care plan." One of the reasons the decisions are difficult is because, in most cases, the person requesting help and making the decisions isn't the person who needs the help.

And it isn't always the potential client who resists. "Often it's the well spouse," Guller says. "They value their privacy and don't want someone in their home. Also, they don't want to appear unable or unwilling to help their spouse. The situation can be very hard on the healthy person, very demanding and wearing."

Breaking down the barriers requires the right approach, which is different for everyone. "Sometimes we rely on children simply saying to their parents, ‘Please do this for me. I'll feel better, and I won't worry about you,'" Guller says. "We just need to find a way to get in the door and give the client time to adjust and see that assistance increases rather than diminishes their independence."

There are many options today, Guller says, but one of the first, best steps is home care. "People resist help for many reasons, and pride is one of them. This generation of seniors has a strong work ethic and getting help goes against the grain. They've cared for themselves for a whole lifetime, and it's humbling to admit they need help." LN