The Humanist Dilemma: When Is It Appropriate to Force an Ailing Parent to Get Outside Help?

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What If He Falls and Can’t Get Up? My wife’s father has been living alone since becoming a widower more than twenty years ago. Now in his late eighties, he has quite a number of health issues but is mentally sound. For the past few years he’s required a walker at all times, but lately has become increasingly unable to endure more than very short distances. So, when he can he’s been using a wheelchair (when there’s someone to push him) or a motorized cart to get around. We’ve begged him to have the second knee replacement surgery that doctors say is the only way to improve his mobility, but he adamantly refuses because he had a very difficult time recovering from the replacement of the other knee three years ago.

Two weeks ago his bad knee gave out and he fell, even though we were right there trying to catch him. He is very heavy and required three medics to pick him up. Nothing was broken, but he was severely bruised and tests confirmed the knee is completely shot. Since then my wife and her siblings have been taking turns staying with him and arranging for his weekly housekeeper to come in and help him out on days we can’t be there. He doesn’t have any friends or neighbors nearby who we can trust to check on him or assist with things like groceries and doctor appointments. We are all falling behind in our work and home lives because we are spending so much time tending to his needs, and his quality of life has become terribly diminished. He can’t even take a shower or bath unassisted.

We’ve laid out his options and he refuses them all. He won’t get surgery, won’t move to an assisted living facility, won’t allow visiting nurses or aides to come in, won’t move in with any of us, won’t even wear one of those devices to call for help if he falls again. He has agreed to keep his cell phone in his pocket, and to allow a physical therapist to come to him three times a week, even though no amount of exercise is going to repair his bad knee.

I’ve talked to my spouse and her siblings about demanding that he accept an aide at the very least, but they all say we can’t force him to do something he doesn’t want to do. Is there anything else I can do other than phone him several times a day and run over if he doesn’t answer or call back within a few hours? We all live more than an hour away from him. I feel awful, not only because can’t I get through to him, but also because I can’t get through to his children about how he requires more care than he’s getting.

-Dreading the Worst


Dear Dreading,

It’s very difficult to know what’s best for aging loved ones. But the key point in your account is that your father-in-law is in command of his faculties and this is his choice. Many people would rather take their chances on worst-case scenarios than give up their independence to ever-present caregivers or a facility or their child’s home. Put yourself in his shoes: Would you want your children to make you do something you adamantly don’t want to do? It would be different if it were an issue that impacted other people’s safety, such as someone with impaired vision who insists on driving, or if he were incapable of comprehending reality.

But in this case the danger is only to himself—and to your peace of mind. Although clearly you are worried about his well-being, this is also about fearing something will happen to him that you might have prevented. Just below the surface of your concern for him is the desire to alleviate your own sense of responsibility and guilt. This is understandable and reasonable, but right now his desires trump yours.

The only other factor I can think of is that perhaps he’s concerned about the cost of in-home or assisted-living care, which can be very expensive, or the burden he would be if he went to live with one of his children (even though the situation is already creating a burden on all of you). He may not be able to afford care, or not want to use up your inheritance or your funds to cover the expenses. Similarly, he may not want to impose on any of his children by moving in with them. Another possibility may be that he’s afraid—not only of surgery, but also of living in a nursing home, or having strangers camping out with him. There are plenty of horror stories about abuse and neglect by aides and nursing homes. Can you tell if those are indeed factors in his choice, and if so, if it’s possible to allay his fears, perhaps by finding him caregivers with excellent reputations, and continuing to call and visit frequently to monitor the quality of his care?

In addition, go over his finances and insurance (health and any long-term care he may have) to assess what various options might cost and to what extent they might be covered by insurance or savings, and review that with him. You might want to involve a financial professional in this, as it can be quite complex.

Conversely, you can lay out exactly what you are and are not prepared to do for him. For instance, maybe you’re going on vacation and won’t be able to come to him for a week or two. You can set up a schedule of who will visit and shop for him when. Beyond that, he’s on his own. It’s his move if he should decide he would, after all, like to arrange for additional services.

Otherwise, I am inclined to agree with your father-in-law and his children that this is not your decision. If his condition worsens and he becomes unable to get to the kitchen and bathroom at all, or if he starts slipping in terms of mental competence, that would be justification for the family to step in and call the shots. But right now your father-in-law prefers staying by himself in his own home, on his own terms, with whatever quality of life that affords him. Even if you could overpower him legally, I don’t think you should. Instead, accept the lifestyle he chooses, regardless of how uncomfortable it makes you. Resist the impulse to swoop in and rescue him unless he asks you to, or unless it’s becomes beyond doubt that you must.