First of all, we need to consider what we mean when we refer to ‘care’? The way ageist stereotypes work can mean that old age is often automatically associated in people’s minds with failing faculties and vulnerability, so that when an older person experiences a problem of some sort (as do we all along life’s journey from time to time) it is assumed that they need to ‘have care’ or be ‘in care’. In this sense, care is being understood to mean ‘looked after’. If we look at it from in terms of independence and empowerment, however, ‘care’ can be understood to mean the process of helping someone to live the life of their own choosing, albeit with some help. So we must ask ourselves in this situation ‘what do we mean by ‘care’?’ and does the person concerned share our understanding of the term? It is likely that someone proposing ‘care’ sees it as something that has the potential to make a positive difference to a person’s life, but that person might see such a proposal as negative and threatening. So, although it isn’t easy, we need to try to imagine the situation from a different perspective – putting ourselves in their shoes, as it were. This can be a useful starting point for a better understanding of someone’s reluctance to accept help, and might spark off ideas that could inform any discussions we might have with the person we are worried about. The following are just some of the assumptions that might arise:

I don’t need ‘care’: Unless there are concerns that someone is not able to safely manage the risks in their lives (due to dementia or any other condition that affects their mental capacity), then we have to accept that they have the right to live with risks in the same way as anyone else does. Often older people manage risk by adjusting their lifestyle and plans, and are happy enough with these adjustments. In some circumstances, the best we can do is to alert people to the existence of forms of support that they might not otherwise have been aware of, and to live with their choices if they decide not to draw on those supports, even though this might cause us some discomfort. Perhaps phrasing discussions in terms of ‘helping you to live your life independently, but more comfortably and safely’ might be a more useful way to broach the subject than suggesting that ‘care’ is needed.

I can’t afford ‘care’: This may well be borne out in reality, as not all care support is provided free of charge. However, if it is agreed by the person that some help is needed, then an advocate such as yourself could help by raising awareness of both (i) what voluntary support might be out there for them; and (ii) ways in which they might be able to increase their income so that they are in a better financial situation to be able to pay for support. For example, welfare benefits are often unclaimed by older people who are entitled to them, but do not realise that they are.

I don’t want to admit I need ‘care’: This can be related to a fear that, once someone has admitted to needing some help, this will place them on what they perceive as the ‘slippery slope’ towards eventual admission into institutional care. Fear of losing the control and spontaneity associated with living in one’s own home can put some people off entering any discussion about help because they don’t realise that care support can promote independent living, rather than threaten it.

Of course, these are only some of the many issues that might be underpinning the reluctance to which you refer, but really listening actively to what the person in question is saying (and sometimes not saying) – and trying not to filter it through your own perspective on the situation – can help equip you to help them because you will have a better understanding of not only their current needs, but also their future aspirations.

Dr Sue Thompson

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