Needs Overload: Preferred Choices

Here is a question I was asked from a caregiver who is feeling overwhelmed:

How do I respond to my 89 year old father who demands much of my attention and doesn’t understand that I have other responsibilities besides him? He lives in a senior residence five minutes away from us, where he is safe, gets meals, has nursing staff available, and other residents with friendly faces. I am his only living child. Guilt guilt guilt!

Here is what I said:

When older adults give up their primary living environment, they feel out of control. Even if the new facilities and support staff are ideal, they can not eliminate the psychological discomfort of being in a new space creates. For most elderly adults, their primary living environment represents the last area of control they have in a world of mounting losses. It sounds like your father is trying to assert some control as he comes to terms with his new living environment and you have become his primary focus.

While this is a natural response, it can be very taxing on the PRIMARY CARE COORDINATOR (PCC) of the family. Unless you find a way to “balance” his expectations, you will exhaust yourself trying to ameliorate his discomfort. For his transition to be successful, you both need “breathing room.”

One way to do this is to offer your father what I call “PREFERRED CHOICES.”? Preferred choices is a way to say to aging parents “you matter” but that you are not at liberty to ignore or renege on the other responsibilities in your life. Even though your resources are limited, you will insure that your aging parents retain a priority status in how they are allocated.

The set up for this strategy is straight forward. Despite the day to day demands of trying to get everything done, you are giving him first choice whenever you can regarding visits, appointments, and outings. If you can only come for a single visit on a given day, what time would he prefer? If you only have time Monday and Thursday this week for his next doctor’s appointment, which day would he prefer? This sends a clear signal that he is of central importance in your life and is not being left out. But it also sends a signal that there will be times when you can’t drop everything and take care of his needs.

This is not say that your father will the thrilled with the “preferred choice”? system. But it will reset his expectations and give him clear choices as to when he gets your attention. Without these boundaries, he will not be motivated to seek out other sources of support and attention in his new environment. Like you, he needs a new structure to rebalance his over dependency on one person to meet his needs.

5 responses to “Needs Overload: Preferred Choices

  1. Very good advice here. Thanks for the clear explanation of the emotional dynamics an elder experiences when s/he gives up their primary residence.

    Most adult children have a difficult time setting boundaries. “Preferred choice” is a gentle way to bridge that difficult space between responsibility to an elder and to yourself.

    Thanks too, for the liberating PCC concept. Viewing oneself as a coordinator rather than a caregiver provides a critical shift in the perception of care giving responsibility. “Caregivers” will hopefully heed this important difference and allow themselves to become better “coordinators”.

  2. Hello Mr. Solie,
    That question could have been written verbatim by me! Your suggestion sounds like something I can put into practice. I have been trying to set boundaries for my 90 year old father but he doesn’t seem to understand that not only do I have other things on my plate, he expects my husband and my 25 year old son to be available to him on demand as well. I find myself withdrawing and disengaging from him now. Is it “normal” in senescence for a person to lose their perspective, or is it part of that control issue? I want to develop more empathy toward him, but I just don’t have it in me. Any ideas? I plan on ordering your book asap. Thanks for your insight.
    Marcy Alvo
    Annandale, VA

  3. I am not sure if your father is losing his perspective so much as he is clinging to the last vestige of control in his life. His world has essentially shrunk to the space around his house, apartment, room or bed. From this contracted position, you are your father’s life line. Not surprising, he forgets that the magnitude of his needs may reach unsupportable levels. For almost all families, they do.

    My advice is to go slow. Focus on the “preferred choice” theme to describe the time you can realistic devote to his care and well being. I think its appropriate to tell him you wish things were different, but their not. It doesn’t diminish how much you care or the frustration you feel not being able to change his situation.

  4. David,
    This is outstanding. After reading your book, “How to Say it to Seniors”, I applied this principal in a similar situation with a lady who felt ignored and as though she was losing control. It worked and she was able to move beyond this to a more secure situation.
    Thanks for your excellent material.

    Steve Davis

  5. Thanks for the kind feedback Steve…It is amazing how a new perspective combined with changing a few critical words can trigger a latent transformation, in most cases, just in the nick of time…Be well

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