Law Talks Episode: Why older Australians resist aged care and how families can help

Robyn: Good morning and welcome to another edition of Law Talks here on 4CRB where we discuss some of the common legal issues our community faces.

If you’ve ever tried to talk to an elderly parent or grandparent about getting extra help, whether it’s in home care, medical support or even a move into an aged care facility, you may have been met with, “I’m fine. I don’t need help. Leave me alone.” So why do older people resist extra support? And what can families do to encourage cooperation without causing conflict?

Joining us today is Attwood Marshall Lawyers Senior Associate and Accredited Aged Care Professional, Larisa Kapur, an expert in Wills and estates, elder law and aged care.

Larisa also holds a psychology degree, so she’s perfectly placed to help us unpack the psychological barriers behind this resistance. There’s a lot of fear surrounding aged care and hopefully we can help ease some of that today. Thanks for joining us today, Larisa.

Larisa: Thanks for having me, Robyn.

Robyn: Well, early this year there was a dreadful story reported about a man and a woman who were found dead inside a Gold Coast home, which prompted a police investigation and uncovered that the elderly couple had allegedly taken their lives to avoid being admitted into an aged care home. Now this is such a tragic and devastating story, but it does highlight the extreme fear that so many associate with aged care. Larisa to start with, let’s talk about why people refuse help even when they may need it.

Larisa: So heartbreaking. There’s so much fear associated with aged care, so there are a few key reasons that come to mind. Firstly, I guess loss of independence, accepting help can feel like admitting that they are losing control over their own lives, perhaps. And many people fear becoming dependent on others.

Number two, there is denial. So many people genuinely believe that they’re managing fine, even if the reality is very different to that. There’s also the fear of being a burden. So often parents don’t want to trouble their children or close relatives, especially if their kids have their own families to look after.

And finally, past experience perhaps can also play a role. So, if someone has seen a friend or relative have a negative experience with an aged care facility or support, they may assume that that’s just what will happen to them too. And really, at the heart of it all is, it’s about control. No one wants to be told how to live their own life.

Robyn: Yeah. And that makes so much sense. So, if a parent refuses care or doesn’t want to discuss needing extra support, how can family members approach the conversation in a way that won’t shut things down immediately?

Larisa: Well, let’s think of a couple of strategies here. So, start small. So, instead of saying you need to move into aged care or try instead of saying would you be open to someone helping you know with cleaning tasks perhaps once a week in your home, so small changes feel less overwhelming.

Robyn: Sure

Larisa: Also give the person a say. So, if it’s your parent or grandparent, instead of making the decision for them, ask what they want. For example, what would help you feel safer and more comfortable in your own home? Or would somebody helping you clean the bathrooms make it a bit more manageable for you? You could also get support from others the individual trusts, so sometimes parents don’t like to listen to their own children.

Robyn: Yeah.

Larisa: But they might take advice from a trusted professional like a doctor or a friend, or even a professional that they’ve dealt with in the past. So, frame it as a trial. I also hear a lot of families say that that’s quite successful, so suggest trying, you know, home care for a short period, say three months so they don’t feel locked in. It’s like let’s organise some cleanings, let’s try it out for a couple of weeks and see how you go.

Robyn: So, it doesn’t feel like a permanent move?

Larisa: Yes, absolutely. And lastly, I think it’s important to go, you know be patient. This is a process. If they resist, I would say plant the seed and come back to it later. Make it seem like it’s just something that they’re coming up with as well. So open communication, you know, say, hey, I know you’ve been independent for 50 years, let’s try and keep you that way. How about some cleaning? Wouldn’t that help you, you know, be able to do other things?

Robyn: Yeah, paint it in a more positive light, that there’s an upside to it.

And Larisa, at what point does stubbornness become a real concern? How do families know if their loved one’s refusal of help is due to a personal preference like we just discussed, or something more serious like cognitive decline, and perhaps they don’t even realise it?

Larisa: So, this is a crucial distinction. So, some warning signs that it may be more than just stubbornness include, you know, memory loss, issues affecting daily life, such as missing meals, forgetting to pay bills, or repeating the same questions, even forgetting to take medication or taking a medication twice, which is something that happens commonly.

So perhaps you notice poor decision making where the individual leaves the stove on or wanders out of the house at odd hours. Perhaps even gets lost or can’t remember how to get home. Neglecting personal care can also be a big red flag, so not bathing, wearing inappropriate clothing for the weather, or forgetting the medications. If these things are happening, it could indicate there’s cognitive decline such as dementia. So, in these cases, families may need to step in, especially if their loved one is at risk.

Robyn: And that brings up a difficult topic. What happens if an elderly person refuses care, but the reality is they are no longer safe in their own home? Can families force someone into care for their safety?

Larisa: This is a really tough situation because in Australia people have the right to make their own decisions, even if those decisions put them at risk. So however, I guess if someone has lost capacity and is no longer able to make safe decisions, there are a few legal avenues we can try.

Such as, you know, the enduring power of attorney using that. So if a family member has been legally appointed to manage decisions, they may be able to organise care and step in and make decisions on behalf of their loved one.

There’re guardianship orders. So, if there’s no power of attorney, families can apply to a tribunal like QCAT or NCAT to be appointed as guardian, which gives them the authority to make decisions on where somebody lives or what medical or healthcare treatment they receive.

Also, getting a capacity assessment done. So, doctors or specialists may be able to determine if the person can still make decisions for themselves or what decisions they might need that help with. But legally you can’t force someone into care just because you think it’s best for them. There must be clear evidence that they lack capacity to decide for themselves.

And can I just add in here, if things are extreme and someone’s in danger, I would even consider getting them admitted to a hospital and letting the hospital be the bad guy.

Robyn: And do the assessment there.

Larisa: And do the assessment and I guess make the plan to, you know, transition them into care if they need or put services in place. This way for families, it might be the way that they’re not the bad guy. It kind of lets the hospital and the doctors take that.

Robyn: Be the decision maker.

Larisa: Hmm.

Robyn: One big reason people resist care is that they assume the worst about aged care facilities. As someone who knows the aged care industry inside and out, what can you tell our listeners to ease these fears, Larisa?

Larisa: So, there are so many misconceptions out there, but think of aged care as a new home that better suits your lifestyle and your needs. Just like in your younger years, when you are growing your family and look for a home with more space, rooms for the kids, you know, perhaps a big backyard and a pool, you look for things that will suit your lifestyle and your needs. Aged care is no different. It’s just a new home.

So, many people think of aged care like a hospital, a place you go as a last resort. But that’s simply not the case. In fact, having access to social activities, professional care, and support can actually make life a lot easier and more enjoyable in the later years. You don’t have to lose your independence. There are options to stay in your own home longer with support. That’s like that in home support where they can come and help you with cleaning or you know, appointments and whatnot.

So, until you have the right conversations and assessments done, you won’t know what options are available to you. So, if you’re closed off to discussing care, you may miss out on a better life and lifestyle.

Robyn: And given these misconceptions, how can families talk about aged care in a way that doesn’t immediately make their loved one resistant?

Larisa: So, it’s all about reframing the conversation. It’s about quality of life, not losing control.

So instead of saying you need aged care, say, let’s find a way to keep you independent for as long as possible.

So, if they’re worried about nursing homes, talk to them about modern facilities and home care options that are available. So perhaps even visit a few aged care places together, sometimes seeing the environment can change their mindset because there is so many options available now.

The most important thing is to involve them early so that they feel in control of their own choices.

Robyn: Before we wrap up today, Larisa, what’s your final advice for families facing these challenges?

Larisa: So, I would have to say start the conversation sooner rather than later. The sooner you discuss options, the more choices your loved ones will have. And don’t be afraid to seek legal and financial advice. Aged care is really, really complex and professional guidance can make a huge difference, especially when someone’s health may have taken a sudden turn for the worst, and you need to find out your options and get the process started as soon as possible.

Robyn: Yeah. It’s interesting. A lot of people, or both if it’s a couple, they’re both healthy, they don’t think this applies to them, they don’t think they need to look into it. But we do know situations can change very quickly. And you know, if you’ve already got that legal and financial advice, it helps if you are faced with that that you know ahead of time what you can and can’t do and what your options are.

Larisa: Exactly and you keep that control by planning ahead.

Robyn: Well, it’s great advice today, Larisa. Thank you so much for joining us. This has been such a valuable discussion for many of our listeners. Thanks for your time, today.

Larisa: My pleasure. Thanks for having me.

Robyn: You’ve been listening to law talks here on 4CRB, which you can hear every Friday morning from 9 o’clock.