As a caregiver, you provide comfort, support, and essential care. But sometimes, the decisions you need to make for your loved one’s safety and well-being can be incredibly difficult.

When a care recipient can no longer complete Instrumental Activities of Daily Living (IADLs) such as managing finances, cooking, or medication management, it has an impact on their ability to run errands, make social visits, and get to important appointments.

Dementia or milder cognitive problems can affect short-term memory, following complex tasks, financial responsibility, and making safe judgment calls. From getting lost in familiar places to struggling to reason through problems, there may come a time where you have or will have to restrict your care recipient’s activities. Additionally, they should not be driving if they are unable to engage in critical thinking.

These decisions feel difficult on two fronts:

1. The Emotional Fallout

  • For the care recipient: Losing these symbols of independence can lead to anger, frustration, sadness, and even a sense of betrayal. They may not understand the necessity, even when it’s obvious to you. This emotional reaction is valid, even if it’s difficult for you to witness.
  • For the caregiver: You might feel intense guilt taking away things they once did freely. Conflict, even when necessary, can be emotionally draining. Anticipating their negative reaction adds a layer of stress to an already difficult decision.

2. The Practical Burden

  • Who takes over? If they can no longer drive, who does the shopping, appointments, etc.? If they can’t manage finances, who pays the bills and guards against exploitation? These responsibilities often fall to the caregiver, increasing an already heavy load.
  • Finding outside help: Hiring in-home aides, deciding if you can help them age in their own home, or exploring alternative living options (assisted living, etc.) comes with its own set of decisions and potential emotional pushback from your loved one. Even the assistance of a family member can feel like an invasion of privacy to the care recipient. It is not uncommon that this situation is met with resistance.

Navigating the Storm

  • It’s important to remember: You are not doing this to punish your loved one. You are prioritizing their well-being and safety, even if they don’t see it that way now. This is one area where care managers can really help you determine what kind of support you realistically need and where you can look to find that support.

Here’s a few tips to make these decisions a bit less overwhelming:

Don’t go it alone: After meeting with the aqing person and involved family members, I find it is important for family caregivers and care managers to consult with the aging person’s doctor. They will be able to explain the necessity of care decisions in medical terms or offer solutions that had not been considered.

Involve your care recipient (when possible): If their condition allows, discuss the concerns beforehand. Offer limited choices (“Would you prefer to give up driving entirely or only drive during daylight?”) to maintain some sense of control. Of course, this is only when it is safe for them to be driving. If they are struggling with IADLs, they should not be left to drive alone.

Focus on the positives: Frame it in terms of what they GAIN (safety, less stress) rather than solely what they lose.

If you are facing the prospect of having to restrict a loved one’s activities, consider connecting with a care manager first. Working with someone who specializes in elder care can offer much-needed support during these transitions.

I work with families who are making tough calls like these to assess their needs, locate services, and help navigate difficult conversations with your loved one, minimizing the emotional burden on you.

Remember: Tough decisions come from a place of love. Seeking support, both emotional and practical, allows you to make these choices with less guilt and find solutions that ultimately ensure the best possible care for your loved one.