Why They Resist, and How You Can Help

I’m going to set some ground rules between us for how today is going to go, OK?

• You have to do this
• You can’t do that
• Eat now
• Drink now
• Get up
• Sit down
• Watch TV
• Turn that thing off!
• Take these pills; don’t worry about what they are
• Go to the bathroom right now, and I’ll help
• I don’t understand you…
• But I know what’s best for you

OK, got all that? Are you ready and excited to comply with my plan for your life?

Is this how your caregiving might sound to your loved one? Even if you don’t say it like this, might they hear it like this? In the rush of things, has your care stopped sounding like a conversation and started sounding like a command?

It happens to all of us. We get into a productive routine that, over time, turns into a rut. To you, the routine has been effective and you try to continue it. But how does your loved one feel about a routine they can’t remember as being beneficial?

If they have lost the context of your years of productive routine together, it’s not a routine for them anymore, even if it is for you. Simple prompts that seem to you like shortcuts based on the context of your caregiving relationship may sound like an order to them.

An example: let’s say your loved one can’t remember who you are today. A “stranger” (you) walks up to them, hands them some unknown pills, and says “take these.” How would you feel about that?

Now let’s say you have a teenager and someone walks up to them at a party, hands them pills, and says “take these.” What would you want them to do? Does that put it in a different context?

Our routines function as shortcuts in life. It’s like when you know a friend or spouse so well that you can have a a whole conversation in single glance. There’s just so much history. However, when that history is taken away and we still try to have that relationship, the steps we shortcut can feel abrupt, condescending, and dehumanizing.

A reminder from a friend can sound like a command from a stranger. When’s the last time someone helped you to go to the bathroom, get in a strange car, or brush your teeth.

There are a lot of reasons why your loved one might resist care, but a breakdown in communication is perhaps the most common one. As language and memory suffer, along with the ability to perform the Activities of Daily Living (ADLs), the frustration that results is, if we’re putting ourselves in their shoes, predictable.

What isn’t always predictable is how we can start communicating effectively again. Your loved one may not be able to participate in the old routine or communicate their needs with you. However, you still know them and their tendencies.

What are their hot buttons? What do they hate? What do they love? How do they like to be talked to? What will soothe them?

At 48, my partner already redirects me when I get aggravated: she knows me and can respond dynamically to the situation. I do the same for her. Even if one of us couldn’t recognize the other, we would still probably respond in ways that were consistent with our personalities and quirks.

That’s one of the big tricks: when you focus on completing a task the same way you always have, your loved one may resist the situation.

However, when you respond to their personality and needs, even the needs they can’t communicate anymore, you can find a way to speak to who they are while still accomplishing the task. Go with the flow.

Communication is one of the topics I cover in my larger course on resisting care. If you want more information on this subject, that’s a good place to start.

In many ways, resistance to care is at the heart of most dementia behaviors. If you master the communication around this subject, everything else gets easier.