Carolynn Nagao Marcotte is a licensed social worker.

By Carolynn Nagao Marcotte

Sometimes we see changes with older friends or family members that spark concerns.  Wanting to help is entirely natural, but those good intentions can sometimes lead to disagreements, frustration, and arguments.

It is a common challenge: what is the best way to tactfully offer assistance? Having worked with many families to help unravel these kinds of issues, I will caution that each circumstance is unique, but the following tips might be helpful:

Recognize when it’s reasonable to help

If you are feeling concerned, there is probably a reason, and it is usually a good idea to take a closer look. Common red flags include unpaid bills, missed medical appointments, or signs of memory loss. Changes in appearance can also be important: if the person was always very neat and their home is now cluttered or they appear unkempt, there could be an issue. Sudden weight change could indicate malnutrition. Be respectful, but don’t assume everything is okay, just because it was in the past.

Discuss the concerns

So you have concerns. The next step is to discuss them. If you think it is a situation where they might eventually need some assistance, my advice is to have that conversation early and often. If you start the discussion before there’s a crisis, it gives everyone more time to think about it. If you wait, the problem might become more difficult to address, and that might lead to more resistance.

Go in with realistic expectations

There is a good chance the older adult will not want to have that conversation and will shut it down. Be respectful. It probably will take more than one conversation, but if you keep bringing up concerns respectfully, it can get easier to address the problem.

Remember to keep it a discussion

The best way to have the conversation is to bring it up is naturally.  If you come in saying, “we need to have a talk” and it is clear you have given it a lot of thought and made up your mind already, it can feel like you are imposing a course of action on somebody else. There is a much higher chance of resistance there. It is much better to bring it up as part of an open-ended conversation, where you are valuing their input as well.

A good way to do this is to start with a general conversation. Maybe you are talking to your mother and she tells you about a friend who recently transitioned to assisted living. That might be a good opportunity to ask questions and get an idea of what she envisions for herself.  Conversations in that context can be much easier, and you can get an idea of what they want.

Call a professional

A professional opinion can often be helpful for these discussions. If there are health concerns, a primary care doctor might be able to offer helpful advice. If the concerns are more in-home and behavioral, your local elder services agency might be a good place to start; they have social workers who can assess the risk factors and help develop a plan of action.

In addition to benefiting from the professional advice, this can also help take the pressure off you, the person who has concerns.

Care resistance

It is fairly common for a family member to take the above steps, only to discover their loved one still doesn’t want any help. Often this is the result of the two people coming at the question with differing goals.

Most of the time family members and professionals value health and safety, and extending life as long as possible, above all other factors. But older adults often prioritize autonomy and independence. They usually want to live in their home, with their current lifestyle, as long as possible.

This is why the discussion is so important. If you want to help, you need to listen and validate what they want. If you do that, there may be room for compromise where change is needed most.

Carolynn Nagao Marcotte is a licensed social worker and former case manager for Adult Family Care, a non-profit program at Somerville-Cambridge Elder Services that supports in-home caregivers across the Greater Boston, North Shore, and Merrimack Valley areas. For more information, visit adultfamilycare.org or call 617-628-2601.