When Good Parents Make Bad Decisions

When you see your aging parent making decisions that you disagree with how do you decide if, when and how to intervene? I’ve encountered this question many times and in a wide variety of situations. I have seen children struggle with how to confront a parent who has demonstrated that he should no longer be driving. I have seen children struggle with a parent who is living in a nursing home and has started a new romantic relationship (that may include sexual contact). There are also the many situations in which seniors are enticed to part with their money (including their home equity through a reverse mortgage).

As we observe our parents making decisions that we don’t agree with we may be tempted, or feel obligated, to get involved. I would argue that in some situations we do have an obligation to our parents and, sometimes to society at large, to get involved. For example, if a parent has dementia that interferes with his decision making, his reaction time, or other faculties that are required for driving, we have an obligation to help prevent him from continuing to drive. However, in other situations it may best to do nothing.

Before getting involved in your parent’s decision making, it may be useful to ask yourself some questions. The first question I would suggest asking is “what is my motivation for getting involved?” If you can truly say to yourself that you have your parent’s, and society’s best interests in mind then you are in a good place to start thinking about getting involved. However, because most of us are good at rationalizing our decisions to ourselves, it may be useful to explain to someone else what you think you should do and why. If you find yourself fumbling over a weak argument or if the person looks askance at you, then you may want to rethink your decision.

Once you are pretty sure your intentions are good, the next question might be “does my parent have a condition that is known to impair decision making abilities?” Some of these conditions, like Alzheimer’s disease, have a permanent and progressive effect on decision making abilities. While others, including delirium, may only temporarily impact decision making. The presence of these conditions, although significant, is sometimes not enough by itself to obviate a person’s ability to make a decision. I have seen situations in residential settings where people with moderate dementia experience an increase in their quality of life through a relationship with another resident that leaves their children shaking their heads. However, I have also seen family members move a person to different facility to get them out of such a relationship.
The next question I would suggest asking is “what are the consequences of intervening versus doing nothing?” Even if the decision made by your parent appears to you as an adult child to be a bad one, ask yourself “what is the harm that will come if I do nothing?” You might also consider the question “what consequences will the decision have on my parent’s life?” It is of course important to think of both the short and long-term when asking these questions.

Consider this example: A woman in her early seventies is talking about taking out a reverse mortgage so she can travel the world with a new companion. For her adult children there is a lot to consider. After they have established that their own motives are “pure” they next consider the conditions that may impact their mother’s decision making ability. Let’s suppose the doctor reports that she has mild dementia, probably Alzheimer’s disease. According to a neuropsychological evaluation, she is believed to have some cognitive impairment, but she can still demonstrate the ability to consider the consequences of her decisions, at least as posed to her in the abstract. The questions that she has a harder time answering involve what happens to her if she lives longer than the money from the reverse mortgage lasts. When it is suggested to her (by the neuropsychologist) that she will likely have to live in a subsidized apartment or, if her health does not hold, go into a nursing home under Medicaid, she does not appear willing, or able, to appreciate the significance of this possibility.

This example illustrates some of the complicated factors that should be considered by adult children as they think about trying to influence, or take over, their aging parent’s decision making.

It is not my intention that this post be a comprehensive treatment of the topic, but only to provide some questions to think about as this very sensitive topic is broached.

If you decide to intervene after diligently considering all other options, the next question is how to go about doing so. In the next few days I will post some ideas on how to go about trying to influence your parent’s decision making, while preserving your relationship with them.