Your parents are getting older. You see things slipping. The house is not as clean as it once was, your mother is increasingly forgetful, your father has lost weight, and you are concerned about their safety when they drive. So as a responsible child you bring up the subject. How do your parents react? They are angry. They feel like you are trying to tell them what to do. Maybe they feel like you want to move them out of their home and place them in a retirement facility. Sometimes your mother complains about the burdens of caring for your father. Other times she tells you everything is fine. You spend as much time helping as possible, however it is never enough. You talk to your parents about retaining outside help, they hedge and refuse. What do you do? What can you do? Sometimes it takes a bit of tough love. Your parents refuse outside assistance because they still have you to depend upon. So you become unavailable. You decide that you cannot be everything to everyone. You have your own family to care for, your own children. When they call for help, you are busy and remind them about the suggestion to obtain outside assistance. So, the situation continues. Your parent or parents continue to make poor decisions in spite of the fact that you have stopped helping and they still refuse to hire paid assistance. One option is to hire a private mediator to discuss the situation. A second option, depending on the severity of the self neglect is to contact the local county social services department. By getting an adult protective service worker involved, an outside party can serve as a mediator and the children can remain somewhat out of the line of direct conflict. This is usually a good step to opening a serious conversation about the need for care. Many children feel that doing this can cause more animosity. However, if all previous options have been exhausted this is usually a practical and reasonable step especially if the situation is serious. After a meeting with an adult protective service worker, results and a plan is usually expected and the worker will check to make sure progress has been made. Accepting care one day at a time, even it if is only one day a week to start is a beginning. Often a parent will find that having care is not as threatening or as negative as they previously thought. They may even find it helpful and may enjoy the company. The key is to be persistent but not threatening. Admittedly sometimes it does take a threat with an extremely resistant parent. For example, accept help or move to a facility or involve an outside individual to mediate. In the case where parents refuse and children are unable to convince the parents to act, the situation usually escalates to guardianship or conservatorship. This can be a family project, or outside individuals can take over. Cases escalate to this when the degree of neglect is causing calls to 911 or emergency response or if there are multiple trips to the emergency room for health issues or if other safety issues exist. Supporting resistant parents is difficult and can be extremely frustrating. Fortunately most parents will eventually accept assistance when children decide to opt out of day to day assistance. Managing this type of situation with parents is somewhat similar to raising children. Discussing the situation, reviewing options and setting boundaries; do you remember what it was like when your parents did this with you? The roles have reversed. Be a good parent to your parents.