If you care for a loved one living with dementia, chances are you’ve found yourself asking the same question at some point: Why is he or she fighting me on this?
Maybe the struggle showed up around a shower. Maybe it involved taking medication. Maybe it happened while getting dressed, using the bathroom, eating, or simply moving from one room to another. From your perspective, the task seems necessary and straightforward. Yet the person you’re trying to help says “no,” pushes back, becomes upset, or stops participating halfway through.
Resistance and refusals are among the most common challenges caregivers encounter in dementia care. They can also be among the most frustrating. As caregivers, we often look at the situation and think the answer is obvious. Your loved one needs a shower. Or needs to eat. Or needs his or her medication. Or needs assistance.
The difficulty is that what seems obvious to us may not feel obvious to the person living with dementia.
Why Someone with Dementia May Refuse Care
There are many reasons dementia can lead to resistance. Sometimes a person feels embarrassed that he or she now needs help with tasks he or she once handled independently. Sometimes the senior is reacting to a loss of control. In other situations, the individual may not fully understand what’s being asked of him or her. And often, the senior may not understand why the request is being made at all.
That last reason comes up more often than people realize.
Caregivers frequently tell me things like “I went to help her take a shower, and she insisted she had already showered.” Or “I tried helping him get dressed, but he told me he dresses himself.” Or “I prepared a meal, and she said she had already eaten.”
What makes this challenging is that your loved one may genuinely believe those statements are true.
If a person with dementia believes he or she already showered, then being asked to shower again feels confusing and unnecessary. Think about it this way: If I came home tonight and my husband told me I needed another shower, I would probably refuse too. I already showered. Why would I do it again?
That is often the disconnect in dementia care. Their reality is different from ours. When we push from our version of reality, seniors with dementia naturally push back from theirs.
Compassion Creates Cooperation
One phrase I often share when teaching caregivers is this: compassion equals compliance.
That doesn’t mean kindness magically solves every problem. Dementia is still dementia. Challenges will still exist. What it does mean is that our approach has a greater impact than many of us realize.
Caregiving is exhausting. Frustration is normal, especially when you’re trying to help someone who clearly needs support and he or she continues refusing it. In your mind, you may be thinking “You need a shower. You’re dirty. I’m trying to help you.”
Meanwhile, the person with dementia may be thinking something very different: “Why are you treating me like I cannot do this? Why are you ordering me around? Why are you making me feel incapable?”
Once we understand that perspective, we can begin adjusting our approach.
One of the biggest mistakes caregivers make is moving too quickly. I often say “Too slow, can’t go.” People living with dementia frequently cannot process information, instructions, movement, and expectations at the pace we would prefer. Multistep tasks may overwhelm a brain that’s already working hard to keep up, especially when we’re talking fast or physically rushing the person along.
What feels simple to us may no longer feel simple to a senior with dementia.
When the Last Step Becomes the Hardest Step
Some of the most frustrating situations happen when the person doesn’t refuse immediately.
Instead, the senior seems willing to participate. Your loved one walks with you and follows directions. Everything appears to be going well. Then your loved one stops at the exact moment you need him or her to complete the task.
I’ve heard caregivers describe helping someone to the bathroom. The person walks all the way there and stands inside the bathroom. Every sign suggests things are moving in the right direction. Then, when it’s time to sit on the toilet, the person freezes.
In many ways, that can feel more frustrating than an immediate refusal.
If your loved one had said “no” in the living room, at least you would have known what you were dealing with. But when you get all the way to the bathroom, you feel like success is right around the corner. You think your loved one understands. You think the task is about to happen. Then suddenly you have to back up, regroup, and start over—sometimes multiple times.
Often, this type of resistance is a sign the person doesn’t fully understand what’s happening or doesn’t feel secure enough to continue. The individual isn’t necessarily trying to be difficult.
Many times, he or she is simply stuck.
Preventing the Word “No”
Another strategy I teach caregivers is this: if you can avoid hearing the word “no” in the first place, it’s often worth doing.
Once a person has said “no,” turning that answer into a “yes” becomes much harder. That’s true in dementia care, and honestly, it’s true for most people.
Imagine walking into a room and announcing “You have to take a shower.”
You may get an immediate “no.”
Once that happens, the person often becomes more committed to the refusal. The position hardens, and his or her mind is made up.
A more effective approach is often to avoid leading with the demand itself. You might offer choices. You might ask for help. You might introduce the task differently. Rather than making it feel like something is being done to your loved one, you want him or her to feel included in the process.
Are We Focused on Our Agendas or Theirs?
A surprising amount of resistance happens because we’re concentrating on our own agendas.
We need them dressed right now.
We need to leave for an appointment.
We need the shower finished before lunch.
We need them to eat because the meal is ready.
Those needs may be completely legitimate. The problem is they may not line up with where the person with dementia is mentally or emotionally in that moment.
I once shared the story of a woman who took an incredibly long time to button her sweater. It would have been easy for a caregiver to step in and finish the job. It certainly would have been faster.
But when we looked closer, we realized something important.
Buttoning the sweater was the piece she could still do independently. It was the part that allowed her to feel like she was dressing herself.
Instead of taking over the entire task, the caregiver helped with the easier clothing layer underneath and then allowed her to button the sweater on her own. If you asked that woman whether she dressed herself, she would confidently say yes.
And honestly, she wouldn’t be wrong.
She completed the part that mattered most to her.
That is the balance we’re always searching for. Can we accomplish part of the task while still preserving some sense of control? Can we provide assistance without taking away everything?
They Often Reflect the Emotions around Them
People living with dementia frequently mirror the emotions they encounter.
If we approach them feeling rushed, irritated, tense, or angry, they often respond with that same energy.
When I worked in memory care, one of the first questions I asked staff after an outburst or refusal was “What did you do?”
Not because staff intentionally caused the problem. Most of the time, they absolutely didn’t.
But people with dementia are often reacting to something. It may be our tone of voice. It may be our body language. It may be the speed at which we approached them or the way we introduced the task.
One caregiver shared with me that he eventually realized he needed to calm himself before helping his wife. Whenever he became agitated, she became agitated. When he stayed calm, she was much more likely to remain calm too.
He even developed a simple breathing technique. Before responding, he would press his thumb and pinky finger together and take a deep breath.
What he learned was powerful.
Managing his own emotions had a far greater impact than trying to manage hers.
That’s not easy, of course. Often, the person with dementia forgets the disagreement quickly, while the caregiver carries the stress for hours afterward. This is why taking a moment to reset before entering a difficult situation can make such a meaningful difference.
Asking Works Better than Telling
There’s a significant difference between asking and telling.
“You’ve to get dressed” feels very different from “Can you help me get ready so we can go?”
“You need to eat this” creates a different reaction than “Will you try this for me?”
This becomes especially important when adult children are caring for aging parents.
In your parent’s mind, he or she may still see him or herself as the caregiver. Your parent may still feel his or her role is to look after you. When you begin telling your loved one what to do, it can feel uncomfortable and even insulting. Your parent may feel as though you suddenly view him or her as a child.
I’ve watched daughters lovingly help their mothers get dressed, carefully adding sweaters and scarves because they want them comfortable and warm.
The daughter’s intentions are wonderful.
But the mother may sit there rolling her eyes, feeling as though her daughter believes she cannot do anything for herself anymore.
The task still needs to happen.
The way we approach it matters.
Trained caregivers who have experience in communicating with seniors with dementia can be a fantastic resource for family members. If your senior loved one has been diagnosed with dementia and needs help with tasks like meal prep, transportation, medication reminders, bathing, and grooming, reach out to Assisting Hands Home Care, a leading provider of Northern Kentucky senior home care.
Setting Up Success before the Task Begins
Sometimes the most effective way to reduce resistance is to prepare the environment ahead of time.
If you tell someone “Go into the bathroom, brush your teeth, and take your medicine,” it may sound simple.
For a person with dementia, however, that may be far too many steps.
Your loved one might walk into the bathroom and stop there. Then you become frustrated because he or she only completed the first instruction.
If you already know you’ll need to guide your loved one through the process, it often helps to prepare everything in advance. Put toothpaste on the toothbrush. Have medications ready. Minimize distractions. Make the environment as simple as possible.
When the person arrives, the experience becomes smoother and less overwhelming.
The same principle applies to bathing.
If five different bottles are sitting in the shower, a person with dementia may pump product from every single one onto the washcloth. Eventually, simplifying to one bottle may make more sense. Later on, it may help to place the soap directly onto the washcloth. At some stage, you may even need to hand your loved one the washcloth and walk through each step together.
The goal isn’t to take over prematurely.
The goal is to remove unnecessary confusion.
I’ve seen people squeeze A&D ointment onto a toothbrush because the tube looked enough like toothpaste. In memory care, we quickly learned not to leave multiple similar-looking tubes available. If a person’s brain can no longer sort through those choices safely, then the environment needs to do more of that work for the individual.
Living with dementia can make it difficult for seniors to manage everyday tasks on their own. Certain age-related conditions can make it more challenging for seniors to age in place safely and comfortably, but 24-hour home care experts are available around the clock to help Northern Kentucky seniors manage their health. At Assisting Hands Home Care, we take measures to help seniors prevent illness and injury by assisting with exercise and mobility, preparing nutritious meals, helping with bathing and other personal hygiene tasks, and much more.
Looking beyond the Refusal
Sometimes resistance isn’t really about the task at all.
Sometimes an unmet need is standing in the way.
The person may be hungry or thirsty. Or he or she may be too cold, too warm, uncomfortable, overstimulated, or need to use the bathroom.
When those needs aren’t addressed, it becomes much harder to focus on what you’re asking.
Bathroom needs are especially common.
A person with dementia may not be able to tell you he or she needs to go, but his or her body may still communicate it. The individual may fidget, rub his or her legs, or shift repeatedly in a chair. The person may cross and uncross his or her legs or touch his or her body in ways that provide clues.
We notice these signs in children all the time. We jokingly call it the “pee-pee dance.”
Adults can have their own version too.
If someone needs the bathroom and we’re trying to get the individual to eat, shower, or take medication, his or her attention may be locked on to that unmet need. Until it’s addressed, cooperation may be difficult.
The same thing happens with lighting and temperature.
If a room feels painfully bright, seniors with dementia may squint, shield their eyes, or become agitated. If they’re cold, they may rub their arms, shuffle their feet, or fidget more than usual. When they can no longer explain what feels wrong, their behavior often becomes the message.
The Power of a Genuine Apology
One of the most valuable skills a caregiver can develop is learning how to apologize—even when they know they didn’t do anything wrong.
That’s difficult.
And it feels difficult because it is.
Recently, I visited a family’s home to complete a home care assessment. The woman living there had dementia. At first, everything seemed fine. I asked a few questions. She answered some. Her husband answered some as well.
Then everything changed.
Suddenly she became upset and accused me of barging into her house, storming in uninvited, insulting her, and asking ridiculous questions.
None of those things had actually happened.
But that wasn’t the point.
In her reality, those things had happened. She felt threatened. She didn’t understand why I was there. As I continued speaking with her husband and asking questions, I stopped feeling like a friendly visitor and started feeling unsafe.
So I apologized.
I told her I was sorry. I said I should have asked permission. I acknowledged that I had made her feel uncomfortable.
Her husband looked at me as though I had lost my mind. His expression clearly said, “You didn’t do anything wrong.”
But I knew arguing facts wouldn’t help.
If I had responded with “I didn’t barge in. Your husband invited me. I only asked a few questions,” we likely would have gone back and forth indefinitely.
Instead, I stepped into her reality.
The change was immediate.
Her posture softened. Her mood shifted. She told me I should be sorry and said she appreciated the apology.
From that moment forward, she was sweet as pie.
This is what can happen when we stop arguing and start meeting people where they are.
Most resistance and refusals in dementia care aren’t attempts to make life harder for caregivers.
More often, they signal something feels confusing, threatening, overwhelming, or simply doesn’t make sense.
The person may feel embarrassed, rushed, not understand the task, or truly believe he or she already completed it.
The individual may be cold, hungry, frightened, overstimulated, or struggling to hold on to a sense of control in a world that feels increasingly unfamiliar.
As caregivers, we cannot control every outcome.
What we can control is how we respond.
We can slow down.
We can ask instead of tell.
We can simplify the environment.
We can look for unmet needs.
We can apologize, even when we know we didn’t do what they believe we did.
Most importantly, we can remember that compassion usually takes us farther than correction.
And in dementia care, that can make all the difference.
Even when families have the best intentions, caring for a senior loved one with dementia can be challenging. Fortunately, Assisting Hands Home Care is here to help. We are a leading provider of dementia care Northern Kentucky families can trust. You can take advantage of our flexible and customizable care plans, and our caregivers always stay up to date on the latest developments in senior care. To create a customized in-home care plan for your loved one, call us today.
Want to hear more of my advice about dementia care? To join my monthly Real Talk webinar, register here.
