Dear Carol: My mom, 79, loved being in her own home even though her physical health was declining. Her mind is exceptionally sharp so there wasn’t much I could change, especially from 800 miles away. I tried to get her to accept in-home help or move to assisted living, but she refused both. I started Meals on Wheels for her, but she canceled it. I even set up a mailed meal delivery service, but she said that the food was “overwhelming.”

Last month she fell and broke her wrist, so I flew out to be with her for surgery. During her hospital stay, the doctors and the social worker complained that she was “malnourished” and laid the responsibility on me. We both explained her choices, but they kept showing me their charts rather than listening.

Mom is now headed to assisted living, but the way I was treated stings. I’d have liked them to have explained just how I was supposed to force her to eat “nutritious and well-rounded meals,” but they didn’t have time for that. — HS.

Dear HS: Of course, that hurt you and was terribly unfair.

In defense of the medical people and the social worker, they were doing their jobs by watching for neglect or abuse of older adults. However, it seems to me that once you and even your mom told them about the situation, they should have backed off.

Newsletter signup for email alerts

Your mother has no diagnosed dementia, so while she may have been taking some risk living alone, she was not unusual in wanting this and was certainly within her rights. You did everything possible given her choices.


Moving forward, since many older people don’t have great appetites especially when it comes to heavy meals, frequent small meals may be better, and the assisted living facility should be able to provide that.

If she still doesn’t eat decently she may have a health problem brewing, so once her wrist heals, a general checkup may be helpful. This is especially true if she is genuinely malnourished rather than just simply thinner than current guidelines indicate is healthy.

Your main point, though, is the way you were treated. I reacted strongly to your letter because I had similar things happen with my array of older adults for whom I provided care.

Family caregivers rarely have absolute control over the way their older relatives live, and in my opinion, they shouldn’t. Yes, dementia changes that to some degree, but even then, personalities and preferences should be considered.

When it comes to eating, the reality is that while encouraging someone to eat might help, forcing is more likely to backfire. With that kind of pressure, eating can become a dreaded activity.

Caregivers face all kinds of judgments, HS, and for the most part, we must live with that and learn to not let it undermine our confidence. You sound like you love your mom and understand her personality enough to leave room for her to choose how she lives as much as possible.

Carol Bradley Bursack is a veteran caregiver and an established columnist. She is also a blogger, and the author of “Minding Our Elders: Caregivers Share Their Personal Stories.” Bradley Bursack hosts a website supporting caregivers and elders at She can be reached through the contact form on her website.