He’d Say No

He came in because he was tired, and he said so in the first five minutes. He was in his mid-fifties, the oldest of four, and for the past two years he had been the one who handled their father. His mother had died three years earlier. Since then, he had found the cardiologist, set up the pill organizer, sat through the appointments and taken notes, and, after a fender bender in a parking lot last spring, taken the car keys. Now he was looking at assisted living facilities on his lunch breaks.

He was good at all of it, and he did it because he loved his father. He called him every night before bed, and twice, when there was no answer, he got in the car in his slippers and drove over. He still thought of him as the man who had raised four children and run a business for forty years, which made it harder to watch what was happening now. His father had gone quiet and irritable. He sighed through doctors’ appointments, waved off the visiting aide and barely touched the meals that were delivered. "I'm doing everything for him," the son said, "and he acts like I'm the enemy."

I asked what his father thought about assisted living.

He looked at me for a moment and said, "He'd say no."

I asked whether he'd asked him.

He hadn't. And he began to realize that he hadn't asked about the cardiologist either, or the aide, or the meals. The keys he had taken in the parking lot with his hand out. He said this without defensiveness. Each decision had been urgent and each one was right. He had no choice. Asking had seemed like a delay with an answer he already knew. Why ask a question when you'll have to overrule the answer?

Many adult children in his position would say the same thing, and there was something underneath it that took him longer to say. His father's no would not have been a simple no. It would have come with his grief over his wife and his anger at getting old, and the son had no room left to hear it. Deciding for him was faster, and it spared them both that conversation. It also taught his father, over two years of being told what would happen next, that his own life was being run by other people. He had stopped expecting to be asked anything, and he had stopped offering.

Researchers have watched this pattern form in ordinary homes. In a study published in 1992, the psychologists Margret Baltes and Hans-Werner Wahl observed older adults living at home with family members or home health aides. When the older person did something for himself, the people around him were about twice as likely to respond in a way that encouraged his dependence as in a way that supported his independence. Baltes called it a dependency-support script. Nobody in those homes had chosen it. She concluded that the helpers' expectation of incompetence, and their investment in being helpful, kept it going.

The keys were the hardest part to talk about. A review of studies on older adults who stop driving found roughly double the odds of increased depressive symptoms afterward. A man who isn't safe on the road shouldn't be driving, and taking the keys was the right call. But in two years, nobody in the family had acknowledged to his father that he had lost something.

When I raised all this, the son had the obvious objection. If he had asked, his father would refuse everything, and then what? We spent most of a session on it. Asking doesn't hand over a veto. It lets the person whose life it is take part in deciding it. Some decisions were settled, and the son was right not to reopen them. Many others still had room in them, and his father had been offered a say in none.

So, he started small. He asked whether his father preferred mornings or afternoons for the aide. His father said afternoons, because he liked to read the paper after Shacharis without someone else in the house. The son had never known that about him.

Over the next few months, the conversations got bigger. His father did move to assisted living in the end, and he did not want to go. But he visited three places with his son and chose the one with a Daf Yomi shiur. He picked the room with the window facing the parking lot, so he could see who was coming.

The son told me about the last weekend before the move. He had asked his father which of his sefarim he wanted to take, assuming it would take ten minutes. It took most of a Sunday. His father took each one off the shelf, said where he'd bought it, who he learned it with, or something interesting about the author, and then decided whether it came along. The son said it was the longest conversation they'd had since his mother died.

He told me he almost hadn't asked, because he'd planned to box the shelf himself. It would have taken him an hour, and he’d never have known what he missed.