For a while, she was satisfied with my weekly hair washing and curling, but when our state reopened hair salons, that changed. Yesterday, she called me “mean” for refusing to take her. As a first-time caretaker, I’m really struggling with this. How should I strike a balance between her quality of life and her safety?

Lauren Krouse

Bridgewater, Virginia

This is a beyond-difficult time for caregivers. The job was intense and mostly thankless even before the pandemic, but now, caring for a frail octogenarian means you have to think about everything you do as something that puts the person at risk. You and others in similar positions deserve more credit than I can begin to express here.

No matter how much you love your grandmother, or anyone, isolating together can bring tension to a boil in ways that wouldn’t happen in normal times. So I hope it’s helpful to hear this: Let your grandmother get her hair done. Make sure she and her stylist and anyone else involved take proper precautions. Make sure she understands that even with precautions in place, there are still risks involved—not only of her getting the virus, but of you getting it, too. If she still insists, take her to the salon, and know that you’re doing the right thing, because it’s what she wanted.

I know that goes against your basic instincts as a caregiver. You didn’t move to Virginia so you could drive your grandmother to the salon for her to get a disease from which she’d have a high likelihood of dying. But we should be clear that what you’re describing is—from a purely medical perspective—a woman approaching the final years of her life. This is always uncomfortable to acknowledge, but it’s important to do because it informs how to make these types of decisions.

A common tendency in these situations is wanting to swoop in and do everything in our power to keep a person physically healthy and, well, alive for as long as possible. But in the process we run the risk of denying agency to elders. Just because people aren’t able to drive, cook, or care for themselves in certain ways doesn’t mean they should lose autonomy in other ways, such as making decisions for themselves. It’s actually crucial that they don’t.

Caring for aging parents and grandparents is sometimes blithely compared to caring for children. In both cases, we always think we have their best interest at heart. But old age is not childhood; it’s a totally distinct phase of life. With children, we aim to keep them safe at all costs. We act as though we know what’s best for them, because we do—or at least we can confidently pretend to.

In caring for elders, their dignity and autonomy are paramount. The goal is to maximize quality time, striking a balance between prolonging life and making it comfortable and joyful. Striking the proper balance isn’t defined by some external standard; it’s defined by their own wishes. We non-elders are rarely positioned to deem those wishes valid or invalid. Even as bodies break down and memories start to fade, as long as people have the cognitive capacity to make decisions for themselves, our job as caregivers is to enable fulfillment of those wishes.

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