Getting Your Loved One with Alzheimer's/Dementia to Comply with Directives
- Neurology Associates
- Mar 30
- 6 min read
"I just want to go home," a father might insist for the third time that hour—despite standing in the living room of the house he's owned for 40 years.
If you're caring for someone with Alzheimer’s Disease or another form of Dementia, this scenario probably sounds all too familiar. The moment you need your loved one to take medication, accept help from a caregiver, or stop attempting to drive, simple requests can transform into heartbreaking standoffs that leave both of you frustrated and exhausted.
What if there were ways to navigate these challenging moments without constant conflict?
In this guide, we've collected real-world strategies from caregivers and dementia care experts who've walked this difficult path before you. These aren't just theoretical approaches from textbooks—they're practical, tested techniques backed by professional experience and research.
As Allison Lindauer, associate professor of neurology with the Oregon Health and Science University School of Medicine, reminds us: "It's all about recognizing that people with dementia are adults. They're dignified human beings. They've had a whole life before this. They deserve our respect."
How Can I Get My Loved One to Accept a New (Non-Family) Caregiver?
Introducing a new caregiver to someone with memory loss or dementia can trigger anxiety, suspicion, and outright refusal. This reaction stems from their diminished ability to understand changes in their care plan and environment.
What Has Worked for Real Caregivers
According to numerous accounts from caregivers in support forums, these approaches have proven effective:
The Gradual Introduction Method
A family might introduce the caregiver as a 'friend' who comes over for coffee first, keeping visits brief and social. Over several weeks, this 'friend' could start helping with small tasks until the person with dementia becomes comfortable with their presence.
Creating the right environment for these introductions is crucial for effective communication. Lauren Massimo, assistant professor at Penn Nursing, emphasizes this importance: "Limit distractions and background noise... and hold the conversation in an appropriate setting when possible. For instance, if you are discussing what to eat, do so in the kitchen, so if the person with Alzheimer's has trouble understanding words, you can show him or her what the options are."
Using Familiar Terminology
Caregivers often find success when framing the new caregiver as a "housekeeper," "assistant," or even a "nurse that the doctor sent" rather than explicitly saying "caregiver." These familiar roles typically face less resistance.
Creating a Structured Routine
People with dementia typically respond well to consistency. Establishing a regular schedule for when the caregiver arrives and what activities they'll help with provides predictability that eases anxiety.
Kate Granigan, geriatric social worker and president of the Aging Life Care Association Board, advises: "Long sentences with multiple parts or commands can be overwhelming and confusing for someone with dementia... It is more successful to provide one short direction or piece of information at a time. Pause between each and guide the person through the task if needed before starting the next."
Leveraging Existing Relationships
Having a trusted family member present during the first several visits can transfer trust to the new caregiver. A person with dementia might be more accepting if their sister or brother (whom they still recognize) stays during the first week to normalize the caregiver's presence.
While establishing this relationship, it's important to balance assistance with independence.
Adria Thompson, a licensed speech-language pathologist with 10 years of experience in dementia care, emphasizes the importance of autonomy: "Often, well-meaning individuals might prematurely take over tasks without asking or assessing if they need to, which can diminish the person's sense of autonomy... Instead of assuming they can't do something, it's more respectful to offer help and let them tell you if they need it — and allow them to still do the things they can for as long as possible."
What Should I Do When They Insist They Can Drive?
Driving represents independence, and surrendering car keys often becomes a symbolic battleground where dementia patients fight for their autonomy. This challenge directly connects to the "loss of freedom" concern highlighted in the care considerations.
Effective Approaches to the Driving Dilemma
The Doctor's Authority Technique
Many families find success when having a physician write a "prescription" that states "No Driving." A person with dementia who argues with family members about driving might finally accept it when presented as a medical order from an authority figure.
The Car "Problem" Strategy
Some families discreetly disable vehicles, remove batteries, or "send the car for repairs" indefinitely. After a few weeks of hearing the car is in the shop, many people with dementia gradually stop asking about it.
Transportation Alternatives
Establishing consistent, pleasant alternatives before removing driving privileges can ease the transition. Arranging for the same friendly driver from a senior transportation service to take the person to their favorite locations regularly gives them something to look forward to instead of focusing on not driving.
Legal and Practical Backup Plans
Having an advance directive or specific care plan documentation that addresses driving can provide legal support for your decision when resistance continues.
How Can I Address Food-Related Compliance Issues?
Food-related challenges—from refusing to eat to sneaking food after hours—present significant compliance hurdles. These behaviors may stem from changing taste preferences, forgotten meals, or even the simple pleasure food represents in a world becoming increasingly confusing.
Strategies for "Not Eating"
Food Presentation Modifications
People with dementia often eat better when food is presented differently. Serving everything in small portions on a plate with sections can help simplify the visual processing of meals, making them less overwhelming.
Nutritional Supplements Disguised
When someone won't eat enough, caregivers might blend protein supplements into chocolate milkshakes or other favorite beverages, which are rarely refused.
Social Dining Environment
Eating alongside the person with dementia often encourages them to eat as well. The social cues trigger habitual eating behaviors that might otherwise be forgotten.
Addressing "Sneaking Food After 10 PM"
Kitchen Safety Modifications
For late-night snacking issues, simple alarms on refrigerators or pantry doors can alert caregivers to nighttime food quests before safety becomes a concern.
Scheduled Evening Snacks
Proactively offering a small, healthy snack before bedtime has helped many families reduce midnight food searches.
Redirection Techniques
Placing a basket of healthy, safe snacks in an accessible location while securing other food items can redirect behavior without creating confrontation.
How Do I Handle Demanding Behaviors and Freedom Concerns?
"Demanding" behaviors often emerge from the frustrating loss of independence that accompanies dementia. Understanding this root cause can help develop more effective responses.
Balancing Safety and Autonomy
The Illusion of Choice
Caregivers consistently report success when offering controlled choices rather than directives. Instead of telling someone they can't go out alone, asking if they'd prefer to walk in the garden or the park with a companion still gives them choice, but within safe parameters.
This approach is supported by experts in dementia care. Leonie Rosenstiel, president of Dayspring Resources, Inc., explains (article from The NY Post): "Open-ended choices may leave a dementia patient confused or frustrated... A more productive question might be, 'Here's a red sweater and a blue one. Which one would you rather wear?' Even then, sometimes a limited choice is too much of an effort for a dementia patient."
Building on this strategy, Allison Lindauer, associate professor of neurology, adds practical advice: "Instead of a general question like 'What do you want for dinner?' ask, 'Would you like pork chops or lasagna?'... You don't want to put them on the spot."
Addressing Alcohol and Cigarettes Concerns
Moderated Alternatives
For alcohol and cigarettes issues, non-alcoholic beverages served in familiar glassware or herbal cigarette alternatives (though these should be discussed with a physician first) might satisfy the ritual without the risks.
Incremental Reduction
Gradually diluting alcoholic beverages over several months until they're essentially just colored water with a drop of alcohol on top for smell often goes unnoticed but maintains the comfort of familiar routines.
How Neurology Associates Can Provide Specialized Support
For families struggling with compliance issues in dementia care, professional medical guidance is essential. Neurology Associates Neuroscience Center at Chandler and Mesa locations specializes in developing comprehensive treatment plans for dementia and Alzheimer's disease that can address the compliance challenges discussed throughout this article.
Our neurologists at Neurology Associates provide expert evaluation to determine which approaches might be most effective based on your loved one's specific cognitive status and living situation.
For families with busy schedules or transportation challenges, Neurology Associates provides flexible appointment options, including telemedicine consultations for qualifying patients, making specialized neurological care more accessible throughout the dementia journey.
IMPORTANT NOTE: While the strategies outlined in this article can help improve compliance with necessary care directives, they should always be implemented as part of a comprehensive medical treatment plan developed by specialists. All care decisions should be made in consultation with healthcare professionals like those at Neurology Associates to ensure both effectiveness and safety for people with dementia.
