Wednesday, 19 July 2017

Care Partner Wednesday--It's All About Approach

Imagine you're snuggled in bed having a great sleep, and at about 7:00 a.m., a stranger walks in your bedroom, turns on the light, and begins rifling through your clothes. As you cower under the sheets, she  grabs the covers out of your hand, ripping them off you, and starts to perform some extremely personal acts on your body.

How would you feel?

Frightened? Disrespected? Violated? Angry? Would you scream? Hit someone?

Yet in places where elders are receiving care, this happens every morning.

"Now wait a minute. I say, 'Good morning, and I'm not a stranger. I'm helping her every morning.'"

But if someone has dementia, they may not recognize you. Even if you go in every morning. Even if you are related. And the natural reaction is fear, leading to aggression.

Try this scenario instead. (Knocking on the door) "Jean, can I come in?" (no answer, enters the room and quietly rubs Jean's arm until her eyes open.) Smiling, speaking softly, "Good morning, Jean, it's Judy. I've come to help you get ready for breakfast. Are you ready to get up?" If the answer is "No," Judy leaves and comes back later.

Approach is key elder care, but especially with people with dementia. We refer to "behaviours" that occur at times when people have dementia. When we say this, we mean actions like aggression, crying, hitting and punching, screaming and sometimes loud, inappropriate laughter. There is a nasty cycle where elders exhibit one or more of these behaviours over a period of time, and the solution is often to medicate them. Problem solved. No more behaviour--they are asleep.

Let's look at approach. It's not magic. Sometimes there is still agitation, and there are times when medication is needed. However, many times, the right approach can change the entire atmosphere, and bring calm, pleasure and even humour. Here are some tips:

1. Slow down. Rushing increases agitation and sends the clear message, "I don't have time for you."

2. Smile.  A genuine smile is hard to disregard.

3. Watch your body language. Did you know most people with dementia can read body language perfectly, even if they can no longer read words, or even speak? Check your attitude at the door. One of my co-workers impressed me with the way she greeted people. She made it sound like meeting them was the best part of her day. I'm sure they picked up on that.

4. Communicate. Ask permission if you want to do something that involves touching them. "Could I just push your glasses up for you, Mary?" I've seen people come up from behind  and hike an elder's pants up or move their wheelchair without saying anything. Next time you see a teenager on the street with his pants hanging around his bottom, come up from behind, don't say anything, and hike them up. Then send me a note, and let me know how it went.

5. Focus. Don't have a conversation with someone else, or interrupt what you are doing to greet another person. When you are with an elder, they are the most important person.

6. What is the unmet need? Often, if you can find this and meet it, the problem dissipates. I observed an elder just this morning who often comes to the breakfast table angry. She talks loudly, accusing others of lying. When she begins to eat her breakfast, the anger disappears. She's hungry. (Later in the day, the same behaviour occurs, and it's not hunger. The same person may have several unmet needs.)

Approach is all about respect. No matter what they do or don't understand, each elder is a person. Give them the gift of respect, approach them with gentleness and joy, and many times behavioural problems will vanish.

Care Partner Wednesday--It's All About Approach Partner Wednesday--It's All About Approach

Wednesday, 12 July 2017

The Small Miracle of the Broken

                            A Shattered Hallelujah

A shattered hallelujah is now my song of praise
Its notes are all the sweeter when my voice can barely raise.

Arms outflung, He calls to me to walk among the waves
To trust beyond what's in my heart, to find my inner brave.

I sob and stumble, gasp and fall
"This journey is too hard!" I call.
"They say I'm strong, but they can't see
the endless, wrenching pain in me."

His loving eyes stretch to my heart, 
He listens to my song.
His hands reach out to grasp my pain,
"I've been here all along.
I'm holding you, each frightening day,
I'm Peace to sleep at night.
I'm the order in your chaos,
the joy that finds the light.
I'm the hazy future you can't see,
 I hold those painful memories.
Your broken song is beautiful. 
I know it's precious cost.
I'm here with you, I'll bring you through.
You're never, never lost."

My shattered hallelujah is still my only song.
The waves are unrelenting and my world still feels so wrong.
Yet I am moving forward with my hands stretched to my Friend, 
Because I know He'll hold me, and some day, my heart will mend.

Ann Peachman Stewart

The Small Miracle of the Broken Small Miracle of the Broken

Wednesday, 5 July 2017

Care Partner Wednesday--"I have no choice"

It wasn't the best of mornings.

I had ten minutes to blow dry my hair, change my shoes and get out the door. At that precise moment, my puppy discovered the enticing, dangling toilet paper, and ran with it in his mouth through the house. The other end was still attached to the roll. I scolded him, salvaged what I could and threw the rest away. Watching the clock, I returned to my blow drying.

He did it again. He responds well to loud noises, and normally I would clap my hands, but I had a blow dryer in one hand and a brush in another. So I banged my brush on the side of the sink.

Wrong move. The entire porcelain corner broke off and fell to the floor, shattering into a million pieces. Stunned, I looked at my ugly sink. Bathroom vanity replacement wasn't in the budget, so I determined to live with it until the day it made it to the top of my "urgent needs" list.

A few months later, that happened. I was cleaning the ugly sink when I noticed copious amounts of water on the floor. Further examination showed that the pipe was no longer connected to the sink because the piece that connected the two had broken off. Any running of water brought floods on the floor. Suddenly my bathroom vanity was at the top of the "urgent needs" list. I could live with an ugly sink, but I couldn't live with no sink. I had no choice.

Then there's my basement. In January, I had a sewer backup. Conversations back and forth with the insurance company, the condominium and the contracted construction company took months, but eventually, they gutted my basement in preparation for renovations. Then, everything stopped. They found mould. Four small spots that aren't related to the sewer backup or each other. Now I am told I have to have an environmental company do an assessment before anything more happens in my basement. The cost of the assessment is astronomical, and I have to pay it. I have no choice.

No choice feels like restrictive clothing. It feels bleak and hopeless and empty. Someone else is in charge of my life.

I make hundreds of choices in a day. But these two instances where I have no choice rankle me. How much worse must our elders feel as their world and their choices shrink as their disabilities increase?

Why does this happen?

Many reasons. Particularly with dementia, it's easy to assume that the elder is no longer able to make choices. The truth is, there are certain choices that are beyond their scope, and many others which aren't. An elder may no longer be able to make or even comprehend financial decisions but can decide what they would prefer to eat, wear, and events they would like to attend. Often, we take choices from elders without thinking about it. We feel we know what is best. We forget to offer choices. We get used to being in charge.

Try wearing a piece of clothing that is too tight for a day. Part-way through, you feel like you can't breathe. You just want to get out of it, to feel comfortable.  Lack of choice feels like that. If an elder can't express how they feel, it can manifest in angry behaviour or resignation. Either way, it's a desolate way to live.

Honouring elder's choices is the essence of person-directed care.

Care Partner Wednesday--"I have no choice" Partner Wednesday--"I have no choice"

Wednesday, 28 June 2017

Care Partner Wednesday--All in the Family

Families can be the best aspect of our lives, or the worst, or somewhere in between.

The reality is that if families aren't functioning well, or one member isn't, becoming a care partner will make this more difficult. Rather than fighting, dysfunctional families will often stay away from each other, having as little contact as possible in order to cope. That works until mother needs more care and has appointed all the siblings as joint powers of attorney.

Resentment can build quickly. How do you find a way to work together? It's not always possible, but here are a few suggestions.

What is your goal? If you want to bring the family together in harmony as you discuss your mother's issues, that's a great goal, but it may not be reasonable. If there hasn't been harmony to this point, being care partners together probably won't bring it. Try looking at small, reachable goals. Getting the right supports for mom to live independently.  Talking honestly about next steps.

Find your best method of communication. Technology makes communication possible, even if people live on the other side of the country. However, difficulties with communication are seldom related to physical space, but emotional. Think about the family member who frustrates you. How do they communicate best? Is face-to-face possible and desirable? Would a phone call work better? Maybe an email, where you have the time to think about what you want to say? Could you Skype as a family? Try to be flexible and find the method that makes the "difficult" person most comfortable.

Be clear. Express what is needed in the clearest, most non-confrontational way possible. Try not to be directive. "You need to..." Rather use phrases like, "The doctor said this was needed, how would you like to go forward?"

Leave your high horse at home. There may be words spoken that anger you or attitudes that make you want to retort in kind. There might be times when you have to seal your mouth with duct tape. Do it. This isn't about you or the other person, but about your elder. The other issues can be dealt with at a later time. (Or not. Sometimes you need to just, as the song says, "Let it go.")

Be realistic If all your best methods don't work, do what you have to do and go on alone. You have tried your best, and you are not responsible for the other person's actions.

Being a care partner when the family isn't working together, or is fighting against everything you are trying to do, is incredibly challenging. In the end, you are responsible for your reactions and no one else's. Concentrate on your relationship with you elder, and do your best.

Care Partner Wednesday--All in the Family Partner Wednesday--All in the Family

Thursday, 22 June 2017

Care Partner Wednesday--A New Look at Deterioration

As words go, it's not one of my favourites.

Deterioration. "The process of becoming progressively worse." 1
Eww. Sounds like mouldy bread.

The reality of life is, deterioration happens to all of us adults. I used to be able to walk farther and run up a set of stairs. At one point in my life, I worked three jobs. My knees didn't hurt and I thrived on less sleep. I would come home from work and clean the house, bake and write until midnight. None of those things happens anymore.

Have I deteriorated? Or changed?

Probably some of both. What's changed is not only my body but what is important to me. I don't need or desire to work three jobs anymore. It would be great to have knees that don't hurt, but I've learned to live with it. It takes longer to clean the house, but it gets cleaned. I only bake occasionally, but that's enough. For the most part, I write on the weekends, when I am fresh. I've accommodated myself to the changes in my body, which corresponds to the changes in how I choose to spend my time.

I ask again: have I deteriorated or changed? If deterioration is becoming progressively worse, what is "worse?" I remember the days of three jobs, and I remember happy family times when my children were young. I also remember exhaustion, constant money worries and overwhelming fear of the future. The truth is, each stage of life, with its plusses and minuses, has its good times and bad, and today is better in some ways and worse in others.

Why the philosophical diatribe? Because people don't look at me with crestfallen faces and say, "She's deteriorated." But we use the D word with our elders all the time.

What would happen if we threw out the D word, and accepted people for who they are today? All the changes that affect us--physical, emotional, social, spiritual (and any other "al" that you can think of) become a part of who we are--today. I may have a life-long interest in tennis, and now I watch matches on television. Or perhaps tennis no longer excites me, but visits from my grandchildren make my eyes glow. I am always in the process of becoming. Growing. Adapting. And even at my most impaired, I am me. Look in my eyes, and find me.

I'm not in the process of becoming progressively worse. I am becoming the me I am today.

Care Partner Wednesday--A New Look at Deterioration Partner Wednesday--A New Look at Deterioration


Wednesday, 14 June 2017

Care Partner Wednesday--The Family had a Party

I saw laughter. I saw whirlwinds of activity. I saw smiles and happy tears. I saw hugs and milling crowds and eating--lots of eating. I saw all these at work today.

But I didn't see helplessness.

"An Elder-centred community creates opportunity to give as well as receive care. This is the antidote to helplessness." Eden Alternative Principle 4

Today, we had a baby shower for two of our care partners who are expecting new arrivals in August. New babies aren't common among our staff, so imagine out excitement when we discovered these two were due within three days of each other. Two neighbourhoods came together to host the shower and everyone else joined in the fun. It was family. Here are some of the scenes in the room.

  • A care partner sent her regrets, because she was spending the day with her mother, who was having a birthday. She was encouraged to bring her. She arrived with her mother and three other ladies she had taken to lunch to celebrate the birthday. All were welcomed.
  • A resident who had a special connection to one of the care partners, had gifts for both. Other residents made homemade wrapping paper to wrap her gifts in.
  • Several residents came just to enjoy the party and the food. And that was fine.
  • Family of residents joined the fun, and brought gifts for their family members to give.
Can you see it? A large room, with food-laden tables covered in pink tablecloths. Care partners, family members, residents in wheelchairs and residents with walkers, talking and laughing and having fun. Everyone oo-ing and ah-ing over tiny shoes and fluffy dresses. 

Those who give care, receiving care. Those who receive care, giving it.

A beautiful day in the neighbourhood.


Wednesday, 7 June 2017

The Small Miracle of Listening to Birds

Have you ever listened to your mind? Mine was a tornado of wildly whirling thoughts as I stood waiting for the train this morning. Here's a tiny peek inside my brain:

The renovations are starting today on my basement. Have we removed everything? Will they go smoothly? Will they be done by the time I go away?
Going away--what do I need to do before I leave? I booked a doctor's appointment for me and a vet appointment for Teddy? What else?
Teddy--how will he travel? Have to talk to the vet about his vomiting. Do I need to drug him for the trip? 
Drugs--need to renew my prescription. So much to do. What about work?
Work--I need to complete my section of my performance appraisal as soon as I finish in the dining room. Then I have to get two staff p.a.'s done before Friday. Not much free time on Thursday, though. Need to get lots done today...

That slice of my thoughts probably took a minute or two. Add to that an ongoing situation that was stressing me out, money worries and chronic physical pain--my mind was tumbling with worries and "to do's."

Breaking through my manic revery, I heard birds calling to each other. Blinking as if waking from a nightmare, I felt the warming sun on my head, and saw a gorgeous blue sky after multiple days of rain. The birds, in a world of their own, called back and forth in the fields on each side of the tracks. I concentrated on their music, forcing the sludge of my thoughts back where they belonged.

I listened. Took deep breaths. Listened more.

There was peace there, if I chose to reach for it. Birds are busy creatures, yet they sing.
I can sing.

As I embraced the peace, it was interrupted
by an announcement. "The 6:56 train will be 10 minutes late, due to mechanical problems." Oh no. I'll be late and I have so much to do.

Dragging my mind back, I chose to listen again.

Lord, help me to listen each day to the song of the birds, rather than the cacophony of my mind.

"The seed cast in the weeds represents the ones who hear the kingdom news, but are overwhelmed with worries about the things they have to do and all the things they want to get. The stress strangles what they heard, and nothing comes of it." Mark 4:19 The Message

The Small Miracle of Listening to Birds Small Miracle of Listening to Birds