Wednesday, 16 March 2016

Care Partner Wednesday--The Cost of a Meal

Daisy shuffled into the dining room for lunch, as she had so many times before. She knew her way , and she knew they would feed her when she sat down in her chair by the window. Daisy could have sat anywhere, but her tottering steps always took her to her favourite chair. Like magic, delicious food appeared, and she enjoyed it. "You girls are so good to us old people," she would say as she patted her server's arm.

As the meal ended, and Daisy started to leave, a thought occurred to her. Who was paying for this? She hadn't brought any money. What was she going to do? Her brows drew together and her head swivelled from side to side. She waved to the server, who hurried to her.

"I don't have any money," she whispered. "Who is paying for this?"

"It's okay, Daisy. The meal is free."

Free? Daisy had lived through the depression, and she knew nothing was free. Beginning to get agitated, she tried again. "How can I pay?"

The server needed to get on to other duties, and wanted to extricate herself from the conversation, so she tried another approach. "Don't worry, Daisy. Your son paid for it."

Daisy didn't want to be a burden to her son. The server left before she could say any more, so Daisy got up to leave, but her pleasant meal was ruined. She left muttering and flailing her arms. She knew something was wrong, but she couldn't put together what it was. She was worried and angry and a little afraid, and she had no idea why.

Some days there wont be a song in your heart. Sing anyway. Emory Austin

When a care partner makes the heart-wrenching decision to move their loved one with dementia into care, things change. Lots of things. Many of these are good, which is why the upheaval occurred. Some are more difficult, and require a long period of adjustment.

Some, like the cost of a meal, are unique to people with dementia, living in community. It's not an issue with everyone, but when it is, it's a recurring problem.

There is no answer that works with every resident, or even works all the time with the same person. Here are a few approaches:

1. Saying, "It's free." seldom works. As with Daisy, people know things aren't free, and there's always a hitch. Suspicion is common among people with dementia, so don't add to it by telling them the lovely meal they just ate is free.

2. Sometimes, saying that their family paid for it works, and sometimes it causes more stress. If I use this tactic, I often say that they paid for it a month ago, so they should eat or the money will be wasted. If there's one thing seniors with or without dementia hate, it's waste! The fact that it was paid for a while ago sometimes overshadows their worries about their children taking on the financial burden.

Another way to approach this is, "Your son paid for it. Isn't he lovely? You did a great job of raising him." This approach takes the emphasis off the money and onto her relationship with her son.

3. There have been times when a resident has become so agitated regarding paying for the meal that they refuse to eat. They might come in, but when they see people being served, the stress starts all over again, and they get up and leave. Sometimes several times. This makes perfect sense, if you think of it. If you just sat down in a restaurant and discovered you had no money, wouldn't you leave as quickly as possible? In this instance, we have tried an official looking printed sign on the table which says, "Your meal is complimentary today." Something about the official look of the sign and the temporary nature of the message makes it okay. People like Daisy feel they are receiving a special bargain for this meal only. When they see the same sign at dinner, it will be brand new.

4. Daisy also has difficulty with activities like trips. She thoroughly enjoys boarding the bus to head out to a restaurant, a park or a museum, but asks me many times leading up to the event, "Do I have enough money? Who is paying for this? What does it cost?" In this instance, I tell her, "Christie Gardens (where I work and she lives) is paying." For some reason, this always works on trips, and she thinks it is lovely and generous of them.

All of this is an illustration of problem solving with people who have dementia. The bottom line is to be respectful and creative, realising that the problem is real, and so is the anxiety. As a care partner, you need to look at the the root of the issue with Daisy and find the solution that releases her from the pain of worry.

And sometimes, you need to be creative with the truth. Just a little.

Every care partner becomes adept at problem solving. Share with us a situation you faced and how you dealt with it. We need to learn from each other.

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