Wednesday, 18 October 2017
Georgina has can anxiety disorder. She doesn't have dementia, but she perseverates (goes over and over the same issue) on many troubles. It doesn't matter if all was well with this problem yesterday. Today is a new day, and you never know...
I have a long history with Georgina. Sometimes, I need to reassure her, sometimes talk to her a bit more firmly than normal, and sometimes, humour works.
Today, she was going over and over the issue of the corn on her toe, her shoes, which pinch because of the corn on her toe, and her corn plaster. "I'm not sure if it's on or it fell off."
Keep in mind this was the third or forth time we'd had this conversation. "Georgina, do you mean the corn plaster or the toe? Because if it's the toe, we really have a problem." She looked at me blankly for a minute, and then a ghost of a grin spread reluctantly across her face.
Humour worked this time.
In your entire arsenal against caregiver stress, a sense of humour is your best weapon.
I can hear the protests now. "Are you nuts? There's not a thing funny about this situation. My heart is breaking, I'm exhausted and most of the time I have no idea if I'm doing the right thing. How can I laugh?"
In many ways, that's true. But the ability to see the funny side of a situation and to laugh when crying is also an option can be your salvation. You're not laughing at. Sometimes you're laughing with, and sometimes you're just laughing. Laughter can give you the strength to go on.
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"A good laugh dissipates more dark clouds than any other one thing." - Laura Ingalls Wilder
In the stories I am about to share, the names have been changed and the people left us long ago. But the stories still make me smile.
Velma had an incredibly sharp mind until the last year of her life. She worked complicated crossword puzzles every day and had many opinions on politics and current events. She loved the symphony and was every bit a lady. Later in life she had a stroke, and her mind became uncharacteristically confused. She hoarded the garters used for the kind of briefs she wore, and was convinced the staff was stealing them and selling them on the black market. (There's a black market for those kind of things?)
One day, Velma made a slow journey down to my desk. Every step was work, but she soldiered forward, grasping her walker and moving with a slightly tipped gait. I saw her coming and wondered why she had ventured this far. In her present state, a journey like this was a lot of work. I stood from my chair as she arrived, wondering how I could help her. For a few minutes, she stood silent, although she seemed to be concentrating on something behind the desk. Ignoring my questions, she began to shake her head. She pointed to my chair. On it was a back rest which displayed the name of the company--Therapist's Choice.
"The Rapist's Choice." read Velma, shaking her head. She turned to leave, but I heard her mutter to herself, "Makes you wonder what they're doing down here."
A lady from our independent living apartments came to my desk, looking as if she had lost something. I asked her if I could help her.
"I'm looking for Ann Peachman Stewart, but she's on vacation."
"I'm Ann Peachman Stewart."
"Oh, you're Ann Peachman Stewart when she's away?"
No, I'm Ann Peachman Stewart all the time."
Brigit was a delightful blind Irish lady who lived in our dementia unit. She had strong opinions about everything, and wasn't the least bit shy about expressing them. Her blindness was recent, but because it was combined with dementia, she didn't have the heightened senses many other blind people have.
One day, the piano tuner arrived just before lunch. He began to work on the piano in the lounge where Brigit was sitting, waiting for her lunch. As he systematically plinked and plunked his way up the keyboard and down again. I noticed Bridget was becoming agitated, making "Tsk." noises and wiggling in her chair. Just before he was done, she could stand it no longer, and burst out with, "If you canna play the thing, you'd be better to leave it alone!"
Even when grief is fresh, there can be a funny side. I had a newly widowed wife ask me what to take to the funeral home. Did she need underwear? I told her to ask the funeral home. I had no idea.
But it's certainly something to ponder in the middle of the night.
And when I was at the funeral home planning my husband's memorial service, I was asked to look at urns. I burst out laughing and got a started look from the person helping me. How could I explain to her how funny Bill would have found that? He wasn't an urn kind of guy. I ended up buying boxes at the Dollar store with pictures of shells on them. Much more his style.
As you start your day as a care partner, ask God to show you where the smiles and laughter lie. It will make your journey a little lighter.
CONTINUE THE CONVERSATION: Do you have a story or two? Share with us!
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Care Partner Wednesday--The Power of Laughter
Wednesday, 11 October 2017
There are points in life when everything changes. Milestones where you can look back and say, "Here is when life was never the same again."
A diagnosis of dementia can be like that.
Probably there were months and even years leading up to that moment when you wondered, suspected or even knew, but it wasn't official. Even when there is no doubt in your mind, hearing the words from a doctor can take your breath away. Everything changes.
Many people come to this point and ask, what now? Now that we know, what should we be doing?
You may have all or part of this in place already, but here are some suggestions as you begin this journey.
1. Make sure powers of attorney are in place. Talk to your elder and discern their wishes. Do they want the family member who lives closest to have POA, or each of the children? With Skype, social media and email, families can connect immediately to discuss problems, but what if someone is needed to physically visit? All this should be considered. Do they want to set it up so any one of the POAs could make a decision, or that they all have to agree? If there are no children, is there a niece, a close friend or someone else who will assume these responsibilities? Some people have a trusted lawyer make both financial and care decisions. Whoever it is, this should be put in place immediately.
2. If your elder is still driving, the doctor who made the diagnosis will be contacting the Ministry of Transportation, revoking their license. However, you will be left with some difficult conversations.
I recently went through a month without a car after mine died. Due to a busy schedule and vacation, it was four weeks before I was able to purchase a new (to me) vehicle. I got dropped off at the grocery store and had to wait to be picked up. I missed church one week because I couldn't get a ride. I felt awkward and embarrassed asking for help in the form of rides. I hated it. It gave me compassion for our seniors who can no longer drive. Independence is tied to a set of wheels, and conversely, no car means a lessening of independence.
When this happens, talk together about a plan. Will they take taxis? The bus? Learn to use Uber? How often will the family be able to help? A plan brings some independence back to the situation.
3. What kind of supports are needed? As part of the assessment to make a diagnosis, the doctor would probably have done a mini-mental status exam (MMSE.) This is scored out of 30, and the score gives a baseline for how your elder is functioning, and some indication how much support they will need. At a certain score, the doctor will deem that they cannot make decisions for themselves, and that is when power of attorney is put in place. Another score indicates your loved one can't safely live independently. It may be, with the right supports (such as someone coming in to give medications, or do light housekeeping) independence can be maintained. Find out what's available, how to access government-funded programs, and look into the cost of accessing those that aren't subsidized. Look into things you don't need presently, so if there is a rapid change, which often happens, you are ready.
4. There will come a day when supports in the home won't be enough. You may be months or even years from that day, but you will be better prepared for it if you start thinking now. What kind of place would your loved one be happiest at? What qualities are the most important to them? What is the process for admission? What do they cost? What is available? Start your research now, before there is a crisis. Have conversations and discover what matters.
5. Read, read, read. Learn about the difference between Alzheimer's and other dementias, what kind of drugs are typically given for dementia and how they work. Ask your doctor to recommend some websites and attend classes with the Alzheimer Society. There is a wealth of information out there, and knowledge helps you ask informed questions and know better what to expect.
You are embarking on a journey. Make sure you have the vehicle you need before turning onto the highway.
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Care Partner Wednesday--After a Diagnosis of Dementia
This list is by no means exhaustive. What information or tools did you find valuable after a diagnosis of dementia?
Wednesday, 4 October 2017
"I just changed his diaper. You grab a bib for me, and I will feed him."
Is this a conversation between two parents holding their newborn infant? Or perhaps two Early Childhood educators in a daycare situation?
No, it's a conversation held between two care partners over the head of a non-verbal elder in a wheelchair.
Is your skin crawling? It should be.
We who are passionate about changing the culture of eldercare need to examine our words and ensure that they are keeping up with our passion. The elder in that chair may have been cognitively impaired and non-verbal, but it's likely he can hear. If he can understand even a small portion of what was said, can you imagine the shame? Not only were the words completely inappropriate, but they were spoken about the elder as if he were a task to be performed and not a person. He might have been one of the wheels on his chair for how person-centered the conversation sounded.
Words matter. We need to examine our language and listen to what is being said. Are the words and phrases ones that we would like to be used about us if the tables were turned?
If you have followed my journey, you know that I fought and lost a battle to remove bibs from our dining rooms. At the very least, let's call them "clothing protectors" and not bibs. Let's offer cloth napkins to those who want them. Let's treat our elders with respect.
When I approach someone who needs to be covered when they are eating, I will say, "Can I put this on to protect your clothes?" This gives them choice and protects their dignity as well as their clothes.
We refer to incontinence products as "briefs." Babies wear diapers. Adults wear pads, pull-ups or briefs.
Rather than referring to what occurs in the dining room with people who need help as "feeding," which is what I do to my dog before I leave for work each day, we call it "assistance with the meal." I put Teddy's dish down and leave the room. That's feeding. In the dining room, I interact with residents and staff. Even if they aren't able to talk, I tell them what kind of food they are eating. "Here's a spoonful of chicken, George." I watch for cues--a look or sound of pleasure, a grimace, or lack of enthusiasm for what is being offered. If they don't like it, we try something else. I smile and we interact. It's a happy, community time. Food gets consumed, but it's only part of the process.
Another word we need to drop from our vocabulary is "refused." "She refused her medication." "He refused his dinner." The word refused makes the elder sound like a cranky person with an attitude. The truth may be they weren't hungry, or didn't feel the need for their pain medication at that time, or didn't understand and no one explained. How much better to say they "chose not to."
Those of us who work in eldercare are familiar with the expression "behaviours." It always refers to something negative, such as aggression, calling out or wandering. Dr. Bill Thomas, the founder of the Eden Alternative, talks about these "behaviours" as being related to an unmet need. We are learning to ask the question, "What is the unmet need?" This moves the responsibility from the elder to us. It also moves the solution from an immediate medical answer "what medication does he need to control the behaviour?" to a social one "what is the unmet need and how can we meet it?"
Why do words matter? Because our words show who we are and what we believe. If we are passionate about caring for our elders in a way that respects their person-hood, let's ensure our words do the same.
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Care Partner Wednesday--Words Matter
Wednesday, 27 September 2017
Care partner stress is real, sometimes intense and wearing. When you are in the middle of the battle, you don't want to hear "10 Ways to Beat Caregiver Stress" because most of them don't speak to your situation, and you already know that stuff anyway. You want to hear how to get through today.
I have a friend who is living with the pulling and stretching and demands and worry of a severely sick husband, and I was thinking about her and prying for them today. I asked myself, "What helped?" all those years ago. What made a difference, and what stands out to me today?
Those tiny, special moments when you were able to change the horror you both were living with into something special that touched you both.
Here are a few thoughts.
Like many terminally ill people, Bill wasn't eating well. Something would sound good, but by the time I prepared it, he wasn't hungry. It broke my heart to watch his face thin to gaunt. He used to enjoy his food, but now a liquid supplement was the best he could do most days. Then one day, he said he was craving lobster.
A few years earlier, he'd gone to Nova Scotia on a "bucket list" journey to visit an old guitar teacher. While there, he'd feasted on seafood in all its delicious forms. I cooked fish frequently and sometimes we splurged on scallops, but I'd never cooked a lobster. The thought of it kind of horrified me. Feeling foolish in front of the counter of an unfamiliar grocery store, I explained my predicament to the server, and he told me how to prepare it. That night, I spread a lobster dinner in front of Bill, complete with the crackers and little forks to scoop it out. It took him over an hour, but he demolished that lobster and ate more than he had in weeks. Every time I open the cutlery drawer and see the little picks and forks, I smile and remember.
One of his last hospital visits involved a week on his back. Because of a procedure they were doing, he couldn't sit up, and it made a difficult season more wearing. Each night I would rush to the hospital after work because he'd been alone all day. In the midst of this pain and stress, we developed a game. His water was restricted, but he could have a few ice chips every hour. I would toss them through the holes in his oxygen mask and he would catch them with his mouth. As silly as it sounds, I remember giggling together when the ice chips missed their mark.
During an earlier hospital visit, he complained about the hospital food. No surprise there. It was pathetic. He'd already dropped so much weight, I worried that he would get sicker from not eating. One night while I was visiting, he mentioned lasagna. On the way home, a crazy idea occurred to me, and I wondered if it would be possible. I stayed up late that night and crafted a lasagna in a small casserole dish. The next day, I kept it in the fridge at work until it was time to go. Then I heated it to a burning fire, wrapped it in the many towels I'd brought and headed to the hospital. I even had china plates and our own forks and knives. When I arrived and unwrapped it, it was still steaming, and we enjoyed a lasagna dinner together. Again, he ate well that night, and I always remember the look of pleasure on his face as he took the first bite.
One of the men at church asked if he could put the word out by email to pray for Bill. Of course, I was delighted, and I began to receive email notes of encouragement from far and wide. Some people wrote out their prayers, and we heard from several people who hadn't been in our lives for years. I realized this was blessing me, but Bill wasn't getting the benefit, so each night when I went home from the hospital, I would print off emails and glue them in a scrapbook. At the hospital, I read all the notes and Bill was touched by the caring of so many people.
Just a few weeks before he died, it was Thanksgiving. One of our fall family traditions was to visit a local apple farm. We loved the place, and our kids had grown up with at least one visit a year. This year, Bill wanted to go before we ate our Thanksgiving dinner. Really? He was so thin and weak and wasn't really eating apples anymore. But dreams overtook the practical, and we headed out. A warm, beautiful day, it looked like everyone in our community thought this was the day to visit the apple farm. We trudged through the parking lot, and worry consumed me as he stumbled along. Near the entrance was a huge log, and Bill said he would sit there and watch while we went in. I rushed everyone through our shortest ever visit, grabbing a few apples, some cider and a jar of jam. Anything he might like. He seemed content just to be there, sitting on the log. Getting back to the car involved another adventure, as he was already tired, but he was glad to have gone. When he died a few weeks later, the apples were still in the fridge.
A few weeks ago, we went to the apple farm as a family for the first time since that last trip. I stood for a moment and looked at the log where Bill sat and remembered.
Memories. As a stressed out, barely-making-it-through-the-day care partner here is my advice to you: make memories. Take the time to do little spontaneous things together like the ice chip game, or ridiculously impractical things like the apple farm.
Because when the day comes that you are looking back at this time from the other side, you will be thrilled that you did.
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Care Partner Wednesday--Lobster, Lasagna, and Memories
Thursday, 21 September 2017
I probably make a thousand choices in a day. Most of them are insignificant and don't even hit my radar. Which of my flavoured coffees will I have this morning? What will I wear? Will I have a salad or a sandwich for lunch? After dinner, will I read a book, watch a movie or knit? What time will I go to bed?
Sometimes, life brings more significant choices. What kind of car will I buy? How will I solve the problem of the needed renovations in my basement? Where will I go for vacation?
For our elders, the ability to make choices shrinks significantly. Physical frailty, and sometimes cognitive decline often mean that others are making choices for them. Some can't manage their own care or find the process of making decisions overwhelming. Choices, and the ability to make them become more important.
"Autonomy is a domain that is challenged early, and often severely, as a result of societal stigmas surrounding dementia. Loss of autonomy is also a common source of anger and resistance. We tend to think of autonomy in terms of big decisions, but autonomy can be created on many levels, and most people have the ability to make choices, with proper communication and support."1
The problem comes when care partners, professional or family, come to believe that because an elder has challenges, all the decisions need to be made for them. The result is an elder who feels helpless. Sometimes "learned helplessness" results when a task is completed for an elder when they could do it themselves, given time and support. After a few attempts, they give up and soon can no longer complete the task. This leads to another of the plagues--boredom.
Here are some examples:
An elder likes to set the table. It's imperfect, and some of the utensils are missing. Do we go back and complete the job, or make a suggestion like, "Thanks so much for your help, Jane. Here are some more spoons to put in these places."
Buttoning a shirt is possible, albeit slow for an elder, and sometimes the wrong button gets in the wrong hole. Do we fix it, or, knowing this is an issue, sit with them and suggest which button goes where?
I am guilty of this one: an elder hesitates with their speech, and sometimes has difficulty finding the words. Do I supply what I think might be the words, even if I'm usually wrong, or wait?
Joan always drinks tea with lunch. Do I automatically pour her tea, or do I say, "Joan, would you like your usual tea today, or would you like a cold drink?"
Joe's family know he was always interested in trains, so they are surprised and disappointed when they bring in his train magazines and he shows little interest. He's fascinated, though, by a visiting dog.
The basis of choice is respecting the personhood of the elder. Respecting the time it takes to make the choice. Giving opportunities to choose when the choice seems obvious. Realizing that choices change.
Choice. Make it as person-centered as possible.
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Care Partner Wednesday--Choices
Wednesday, 13 September 2017
My friend, who I will call Jane, has been going through hell as a care partner. Her husband is suffering from a serious form of brain cancer, and their lives have been one crisis after another lately. Surgery after surgery, infection, seizures and multiple hospitalizations. Each day is a roller coaster of emotions, as she tries to negotiate devastating decisions while encouraging him. It's exhausting in every way.
Recently, Jane told me of several scenarios where "friends" questioned her decisions. They stopped visiting. They refused to go out with her husband because they felt uncomfortable. They said she shouldn't have encouraged her husband to have his latest surgery (although it saved his life.) They said he didn't want more surgery, although he had expressed many times that he wanted to live. They made her question herself at a time when she is feeling most vulnerable, and most in need of support.
These "friends" aren't the kind who read what I have to say, but maybe others have experienced this incredibly insensitive behaviour. So, to these "friends" I say, "How dare you?"
How dare you presume you know best? You have no idea the pain this couple is going through as they navigate this difficult journey. I hope you never will know how this feels because I doubt you could handle it with the grace Jane has.
How dare you question these decisions that are made through pain and tears? What gives you the right?
And at this time, when your friend needs the gift of your friendship more than ever in your relationship, and his wife needs your support and perhaps a break for a few hours, what gives you the right to withdraw, because you feel uncomfortable?
Dear "friend," you are not a friend. I have told Jane to get new friends, and that's happening. The couple who visit her husband in the hospital. The ones who bring meals or offer to shop for them. The ones who listen. I'm thankful there are people in their lives that go beyond themselves and what is comfortable and give to Jane and her husband. I am praying God sends more--an abundance of real friends who care.
Jane's experience can teach us all. When someone you love is a care partner:
1) Be there. Find out what they need, however practical, and actually do it. Shop, make dinner, clean the house, babysit--these gifts will never be forgotten.
2) Never, never say, "Call me if you need something." That's putting the responsibility on the already overburdened care partner. Instead, find out what they need and do it.
3) Listen. Don't fix, don't judge, don't give opinions unless asked. Just listen. It's truly a gift.
4) Be thankful. As you support your friend going through their journey, thank God for every day He has given you. Never take it for granted.
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Care Partner Wednesday--Dear "Friends," How Dare You?
Wednesday, 6 September 2017
Have you ever had your shoelace come undone at a time when it's impossible to stop and do it up? Your arms are full of parcels, or you are standing on a crowded subway platform? There is nothing more awkward than trying to two-step around a dangling shoe lace while attempting to keep your body upright.
That's kind of like my life right now.
There are loose ends everywhere. Small, annoying issues that need almost daily follow up, and big, audacious problems--that need almost daily follow up. I push one ahead by a centimetre and another stubbornly drops back two centimetres. These loose ends require constant attention--phone calls, emails, follow up and more follow up. It's beyond annoying and stressful.
One of my loose ends has been my car. At almost 10 years old, she has served me well. I bought her after my husband died, trading in both his vehicles. She was my first brand new car, and my favourite colour--red. I always name my cars, and she was Minnie. Like the mouse.
About six months ago, she started to develop electrical problems. I never knew what I was going to find when I got in. One day, the radio wouldn't work. Another, the windows stopped responding. The day she wouldn't open without several tries, I stopped locking her. Horribly stressful was the day the gas cap locked shut, and I couldn't put gas in her. However, worse than all of that was the morning I started her and had to push the brake to the floor to get a response. Oh, my.
Then there are the days of indecision. Do I fix her, to the tune of several thousand dollars, or do I start looking for something new? If I fix her, will that be all that is needed for a while, or will I have more problems in a few months? If I look for something new, should it be leased or owned, new or used? What brand? What colour?
Hey, colour is important!
This shoelace was dragging in the mud, and I wasn't at all sure I could stay upright.
Prayer and consulting lots of counsellors helped me to decide I needed a new-to-me, used Honda Fit. There is a Honda dealership within walking distance, and for me, it was a good fit. (Sorry...) My son-in-law helped me work through how much I could spend and various other options, and last Saturday, we headed to the dealership.
Two important facts to note here. I had a good friend praying that God would have exactly the right car waiting for me. And I, in a tiny voice, was reminding God that colour was kind of a big deal for me. With apologies to all my friends and family who have grey or black vehicles, I hate black and grey vehicles. In my little voice, I asked God if maybe the car He had for me could be something other than black or grey. I loved my red car, but I was open to other options. Just not black or grey.
In the dealership, our salesman took us out to look at the used cars. "Unfortunately, we don't have any Fits on the lot. They go as quickly as they come in." We looked at used Civics, but they were more than I could afford. I whispered to God that emotionally, I couldn't handle a long search. He knew that, right? We went inside to compare the cost of new Fits to used Civics, when our salesman came running to us with an enormous grin on his face. "We just had a Fit brought in. I didn't even know about it!"
We went outside, and there is was. I knew immediately it was my car. Not too old, good mileage, and white. I could live with white. If we had gone to the dealership a few hours later, it probably wouldn't have been there. The car I needed at the price I could afford. And white.
I brought her home tonight. I am overwhelmed by my Father who cares about my loose ends, my dangling shoelaces, and provides the right car, in the right colour, at the right time. Just for me. This God, the God of loose ends, can be trusted with all the other dangling bits of my life.
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The Small Miracle of Loose Ends
Wednesday, 30 August 2017
Few people seek out the role of care partner. Of those who do, most of them are paid to fulfil the role, and only a small portion of those feel called to the position. For the most part, the role of care partner is thrust upon family members who embrace it more or less reluctantly.
For some, the "reluctant" is definitely more.
Some people try to live in denial for a long as possible, thinking that if they don't admit the diagnosis, it won't be true. They refuse to see the losses that are obvious to others or attribute them to unrelated issues.
"She's developed a hearing/seeing problem, and that's why she can't keep up with the conversation."
"He's having a bad day. Everyone has those."
"She's just stubborn."
Denial is a difficult river to travel on.The inevitable end is the realization of truth, and that can be devastating when you've been building a fantasy to protect your emotions. Along the way, you may experience anger, there will inevitably be fear and profound sadness. Denial isn't pretty.
Even without denial, the reluctant care partner may struggle with anger. Why did life take this unexpected turn? Many times a wife or a child will think, "I didn't sign up for this."
Or, the care partner will focus on who the person was before their disease. With each passing day, the losses become glaringly obvious, and they may feel that they no longer know the person, or that they've lost them.
All of this adds up to a tsunami of pain.
How can we help?
Helping the reluctant care partner requires time and sensitivity. They may not be open to much advice, and most of the coaching needs to be done indirectly.
1) Give time. As the reluctant care partner processes what they are going through, it will help them to have frequent breaks. Even if the time away is for mundane tasks such as grocery shopping, they will appreciate the relief.
2) Give understanding and a listening ear. If they want to talk, be there to listen without judgement. Care partners often spend hours on their own, coping with their situation, and a listening ear can be welcome.
3) Give practical help. Housecleaning, a few meals for the freezer, running errands--all of these can give the support needed to help them adjust.
4) Be positive. You know that an elder, even one who is physically frail and has dementia, has much to offer. Model this by the way you interact. Treat the elder with love and respect, and show a genuine interest in them. Talk with them, ask questions, listen, laugh together and show how you are enjoying the relationship. One of the most difficult tasks for the reluctant (or any care partner) is to accept that the person they love has changed, and that's okay. They are still a valuable, contributing person. This realization is a stretch for many, and you will need to lead them gently toward this understanding. Show them how you are enjoying their elder.
The reluctant care partner isn't a bad person. They have been handed a difficult task, and they are grieving and struggling to find their way through. A smile, a hand to hold and an encouraging word can be the lifeline they need to bring them through.
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Care Partner Wednesday--The Reluctant Care Partner
Wednesday, 23 August 2017
A special person I know is moving her mom into care in the next month. What a frightening journey that can be! She wrote to me, asking for advice. This was my reply:
I was so pleased to hear you and your family had made the difficult decision to find a place for your mom to live, and that it sounds like a great place is available to you. That’s such a major decision, but I want to assure you, it’s the right one in so many ways. For your mom, she will get the social aspect of life that it’s just not possible to give her at home. Amazingly, she will make new friends and enjoy activities. You will be blown away by the way she blossoms socially. For you and the rest of your family (but especially you), you will be able to enjoy time with her without being exhausted by the care aspects.
So here are a few things that might help:
- try to come up with two, one-page documents. It will be tempting to make them longer, but stick to one page, as that is what people will read. The first should be your mother’s routines. When does she like to get up in the morning? What does she like to wear? How does she like her coffee (or tea.) etc. All those little things, that if someone knew, it would make life and the transition easier for her. I don’t know how the staffing works where you are going, but there will be someone who is going to put together a care plan for your mother. It may be a nurse. I would give a copy to them. I would also give a copy to the full-time PSW for days and one to the full-time PSW for evenings. For the most part, these are the people who will be caring for her, and they will probably appreciate knowing these things. It makes their job easier.
- The second document (one sheet again) should be who your mother is. Her simple pleasures (what makes her eyes light up?) and some of her personal history. Interesting facts that, if someone was talking to her, they could mention these things and she would remember and participate in the conversation. We try to come up with fascinating things that someone caring for her would read and comment on. (You met Pierre Trudeau? You golfed into your 90s? Wow, you travelled a lot of places! What was France like?) Put this one sheet into a frame and put it in a conspicuous place in her room. Maybe have a brightly coloured title like WHO AM I? or something like that. The idea is that people caring for her will get to know who she is as a person and talk to her about her experiences.
- Photo albums are also good. Of course, you and others can go through them and remember things, but people caring for her can as well, and there may be things she can tell them. Even if she doesn’t remember names or even what they are about, it’s always fun to look at pictures.
- Setting the room up, you should bring her favourite things. The chair she likes to sit in, pictures for the wall that are familiar to her, and whatever else will make this seem like home. One mistake people make is trying to cram too much in a small room. Especially if there’s a wheelchair involved, space is an issue. No rugs (tripping hazard) and maybe two chairs—one for her to sit in, and one for whoever is visiting. If it is labelled, you can probably have her favourite afghan or comforter for her bed, and a few other things. Definitely her basket of knitting
- Make sure they put her with people she can talk with in the dining room. Your mom is social, and she’ll be there every day, so this is important.
Now, for you:
- Emotionally, you might be surprised by how hard it is to let go. You have been a full-time caregiver, and no one is going to do things exactly like you, or care as much as you. You might experience some separation anxiety. Even though this is what you wanted, it will be hard to see someone else care for your mom. What you want is to see your mom connect with the people who care for her. But when she does, it might also be hard. Knowing this ahead of time will be helpful.
- Get to know her full time and part time PSWs (so, 4 people) and the full and part time nurses (2 people.) Try to connect with them and let them know you appreciate them. Sincere appreciation goes a long way. That way, if there is a problem or issue you need to bring to them, you have trust and relationship as “money in the bank.”
- From my perspective, we have two kinds of family members. Well, no, maybe three, but the third doesn’t apply to you at all. The third is the absent one, and thankfully, we don’t have many of those. The other two are “the families from hell” and the ones we all love. The families from hell question every single thing that is done, take a huge amount of time discussing the same issues over and over again, and stress about everything. I have been known to duck into a bathroom when I see one of them coming! We would never let it affect their family member’s care, but it makes life unnecessarily difficult for the rest of us. The ones we all love work WITH us to provide the best of care, and we feel that we are part of a team, rather than trying to paddle against waves of disapproval all the time.
- Also get to know whoever is in charge of activities. I have worked in that department, too, for many years, and believe me, they will be delighted to know your mom and know what she would enjoy participating in. Ask for a monthly calendar, and you can either time your visits so you can be there to take her to things she would enjoy or ask them to take her when you aren’t able to. Families who participate in activities with their loved one are so great and make everything more fun.
- Get to know other families, as well. I’ve seen wonderful friendships develop between family members.
That’s all I can think of for now but talk to me anytime about anything.
Wednesday, 16 August 2017
My car has reached that unfortunate state where the repairs and anticipated repairs mean I need to replace it. Ugh. I am leaving for vacation in less than a week. I wasn't planning on taking my car, but the multitude of decisions necessary to get a new one will have to wait until I get back.
The problem is, I have things I need to do before I go. Things that involve me going places and doing things. I need groceries. I need food for the puppy. I need to pick up something for work.
I need my car.
My car doesn't work.
I don't consider myself to be a super independent person, but this is annoying. Every task I would do without thinking now has to be strategized and organized and sometimes involves me going, hat in hand, and asking for a favour. It's frustrating and embarrassing.
But it's only for a few weeks.
I started to think about elders and their independence. Losing your car is only the first of many losses. What if I also lost my mobility, my ability to think clearly and my independence in the bathroom? In thinking about the residents I serve, I am struck by the grace and patience with which they accept their limitations.
One of my residents is blind. She sees only vague shadows, and can't find her way around. She calls on her friend, and they go everywhere together because her friend can see. I've never heard her complain, except to state in the most matter of fact way, "I can't see." She has a sense of humour and an enthusiasm for life that inspires me. When she comes back from the hairdresser and I tell her how nice she looks, she grins and says, "I'll take your word for it."
When I grow up, I want to be her. I want to face my disabilities with grace and humour, and never complain.
Remind me I said this.
As care partners, we need to develop a sensitivity to elders who struggle with shrinking abilities. Especially when you work in the industry, it's easy to become desensitized, and not realize how difficult the losses are. We need to extend grace, patience and love to those who struggle. Imagine what it's like to live in their bodies and give them the gift of understanding. Maximize their strengths and the abilities they still have, and give them opportunities to use them. Respect their limitations, and don't expect what isn't possible.
I have chronic arthritis. One day, and for several weeks, my right knee will hurt like the dickens when I walk. Without notice, the pain will shift to my left ankle, and I'll be hobbling even worse than before. Or I will go to grab something, and my thumb joint will remind me that it's there. I hate being slow and limping and looking pathetic, but that's my life at the moment. I can't help it. Often, on my commute, I will hear the impatience of people behind me on stairs or going through doors. I try to wait until most have passed, but I have to get to work, too. When I sense someone hovering and trying to hurry me along ("why don't you just pass--there's plenty of room?") or making an impatient noise as they rush by me, I want to say, "Would you like to travel for an hour in my body?"
As a care partner, I need to extend that grace to the elders I serve. I may not fully understand their challenges, but I can extend the gift of empathy.
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Care Partnr Wednesday--Independence
Wednesday, 2 August 2017
Imagine you are 10 years old. Do you remember the house you lived in at that time? What did it look like? What did your mom and dad like to wear? Did your mom wear an apron and make your favourite foods? Was your dad busy at work all day, and did the family eat around the table at night? Did your brother tease you, and your sister take your things? What about the friends you played with
--what were your favourite games?
What if you weren't imagining or remembering. What if you woke up one morning and this was your world--except it wasn't. You feel like a 10-year-old version of yourself, and you expect to hear your mother calling you for breakfast at any moment. Except something isn't right. You look around, and nothing is familiar. This isn't your room. This isn't your house.
What would you do?
You'd say, "I want to go home! Where is my mother? She's going to be looking for me!"
Now, what if someone came up to you and said, "Of course this is your home. You live here." You look around, and you know they are lying because you know this isn't your house. Even worse, someone says to you, "Your mother? you're 80 years old. Your mother died years ago."
Your reality--your real world--is the home you grew up in, with your family all around you. My challenge, as your care partner, is to leave my reality and enter yours. I'm not lying to you, or patronising you, but I enter your world with you, and we explore it together.
So, as you panic, because you are in this "twilight zone" state, where nothing is familiar, and you can't find the people you love, I need to go there with you.
"What does your mother look like? I bet she is a good cook. What is your favourite food that she cooks? I bet she has lots of advice for you--what kinds of things does she tell you? My mother always told me to eat my peas, but I hated peas, so I always looked for ways to get out of it. Did you use to do that? Was there a food you really hated?"
Slowly, your panic dissipates, and you begin to reminisce.
Dr. Bill Thomas, the founder of the Eden Alternative, has said, "if you have met one person with dementia, you've met one person with dementia." Every situation is different, every person is unique, and what works today may not work tomorrow.
Speaking dementia requires creativity. The bottom line is to realize that the person with dementia is in a different place right now. You need to find the place where they are and go there with them. You should never try to drag them back to your world. That will confuse, frighten and anger them, and it won't work. In the end, they will know you are wrong.
- One daughter made a fake medical degree and framed it for her father, who was convinced he was a doctor. (He had started in medicine, but the war interrupted his efforts. But in his mind, he practised medicine, so his daughter made it happen.
- The same man was convinced he'd been asked to appear as a guest conductor on the Lawrence Welk Show (long after Mr. Welk was dead because he saw reruns on TV.) His daughter bought him a conductor's wand and big band CDs, and he conducted the band. 1.
- I have spoken on a dead phone to a "father," asking him if his daughter could stay for dinner with us. She was afraid he would be angry if she didn't leave right now. He "gave his permission" and she immediately relaxed. After dinner, she'd forgotten the whole conversation.
"Validation is not about treating someone as a child. It's about respecting the person with dementia as he or she sees the world. It's about overcoming our own bias. It's about adding some dignity to the last years of our elder's lives by accepting that maybe there is more than one way to see the world. There is our way, of course. There is our neighbour's way. And there is our elder's way, even when dementia is present." 1.
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Cre Partner Wednesday--I Speak Dementiahttp://ctt.ec/S05c2Care Partner Wednesday--I Speak Dementia
Wednesday, 26 July 2017
We often associate anxiety with dementia, and that's legitimate. There's nothing like an impaired memory to cause fear, especially if everything and everyone is new to you every day--that's scary.
But that's a topic for another day. Elders who don't suffer from cognitive decline, but have an anxiety disorder, have an especially poignant struggle. I am care partner for one such elder, and I've worked with others in the past. They live a special kind of hell, and their care partner's challenge is to bring both peace and well-being into each troubled day.
Each person with an anxiety disorder has triggers. Small events can escalate into a full blown attack in minutes. An unfamiliar environment, some small medical issue (like a rash or a cough) an unfamiliar person giving care--these are just a few examples. An event which seems minuscule to us has huge, unresolvable implications for them.
When an attack occurs, there are several aspects:
- Speech may become slurred, and the ability to express themselves is hampered by hundreds of conflicting thoughts, running through their brain. Picture a Pacman game, where the little creatures are constantly colliding.
- Reasoning is missing. Don't even try to explain or reason with the person, as they aren't listening.
- Conversation is cyclical. You will go around in circles. Over and over again.
- They might become short of breath and dizzy. They are definitely a fall risk.
- There is no sense of humour present. You may be able to joke this same person out of mild anxiety, but it won't work during an attack.
- Distraction seldom works during a full blown attack. They know something terrible is about to happen, and they won't be distracted.
For the care partner, special grace is needed. Patience, wisdom, love, compassion and a sense of humour. (Keep the sense of humour to yourself during a full-blown attack, but it will help you get through.)
Sometimes, attacks come out of the blue, and you will shake your head, wondering where that came from. There are times when you can identify triggers and head them off. Sometimes, you just have to go through it with the person, because there is no way around it.
I am facing such a circumstance. On Monday, I have to tell someone with high anxiety that she needs to move from the room she is in, to another one down the hall. It's an unusual circumstance, but it's necessary. Here are some of the steps I have taken to make this go as smoothly as possible.
- I will tell her Monday afternoon. The move will happen Tuesday morning. This gives her the respect of knowing ahead of time but minimizes the stress time.
- I have a whole team of people ready to swoop in as soon as she goes to breakfast. We should be totally finished (including pictures hung) by lunch.
- Someone is taking her out for the morning after breakfast. Someone else is coming to have lunch with her.
- Her new room will be set up as closely as possible to the way the old room is set up. The bed she is used to is being moved.
- All staff are aware and are supportive.
- Staffing assignments are being changed so that she will have familiar staff in her new room.
- She has an (as needed) order for anti-anxiety medication, and it will be needed those few days.
With all this preparation, will it be seamless, and without anxiety? No, it won't. But we've made a plan, and it will be as good as it can. In a few days, we will be over this challenge, and on to the next.
Living with chronic anxiety is a burden. Care partners need to offer both strength and grace, through a filter of wisdom.
And don't forget the sense of humour!
CLICK TO TWEET--Care Partner Wednesday--The Crippling Force of Anxietyhttp://ctt.ec/0LsMaCare Partner Wednesday--The Crippling Force of Anxiety
Wednesday, 19 July 2017
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 Approachhttp://ctt.ec/AkHufCare Partner Wednesday--It's All About Approach
Wednesday, 12 July 2017
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
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The Small Miracle of the Brokenhttp://ctt.ec/UMdJdThe Small Miracle of the Broken