Wednesday, 16 August 2017

Care Partner Wednesday--Independence



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.

Every day.

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Care Partnr Wednesday--Independence

Wednesday, 2 August 2017

Care Partner Wednesday--I Speak Dementia


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.

Creative Speaking

  • 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.

1. https://www.agingcare.com/articles/validation-therapy-for-dementia-166707.htm

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Wednesday, 26 July 2017

Care Partner Wednesday--The Crippling Force of Anxiety



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!


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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 Approachhttp://ctt.ec/AkHufCare 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

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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.

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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.

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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.

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1.https://en.oxforddictionaries.com/definition/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.

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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

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Wednesday, 31 May 2017

Care Partner Wednesday--When You Can't Make it Work



We all know that some personalities don't get along well.

There's the person with the loud and flamboyant personality to your quiet, introverted one. Or the one who is the heroine of all her stories, who makes you want to scream. What about the one who always looks grumpy to you? Or someone who is always too busy to give you the time of day?

Taking personality out of the mix, culture has a significant effect on how we act and interact with others. Family background, environment--it's a miracle any of us get along. Most of us can find a common ground and a way to connect with most people. Most of the time, it's great and we are enriched by relationships with people who aren't like us.

What about the times when it doesn't work?

Sometimes, we can forge a working relationship with someone who we would never choose to spend time with. We can make it work if we focus on the task at hand and make interactions brief.

What happens when that's not possible?

The relationship between the care partner and the elder is a special one. It's a relationship, and both partners contribute. If you, as a family member, sense it isn't working, what do you do?

1. Give it some time. There is a period of adjustment when someone moves into care, and it's necessary for everyone to get to know each other. The care partner needs to lear the elder's routines, and how they like things done. The elder needs to communicate their preferences, and sometimes this takes several days. They need to get to know each other as people.

2. Talk to the care partner one-on-one. It's usually best to do this when the elder isn't in the room, and when things are as relaxed as possible. Trying to address the situation in the middle of a confrontation  probably won't give you the best outcome. Address the concerns, but rather than being confrontational, come at it with an attitude of "how can I help to make things better?" Listen. Be open. Look for practical ways you can improve the situation. Try to convey to the care partner that we are all on the same team here.

3. What you do next depends on the outcome of your talk. If you felt progress was made, you need to give it more time again. Look for ways to encourage the relationship and connect with the care partner in the next several weeks. If your attempts were met with defensiveness, or even anger, it's time to make an appointment with someone in administration, perhaps the director of care. During this meeting, have notes from your meeting and other issues that you feel are a problem. Be comprehensive, but not nit-picky. Remember to continue to look for solutions.

4. The administration may want to bring the care partner in, either with you or in private, to address the issues. You may want to wait a little longer, to see if this helps, depending on the seriousness of the conflicts. Or, you may decide to ask for a switch. It's possible to switch assignments, so that the care partner in question works with another resident, and another care partner works with your elder. Although not common, this happens and in some circumstances it is better for both.

The end result you want is harmony and a relationship that benefits both.

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Wednesday, 24 May 2017

Care Partner Wednesday--Connecting with Staff





Everyone's journey is different, but here is one I see frequently.

Diane cared for her husband all their married life, and became a care partner the day he was diagnosed with Parkinson's Disease. She read everything she could find about the disease, and related topics such as the side effects of the medications. She watched over every aspect of his life with care and love, and a bit of obsession. Keeping him functioning became her purpose in life.

Inevitably, the day came when she couldn't cope. Her own health was affected, and her family insisted their dad get more care. She could visit every day, and was a partner in his care, but she was now part of a team.

From the first day, she went to war with the staff. They had strange names she couldn't pronounce, they didn't do things the way she did or give him the constant attention she had. What galled her the most was that her husband was thriving under their care. When she visited, he seemed happy, and often wasn't in his room, but attending an activity. She wasn't self aware enough to know that her criticism grew from her feelings of insecurity. Her role was threatened.

Not everyone struggles like Diane. Many are delighted to share the caring role, and realize how much they need to divide the load. No matter on which end of the spectrum you land, the ways in which you connect with staff is key. Here are a few simple ideas to enrich your experience.

1) It sounds simplistic, but get to know their names. Find out the names of the regular full time and part time day and evening staff who care for your elder. Write them down, and make sure you are pronouncing them correctly.

2) Ask them about themselves. Not everyone is open to sharing, and if you sense resistance, back off on this one. But if you get information, write it down beside their names. Next time you see them, ask them about their children or their dog.

3) Ask their advice. Care partners have some great ideas, and invaluable experience.

4) Take a picture of them with your loved one. It's a beautiful, non-verbal affirmation.

5) On occasion, take them a small, token gift such as some baking or flowers from your garden. It means a lot.

6)  Affirm them in front of your elder. "Dorothy knows how to shower you and she will do a wonderful job. You have nothing to be afraid of."

7) Ask them to tell you stories. Ask what your loved one's day was like, what activity he enjoyed the most in the last week, what meals seem to be his favourite. Staff is a connection to your elder when you aren't there.

8) Affirm them. Sincerely tell them how much you appreciate the impact they are having on your loved one's life, and how much it means to you.

What happens when you have a staff member with whom there is a problem? I'm not talking about abuse, which of course you would report immediately, but personalities which clash. Next week, we'll talk about some strategies for that.

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Care Partner Wednesday--Connecting with Staffhttp://ctt.ec/cBtN1

Wednesday, 17 May 2017

Care Partner Wednesday--A Precious Gift




It’s no surprise that one hundred percent of the time, the end of the care partner journey is the death of their loved one.  

The problem is, death is an unpredictable creature. Sometimes he sneaks in at night, and just like that, it’s over. At other times, symptoms point in the direction of the end, and we wonder--is this it? It isn’t. What may look like end-of-life in a fragile elder can be something easily treatable like a urinary tract infection.

Deciding when “the end is the end” is  difficult, even for the medical community. As a care partner, you may be asked to make complicated decisions--decisions that have no clear answer.
It helps to reason through the choices before you are caught in the web of conflicting emotions.

The final “R” in care partner is release.

As people age, their appetite dwindles. Even with nutritious, attractive meals, many eat slowly and leave half of even a small portion. They need encouragement to drink, and many are dehydrated.  A doctor, nurse or dietician may suggest a supplement. Liquid supplements are popular, as most people enjoy the flavour, and they provide the nutrients for an entire meal in a small glass. For many elders, supplements provide stable health and quality of life for a period of time.

Here are a few scenerios:

Madeline struggled with eating and swallowing for over a year, and there were many choking incidents. One day, she could no longer swallow anything. Her family decided to send her to hospital to get a feeding tube. Over the next three months, her struggle intensified, and there were multiple trips to hospital. The tube became blocked, detached, and her body swelled because it wasn’t absorbing the nutrients. In the end, her family had the tube removed and she passed away peacefully.

If there was someone you might think wouldn’t benefit from supplement, it was Mary. In a wheelchair, unable to speak or do anything for herself, it would be normal to suggest Mary wasn’t a candidate for supplement. Mary didn’t think so. She pointed to the glass, indicating she wanted it, and now. She lived on supplement for a few years, and it was her choice to do so.

Amy ate little. Some days, she drank part of her supplement, and some days, not at all. One day, she didn’t eat at all, and had only a few teaspoons of water. The next was the same. On the third day, her family was called. We all agreed, Amy was sending us a clear message. She was done. Staff kept her clean and comfortable. Mouth care moistened her tongue and lips and medications were given to ensure she had no pain. Oxygen made her final breaths easier. Her favourite old movies were playing on the television. Over the course of a few days, she slipped away.
Ralph’s family made the decision that they would let him lead in his final journey. When he stopped eating and drinking, they accepted that, and other comfort measures were put in place. After two days, Ralph looked at his sister, and said, “I’d like some chocolate ice cream.” Stunned, she rushed for the nurse, unsure of the next step. Was this a miraculous revival? Reassured, she came back to the room with a small bowl of ice cream, and fed it to her brother. After a few spoonsful, he lay back and indicated he’s had enough. A few days later, he passed away peacefully. His sister still smiles when she remembers sharing that ice cream with her brother.

In death’s unpredictable course, every care partner is called upon at some point to release their loved one. Although painful and difficult, it’s a gift.

A final, precious gift.

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