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.

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

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.

Care Partner Wednesday--Connecting with Staff

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.


Wednesday, 3 May 2017

Care Partner Wednesday--What is an Elder?

"An elder is someone who, by virtue of life experience, is here to teach us how to live."
          --The Eden Alternative definition of an elder

When I was a little girl, there was a lady in the church who "adopted" me. I was shy and socially backward, and she called me her pet, and sought me out after every service. She would hug me and tell everyone who would listen how special I was. I remember a card she sent me, where she addressed my tendency to worry with a special scripture. To this day, over 50 years later, I remember her silver hair, her soft, pink skin and how she made me feel. She was my first experience of an elder teaching me how to live.

My first, but far from my last. The final "e" in care partner is for elder. Here are some truths and nuggets of wisdom I have learned from elders over the years:

1) Compassion. The day I retuned to work after my husband died, an elder was waiting for me at the elevator. She held her arms out to me as I knelt at her wheelchair and we both sobbed. I don't remember much else from that day, but I remember her compassion.

2) Friendship. Doris has an anxiety disorder and Glenda is blind. They go everywhere together, as Doris helps Glenda find her way, and Glenda encourages Doris to be brave.

3) Love: For years, Mrs. Richards couldn't speak, or respond in any way, but Mr. Richards would take her for walks, talking to her in a soft voice and greeting everyone along the way.

4) Celebration. At a recent luncheon, a woman in her 90s proudly and with great love, presented a birthday card to a friend turning 106. 

5) Fun. Elders donning outrageous Easter bonnets and giving cheesecake smiles for the camera.

6) Servanthood. Loretta comes each week to knit with her friend. It's not about the knitting, really, but about helping Vera focus on the positive and keep anxiety at bay.

7) Interest. Marjorie gave one word answers to most questions since a serious medical event seemed to steal most of her language. But when we started talking about china patterns, words poured forth as she shared her knowledge.

8) Grooming. Sarah never leaves her room. She's comfortable there, and totally happy to sit in her chair and watch the world go by. Did I say never? One day a week when she is happy to leave for an hour--to visit the hairdresser.

9) Courage. Mona watches her husband struggle from the ravages of Parkinson's disease. Every day, she looks for new ways to make the struggle easier and show him respect while helping him find his way.

10) Wit. Irene was Scottish and blind, and becoming quite agitated as the piano tuner plunked away at the keys, doing his job. Her body language showed her increasing disgust. Finally, she blurted out, "If ye canna play the thing, why don't ye just leave it alone!"

Each elder has a lesson to teach.


Care Partner Wednesday--What is an elder?